How The Changing Climate Is Impacting Your Breathing And What You Can Do About It

The horrific, unpreceded wildfires that have hit Los Angeles this past week destroyed 12,000 structures and cost lives, and left city and county officials reeling in their attempts to contain the damage. But the fire’s impact goes beyond the spaces it physically touched – the nation’s second largest city and its surrounding areas are now experiencing hazardous air quality with fine particulate matter reaching concentrations up to twenty-times the maximum limit recommended by the World Health Organization. Officials have urged residents to stay indoors where smoke is visible, with one health scientist predicting the region’s smoke could cause a 5-15% increase in daily mortality.

I am a board-certified lung surgeon, but until recently I spent little time thinking about how our changing climate and shifting weather patterns affect how we breathe. But with rising temperatures, increasingly frequent wildfires, and extreme weather events, I’ve seen firsthand how climate change is directly and negatively impacting our respiratory health. The effects are particularly severe for vulnerable populations like children, the elderly, and those with preexisting lung conditions, and will only get worse if we don’t proactively respond to our changing environment.

The Triple Threat: Heat, Ozone, and Particulate Matter

Heat does more than make us uncomfortable; it triggers airway inflammation and worsens conditions like asthma and chronic obstructive pulmonary disease (COPD). In certain cases, hospitalization rates were found to increase by 21% to 33% during heatwaves. A European study also found that respiratory mortality increased by a staggering 6.7% for every 1.8°F jump in temperature.

Rising temperatures also accelerate the production of ground-level ozone, a harmful gas that irritates airways and can trigger asthma attacks. While stratospheric ozone protects us from UV radiation, ground-level ozone, produced when sunlight reacts with pollutants, poses significant health risks, especially for those with weakened immune systems. Ozone irritates the airways, and even “low-level” ozone exposure has a noticeable effect on children’s ability to breathe and is linked to a rise in child emergency department visits. In patients on whom I’d performed heart or other organ transplants and consequently were on chronic immunosuppressant medicines to prevent organ rejection, I was especially careful to instruct them to avoid high-ozone environments and heed air quality warnings.

Particulate matter (PM), particularly PM 2.5 – fine particles 2.5 millimeters or less in diameter – poses another major threat. These tiny particles from vehicle emissions, industrial activity, and wildfires can penetrate deep into our lungs and enter the bloodstream, potentially causing lasting damage to multiple organs via oxidative stress. In Los Angeles today, the burning of buildings and vehicles releases a host of chemicals present in plastics, fuels and metals. Over time, this damage to our organs can lead to conditions like pulmonary fibrosis, a type of scarring of the lung, or lung cancer, even in non-smokers.

The impact of wildfires on respiratory health has become increasingly severe. Every county in the contiguous U.S. now experiences at least 16 days of wildfire smoke annually. A study focusing on elderly individuals in the Western United States found that each “smoke day with high wildfire-specific PM 2.5” corresponded with a 7.2% increase in respiratory hospitalizations.

Children are particularly susceptible to the dangers of wildfire smoke, as their lungs are still developing and because of the high ratio between the amount of air they breathe and their body size. Studies have shown that asthma emergency room visits rise dramatically during wildfires. And long-term exposure to wildfire smoke increases a child’s risk of developing a respiratory disease later in life.

Wildfires can even impact the unborn. Children whose mothers were exposed to wildfire smoke during pregnancy are more likely to experience “delay[ed] development” and “suffer from asthma later in life.”

The Impact of Extreme Weather Events

Floods bring their own set of dangers. After major floods, respiratory illnesses increase due to mold growth and the spread of airborne allergens. Those with existing lung conditions are particularly at risk, as the stress of coping with a natural disaster can weaken the immune system, making them more susceptible to infections and pollutants. Those exposed to flooding in the aftermath of 2017’s Hurricane Harvey, for example, were reported as having a significantly “higher risk of upper respiratory tract symptoms.”

