Climate Change and Your Health

Podcast Transcript

Raed Dweik:

Hello, and welcome to the Respiratory Inspirations Podcast. I'm Raed Dweik, chairman of the Respiratory Institute at the Cleveland Clinic. This podcast series of short, digestible episodes is intended for patients and families and covers topics related to respiratory health and disease. My colleagues and I will be interviewing experts about timely and timeless topics in the areas of pulmonary critical illness, sleep, infectious disease, and related disciplines. We will share with you information that will help you take better care of yourself and your loved ones. I hope you enjoy today's episode.

Sumita Khatri, MD:

Hello everybody. My name is Sumita Khatri. I'm a pulmonologist and director of the Asthma Center here at Cleveland Clinic, and I'm hosting this episode of Respiratory Inspirations where we will be talking about climate change. I'd like to welcome my guests and good friends, Dr. Neha Solanki, and Dr. Emily Pennington. Thank you for joining me in this very important discussion.

Neha Solanki, MD:

Glad to be here.

Emily Pennington, MD:

Thank you for having us.

Sumita Khatri, MD:

Great. Wonderful. It is a joy really to talk with you both. It's nice to work together, but also be friends and have similar interests in trying to improve the health of not just our own patients, but really for the area and just public health in general. And so, you know, people may have tuned in because they're interested and believe and understand climate change, and they want us to understand it better from our healthcare standpoint. Or some people might be like, you know, I hear climate change and I have no idea what it is. And I know there's naysayers and there's people who understand it.

So, if you have questions, and you have interest, this podcast is for you because we are going to try and explain to our best ability not being geologists, but being interested in the Earth and the atmosphere and the way it affects health and in particular lung health. So, we're glad you joined us today as well. But before we get into the details, you know, I always like to ask people who are my guests to say, you know, what prompted your interest in this area? So, I think Dr. Solanki, you had a very lovely story of your childhood.

Neha Solanki, MD:

Well, when you said to, you know, you wanted me to come talk about the climate, I really started trying to go back into my past and try to think about what it was that really sparked that interest. And because I do gravitate towards it. And I remember when I was younger, I remember learning about ozone layer depletion when I was in school. It was just taught to us in science class that this was happening and that if it continued there could be UV paths could get through and that people could have more skin cancer, suffer from more immune diseases. And that scientists were thinking about how we, you know, were working on ways to close the ozone layer. And that just made such an impression on me that there was this thing that humans had created from hair sprays. We had created using hair sprays.

Sumita Khatri, MD:

I know.

Neha Solanki, MD:

We had created this hole in the ozone layer, and it was just amazing to me that scientists were able to turn this around with research, with the use of economic resources, with international political action, we were able to reverse that change. And as I've gone through my training and career, I keep learning more about the climate and I keep reading about it and reading about what, what is happening and what people are doing, and the more I study, the more I take care of patients who have lung problems, the more I feel that it is very important that everybody know about the effects of the climate on their health.

Sumita Khatri, MD:

Mm-hmm. So well said. And you know, it's funny because, yeah, ozone layer, we don't want to hold in the ozone layer.

Neha Solanki, MD:

Do you remember that?

Sumita Khatri, MD:

I do. And the thing is, we want the ozone layer to be high. You know, it's good up high, but it's bad nearby.

Neha Solanki, MD:

Right.

Sumita Khatri, MD:

And the EPA says that because the ozone layer is in the stratosphere, that's out high up, you know like a mile or so away from the earth and that's what shields us from that radiation. But if we have high ground level ozone, that's the pollution that we're worried about.

Neha Solanki, MD:

Yes.

Sumita Khatri, MD:

We're gonna get to that soon but thank you for that vignette. I'm just picturing you in seventh grade.

Neha Solanki, MD:

Curious little girl.

Sumita Khatri, MD:

Yes.

Neha Solanki, MD:

Right.

Sumita Khatri, MD:

Not so different now. Go ahead, Dr. Pennington, how about you? How did you get interested in this area?

Emily Pennington, MD:

Yes, so my clinical interest is in asthma and of course the environment plays an enormous role in asthma care and asthma control for our patients. And so, I think that's where I, sort of first started thinking about this and then thinking about how climate of course affects our environment. So, we know that things like rainfall, thunderstorms, pollen counts, severe cold temperatures, really hot, humid days, all of that impacts asthma control. And with climate change, we're seeing more of those extremes. So more, you know, days of really high pollen counts. More really cold weather, more really hot weather, and all of that impacts how patients perceive their asthma and our ability to help take care of those patients and help them manage their asthma.

