The lungs are an important interface between the body and the environment. As a consequence of climate change, heat waves and local air pollution will increase. Thereby, the pathogenicity of heat and local air pollution act together as cofactors, with effects ranging from acceleration of chronic inflammation up to exacerbations and/or decompensation. During heat waves, heat-related morbidity of patients with chronic obstructive pulmonary disease (COPD) increases by up to 9% and the mortality by 3-6%. At 6.7%, the healthcare system in Germany produces a significant proportion of the nationwide CO2 emissions for a total of 55 million tons CO2 or 0.68 tons CO2/person. Thus, it is one of the five largest emitters among healthcare systems worldwide. The propellants used in metered-dose inhalers for the management of lung diseases are hydrofluorocarbons, which are greenhouse gases. In 2020, hydrofluorocarbons were used in 48% of all prescriptions for inhaled drugs in Germany, and their global warming potential is more than 1000 times greater than that of CO2. Compared to Respimat (Boehringer Ingelheim, Berkshire, UK; soft mist inhaler without a propellant) and powder inhalers, the CO2 equivalent per treatment year for metered-dose inhalers with hydrofluorocarbons is 20-30 times higher. Thus, there is evidence to support a change in prescribing behavior. Because patients with lung diseases are particulary vulnerable to heart stress, more initiatives are needed, including patient education for self management during heart stress periods, climate adapted treatment, air conditioning of hospital patient ' s room and decreasing patient ' s travel (e.g., using tele medicine). For the management of outpatients, consultation formats taking into consideration a holistic view of the disease and the lifestyle of patients as so-called climate consultations were recently proposed.
Witt, C; Liebers, U
Outpatient management of lung diseases in times of increasing global warming Which evidence-based clinical adaptations are currently recommended?
Zeitschrift Fur Pneumologie