UC Davis Health experts call for wildfire preparedness action plans to support respiratory patients

A multidisciplinary team of UC Davis Health experts is urging health systems to create wildfire preparedness action plans to support patients with pre-existing respiratory conditions. They are urging providers to proactively implement interventions to mitigate the effects of impoverished air quality caused by smoke.

Their article published in COPD Foundation Magazineidentifies the needs of high-risk populations when affected by wildfire smoke. Provides an action plan for health systems to facilitate these groups cope with the burden of impoverished air quality caused by wildfires.

“Patients treated for respiratory illness are at high risk for exacerbation of symptoms when exposed to wildfire smoke. Unfortunately, the frequency and severity of wildfires in the United States are increasing, negatively impacting these clinically vulnerable and underserved communities. Therefore, there is a significant need for interventions to mitigate the health risks posed by wildfires.”

Reshma Gupta, chief of population health and accountable care at UC Davis Health and co-author of the paper

The impact of impoverished air quality on health

Many components of wildfire smoke can have adverse health effects, especially for people with pre-existing respiratory conditions.

According to the American Lung Association, more than 34 million people in the United States currently suffer from chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), or alpha-1-antitrypsin deficiency (AATD).

Exposure to air pollution from forest fires has been shown to cause and exacerbate diseases of the lungs, heart, brain and nervous system, skin and other vital organs.

In patients treated for pre-existing respiratory conditions, impoverished air quality causes inflammation in the lungs. This can worsen symptoms and lead to emergency room visits and hospitalizations.

“Impoverished air quality can trigger exacerbations — a keen boost in shortness of breath, cough, shortness of breath — and even lead to hospitalization,” explained Brooks Kuhn, co-director of the Comprehensive COPD Clinic at UC Davis Health and a co-author of the paper. “The impact is not just transient: respiratory exacerbations lead to a persistent and accelerated decline in lung function.”

Not only adults are at risk of these complications.

“Children also feel these effects when they are exposed to impoverished air quality as a result of wildfires,” said Kiran Nandalike, chief of pediatric pulmonology at UC Davis Children’s Hospital. “As we see more wildfires impacting our communities each year, the need for health systems to map out a response to support patients becomes urgent.”

Approaching Population Health in the Face of Wildfires

UC Davis Health’s targeted wildfire preparedness action plan uses a population health approach. That means care teams with providers from different specialties are proactively working with patients who are at higher risk of developing symptoms due to impoverished air quality.

“A population health approach focuses on targeted interventions tailored to specific communities or population groups,” Gupta explained. “This approach takes into account a range of determinants, including social, economic, environmental and behavioral factors, that affect the health of these groups.”

The team’s forest fire preparedness action plan includes:

• Identify clinically at-risk and underserved patient populations using well-validated, condition-specific registries
• Creating multidisciplinary care teams to understand the needs of these communities and patients
• Creating custom forest fire risk analysis and stratification
• Developing care pathways based on wildfire risk levels based on disease, exposure risk, and access to healthcare
• Defining outcome measures aligned with interventions with a commitment to continuous, iterative improvement efforts

“We’ve seen population health approaches successfully implemented to support patients with dementia, chronic kidney disease and cancer,” Gupta said. “Using this model, we can adapt to the threat of impoverished air quality from wildfires and take a proactive approach to meeting the needs of clinically vulnerable and underserved patients.”

UC Davis Health’s Wildfire Experience

As a regional academic health system in Northern California, UC Davis Health has been at the epicenter of recent wildfires—including the recent Park Fire, the fourth largest in California history. That experience gives the health system team experience caring for patients in some of the hardest-hit areas.

“For the past several years, our physicians have routinely cared for patients with physical, financial and occupational barriers to accessing pristine air,” Kuhn explained. “We are uniquely positioned to share our experience serving communities impacted by wildfires.”

To direct wildfire preparedness interventions to those who need them, UC Davis Health has assembled a multidisciplinary care team to serve as liaisons between wildfire-affected communities and the health care system. Some of the team’s activities include:

• Identification of patients at risk
• Providing health education on air quality
• Personalization of activities for patients
• Creation and distribution of “emergency bags” with supplies for patients
• Collaboration with community organizations to provide support to patients

“Patients were very grateful to receive this proactive approach,” Gupta said. “Often patients feel lonely and isolated when confined to their homes due to impoverished air quality. Working with our team gives them the opportunity to protect themselves in the comfort of their own homes.”

Call to action

As climate change continues, wildfires are now an annual occurrence in the United States. To meet the needs of clinically vulnerable and underserved patients affected by this growing health threat, the authors of the article call on health systems to replace reactive approaches with collaborative, inventive, and proactive approaches.

“In the coming years, it will be crucial to prepare health systems, clinicians and communities to address the profound health impacts of environmental events and prevent potentially devastating consequences,” Gupta said. “We must come together to maintain this reach and support patients at risk from wildfire.”