Sumita Khatri, MD:

Mm-hmm. Yeah, that's true. And I remember reading this article about the Olympics in Atlanta in 1996, and it was not soon after that, that we moved to Atlanta. And the idea that during the Olympics, they changed a lot of the traffic routing, you know, the routing of traffic into the city to have just public transportation or very little transportation. And during that period, for those few days or weeks, there was a reduction in the ground level ozone. So, ozone comes from the burning of fossil fuels, in other words, like gasoline emissions and heat and sunlight, right? So that's the three things that you need for ground level ozone. And then I remember hearing that children's visits for asthma emergency visits had gone down because the ozone levels went down.

There was like a correlation, and then when traffic went back to usual the, you know, you saw this natural experiment where it went back up again. So, I think that was a kind of like turning point for me, and I was already a grownup by then. But I thought, you know, this is something we need to talk about more. So that's again, the intent of this conversation. Like we're just saying that, you know, we want people healthy. You know, we want you healthy out there and we want.

Emily Pennington, MD:

I want everyone to talk about it.

Sumita Khatri, MD:

Well, there we go. There is that sneaky plan too, of course. So, Dr. Pennington, I was just wondering, you know, we hear climate change, global warming, all these kinds of topics. But can you explain to us? Let's just get on the same page. What is climate change?

Emily Pennington, MD:

So, climate change, first of all, I guess I'll differentiate climate change from weather. Okay. So, the weather is when you look out the window, it's raining, it's sunny out, it's cloudy outside. That's kind of what our day-to-day weather patterns is. Climate is a larger concept, looking at a number of different parts of our atmosphere. So, looking at how much rain we're getting, precipitation, temperatures, wind currents, the pressure on the atmosphere, all those kinds of encompass what we call our climate. So, climate change occurs when there's a significant change in what we expect from all of those different variables.

So, there's kind of a normal range of what we consider, you know, how much rain we get, what our wind currents are, but then climate change happens when we're kind of way outside of what we expect. The other important part of this is that this is something that's measured in years and decades. This isn't something that's measured day-to-day changes. The amount of precipitation we get now is different than it was in the 1950s than it was in 1900 in 1850. And sort of going back from there, that's what we talk about when we're talking about climate changes. You know, big decade-long changes in our atmosphere.

Sumita Khatri, MD:

Yeah. So, one day's hot and another day's hotter, that's not climate change.

Emily Pennington, MD:

No.

Sumita Khatri, MD:

That's just temperature changes.

Emily Pennington, MD:

Right.

Sumita Khatri, MD:

And Dr. Solanki, I'm just curious, like, why are we talking about it now? How come we didn't know anything about it? Like, when did this all happen?

Neha Solanki, MD:

Right.

Sumita Khatri, MD:

Are we lying about this?

Neha Solanki, MD:

Right. So going back to my childhood intrigue into the climate, I remember learning in class that it's happening, but it's happening at a rate where we won't necessarily see effects of it in our lifetime. That's what we learned when we were much younger in school. But that has since been updated. There's a panel that convenes every couple of years, and they are now saying that they're very concerned and they are saying that it is progressing, the change is progressing faster than what we had originally thought and all of that, all this understanding in the scientific community has just developed over the past several years. And we are going to see the changes of climate in our lifetime.

Sumita Khatri, MD:

Yes.

Neha Solanki, MD:

And we are already seeing changes.

Sumita Khatri, MD:

Yes. Yeah.

Neha Solanki, MD:

If we look at the wildfires, if we look at the increase in the hurricanes, if we look at droughts, we look at countries that have temperatures going above, way above 100 degrees, 110 degrees in some places.

Sumita Khatri, MD:

Mm-hmm. Mm-hmm.

Neha Solanki, MD:

So, it's our understanding of the science of climate change has evolved.

Sumita Khatri, MD:

It has totally evolved and that group that you're talking about is the Intergovernmental Panel on Climate Change.

Neha Solanki, MD:

Mm-hmm. Exactly.

