Sun, Jul 09, 2023 page9

• Just ask asthmatics how perilous wildfire smoke can be

  • By Lara Williams / Bloomberg Opinion
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  Canadian wildfire smoke is back with a vengeance as, once again, millions of Americans were told to stay inside last week or wear masks to protect themselves from dangerously high levels of air pollution. As an asthmatic, I fear for my fellow sufferers.

  Wildfire smoke — containing nasties such as particulate matter, hazardous air pollutants and nitrogen dioxide — is bad for everyone, but can be life-threatening for those with pre-existing respiratory conditions such as asthma. On June 7, New York City had the worst air quality of any city in the world; emergency-room visits for asthma-related conditions spiked.

  In January, a high air-pollution alert was issued for London as low winds and a blanket of very cold air meant pollutants accumulated, lingering rather than dispersing. For almost a week, it felt like something heavy was sitting on my chest. Instead of flowing in and out of my lungs, air squeaked and whistled and wheezed. My inhalers, usually a source of instant relief, barely made a difference.

  The trigger for my asthma flare-up was mild compared to what people in New York faced at the start of last month, when the air quality index reached 366 — 24 times what the WHO says is OK. The WHO estimates that asthma affected 262 million people in 2019 and caused 455,000 deaths. Air pollution is not only dangerous for people with pre-existing conditions, it can also cause lung ailments.

  However, asthma is not just an air-pollution problem, it is also tied to the climate crisis in several ways.

  What is bad for the planet is also harmful for asthmatics. Combustion engines, industrial facilities and wood-burning stoves do not just pump out carbon dioxide; they also add pollutants that can inflame people’s airways, triggering potentially lethal emphysematous attacks. A 2023 EPA study found that new annual cases of asthma could increase by 4 percent to 11 percent at 2°C and 4°C of global warming respectively.

  Climate change is also making asthma worse by exacerbating common triggers. As the planet warms, people can count on more wildfires like the ones in Canada. The allergy season is getting longer and more severe, which is also bad news for hay fever sufferers. Even the weather makes a huge difference: Hot, humid air can inflame airways, as well as increase the presence of pollutants like ozone which — you guessed it — also inflames asthma symptoms.

  The good news is that because most air pollution is created locally, it can be controlled. Tim Dexter, clean-air lead at Asthma + Lung UK, sees opportunities to improve air quality and fight climate change at the same time: “Because they’re so linked, the solutions for one are often solutions for the other,” he told me. Swapping short car trips for a walk or cycle, not leaving engines idling and abandoning wood-burning stoves are all quick, easy fixes.

  Here is the irony: Many of the inhalers that asthmatics rely on emit substantial greenhouses gases. Inhalers account for 3 percent of the UK National Health Service’s entire carbon footprint; pharmaceutical giant GSK PLC estimates that almost half of its climate impact is caused by its inhalers.

  The specific culprits are pressurized metered dose inhalers, which use a hydrofluorocarbon (HFC) propellant to deliver medicine to patients. HFCs, also found in fridges and aerosols, are greenhouse gases with far greater warming effect than carbon dioxide.

  If you are an asthmatic, you might have two inhalers: a maintenance inhaler and a rescue inhaler. Maintenance inhalers are used daily to keep the condition under control. Rescue inhalers are fast-acting relievers for when you are feeling breathless and wheezy.

  There are straightforward alternatives for maintenance inhalers — rather than a pressurized metered dose inhaler (pMDI), asthmatics can switch to so-called dry-powder inhalers, using deep, forceful inhalations to suck in the dose. That is great if you have lung capacity, but in an emergency — and for breath-challenged patients such as children or older folk — that might not be an option. So, how do you continue giving people access to life-saving medical devices, while slashing emissions?

  That has become a priority for GSK, says Margaret Rumpf, global commercial head of established pharmaceuticals at the company. GSK is making a “significant” investment into a research and development program with the aim of reducing the emissions from its blue rescue pMDI inhaler by as much as 90 percent. It is in clinical trials — work has to be done to make sure it is as safe and effective as the previous iteration, and there are some important milestones still to hit — but there is a sense of urgency, Rumpf told me.

  I have some sympathy for pharma companies, which have already spent hundreds of millions of dollars to phase out CFC inhalers that were contributing to the hole in the ozone layer. Both GSK and AstraZeneca PLC are effectively repeating that effort by working on low-carbon inhalers. It is the sort of hard emissions-reduction work that all companies need to invest in.

  Work also needs doing on the prescribing and public awareness side. It is a tough balance — people should not feel guilty about taking their medicine, and they definitely should not stop taking it. Yet, 70 percent of inhaler prescriptions are for pMDIs in the UK, compared with 47.5 percent in Europe.

  The authors of a study of pre-pandemic guidelines for prescribers in the UK concluded that providers “are often steered toward MDI use.” That suggests there might be plenty of people on high-carbon inhalers who could cope well with a more planet-friendly alternative, but are not even aware of the issue.

  Although asthma inhalers’ contribution to climate change is miniscule versus the burning of fossil fuels, it is a good illustration of how nothing escapes the tendrils of the climate crisis.

  Lara Williams is a Bloomberg Opinion columnist covering climate change. This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
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