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

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

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

Patients receiving treatment for respiratory conditions are at high risk of exacerbations when exposed to fire smoke. Unfortunately, the frequency and severity of wildfires are increasing in the United States and are negatively impacting these clinically at-risk and underserved communities. Therefore, there is a significant need to put in place interventions to mitigate the health threat posed by wildfires.”

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

Health effects of poor air quality

Many components of wildfire smoke can have adverse health effects, especially for those with pre-existing respiratory illnesses.

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

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.

For patients receiving treatment for pre-existing respiratory conditions, poor air quality causes inflammation in the lungs. This can worsen symptoms and lead to emergency department visits and hospitalization.

“Poor air quality can cause exacerbations—a sharp increase in shortness of breath, coughing, shortness of breath—and even lead to hospitalization,” explained Brooks Kuhn, co-director of the Comprehensive COPD Clinic at UC Davis Health and co-author of the paper. . “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 of these complications.

“Children also see these effects 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 fires impact our communities each year, the urgency for health systems to outline a response to support patients is pressing.”

Population health approach to forest fires

The targeted wildfire preparedness action plan adopted by UC Davis Health uses a population health approach. This means that care teams with providers from different specialties work proactively with patients who are at higher risk of developing symptoms from poor air quality.

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

The team’s action plan for fire preparedness includes:

• Identifying clinically high-risk and underserved patient populations using well-validated condition-targeted registries
• Bringing together multidisciplinary care teams to understand the needs of these communities and patients
• Create custom analytics and fire risk stratification
• Develop care pathways based on levels of fire risk by disease, risk of exposure and access to health care
• Identify outcome measures tailored to interventions with a commitment to continuous, iterative improvement efforts

“We have seen population health approaches successfully applied 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 wildfires and take a proactive approach to meeting the needs of clinically at-risk and underserved patients.”

UC Davis Health experience with wildfires

As a regional academic health system in Northern California, UC Davis Health has been at the center of recent wildfires – including the recent park fire, the fourth largest in California history. Because of this experience, the health system team has experience in caring for patients in the most affected areas.

“In recent years, our clinicians have routinely cared for patients with physical, financial and occupational barriers to fresh air,” explained Kuhn. “We are uniquely equipped to share our experiences serving communities affected by wildfires.”

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

• Identification of patients at risk
• Providing health education on air quality
• Personalization of the patient approach
• Manufacture and distribution of ‘go-bags’ with supplies for patients
• Partnering with community organizations to provide support to patients

“Patients have been so grateful to receive this proactive approach,” Gupta said. “Patients often feel alone and cut off from the world when they are locked in their homes due to poor air quality. Working with our team enables them to 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 article’s authors urge health systems to replace reactive approaches with collaborative, innovative, and proactive approaches.

“In the coming years, it will be critical to prepare health systems, clinicians and communities to manage the profound health impacts of environmental events and prevent potentially catastrophic consequences,” Gupta said. “We must come together to maintain this approach and support patients at risk from bushfire exposure.”