Sumita Khatri, MD:

So, the goal from this panel is that we need to limit the change in the climate to only 1.5 degrees Celsius warmer by 2030. Oh my gosh. We're like seven years away to kind of readjust.

Neha Solanki, MD:

That's so soon.

Sumita Khatri, MD:

It's so soon. And in contrast to for a while, we're like, okay, two degrees warmer's good enough. And now we're realizing, wow, that's just moving too quickly. And you know, the modeling shows that if we don't bring it down to 1.5 by like 2050, and by the end of our century, we're going to be uninhabitable in many areas. I mean, how did this happen so fast? So that is what's very concerning. So, we talked about climate change and with that comes, you know, a lot of complex issues. I did want to mention that the sources of air pollution, just to get everyone on the same page, are the global causes and sources of air pollution.

For instance, you may hear about particulate matter. That usually comes from traffic or fuel. Nitrogen dioxide mostly comes from industry and factories. Sulfur dioxide also comes from combustion and power plants. Sometimes you smell it. It's got that eggy smell. And then volatile organic compounds. You might hear that a lot, VOCs, that also come from fuel and fossil fuels. It's like, you know, that gasoline smell that's not good for you. And especially when that's actually, if you're idling and you've got sea- heat and sunlight, that's where that ozone comes in. So, I was wondering Dr. Pennington, what have you seen from the aspect of pollution and climate change, and maybe do you want to cover extreme weather events? What would you like to cover?

Emily Pennington, MD:

Yeah, so I mean, I think just day to day we see our patients experiencing more issues with their asthma, and especially they notice it, you know, they notice when we get these air quality alert days on those really hot, humid days, that's related to our ground level ozone, and that's increased, and that was what makes it harder for patients to breathe on those days. That's why they notice when they go outside that it's harder to breathe. We know that pollen counts are higher in our days that we have pollen Ha increased and that affects patient's ability to breathe comfortably too.

More on the kind of extreme end, you know, I think that we're seeing, it's maybe not so much more hurricanes, but the hurricanes we're getting are more severe or more intense, and so they cause more damage when they make landfall.

We also see that with rising sea levels, we get an increase in storm surge that occurs with these storms and that creates its own set of challenges and damage for people that are living on our coast. And then of course, with these extreme events and hurricanes, we get power systems that are disrupted and then we have all the indirect effects that come from, you know, people losing power and that we see they're not able to use their medical equipment that requires power, their oxygen equipment, their ventilators, CPAP machines, they aren't able to keep their medications refrigerated that require refrigeration.

And then it also means that when we lose infrastructure because of the damage that patients have less access to clean drinking water, to food, to being able to store their food safely. So, I think there's, there's a number of effects that come from those extreme weather events. And then you also think about the other extreme events that we've heard a lot about on those heat waves where it gets much hotter than people are used to, especially in areas of the country that aren't used to it or other parts of the world, like the UK saw really severe heat wave, more patients die from those events when they're not able to handle it. When they don't have access to air-conditioned environments, they are able to stay safe in.

The dryer conditions out west especially have led to more wildfires and, you know, people losing their homes over it, over those wildfires that sometimes spread very rapidly. So, there's just several downstream effects that we see from climate change.

Sumita Khatri, MD:

You know, it's fascinating because I don't think when we talk about health, that we think so much about infrastructure, and this was so nicely articulated by this list. I mean, you're sitting here going, well, of course it's gonna be hot. But then you don't think about the fact that, okay, how about the oxygen generator or, or you know, the air conditioning that they don't have? And you know, as I'm listening to you, I keep thinking about, and who is affected most? It's the vulnerable people, right? It's the elderly, the ones who are frail, the ones who don't have transportation, their kids, and of course the people who continue to have to work to pay their bills and eat, and they're going out in this extreme weather events and just sacrificing for others. It just seems wrong in so many ways that we are not addressing this a little bit more intentionally. You know, one of the things that I find fascinating with this thunderstorm asthma concept, have you ever seen anybody who's had this issue before?

Emily Pennington, MD:

Yeah.

Sumita Khatri, MD:

Yeah. So, Dr. Solanki, what is thunderstorm asthma? Because it's kind of cool.

Neha Solanki, MD:

The variation in the, I suppose the pressure and the wind pattern.

Sumita Khatri, MD:

Yep, exactly.

