UC Davis Health experts urge wildfire preparedness action plans to support patients with respiratory diseases

A multidisciplinary team of UC Davis Health experts is calling on health care systems to create wildfire preparedness action plans to support patients with pre-existing respiratory conditions. They urge providers to proactively implement interventions to mitigate the effects of poor air quality caused by smoke.

Their article, published in the Journal of the COPD Foundationidentifies the needs of high-risk populations when affected by wildfire smoke. It outlines an action plan for health care systems to help these groups cope with the burden of poor air quality caused by wildfires.

Patients being treated for respiratory illnesses are at high risk for worsening symptoms when exposed to wildfire smoke. Unfortunately, the frequency and severity of wildfires are increasing across the United States, negatively impacting these clinically at-risk and underserved communities. So there is a dire need for us to implement interventions to reduce the health threat of forest fires.”

Reshma Gupta, chief of population health and accountable care at UC Davis Health and co-author of the article

Health consequences of poor air quality

Many components of wildfire smoke can have negative health effects, especially for people with pre-existing respiratory conditions.

According to the American Lung Association, more than 34 million people in the United States currently live with a chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD), or alpha-1 antitrypsin deficiency (AATD).

Exposure to wildfire-related air pollutants has been shown to cause and worsen diseases of the lungs, heart, brain and nervous system, skin and other major organs.

In patients being treated for pre-existing respiratory conditions, poor air quality causes inflammation in the lungs. This can worsen symptoms and lead to emergency room visits and hospitalizations.

“Poor air quality can cause exacerbations – acute increases in shortness of breath, coughing, shortness of breath – even lead to hospitalization,” explains Brooks Kuhn, co-director of the Comprehensive COPD Clinic at UC Davis Health and co-author of the article. . “The impact is not just transient: respiratory exacerbations lead to persistent and accelerated deterioration of lung function.”

And adults aren’t the only ones at risk for these complications.

“Children also see these impacts when exposed to poor air quality from wildfires,” said Kiran Nandalike, chief of pediatric pulmonology at UC Davis Children’s Hospital. “As we see more wildfires impacting our communities every year, the urgency for healthcare systems to formulate a response to support patients is urgent.”

Health approach to wildfires

The Targeted Wildfire Preparedness Action Plan adopted by UC Davis Health uses a public health approach. This means that care teams with healthcare providers from different specialties proactively work with patients who are at greater risk of developing symptoms due to poor air quality.

“A public health approach focuses on targeted interventions tailored to specific communities or population groups,” explains Gupta. “This approach takes into account a range of determinants, including social, economic, environmental and behavioral factors, that influence the health of these groups.”

The team’s wildfire preparedness action plan includes:

• Identifying patient populations at clinical risk and under-treated using well-validated, condition-targeted registries
• Building multidisciplinary care teams to understand the needs of these communities and patients
• Creating custom analyzes and stratification of wildfire risks
• Develop care pathways based on wildfire risk levels by disease, exposure risk, and access to health care
• Identifying outcome measures aligned to interventions with a commitment to continuous, iterative improvement efforts

“We have seen public health approaches successfully implemented to support patients with dementia, chronic kidney disease and cancer,” said Gupta. “Using this model, we can adapt to the threat of poor air quality from bushfires and take a proactive approach to meeting the needs of clinically at-risk and undertreated patients.”

UC Davis Health experience with wildfires

As a regional academic healthcare system in Northern California, UC Davis Health has been at the epicenter of recent wildfires – including the recent Park Fire, the fourth largest in California history. This experience gives the healthcare team experience in caring for patients in the most affected areas.

“Over the past several years, our physicians have routinely cared for patients with physical, financial and occupational barriers to clean air,” Kuhn explains. “We are uniquely equipped to share our experiences serving communities affected by wildfires.”

To target wildfire preparedness interventions to those who need them, UC Davis Health has created a multidisciplinary care team to serve as a liaison between communities affected by wildfires and the health care system. Some of the team’s efforts include:

• Identifying patients at risk
• Providing health education about air quality
• Personalizing care for patients
• Building and distributing “go-bags” of supplies for patients
• Collaborate with social organizations to support patients

“The patients are so grateful for this proactive approach,” said Gupta. “Patients often feel alone and disconnected from the world when they are cooped up in their homes due to poor air quality. By working with our team, they can protect themselves in the comfort of their own home.”

Call to action

As climate change progresses, wildfires are now an annual expectation in the United States. To meet the needs of clinically at-risk and underserved patients affected by this growing health threat, the authors of the article urge healthcare systems to replace reactionary approaches with collaborative, innovative and proactive approaches.

“In the coming years, it will be critical to prepare healthcare systems, clinicians and communities to manage the profound health impacts of environmental events and prevent potentially devastating consequences,” said Gupta. “We must work together to support this response and support patients at risk of wildfire exposure.”