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Respiratory disease in the age of climate change - (9/25/2019)

By Dr. Ron Gasbarro

In the millennia before climate became politicized and facts became false, we knew the planet was changing. The climate of the Earth has changed throughout history, according to the National Aeronautics and Space Administration (NASA). In the last 650,000 years, 7 seven cycles of glacial advance and retreat, have occurred with the abrupt end of the last ice age about 7,000 years ago marking the beginning of the modern climate era — and of human civilization. Most of these climate changes are due to minute variations in Earth’s orbit that alter the amount of solar energy the planet receives. The current warming trend is extremely likely (>95% probability) the result of human activity since the mid-20th century and happening at a rate that is unparalleled over decades to millennia [Ramaswamy, 2006]. 

In the 1860s, physicist John Tyndall recognized the Earth's natural greenhouse effect and suggested that slight changes in the atmospheric composition could bring about climatic variations. In 1896, a seminal paper by Swedish scientist Svante Arrhenius first predicted that changes in the levels of carbon dioxide in the atmosphere could substantially alter the surface temperature through the greenhouse effect. Ice cores drawn from Greenland and Antarctica show that the Earth’s climate responds to changes in greenhouse gas levels. Ancient evidence can also be found in tree rings, ocean sediments, coral reefs, and layers of sedimentary rocks. This ancient, or paleoclimate, evidence reveals that current warming is occurring roughly 10-fold faster than the average rate of ice-age and recovery warming [NRC, 2006]. 

What climate change changes.

According to the American Lung Association, changing climate patterns are eroding air quality and increasing the frequency and intensity of certain types of extreme weather such as droughts, floods, and wildfires. Climate change affects the air we breathe by increasing the risk that air pollution, including ozone and particle pollution, will worsen. As temperatures increase, warmer air helps to form ground-level ozone, sometimes called smog, which is a powerful air pollutant. Ozone irritates the lungs and acts like sunburn on your lungs that can trigger an asthma attack. Additionally, in some areas of the United States, wildfires are becoming more frequent and intense, and wildfire seasons are lengthening. Wildfires produce smoke that contains particle pollution, consisting of dangerous particles tiny enough to travel through the lungs into the circulation. Particle pollution can cause asthma attacks, heart attacks, early death, and lung cancer. The wind can carry these particles for thousands of miles causing air pollution to increase in other areas, which can cause you to have an unknown exposure.

Climate change also increases the frequency and severity of certain types of extreme weather, such as droughts, floods, and extreme storms. These events force people to evacuate and often result in the loss of homes. Evacuating may force people to leave behind medications and lose communication with their healthcare providers, causing a disruption in their asthma management. Repairing damage due to a storm opens up additional risks, such as mold and toxic chemicals found in flooded buildings and open burning of debris from gutted buildings. These risks are especially dangerous for individuals with asthma and other lung diseases.

In October 2018, the Intergovernmental Panel on Climate Change (IPCC) released a report, Global Warming of 1.5°C [IPCC, 2018]. Invited to provide guidance to the United Nations,  this group of 91 scientists, authors and editors from 40 countries reviewed over 6,000 scientific papers. Their conclusions tell us that we have very little time to act. Many places on Earth have already reached 2.7°F (1.5°C) of warming above pre-industrial levels. Another overall global increase of anothr 2.7°F could occur as early as 2040 with devastating consequences for the world. So, if your child is 10 years old today, he or she will be dealing with this in the primes of their lives.

Heat and stagnant air, both created by climate change, increase the risk of ground-level ozone, or smog. Increasing heat can also cause drought and wildfires, both of which produce particle pollution. Smoke from wildfires can impact people hundreds of miles away, for example, in one study, a forest fire in Quebec, Canada increased the particle pollution in Baltimore, Maryland by 30-fold [Sapkota, 2005]. Dust storms are happening now in Arizona, caused by drought, reduced vegetation, and a lower water table.

What a single volcano can do. 
On August 26 and 27, 1883, between the islands of Java and Sumatra, the volcanic island of Krakatoa erupted multiple times. These events were among the most violent volcanic events in recorded history. The eruption was equivalent to 200 megatons of TNT—about 13,000 times the nuclear yield of the Little Boy bomb that devastated Hiroshima, Japan, in 1945 [Thornton, 1996].  