Neha Solanki, MD:

And the movement of the particulate matter, all of this can exacerbate or make someone's breathing worse.

Sumita Khatri, MD:

Worse. It does. And then also add to that the allergens. Like when I think you were saying, if I'm allergic to, let's say ragweed. Okay? And then it's been a long fall. And so, it's just ragweed, ragweed, ragweed. And then it's an extreme weather event. Let's say it's thunder storming, and then there's a cloud with a lot of droplets. And these big, super ragweed particles adhere to these large droplets. And then a little rain won't matter, but a thunderstorm they'll drop with all this, like basically a lot of velocity. And these granules just pop. And so, people who are allergic get flareups like within the next day. It happens in Australia a lot. It's been steady. It's very funny.

It's a thunderstorm asthma. So just think about that. If your asthma gets worse, you might have thunderstorm asthma. I just like showing that because people otherwise don't know.

Neha Solanki, MD:

Yeah.

Sumita Khatri, MD:

I was just wondering also about the vulnerable people. Like what would you say Dr. Solanki, if you have patients or you know, somebody who has family members who are vulnerable, you know, during these, how do you guide them? What do you ask them to do and be careful?

Neha Solanki, MD:

So, it's, I think it's gonna be different depending on where they live. I think in Ohio, which is where we are based if they have lung problems, COPD, asthma, any kind of lung issue, to check air quality if they're not already checking that and to stay indoors if the air quality is very poor. Also, people who travel by car. I've had patients who complain about when they get in the car, their breathing gets a little bit worse, and what they're doing is they're filtering the air from outside of the car into the car. So, the air pollution is coming into the car from their vent. So, try to turn that off as well. We don't really deal with droughts in Ohio, but you know, that would be something that you probably see more of in California, but to always stockpile on water and that sort of thing. But it's difficult because you can't control everything. All we can do here is to avoid going out in times of air pollution and extreme heat.

Sumita Khatri, MD:

And it's interesting, like what happens in Vegas, doesn't stay in Vegas, you know? Like air pollution from wildfires, how far does that effect go? Do you know Dr. Pennington, is it right there?

Neha Solanki, MD:

Oh, it comes across the country. No.

Sumita Khatri, MD:

It does, right?

Neha Solanki, MD:

It's fascinating. When wildfires are occurring out west. You can look at satellite images and just track how that smoke just comes right across the country and affects all of us.

Sumita Khatri, MD:

It really does.

Neha Solanki, MD:

And so, it's something that we can't just say, oh, well that's out in California. That doesn't matter here in Ohio because everything that happens out there, you know, still has a way of coming over to us.

Sumita Khatri, MD:

Yeah, and it does affect the air quality for sure with the particulates. It's so funny because each state has national guidelines, but there can be even states that say, okay, we want more strict guidelines. Like California wants to do that, but you can't. But there's no wall between states, you know, this is all the same country. And so, I think collectively, regardless of one's maybe political leanings, we do need to have air that is cleaner or cleaner because otherwise we're going to have, you know, more issues.

And another thing that I know that we've talked about too is how do we reduce some of the heat? What are things that you know that people are doing? Like vegetation and concrete, you know?

Neha Solanki, MD:

Right.

Sumita Khatri, MD:

That's part of the issue in the urban areas, but what can we do to engineer our cities better?

Neha Solanki, MD:

The greenery, lots of trees. Lots and lots of trees. Places, you know, we've talked a little bit about the concept of heat islands before, but there are places that consists of just buildings and roads and more buildings and more roads, and there's no forests or bodies of water. And these areas are heat islands, so they just soak up all the heat and they've found that they're a, a couple degrees warmer than the surrounding area. What seems to bring that heat down is the tree cover. And so, if there's a way to plan cities better so that they have more of that, I think that that would be helpful in combating some of this climate change.

Sumita Khatri, MD:

Also, areas where people have more affordable housing. So, people who have issues with income can't leave to get to the greener area. So even within Cleveland, there's disparities just as there are in other areas. And I think just so our listeners know that we also know that medicine and medical care plays a toll on the environment. Dr. Pennington, you and I were talking about that and, like how do we do that? And how can we be better? And what are we doing?