Droughts, with the drying up of riverbeds and lakes, lead to dust storms and air pollution. For example, extensive development and water diversions in Utah have led to the accelerated drying up of the Great Salt Lake, resulting in the emission of carbon dioxide and other greenhouse gases on par with that of 140 commercial planes.

The Rise in Respiratory Conditions

Asthma affects approximately 1 in 12 Americans, and the changing climate poses a particular threat to these individuals. Those with asthma have weakened antioxidant defenses, making them especially vulnerable to ozone and particulate matter. Research indicates that children living in areas with high ozone levels are more likely to develop asthma.

Even more concerning, lung cancer is increasing despite declining smoking rates. Air pollution is now recognized as the second leading cause of lung cancer after smoking, with lung cancer in never-smokers becoming the seventh leading cause of cancer deaths worldwide.

What Can You Do?

The same pollution that drives climate change also contributes to serious health outcomes. Tackling both air pollution and climate change could significantly reduce the risk of illnesses like lung cancer and childhood asthma in the future.

The good news is, there are things we can all do to protect our lungs and reduce the impact of climate change today. These steps include:

Individual Actions

– Monitor local air quality and avoid outdoor activities on high-pollution days

– Wear N95 masks if you must be outdoors during periods of dangerous air quality (like with the LA wildfires)

– Consult healthcare providers about specific climate-related health risks

– Support local environmental initiatives

Community and Policy Solutions

While federal change is important, states and regional compacts also make a difference and serve as a testing ground for effective policy. For example, the Regional Greenhouse Gas Initiative in the northeastern U.S. exemplifies the way in which policy can help decrease the impact of air pollution on respiratory health.

In 2005, the governors of seven northeastern states signed an agreement to limit the production of greenhouse gases by power plants. In 2009, the Regional Greenhouse Gas Initiative would go into effect. Four more states would join over the following years. In 2014, it was estimated that the Initiative had “prevented more than 16,000 cases of respiratory illness, 537 cases of asthma, and other illness[es] in children.”

Small-scale community action can also positively impact the local environment and, consequently, the health of local populations. In 2017, the Green Heart Louisville Project began planting new greenery in South Louisville, Kentucky; by the end of the project, 8,000 new trees and shrubs were introduced to the area.

The result? A quantifiably healthier community. Those living within 4 miles of the new greenery showed 13-20% lower levels of C-reactive protein, which is produced in response to inflammation. Less inflammation means fewer serious respiratory conditions. Also, this specific decrease in C-reactive protein is associated with a 10-15% lower risk of heart attacks, cancer or death as a result of any disease.

Private Sector Role

Business can also play a role. Last summer, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) proposed a new rule that would guarantee certain provisions for workers exposed to extreme temperatures. Under specific conditions, workers would be provided with cool water, paid rest breaks if needed, and shade or air-conditioned areas. There is reason to believe that this rule would not only benefit workers but also employers. Similar programs have been implemented elsewhere. For example, a 2017 program meant to protect workers from extreme heat in Nicaragua was found to result in fewer injuries and hospitalizations (decreases of 72% and 94% respectively) as well as a “20% increase in productivity.” Businesses should consider proactively implementing this proposed rule (as Dr. Vanessa Kerry and I outlined here), and considering other ways to protect employees during periods of extreme heat and hazardous air quality.

Healthcare Sector Response

The National Academy of Medicine’s Grand Challenge on Climate Change, Human Health, and Equity, where I serve on the steering committee, is working to address climate change as a public health crisis, focusing on finding ways to creatively engage healthcare systems in the response. U.S. healthcare activities account for an estimated 9% of domestic greenhouse gas emissions, and are responsible for about a quarter of all global healthcare emissions (more than any other nation). Increasingly, there are opportunities for our healthcare systems to play a role in reducing emissions and improving the health of the communities they serve, including through accreditation programs like The Joint Commission’s new sustainable healthcare certification.

The science is clear: the changing climate and air pollution threaten our respiratory health. By staying informed, making healthier choices, and advocating for systemic change, we can help protect our health and that of future generations.