Jon Ayres

Institute of Occupational &Environmental Medicine

University of Birmingham, UKj,g.ayres@bham.ac.uk

The effects of global warming on pulmonary health

The effects of global warming on pulmonary health

• Climate change• Possible effects on patients with lung disease

– Heat, cold and weather changes– Pollution– Allergic responses– Infections

• What can be done– Mitigation – Adaptation– Advocacy

John Tyndall 1820-93

Recognised the greenhouse effect andidentified the relative radiative forcing of the different greenhouse gases.

"The waves of heat speed from our earth through our atmosphere towards space. These waves dash in their passage against the atoms of oxygen and nitrogen and against molecules of aqueous vapour. Thinly scattered as these latter are, we might naturally think of them meanly as barriers to the waves of heat."

Temperature trends in central England

Greenhouse gas emissions are warming the earth

GHG emissions have increased by 70% over the last four decades (IPCC 2007).

Energy and transport are the biggest emitters.

Transport emissions projected to increase by about 50% by 2030 compared to 2000 (EEA

2007). Projected temperature

increase by the end of the 21st century is 2.3 - 6°C (IPCC 2007).

How climate change can affect health

Climate change

Direct exposures

Environ-mental

conditions

Indirect exposures (through changes vector ecology, food yields, etc.)

Health impacts

Health system

Social & economic disruption

Socio-economic conditions

Modifying influence

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Key respiratory conditions

• COPD– Prevalence– Severity

• Disease progression and exacerbations– Mortality

• Asthma– Prevalence– Severity

• Respiratory infections– Pneumonia

• Rhinitis and other allergies– Prevalence– Severity

To what extent?Which interventions?What advice? > to Governments > to our patients

1 Extreme temperature events• both heat and cold2 Changes in air pollution• ozone (sulphates, PM)3 Flooding4 Damp housing5 Thunderstorms6 Infections7 Changes in allergen disposition• and consequent allergies8 Forest fires9 Dust storms

Climate change and respiratory disease

ERS position statementAyres et al Eur Respir J 2009;34:295-302

Temperature

Phewe EU ProjectMax temperature and hospital admissions

Michelozzi et al, AJRCCM, 2009

Stafoggia et al, JECH, 2008

Place of death and heat-related mortality

Thanks to Mercedes Medina-Ramon

Thanks to Mercedes Medina-Ramon

Temperature, PM10 and Mortality

Stafoggia et al, AJE in press

Wild fires

San Diego October 2007

With thanks to Bert Brunekreef

Saharan dust storms

With thanks to Bert Brunekreef

• Will likely increase in some areas

• Effects in asthma – Temperature drop– Grass pollen

Packe & Ayres Lancet 1985;ii:199-203

Thunderstorms and asthma

But…cold weather still affects Europe

Cold outdoor and indoor temperatures can cause cardio-pulmonary problems.

These effects may be most serious for poorer households.

Most European countries suffer from 5-30% excess winter mortality (IPCC 2007).

Health risks may arise from the use of solid fossil fuels and biomass

HOW TO REDUCE HEALTH EFFECTSEnsure health systems preparedness by adapting health care infrastructures; advocating access to clean, affordable

and reliable energy with other sectors; promoting energy efficiency

Photo: WHO

What we need to know…..

• More about the effects of CC – on those with existing lung conditions– on the incidence of new disease

• Monitoring respiratory disease indicators • Improve basic research into respiratory disease

aetiology/mechanisms in the context of CC• Assess interventions

– e.g. warning systems for heat waves– targeted housing design

What we can do immediately…..

• Be aware!• Press for continued downward pressure on air

pollution by Governments• Home insulation/air conditioning• Advise the susceptible• Warning systems for heat waves

• Cost-benefit…..

What we can do as individuals

• Inform our professional colleagues• Set an example

– Tensions when it comes to international conferences!

• Advocate– Ensure our own Governments and the EU are

aware of the legislative options– Evaluate the interventions

Thank you for your attention