Emily Pennington, MD:

Yes. So, you know, I think in healthcare we definitely produce a lot of waste. You know, a lot of that is unavoidable of course, but I think we still want to do whatever we can to help improve that and reduce our waste products. The Cleveland Clinic has really taken the lead on that and is making sure that we're doing everything that we can to help improve our environment. So, we have a number of different goals that the clinic has set that they want to reach by 2027 to become carbon neutral, to reduce our energy usage, and to look at getting more food locally from sustainable sources.

To divert at least our non-hazardous waste from landfills and to reduce our water usage, our water consumption, work with our vendors to come up with better packaging that is more recyclable, that uses less packaging for the products that we need. So, there's several different ways that we're looking at to reduce our environmental impact from our institution.

Sumita Khatri, MD:

Yeah. It's good. As we're trying to heal people, we don't want to hurt people at the same time, right?

Emily Pennington, MD:

Right.

Sumita Khatri, MD:

Yeah. That's great. So, this podcast is meant to share with you from a group of us clinicians who are doctors and care about your lungs, but also care about your overall health. I mean, even though lungs are affected, also the heart is affected and there's more strokes and cancers related to this. We don't mean to scare y'all, but 30 percent of all deaths and diseases from lung cancer are coming from air pollution globally. And then 24 percent of all deaths from stroke, you know, just from the thickness of the blood that happens from air pollution. And then of course, COPD, which some of you may know in America or in the Western world is mostly from smoking, but in some of the emerging countries, it's coming from biomass burning, you know, when people are burning trees and wood in closed quarters. So, there's a lot to be done. All of that adds to climate change. And so, changes in climate go along with air quality, water quality, and that's the message that we wanted to share with you. And you know, I guess I'm encouraged by our generation of physicians, I think we think a little bit more about where patients are in their lives and for their health. People want to take less medications and also want to be advocates. So, if anybody's interested, you could look at joining the American Lung Association. It's a great advocacy organization that talks about climate and health and you can work them and you know, the younger generations in our schools are also interested in this to see what you can do.

But any last sort of pieces of advice for our patients or for our listeners about climate change, what you can do about it, and how to stay healthy? Dr. Pennington, I'm gonna start with you.

Emily Pennington, MD:

So, I think as Dr. Solanki, I think I had mentioned earlier, just, you know, looking at air quality alerts, making sure that you, as much as you can stay indoors on poor air quality days, that especially occur in the summer here in Ohio. Even in the winter a lot of people are bothered by that really cold air. So, cover your mouth. So, the masks that we've been wearing for the last two years have another purpose and just keep you a little bit warmer and help you breathe a little bit more comfortably outside too. Or of course you can wear a scarf as well. And I think the other side of it is just advocating for this too, and asking your healthcare institutions that you go to, what they're doing to help deal with climate change, talking to your physicians about it. How is this impacting me? And just I think as we all become more aware of this and aware of the impacts of it, then, you know, something that we're gonna be able to focus more on and we'll put more research dollars into it to help us understand this better. Because I think there's still probably a lot that we don't fully understand yet in terms of the impact that all of this climate change has had on us and on our health.

Sumita Khatri, MD:

Mm-hmm. Oh, such great words of advice. Yeah.

Neha Solanki, MD:

I know. That was so well-put.

Emily Pennington, MD:

Thank you.

Neha Solanki, MD:

Hard to follow that, Dr. Pennington. I think it's very painful to think about all of this. I mean, this is a lot of information about how our world is changing and I think that a lot of people probably find it easier to not think about it because you know, on some level, what one person can do to really make a difference? But I think it's important that we take time to talk to each other about it because people should know what is happening, and I think that that awareness is worth more than you think. So, I think taking the time to read about it, talk to people about it, post about it, that's worth more than you think it is.

Sumita Khatri, MD:

Mm-hmm. Well, that's beautiful thoughts on both ends of your life. Talk to your doctor and stay informed and everybody can make a difference.

Neha Solanki, MD:

With good articles.

Sumita Khatri, MD:

With good articles.

Well, thank you for this very empowering, impactful, and informative session today. Again, so wonderful to be with you. Sumita Khatri here and wanting to thank Dr. Emily Pennington and Dr. Neha Solanki for being with me today.

Raed Dweik:

Thank you for listening to this episode of the Respiratory Inspirations Podcast. For more stories and information from the Cleveland Clinic Respiratory Institute, you can follow me on Twitter at RaedDweikMD.