By Mike Iorfino
For the millions of Americans with asthma, summer heat waves and stifling humidity can trigger flare-ups and lead to emergency department visits.
The weather conditions also can contribute to higher levels of air pollution, such as ground-level ozone – the primary ingredient in smog – which forms most often in summer months, on days with clear skies and low winds. Exposure to high levels of ozone is particularly harmful for people with asthma, as it causes muscles in the airways to constrict, making it more difficult – and even painful – to take a deep breath.
“For people with asthma, even short-term exposure to air pollutants can exacerbate symptoms,” said Michael Phillips, MD, a professor of Medicine in the Division of Pulmonary, Allergy and Critical Care at Penn Medicine, who noted that there’s usually a significant uptick in asthma-related emergency department visits on days with poor air quality.
More than 25 million Americans have asthma, a chronic condition in which one’s airways narrow and swell, and produce extra mucus. While the severity and frequency of the symptoms vary from person to person, the condition often causes periods of wheezing, chest tightness, shortness of breath, and coughing. Severe asthma attacks can be life-threatening, and the condition accounts for more than 1.6 million emergency department visits each year, according to the Centers for Disease Control and Prevention.
For some people, the signs and flare-ups emerge after exercise, or following exposure to workplace irritants, like gases or chemical fumes, or allergens such as pollen and mold. In the summer, elevated temperatures and high humidity can trigger symptoms. In fact, researchers found that exposure to extreme heat and precipitation participation, particularly in the summer, is linked to an increased risk of hospitalizations from asthma.
Navigating Poor Air Quality – Particularly in Philadelphia
While no cure exists, effective treatment plans can help patients better manage their condition and prevent complications. However, a variety of factors, like increased exposure to poor air quality, can make life more challenging for people with asthma.
Air pollution affects communities nationwide, though the severity of pollution varies region-to-region. Philadelphia County, for example, received a “B” for particle pollution and an “F” for high ozone days, according to the 2019 “State of the Air” report recently released by the American Lung Association. Comparatively, Luzerne and Lycoming counties in northeastern Pennsylvania, both received a “B” for ozone. The report, which pulled data from air quality monitors from 2015 to 2017, focused on ozone and particle pollution, the two most common and harmful types of air pollution.
From 2015 to 2017, there were 31 “code orange” ozone alerts issued in Philadelphia County, meaning the air quality index had reached “unhealthy levels for sensitive groups,” including people with respiratory problems, like asthma. When compared to cities across the nation, Philadelphia didn’t fare much better. On the most polluted cities list, the Philadelphia-Reading-Camden metropolitan area ranked No. 21 out of 228 areas for high ozone days, and No. 18 out of 203 for annual particle pollution.
Steps to Better Asthma Control
The report’s findings underscore the need for patients in this region to adhere to a comprehensive treatment approach, which includes routinely tracking symptoms and monitoring whether they need to adjust medication, said Patricia Takach, MD, interim chief of the section of Allergy and Immunology at Penn Medicine. For example, patients should track how often they experience disturbed sleep caused by shortness of breath, as well as any triggers they may notice, such as post-exercise symptoms.
Patients use two main types of medications to treat asthma. Long-term control medications, such as inhaled corticosteroids, are preventive medications used on a daily basis to treat airway inflammation and reduce flare-ups. Quick-relief inhalers, or rescue inhalers, contain fast-acting medication and are used as needed to quickly open airways.
tes it’s important for patients to track how often they use the rescue inhaler each week. If they are using it more than a doctor recommends – often no more than twice a week – it means their asthma is not under control, and they should discuss adjusting the long-term preventive treatment.
To better manage their condition, every patient with asthma should work with their primary care provider or allergist to develop a personalized asthma action plan, Takach said. The action plan, or worksheet, is split into three categories – doing well, caution, and get help now – and outlines a variety of information, including past triggers and when and how much medication patients should take when they experience certain symptoms. The worksheet also enables patients to track their lung function by examining how new readings – taken by a hand-held device, called a peak flow meter – compare to their best measurement.
“The asthma action plan is a critical resource that allows patients to identify when their asthma symptoms are increasing, and what they need to do to treat it,” Takach said.
Patients who experience worsening symptoms during the summer should connect with their doctor or specialist at least once a month – whether in-person or via the patient portal, said Takach. She advises patients to carry their rescue inhalers at all times, and to make sure it’s not expired. Similarly, she recommends patients who use maintenance inhalers get a new one two weeks before their current one expires, so there isn’t a gap in treatment.
She encourages patients to be aware of the local outdoor air quality – whether it’s via the Weather app on their phone or online at AirNow.gov – and, if it’s bad, advises them to limit prolonged exposure.