Asthma, a condition that affects the ability of millions of Americans to breathe adequately, is changing.
That’s because earth’s climate is changing, leading to alterations and increases in the substances we breathe that can trigger or exacerbate an asthma attack.
Alison Kenner, a Drexel University assistant professor and interdisciplinary social scientist, has long been interested in this intersection of the planet’s health and human health. A member of Drexel’s Center for Science, Technology and Society, she recently wrote Breathtaking: Asthma Care in a Time of Climate Change. In it, she argues that no longer will individual approaches to asthma — such as one person managing specific triggers — be enough. Treating the disease will require a collective approach, such as taking major steps to clean the air we all breathe.
We recently spoke with her about her book.
What aspects of climate change have the most potential to affect people with asthma?
First, it’s important to define what asthma is. It is a chronic disease of the airways. It causes inflammation of the airways, which can obstruct airflow in and out of the lungs. There are a lot of things that can trigger inflammation and cause asthma symptoms: air pollution, smoke from forest fires, cigarette smoke, exhaust from cars and trucks, pollen. Pollen affects air quality, but it’s also an allergen. More than half of all people with asthma also have allergies.
Dust and mold also can produce asthma symptoms. These are common in home environments, but they are also present in other spaces, such as when you are walking past a construction site. Coastal areas, which are warm and wet, can be plagued by mold. Another thing that triggers asthma is cold air and rapid changes in weather.
So the first thing to understand is that asthma symptoms are produced by conditions in our environment. Climate change affects all these. Increases in air pollution. More extreme weather events. Higher pollen counts and greater pollen allergenicity. It is going to impact the atmosphere and air quality in ways that make asthma more difficult to control.
Are we already seeing these effects?
Yes. We’re totally seeing these now, and I’ll point to three examples: mold, pollen and forest fires.
Most people in this country, when they think of forest fires, are thinking of the West Coast. But scientists are warning us that the U.S. Southeast is going to see an uptick in forest fires, and large ones. You might not think that a forest fire in Tennessee or Virginia matters in Philadelphia, but it does. That smoke can be transported far from the site of the fire. The San Francisco Bay area, for example, got absolutely smashed with particulate matter pollution in the weeks following the Camp Fire in northern California last fall. I was in San Jose for a week, and I can tell you that you can feel a code red air quality action day. You can feel the smoke in your throat and in your eyes and on your skin. And when you wake up the next morning, it stays with you. You can feel it in your chest. These are the kind of events that send people with asthma to the hospital.
Mold is another issue that’s on the rise, particularly here in Philadelphia and other parts of the Mid-Atlantic. Philadelphia is going to become warmer and wetter. As I said, mold thrives in warm, wet conditions. This is already impacting Philadelphia’s housing stock. Over the last two years, we’ve had a number of Philadelphia schools close because of mold issues. This isn’t going to go away. If there is an old building that has a leaky roof, or windows that are not well-sealed, and you have heavy precipitation events, that water gets into the building.
As for pollen, I think most people are feeling the impact of pollen. If you yourself don’t have allergies, you are likely living or working with people who do. With climate change, pollen seasons are longer. There is more pollen. We are seeing an increase in pollen allergenicity — its potential to produce an allergic reaction is higher. There are good data to show that this is getting worse.
You’ve said that climate change makes dealing with asthma more complex. How so?
My research shows that stability, consistency and familiarity make asthma care easier. People with asthma manage their disease through awareness of environmental conditions and environmental quality. In other words, they’ve lived with asthma long enough and have enough experience to kind of feel out the environment and know what’s coming. I call this attuned care.
But climate change is making the weather more variable, less predictable and more extreme. That variability poses more risk for people whose symptoms are related to weather. What was normal is no longer normal.
Also, the language of asthma includes “triggers” — specific things that can cause difficulty breathing. But when you say pollen is an asthma trigger, or dust is, it sounds very simple. In reality, triggers often work together. It’s just not one thing. The air, our atmosphere, is like a complicated soup. In the summer, you have high temperatures and humidity and particulate matter and mold spores all acting together. So, it’s really not about triggers. It’s really about environment.
You also say that dealing with the effects of climate change will require a collective approach rather than individual ones. Can you explain that?
I always lead with the policy. We need policymakers first and foremost to reduce greenhouse gas emissions. We have to acknowledge that climate change is here and now, and we need to deal with it day to day. This doesn’t get brought up as much as it should, but many of our greenhouse gas emissions are asthma triggers, too. Fossil fuel emissions are asthma triggers.
Another collective approach is that we need to deal with our built infrastructure. Philadelphia is an old city, and even in newer cities you have to maintain infrastructure and repair it. Part of the collective approach to dealing with climate change in order to reduce asthma is to make sure our buildings are robust.
In my book, I refer to carescapes. I think probably the best example of carescapes in Philadelphia are healthy homes programs, which are run by organizations like the National Nurse-led Care Consortium and St. Christopher’s [Hospital for Children]. It’s an example of collective approaches that can address asthma at the ground level. The National Nurse-led Care Consortium has also started teaching people about climate change, about how environmental conditions can cause asthma symptoms.
Are there other examples of this kind of collective work happening in Philadelphia, to address the effects of climate change on people with asthma?
Over the last five years, I’ve been part of a group called Climate, Health, and Home that has run a dozen workshops attended by almost 300 Philadelphians. In those workshops, we teach people — not just people with asthma — about how climate change is going to impact Philadelphia, and how it is going to impact health.
Another is CUSP — the Climate and Urban Systems Partnership — run by the Franklin Institute. This is a network of climate change educators bringing information into communities and organizations across the city. It includes about four dozen organizations, a number of which focus on asthma, specifically.
The Climate, Health, and Home workshop series, which is part of this network, is designed to teach people how climate change worsens asthma and what they can do to address it. We’ve very focused on solutions — reducing exposure to air pollution, for instance. We talk about mold in the home and exposure to pollen. We also talk a lot about energy efficiency. More and more research is showing that a weatherized, energy-efficient home has a lot of health benefits, including helping people manage asthma.
Children’s Hospital of Philadelphia has the Community Asthma Prevention Program, and just last month they announced a new project that will provide basic home repairs for families with children who have asthma.
Sometimes I think we’re still in a mode of thinking that climate change is coming. No. Climate change is here now. We are already seeing the effects. We need to accept that and start addressing it.