The Krakatoa eruption injected an unusually large amount of sulfur dioxide (SO2) gas high into the stratosphere, which was subsequently transported by high-level winds all over the planet [Thorton, 1996]. This led to a global sulfuric acid (H2O4increase concentration in high-level cirrus clouds. The resulting increase in cloud reflectivity (or albedo) reflect more incoming light from the sun than usual and cooled the entire planet until the suspended sulfur fell to the ground as acid precipitation (aka acid rain). Sulfuric acid is a highly corrosive chemical that can cause irritation of the eyes, nose, and throat. Splashes to the eyes or contact with skin cause severe burns and can cause blindness. Inhalation can also cause bronchial damage or even cancer. The eruptions killed over 30,000 people with many survivors experiencing respiratory problems, often, for the rest of their lives.

From Krakatoa to Dorian
Krakatoa, at least temporarily, disrupted the planet at large. Average global temperatures fell by as much as 1.2 °C (2.2 °F) in the year following the eruptions. Weather patterns continued to be chaotic for years and temperatures did not return to normal until 1888. 

However, a volcano eruption is a once-in-a-while thing. Just a pimple on the planet that quiets down after a while as Earth gets back to normal. Whatever “normal” has been defined in the past is changing in terms of the planet.  

According to an exclusive 2019 USA Today report, wildfires are burning around the world, clogging the sky with smoke from Alaska to the Amazon, and scientists say it is no coincidence that July was the warmest-ever month recorded on Earth. The fires have forced evacuations worldwide, most recently on Spain's Canary Islands, where more than 8,000 people have fled. Smoke from some of the fires is so horrific that satellites can see it from space, blanketing large portions of South America and the Arctic. Climate scientists say the fires are partly the result of a world growing warmer, making it easier for flames to spread.

The average global temperature in July 2019 was 1.71°F above the 20th century average of 60.4°F, making it the hottest July in the 140-year record, according to scientists at NOAA’s National Centers for Environmental Information (NCEI) [NCEI, 2019]. The previous hottest month on record was July 2016. Nine of the 10 hottest recorded Julys have occurred since 2005; the last 5 years have ranked as the 5th hottest. July 2019 was also the 43rd consecutive July and 415th consecutive month with above-average global temperatures.

Hurricane Dorian was a long-lived and extremely powerful tropical cyclone that devastated the northwestern Bahamas and caused significant damage to the Southeastern United States and Atlantic Canada, and the strongest in the basin by wind speed since Hurricane Wilma in 2005 [NCEI, 2019]. It was the fifth tropical cyclone, fourth named storm, second hurricane, and the first major hurricane of the 2019 Atlantic hurricane season. The hurricane caused catastrophic damage to Grand Bahama and the Abaco Islands, with at least 70,000 people left homeless. The true death toll is unknown, but news sources in the Bahamas suggested, that as of September 2019, fatalities could exceed 1,000.

According to a study from the National Center for Atmospheric Research (NCAR), global warming is causing an ever-increasing number of more hurricanes in the North Atlantic and Gulf of Mexico [NCAR, 2019]. The increased frequency is largely a response to a 1°C (1.8°F) rise in seawater temperatures since 1905 that was caused by greenhouse gases. Other research has shown that there are more storms with higher wind speeds, and these storms will be more destructive, last longer and make landfall more frequently than in the past. Because this phenomenon is strongly associated with sea surface temperatures, a strong probability exists that the uptick in storm intensity and climate change are linked.

Nothing is “normal” anymore. 

Health effects of climate change in the United States
Climate change is the result of many different weather events. Each negatively influences human health with certain populations being more affected. 

Hurricanes cause death from drowning, severe injuries, mental health impacts such as depression and posttraumatic stress disorder (PTSD), increased carbon monoxide poisoning, increased gastrointestinal illness as well as population displacement/homelessness. The populations most affected include coastal residents, the poor, the elderly, and children. Extreme rainfall and floods include all of the aforementioned as well as increased water-borne diseases from pathogens and water contamination from sewage overflows, and increased food-borne disease. The populations most hit include coastal residents, the poor, the elderly, and children.

Conversely, droughts cause disruptions in the food supply, changing patterns of crops, pests, and weed species, water shortages, malnutrition, food- and water-borne diseases, and the emergence of new vector-borne and zoonotic diseases. Again, the poor, elderly, and children will be at the highest risk for these problems. Increased average temperatures can result in increased food-borne diseases, such as Salmonella poisoning, increased vector-borne diseases such as West Nile virus, equine encephalitis, Lyme disease, Rocky Mountain spotted fever, and hantavirus, increased strain on regional drinking water supplies, increased vulnerability to wildfires, and associated air pollution. These will negatively influence the health of those people who are active outdoors, such as highway and construction workers, and athletes.  

