Toxic air causes 36,000 deaths every year, can bring on asthma attacks, COPD flare-ups and even increase the risks of stroke, ischaemic heart disease, and lung cancer. It is particularly problematic for the elderly, children, and people with respiratory conditions.
This week world leadesr have gathered in Glasgow for the UN Climate Change conference (COP26), where, among other things, they will be trying to work out how to solve the wider problem of air pollution. But what can we do now as GPs and health professionals to help our patients stay as well as they can when they are breathing in dirty air?
Air pollution has dominated the news agenda in recent months, from the impact vehicles on our roads are having on the environment to harmful effects of fuels we use for cooking and eating food.
The death of Ella Kissi-Debrah made asthma and pollution headline news. Ella was just nine when she died from a fatal asthma attack caused by the toxic air near her home in Lewisham, south-east London. It was the first time ever that air pollution was listed as a cause of death on a death certificate.
Unsafe air pollution levels
Just last week, Asthma UK and the British Lung Foundation revealed new analysis which showed every two minutes in the UK a baby was born in an area where there was toxic air, where air pollution levels are deemed unsafe according to the World Health Organisation (WHO).
For those with pre-existing lung diseases like COPD and asthma, air pollution can cause an exacerbation of symptoms and even lead to life-threatening asthma attacks. Around two thirds of people with asthma – an estimated 3 million – find that poor air quality makes their symptoms worse, according to research by Asthma UK.
As GPs we have plenty to do already to support patients with their health, including addressing the surge in demand (much of it respiratory), flu and COVID-19 vaccination programmes and catching up with optimising the care and self-care of people with long term conditions. But there are some simple things we can do too to play our part in helping respiratory patients stay well too, in spite of air pollution.
1. Talk to them about regularly and correctly using their preventer inhalers
We all know that people with asthma are less likely to experience symptoms from triggers such as air pollution if they take their preventer medicine because it builds up protection in their airways over time.
Corticosteroid inhalers suppress the airway inflammation that leads to symptoms and can cause asthma attacks. This means that patients are less likely to react to triggers such as pollution and less likely to require their reliever medication.
It’s vital that we explain this to patients and stress that just because their preventer inhalers don’t have an immediate noticeable impact, it doesn’t mean that they aren’t working. It can take several weeks for the protection from a preventer inhaler to build. Some patients may still get symptoms in the meantime but must continue with the treatment.
Sometimes routines slip so you can tackle this by suggesting patients make taking their inhaler part of their daily routine – such as doing it just before brushing their teeth or after a morning shower.
2. Make sure your patients are getting basic care
It’s been an incredibly tough 18 months trying to deliver care through virtual appointments while ensuring the safety and wellbeing of both staff and patients. But giving your patients basic asthma information, advice and treatment can make a huge difference in preventing hospital admissions.
Worryingly, research from Asthma UK revealed that two thirds of patients are still not getting basic asthma care, despite guidelines from NICE.
You should remind those with asthma to:
- attend their yearly asthma review
- use a written asthma action plan
- get their inhaler technique checked.
People who have asthma action plans are better equipped to manage their symptoms and so less likely to be admitted to hospital. Make sure everyone in your team knows the best way to take every type of inhaler. There are videos on the Asthma UK website here on how to use inhalers.
You may also want to share these videos with patients as you can share the links via email or SMS or even add them onto your patient’s prescription.
3. Advise on how to stay away from pollution hotspots
Main roads, junctions, bus stations and car parks are all areas of high traffic pollution and should be avoided as much as possible by those with lung conditions.
You could suggest your patient uses quieter back streets as much as possible when going somewhere and, if they have to commute to work, they could go out a little earlier before the morning and evening rush hours when pollution levels haven’t yet had a chance to build up.
If they cycle, run or walk as part of their commute, advise them to use back streets away from the bulk of vehicle congestion and walk on the inside of the pavement – the further they are from the traffic the lower the pollution levels are. Patients can check pollution levels on the DEFRA website here.
4. Encourage safe exercise
There is strong evidence that people with COPD benefit from exercise and pulmonary rehabilitation - a treatment programme that can help those with lung conditions stay active that involves physical exercises and advice from professionals. It’s important that patients aren’t deterred from getting exercise if air pollution is high outside – they may want to exercise inside instead.
Explain to your patients that the right kind of exercise and being active generally can really help those with lung conditions, strengthening the muscles involved in breathing as well as benefiting their heart health and blood pressure. It also makes them less likely to develop other health problems such as diabetes and osteoporosis.
The important thing is that the patients find a way to be active that they enjoy, but if they need help in determining how to exercise at a level that is safe for them, you can refer them for pulmonary rehabilitation. Make sure you remind your patients that if they do exercise, they should keep their reliever inhalers with them in case they need them.
5. Help patients identify other air pollution sources to avoid
While fumes from road traffic accounts for 80% of air pollution, it’s not the only cause that may affect your patients. Ask them questions to see if there are other pollutants which could affect their condition, such as smoke from open fires or wood burning stoves, especially as we head into winter.
If they are using a wood-burning stove, tell them to make sure it’s well maintained, and that they are using dry woods. Newer designs are usually better and pollute less. With open fires, keeping flues clear and chimneys swept to allow the smoke to escape can also help.
Most importantly, remind them to always have their reliever medication nearby to help immediately relieve symptoms if they need it. Remind them also to keep an eye on their inhaler device counters and contact you for a new prescription before their medication runs out.
- Dr Andrew Whittamore is clinical lead at Asthma UK and the British Lung Foundation and a practising GP in Portsmouth.
- For more information on how to help patients with lung conditions reduce the effects of air pollution from the British Lung Foundation please click here