How poor air quality and other climate change issues should change the way doctors treat patients
Even without smoke from Canadian wildfires, Philadelphia is ranked by the American Lung Association as one of the cities with the worst air quality.
Diamond could finally breathe again. After weeks of missed school, hospitalizations, intense treatments, and no clear answers, I felt we were finally turning the corner on her asthma treatment.
Chatting before her most recent appointment, the eighth grader rattled off her lengthy medication list and calmly explained how she used her inhaler each morning. She said she’d rejoined the softball team and cheerleading, went to her eighth grade dance, and was looking forward to graduation.
Then, smoke from wildfires in Canada settled over Philadelphia and raised the region’s air quality index to the most hazardous levels in years.
I first met Diamond in the fall of 2022 as a part of the Perelman School of Medicine’s patient shadowing program. The goal is for medical students to see health care through the eyes of the patient. She struggled with asthma flare-ups and allergen sensitivity. Some of her attacks were so severe that they required hospitalization.
Even without smoke from Canadian wildfires, Philadelphia is ranked by the American Lung Association as one of the cities with the worst air quality. As of 2018, nearly 18% of Philadelphia School District students had asthma.
When climate change worsens Philadelphia’s already dirty air, students like Diamond will suffer. Poor air quality following the wildfires reached record-breaking levels for the Philadelphia region, but experts warn that climate change will continue to increase the risk of air quality deterioration.
Air pollution wreaks havoc on our bodies, which can’t handle such thick, irritant-filled air. The tiny PM2.5 particles given off by car exhaust and forest fires are too small to be filtered out by our immune system. Reams of research have found that air pollution harms respiratory function, increases the risk of heart disease, and harms pregnant people.
Climate change is already changing how we think about medicine. When medical students are presented with a clinical vignette — the story of a patient as they walk into the office — we are trained to build a “differential,” a list of all the possible ailments that could contribute to that person’s concerns.
After this week, I will be adding “climate change” to every future differential.
When Diamond walks into the clinic, her symptoms are inextricably linked to the air she breathes. Diamond spent Philadelphia’s worst air quality days in June lying in bed, worried she would miss her middle school graduation due to the air quality. Her school closed one day because the air was so hazardous.
As a future physician, I plan on asking all of my patients about their air quality, inquiring if their neighborhood is near a factory or expressway. When parents express concern that their kids might be in harm’s way, I will show them pictures of how to make an air purifier out of a box fan and HVAC filters. I’ll talk to them about masking outdoors and help brainstorm indoor activities for their kids.
The air improved in time for Diamond to walk across the stage and accept her well-earned middle school diploma. The temporary reprieve was welcome. But as the planet heats up, forest fires will become more common across North America.
I worry how this will affect patients with asthma, like Diamond, and others with medical conditions that make them sensitive to poor air quality. Climate change is more than a political disagreement; climate change is a medical risk to us all.
Alex Nisbet is a medical student at the Perelman School of Medicine in Philadelphia at the University of Pennsylvania. Follow him on Twitter @alexfnisbet.