Respiratory triggers
Bad air affects everyone because everyone breathes. However, it is worse for people who already have respiratory diseases, such as asthma or chronic obstructive pulmonary disease (COPD). For example, heat waves cause premature death as well as heat-related illnesses such as heat stroke, heat exhaustion, and kidney stones in people with breathing problems. Poor air quality can make asthma worse. 

The top three respiratory problems are getting worse
COPD, asthma, and lung cancer are among the most common causes of severe illness and death worldwide [Forum, 2017]. All of these diseases will worsen and become more prevalent as air quality decreases. 

COPD
Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term breathing problems and poor airflow. The main symptoms include shortness of breath and cough with sputum production [Global, 2017]. COPD is a progressive disease, meaning it typically worsens over time. COPD affects more than 200 million people in the world, 65 million of whom have moderate or severe airway disease [WHO, 2007]. This is higher than reported for hypertension, hypercholesterolemia, and many other prevalent disorders. 

The most important factor leading to the development of COPD is tobacco smoking. Tobacco smoke causes destruction of lung tissue (emphysema) and obstruction of the small airways with inflammation and mucus (chronic bronchitis), leading to the chief symptoms of COPD, namely shortness of breath and cough. Indoor and outdoor air pollution, inhaled tobacco smoke and occupational dust, genetic syndromes (such as a1-antitrypsin deficiency), childhood pneumonia, and other diseases that involve the airways (such as chronic asthma and TB) are also factors contributing to the development of COPD [Eisner, 2010]. About 3 million die each year, making it the third leading cause of death worldwide – and the numbers are increasing [Burney, 2015].

Discouraging individuals from starting to smoke tobacco and encouraging smokers to reduce and quit smoking are the first and most important priorities in preventing COPD [Forum, 2017]. Chimney cookstoves and other devices that decrease indoor smoke exposure lessen the risk of respiratory infections in children and potentially the incidence of COPD in nonsmokers, particularly in women. Childhood vaccines and prompt recognition and treatment of lower respiratory tract infections will minimize the airway injury that predisposes one to COPD in adulthood. COPD can begin in childhood. Management of childhood asthma, controlling occupational exposure to dust and fumes, and other environmental controls could have substantial benefits in reducing the burden of COPD.

Asthma
Asthma is a common long-term inflammatory disease of the airways of the lungs [NHLBI, 2007]. Asthma causes both variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. Asthma afflicts up to 334 million people worldwide and its incidence has been increasing for the past three decades [Asher, 2014].

According to the American Lung Association, changing climate patterns are eroding air quality and increasing the frequency and intensity of certain types of extreme weather such as droughts, floods, and wildfires. Climate change affects the air we breathe by increasing the risk that air pollution, including ozone and particle pollution, will worsen. As temperatures increase, warmer air helps to form ground-level ozone, sometimes called smog, which is a powerful air pollutant. Ozone irritates the lungs and acts like sunburn on the lungs that can trigger an asthma attack. Additionally, in some areas of the United States, wildfires are becoming more frequent and intense, and wildfire seasons are lengthening. Wildfires produce smoke that contains particle pollution, consisting of dangerous particles tiny enough to travel through the lungs into the circulation. Particle pollution can cause asthma attacks, heart attacks, early death, and lung cancer. The wind can carry these particles for thousands of miles causing air pollution to increase in other areas, which can cause one to have an unknown exposure.

Climate change also increases the frequency and severity of certain types of extreme weather, such as droughts, floods, and extreme storms. These events force people to evacuate and often result in the loss of homes. Evacuating may force people to leave behind medications and lose communication with their healthcare providers, causing a disruption in their asthma management. Repairing damage due to a storm opens up additional risks, such as mold and toxic chemicals found in flooded buildings, and open burning of debris from gutted buildings. These risks are especially dangerous for individuals with asthma and other lung diseases.

Lung cancer 
In the United States, approximately 80 to 90% of lung cancer deaths are caused by cigarette smoking, according to the CDC. Using other tobacco products such as cigars or pipes also increases the risk for lung cancer. Tobacco smoke is a toxic mix of more than 7,000 chemicals [Benjamin, 2011]. 

