People exposed to noxious smoke from fires often live away from lung specialists

Smoke began to float in the skies of northwestern Nevada in September, clouding the mountains, obscuring the sun and nullifying residents’ hopes that they would be spared from the fires and terrible air quality produced by the flames.

Lung-irritating particles blew from burning forests in California and settled in Douglas County, Nevada, where nearly 50,000 people live, warning that air quality had reached dangerous levels.

Those levels meant the air was very unhealthy, bad enough to raise alarms about people’s immediate health needs and wonder if worsening pollution could cause long-term health problems. People could face increasing risks as climate change makes fires, droughts, dust storms and floods more frequent in the United States and around the world.

Some people just feel helpless.

“There’s not much we can do about it,” said Serrell Smokey, president of the Washoe Tribe of Nevada and California. The tribe’s land straddles the California-Nevada border near Lake Tahoe and extends into Douglas County, approximately 60 miles south of Reno.

Tribe members and other residents in the area are among the millions of people nationwide who will experience poor air quality this year due to the fires. In September, when smoke settled over Nevada, air quality warnings were sent out regarding fires in six other states: California, Idaho, Montana, Oregon, Washington and Wyoming.

Yet, to one extent, people living in Douglas County are better off than those in other hard-hit areas. Douglas County residents have to drive an average of 30 minutes for medical attention by lung specialists called pulmonologists. In other parts of the West and Upper Midwest, however, patients must drive for an hour or more, according to data analyzed by GoodRx, a website that tracks prescription drug prices and conducts research.

Specifically, the research found that approximately 5.5 million Americans live in the 488 counties where driving times for pulmonologists are an hour or more. Much of Nevada and much of Montana fall into those gaps among specialists, places that have recently been grappling with fires that fill the air with smoke and ash, which can cause lung problems or exacerbate existing ones.

Allergies, asthma, and similar problems are often handled by primary care physicians, but patients are referred to pulmonologists when problems escalate: think severe asthma; chronic obstructive pulmonary disease or COPD; or emphysema.

Data from the Association of American Medical Colleges shows that the number of lung disease specialists in the United States decreased by nearly 11% from 2014 to 2019. The group, which is based in Washington, DC, and represents the community of the academic medicine, noted that the decline may not be as high as it seems because some doctors are opting to practice pulmonary intensive care rather than just pulmonology. Many of these types of pulmonologists work in hospital intensive care units.

About 15,000 pulmonologists are practicing in the United States, according to the GoodRx report. Yet large areas of the country have few or none.

“New Mexico has a pulmonologist for the entire southeastern part of the state, not counting Las Cruces, which is closer to El Paso,” said Dr. Victor Test, a pulmonologist with Texas Tech Physicians.

Test, one of 13 pulmonologists in the Lubbock region of Texas, said his patients from Texas sometimes drive four hours for an appointment and that other people travel from “New Mexico, Oklahoma, even far western Kansas.”

The increase in fires and their intensity will likely increase the need for pulmonologists.

“Climate change will affect lung disease,” said Dr. Nicholas Kenyon, professor of lung medicine, critical care and sleep medicine at the University of California-Davis School of Medicine in California, where he and several other researchers are monitoring the effects of fires. In his Sacramento office, Kenyon said, he sees patients from far northern California, including Eureka, a five-hour drive from the state capital.

The short-term effects of smoke breathing are fairly well known. People come to the emergency room with attacks of asthma, COPD exacerbation, bronchitis, and even pneumonia, Kenyon said. Some have chest pain or other heart problems.

“But we have very little understanding of what happens in the long term,” he said. “If people have two or three weeks of fire exposure for two or three years, does that lead to worsening of asthma or COPD? We just don’t know.”

Fires release multiple pollutants, including carbon dioxide, carbon monoxide, and chemicals like benzene. All fires send particles into the air. Health researchers and air quality experts are most concerned about the tiny fragments called particulate matter 2.5. Much smaller than a human hair, the particles can lodge deep in the lungs and have been linked to heart and lung conditions.

According to a 2020 New England Journal of Medicine overview, the increase in those tiny particles is associated with an increased risk of death from all causes, excluding accidents, homicides, and other non-accidental causes, for up to four days after exposure. of a population. .

The concentration of fine particles is one of five indicators used to calculate the Air Quality Index, a numerical and color-coded index used to inform the public about local air pollution levels. Green indicates good air quality and is given if the total index is 50 or less. When the measurement exceeds 100, the air quality gets an orange label and may be negative for some groups. Levels above 200 get a red label and are considered unhealthy for everyone.

Government agencies track these levels, as do people using apps or websites to determine if it’s safe to go out.

When the AQI goes above 150, Dr Farah Madhani-Lovely, a pulmonologist, said Renown Regional Medical Center in Reno closes its outpatient pulmonary rehabilitation clinic because it doesn’t want to encourage patients to drive. Some Douglas County patients opt for care close to home, about an hour away. “We don’t want these patients to be exposed outdoors because just one minute of smoke exposure can trigger an exacerbation of their chronic disease,” said Madhani-Lovely.

Smokey said connecting with pulmonologists can be difficult for Washoe Tribe members, particularly those living in the Californian part of the reservation. “We can’t find suppliers for them,” he told her. “We end up targeting them and sending them hundreds of miles out of their way just to get care that we should be able to provide here.”

Recruiting specialists in rural areas or in smaller towns has long been difficult. For one thing, a specialist might be the only one miles away, “so there’s a huge burden in terms of coverage and days off,” Test said.

Another concern is that doctors tend to train in larger cities and often want to practice in similar locations. Recruiting pulmonologists in Lubbock, a city of 260,000 in West Texas, is also a challenge, Test said.

“I love Lubbock,” he said. “But I tell people who have never been here, I say, ‘It’s really flat.’ They don’t understand until they get here.

In Nevada, on days when the air quality is bad, members of the Washoe tribe try to protect themselves with makeshift air purifiers made from fans, duct tape and air filters, Smokey said.

In the long run, Smokey and other tribal leaders are pushing the Indian health service to establish a specialty hospital in northern Nevada. The closest specialty hospital for Washoe tribe members is more than 700 miles away in Phoenix.

It’s difficult because “there is a need that we should take care of,” Smokey said. “But we have to fight for it. And sometimes that fight takes years, years and years to complete. “

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on health issues to the nation.

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