Climate-Related Wheezing, Allergy, Trauma Affecting Practice

Laura Arenschield

November 27, 2019

At her pediatric practice in Reno, Nevada, Debra Hendrickson, MD, sees the effects of climate change first-hand: a little girl wheezing from wildfire smoke inhalation; a young boy suffering heatstroke on yet another record-high temperature day; a child with sustained stress after fleeing a hurricane.

Reno is about a 3-hour drive, through the Tahoe National Forest, from Paradise, California where, in 2018, the deadliest wildfire in the United States in 100 years destroyed homes, businesses, and lives.

Some of the families who fled Paradise ended up in Hendrickson's office, and seeing the effects the fire had on those children saddened and angered her. "Climate change is overwhelming, and I think that's why it's hard for us to talk about it," she said, "but we know the outcome of doing nothing, of saying nothing. And I think pediatricians are in a position to really make a difference."

In fact, they have a responsibility to do so, because "when it comes to the effects of climate change, kids are just more vulnerable than adults," Hendrickson said during a plenary presentation at the American Academy of Pediatrics (AAP) 2019 National Conference in New Orleans.

Paradise on Fire

"We are seeing wheezing and coughing in kids who have never had respiratory issues," she said. "We are seeing increases in pollen allergies as allergens become more potent and pollen levels increase. And we are seeing trauma and other mental health issues."

Many of the children who fled Paradise were terrified, Hendrickson reported. "You could just see the ripple effect of trauma on the families," she explained. And some kids who lived in Reno were "secondarily exposed to trauma" because they had relatives who lived in Paradise.

"It was such a traumatic thing," she told Medscape Medical News.

The question of whether physicians should care about climate change — and advocate for policy change — is one that professional medical organizations, such as the AAP, have been considering for a number of years.

Since 2007, the AAP has written policy statements on climate change. The most recent, issued in 2015, advocates for "a paradigm shift in production and consumption of energy" and describes the "uniquely valuable role" pediatricians can play in the way society responds to the greenhouse-gas emissions that contribute to climate change.

In March 2017, the AAP and a number of other organizations formed the Medical Consortium on Climate and Health, which gives physicians and other medical professionals tools to help them advocate for a healthier climate.

Medical Consortium on Climate and Health

"I think of this as a whole new dimension to medicine," said Samantha Ahdoot, MD, a pediatrician in Alexandria, Virginia, who was lead author on the 2015 AAP policy statement.

"It's something physicians have never had to think about before; it's an entirely new variable," she told Medscape Medical News.

Politicians can debate the causes of climate change, but Ahdoot said that the AAP, in considering its policy statement, did what it does for all other policy statements: it examined the science.

"In terms of the scientific data on climate change, if one were to only refer to those organizations, to NASA and NOAA and the American Geophysical Union and the American Academy for the Advancement of Science — all the scientific authorities for our nation — if we were to only rely on them, there's absolutely no other conclusion except that rising greenhouse-gas emissions are warming the planet," she said. And once that became clear, Ahdoot said the AAP and others had no choice but to act.

Although organizations such as the AAP and the American Medical Association are advocating for policies that curb climate change and educate patients and caregivers on how to mitigate the effects of climate change, many individual physicians are not, said Aaron Bernstein, codirector of the Harvard University Center for Climate, Health and the Global Environment.

"Many physicians will have heard of climate change; they may have understood it as a problem for polar bears, for sea-level rise; they may even know that it matters to health, for things like heat waves and allergies and potentially infectious diseases," he said, but they are not all convinced that it is their place to advocate.

But for Bernstein, it is clear that climate change is also a medical problem.

In addition to the way climate change affects air quality, allergens, and other environmental hazards, it can also affect how certain medicines interact with the body, he told Medscape Medical News.

"Heat waves are happening earlier in the year, they're more extreme, and temperatures are higher. Medicines that affect our bodies' ability to handle water — diuretics, medicines that affect sweating, even medicines like ibuprofen — may not be as safe as they used to be because people, especially children, are going outside in temperatures that are unprecedented," he explained.

So what is a healthcare provider to do?

The number one thing is educating parents that this is a health risk to their kids.

"The number one thing is educating parents that this is a health risk to their kids. If they understand the risk, they're going to be much more motivated to do something about it," said Hendrickson.

"But there are also small steps that everyone can take to reduce greenhouse-gas emissions in their own lives, things like contacting their utility company and asking that their energy come from renewable resources instead of fossil fuels," she said.

In addition to taking action in their own lives, pediatricians "can also educate other people and push — at the government level and at their hospitals and clinics — for better policies and more renewable energy sources," she told Medscape Medical News.

"I think among pediatricians, the belief in the science and the desire for something to happen are very high, but getting people to take that next step and take some action, that's harder," she said.

"It's frustrating when you see the urgency of something but even people who should be the most ready to stand up and do something often aren't."

American Academy of Pediatrics (AAP) 2019 National Conference. Presented October 28, 2019.

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