Living long-term in a city with elevated levels of air pollution – which is becoming more common due to climate change – can harm one’s lungs as much as smoking a pack of cigarettes a day for 30 years, An August 2019 Journal of the American Medical Association (JAMA) study has revealed [Wang, 2019]. Previous studies have shown a clear connection between air pollutants and some heart and lung diseases. However, the new research shows a correlation between long-term exposure to all major air pollutants, especially ground-level ozone, the main component of smog and lung diseases, such as emphysema and COPD. While these diseases do not “turn into” lung cancer, people with emphysema or COPD are at higher risk of lung cancer - just by nature of the primary cause of COPD - smoking. Hence, breathing polluted air continuously can conceivably result in carcinoma of the lungs. 

Consider this: Lung cancer is the leading cancer killer in both American men and women, according to the American Cancer Society. In the US, lung cancer is responsible for 29% of cancer deaths – over 150,000 annually – more than from breast cancer, colon cancer, and prostate cancer combined. As air quality decreases, the prevalence of lung cancer will skyrocket, especially if one continues to smoke. As temperatures rise with climate change, ground-level ozone will continue to increase unless steps are taken to reduce this pollutant," said R. Graham Barr, a professor of medicine and epidemiology at Columbia University and senior author of the paper. "But it’s not clear what level of the air pollutants, if any, is safe for human health."

Ka-BOOM! Asthma epidemics related to thunderstorms.
Climate change means more thunderstorms. More thunderstorms will make asthma attacks and allergy events more frequent and more severe. According to a 2013 National Aeronautics and Space Administration (NASA), researchers have evidence that global warming will warm the earth’s surface and heavily saturate the air via evaporation. This is bad news for asthma and allergic rhinitis patients. An increasing body of evidence shows the occurrence of severe asthma epidemics during thunderstorms in the pollen season. Several epidemics of asthma have been reported following thunderstorms in various geographical zones, predominately in Europe and Australia [Wayne, 2002; D’Amato, 2012; D’Amato, 2007]. Asthma epidemics related to thunderstorms are limited to seasons when there are high atmospheric concentrations of airborne allergenic pollens. In particular, during the first phase of a thunderstorm, that is, the first 20 to 30 minutes, the air becomes replete with highly breathable allergens. This is due to dry updrafts that, during thunderstorms, entrain whole pollens into the high humidity at the cloud base where pollens may rupture and cold downdrafts carry pollen fragments to the ground level where outflows distribute them. Note that whole pollen grains are too large to penetrate the deeper airways. Due to strong electric fields that develop during thunderstorms, positive ions are released from the ground and could attach to particles and/or electric charge may enhance pollen rupture, thus enhancing the bronchial hyperresponsiveness we know as asthma. 

Thus, subjects affected by pollen allergy – not only asthmatic patients but also subjects affected by seasonal rhinitis without asthma symptoms – should be increasingly alert to the danger of being outdoors during thunderstorms in the pollen season, as such events may be an important cause of severe exacerbations. This is an even biggest risk for those whose asthma is not treated properly with medications.

Your cashmere scarf is strangling the planet! 
Mongolia produces a third of the global supply, and cashmere makes up 40% of the country's non-mineral exports. Mongolia produced more than 7,000 tons of cashmere in 2015, the last year on record [Schlossberg, 2019; Schmitz, 2016].

The rise of China's consumer class and the demand for luxury goods has meant the price of cashmere has risen by more than 60% since the 1980s. Now, Mongolia's million nomadic herders have turned to herding goats to make a living, destroying their own grasslands in the process. In the past, they relied on cows, sheep, camels, and yaks to make a living instead. Why is this a problem?

The need for more cashmere means more cashmere goats. These goats have sharp hooves that break up the soil, leaving it unstable. In addition, the way they eat grass is to tear it up from the roots, further destabilizing the soil. Loose soil is blown by the wind more easily. These factors are contributing to the desertification of Mongolia and Inner Mongolia. Making matters worse, climate change is occurring at a faster rate in this part of the world, because it is such an extreme environment at a northern latitude. Hence, the area is becoming hotter and drier. Factor in the goats’ contribution as they release methane gas from their belching. When the dust from the desert gets blown in storms, it travels toward Beijing, a large industrial city. The dust from the desert combines with pollution from factories and coal-fired power plants and worsens Beijing's air pollution. But it also travels east from China, across the Pacific Ocean and contributes to air pollution in California.

