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Improving diagnosis of respiratory ailments in patients due to air quality issues
Russell D Hadan; MA
QA/QC Officer Air Quality, Douglas County Health Department, Omaha, Nebraska
Air quality data used to be remote but new instrumentation allows
instantaneous readings of particulates, CO2, SO2, and ozone data for
easy publishing. All are common air pollutants which cause many
respiratory ailments. The EPA has introduced an Air Quality Index
(AQI) system for forecasting and looking at current air pollution
conditions. The data is easily available from email or website
access. I believe once medical professionals understand the ease of
finding air quality data, they will use it as an informative tool in
diagnosing respiratory ailments. Physician use of air quality
information remains low because the medical field is not properly
trained on how to access this data. Change would require more
training and outreach which would complicate current Medical
curriculum. Reaching current practicing medical professionals will
be tougher due to years of using the route of prescribing medication
for respiratory ailments. Current physician’s benefit and profit
from prescription of medications. Also patients want and expect a
result from their visit to the physician’s office which most patients
view this result as a drug prescription. Change can only be made
by educating our medical professionals on the importance of using
air quality data in the diagnosis of patients with respiratory
ailments.
Materials and methods
Events
Establish partnerships with Faculty, Staff and Dean at
regional Medical Universities. Include partnership groups
such as Nebraska Lung Association and Asthma Alliance.
Activities
Discuss possibility of seminar for Medical Students for
credit.
Possible Public Health guest speaker at a scheduled
course class for medical students.
Include air quality access information by Faculty member
in medical curriculum.
Possible partnership between SOM and Public Health on
variety of health related topics for medical students in
seminars.
Media campaign on AQI forecast and Enviroflash email
Next Steps
Lack of interest
for medical
professionals to
participate in
non mandatory
session
Quick fix: Medical
professionals prescribe
medication for treatment
of respiratory ailment
Step 2
Figure 5. EPA email notification system
Incidence of
misdiagnosis of
respiratory ailments in
patients
Step 1
Delay
Step 3
B
Long term: Medical
Professionals make use of
available air quality
information and quality
of patient diagnosis goes
up
Introducing more
information to a
already heavy
student/professional
workload
Side effects: Time
available to invest in
training to learn how
to use Air Quality
Information
R
SOM and SPH
agree to give
credit for
training into
public health
Are Medical
Professionals
willing to take
the time to
research daily
air quality
conditions?
Figure 2. Shifting the Burden behavior of medical professionals
Figure 6. DCHD email notification page
Figure 4. EPA Air Quality Index chart
How to reach Long term goal in Figure 2
Other information to be introduced to Medical Professionals
Have meeting with stakeholders about teaching air quality information to
incoming and current medical students through annual seminar
Common health effects of Air Pollutants
Have air quality information included in the curriculum of medical
student training courses
Where and who to contact to find out more data on air quality conditions
Have air quality information presented to public through media campaign
which in turn influences practicing Medical Professionals
Misdiagnosis of
Respiratory Ailments
.
Medical Use of Air
Quality Information
Desired Level of
Diagnosis When Using
Air Quality Data
Time
Figure 3. Medical behavior over time
Changing Medical Behavior
The levels of misdiagnosing respiratory problems due to air quality have
remained about the same levels over time (Figure 3). Medical
professionals are not educated through their curriculum about where to
find or use air quality information. Drugs are being prescribed to patients
who may be sensitive to their outside environmental conditions. Easy
solutions such as cutting back or rescheduling strenuous outside activities
may be the only prescription needed to help a percentage of respiratory
problems. The recent accessibility of air quality information makes
reaching the desired level of diagnosing respiratory ailments easier.
When more medical professionals start to use air quality data for
diagnosis, correlations between respiratory ailments and air pollution can
be prepared.
Figure 1. Logistics Model of Input, Activity, Output, and Outcomes
•
B
Variables
Introduction
Information to be presented to Medical Professionals
Expected Conclusions
Air pollution exacerbates the condition of people with respiratory
and cardiovascular diseases and causes measurable increases in the
rates of hospitalization for these diseases. We do not yet understand
the role of air pollution in causing these illnesses because
correlations between medical visits and high pollution days are not
often reported. I expect in the coming years more advancements in
access to air quality data including real time data for almost all
common air pollutants in most larger cities. After completing the
media campain and University School of Medicine training, I
expect a larger pool of regional medical professionals to use
ambient air quality data as a tool in diagnosing and treating patients
with repiratory ailments. “Physicians are concerned about the
negative health effects of harmful air pollutants,” said Dr. Janet
Abshire, a general practice physician who sits on the Public and
Environmental Health Committee of the Sierra Sacramento Valley
Medical Society. “We see patients everyday who suffer from
respiratory and cardiovascular illnesses. It is time for physicians to
play an increased role in the solutions to this problem.”3 The
Douglas County Health Department expects to continue to play a
role in the development and training of medical professionals in
other avenues of Public Health along with air quality training in the
future.
How to read AQI chart and possible health effects for AQI zones
Introduce national ambient air quality standards for each pollutant
Table 1 Cost Benefit Analysis of Change
Changing
Not Changing
•Benefits •Better diagnosis of patient
•Drug cost for patient down
•Less patient reliance on drug
medications
•Doctor knowledge of daily
outside environmental impacts
go up
•Cost •Less money for doctors
related to the sales of
pharmaceuticals
•Doctor spends more time
looking at a decision on
patient medical ailments
•More study hours required in
already long medical
curriculum
•Time burden for Medical
Students
•Extra classes or seminars are not
needed
•Judgment call by medical
professionals on respiratory
ailment of patient not needed
•Increased risk of misdiagnosis of
patient
•Patient drug cost increase due to
seasonal ailment of one time flair
up
•Quality of patient life decreases
due to new drug interactions
•Medical liabilities due to
misdiagnosis of patient
Literature cited
1. ALA Lung Disease Data 1996: p3.
2. Boushey etal. Environmental Health Perspective 1995: 103.
Supp6: 229-33
3. California Medical Association Supports Efforts to Clean
Unhealthy Air Dec. 11, 2008
http://www.medicalnewstoday.com/articles/132669.php
Acknowledgments
This project was a direct result of EPHLI and the assistance provided by the
CDC. The Douglas County Health Department in Omaha, NE is responsible for
allowing time to research the project and attend EPHLI where the project started.
The project would have not succeeded without the help of my mentor Joy Harris
and EPHLI Cohort IV members Lisa Swanson and Kristi Campbell. I would
like to thank my wife Molly and two children, Anna and Kyle for accepting the
time this project needed. I would also like to thank the numerous stakeholders,
reviewers, and staff that trained Cohort IV on the process of making a successful
project.
Health Problem
Asthma accounts for one in six of all pediatric emergency room visits in the
U.S.1 Levels of pollutants which may not interfere with normal breathing
affect people with asthma in more profound ways, causing greater
inflammation or constriction of airway. 2 While air pollution is not believed
to be the single underlying cause of the asthma epidemic, there is strong
evidence that it exacerbates the illness and that cleaner air would help
prevent a significant number of asthma attacks. The medical profession
must be aware of where to find daily air quality information and how to use
that information in patient diagnosis.
For further information
Please contact [email protected]. More information on this
project can be obtained at
http://www.heartlandcenters.slu.edu:16080/ephli/finalProjects.htm