The cashmere glut may be ending. Because they have eaten the grasslands, their food supply is quickly shrinking. No cashmere means no more sweaters. This could clean up the air on the US West Coast. But that's not likely to happen. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com


This article is for informational purposes only. Consult with a healthcare provider for any personal issues. 


References
Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis. 2014;18:1269-78.

Benjamin RM. Exposure to tobacco smoke causes immediate damage: a report of the Surgeon General. Public Health Rep. 2011;126:158-9. 

Burney PG, Patel J, Newson R, Minelli C, Naghavi M. Global and regional trends in COPD mortality, 1990- 2010. Eur Respir J 2015; 45: 1239–247.

D’Amato G, Cecchi, L, D’Amato M, Annesi-Maesano I. Climate change and respiratory diseases. Eur Resp Rev. 2014;23:161-9. https://err.ersjournals.com/content/errev/23/132/161.full.pdf

D'Amato G, Cecchi L, Annesi-Maesano I. A trans-disciplinary overview of case reports of thunderstorm-related asthma outbreaks and relapse. Eur Respir Rev. 2012;21:82–7.

D'Amato G, Liccardi G, Frenguelli G. Thunderstorm-asthma and pollen allergy. Allergy. 2007;62:11–6.
 
D'Amato G, Pawankar R, Vitale C, et al. Climate change and air pollution: Effects on respiratory allergy. Allergy Asthma Immunol Res. 2016;8:391–5. 

Eisner MD, Anthonisen N, Coultas D, et al. An official American Thoracic Society public policy statement: novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010; 182: 693–718. 

Forum of International Respiratory Societies. The Global Impact of Respiratory Disease – Second Edition. Sheffield, European Respiratory Society, 2017.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Eur Respir J. 2017;49: 1700214.

IPCC, 2018: Summary for Policymakers. In: Global Warming of 1.5°C. An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. Available at: https://www.ipcc.ch/site/assets/uploads/sites/2/2019/05/SR15_SPM_version_report_LR.pdf

Maibach E, Nisbet M, Weathers M. Conveying the human implications of climate change: A climate change communication primer for public health professionals. Fairfax, VA: George Mason University Center for Climate Change Communication; 2011.

National Center for Atmospheric Research (NCAR). Climate. Investigating a changing world; 2019. Available at: https://ncar.ucar.edu/where-we-focus/climate 

National Climate Report – August 2019. Available at: https://www.ncdc.noaa.gov/sotc/national/201908 

National Heart, Lung, and Blood Institute (NHLBI). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma; 2007. Available at: https://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf

National Institute of Environmental Health Sciences. Asthma, respiratory allergies, and airway diseases; 2017. Available at: https://www.niehs.nih.gov/research/programs/geh/climatechange/health_impacts/asthma/index.cfm

National Research Council (NRC). Surface temperature reconstructions for the last 2,000 years., Washington, DC: National Academy Press; 2006.

Ramaswamy V, Schwarzkopf MD, Randel WJ, Santer BD, Soden BJ, Stenchikov GL. Anthropogenic and natural influences in the evolution of lower stratospheric cooling. Science. 2006;311:1138-41.

Sapkota A, Symons J, Kleissl J, et al. Impact of the 2002 Canadian forest fires on particulate matter air quality in Baltimore City. Environ Sci Tech. 2005;39:24-32.

Schlossberg T. Inconspicuous Consumption New York: Grand Central Publishing; 2019. 

Schmitz R. How your cashmere sweater is decimating Mongolia’s grasslands. National Public Radio; 2016. Available at: https://www.npr.org/sections/parallels/2016/12/09/504118819/how-your-cashmere-sweater-is-decimating-mongolias-grasslands

Thornton IWB. Krakatau: The Destruction and Reassembly of an Island Ecosystem. Cambridge, Massachusetts: Harvard University Press; 1996.

Wang M, Aaron CP, Madrigano J, et al. Association between long-term exposure to ambient air pollution and change in quantitatively assessed emphysema and lung function. JAMA. 2019;322:546–56.

Wayne P, Foster S, Connolly J, Bazzaz F, Epstein P. Production of allergenic pollen by ragweed (Ambrosia artemisiifolia L.) is increased in CO2-enriched atmospheres. Ann Allergy Asthma Immunol. 2002;88:279–82.

World Health Organization (WHO). Global surveillance, prevention, and control of chronic respiratory diseases. A comprehensive approach. Geneva: WHO, 2007. 

 


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