Climate Change and Respiratory Health

Abstract and Introduction

Abstract

Climate change is a key driver of the accelerating environmental change affecting populations around the world. Many of these changes and our response to them can affect respiratory health. This is an expert opinion review of recent peer-reviewed literature, focused on more recent medical journals and climate-health relevant modeling results from non-biomedical journals pertaining to climate interactions with air pollution. Global health impacts in low resource countries and migration precipitated by environmental change are addressed. The major findings are of respiratory health effects related to heat, air pollution, shifts in infectious diseases and allergens, flooding, water, food security and migration. The review concludes with knowledge gaps and research need that will support the evidence-base required to address the challenges ahead.

Introduction

Whether the term used is climate change, environmental change, global warming or increase in extreme weather events, the global environment is undergoing profound change and many of these changes can affect respiratory health. Temperature increases are associated with increases in air pollutants, wildfires cardio-respiratory disease. Extreme storm events and sea-level rise increase opportunities for flooding.^[1,2] A strong majority of scientists now agree that Greenhouse gas (GHG) production by humans is the primary cause of these changes.^[3,4] Though the most profound temperature increases and environmental changes are in the far north with dramatic reductions in sea ice,^[3] the most significant effects at the population level are occurring where large urban areas are vulnerable to the direct and indirect effects of climate change.^[5]

Direct health effects include heat related illness and related exacerbation of underlying cardio-vascular disease, COPD and asthma, increases in hazardous air pollution days from ozone and particulate matter (including forest fires and desertification) and mortality and morbidity from extreme weather events.^[6–8] Indirect effects include shifts in vector borne illness, allergen load, malnutrition, reduced freshwater resources, flooding and forced migration with accompanying societal disruptions and their 'downstream' effects.^[3,6,9] The WHO conservatively estimated over a decade ago in 2000, that more than 150,000 deaths per year from climate change related causes along with over five million disability affected life-years lost per year over the previous three decades.^[10,11]

This paper reviews the latest scientific studies on climate change and respiratory health including global health impacts in low resource countries. It concludes with an outline of knowledge gaps and research needs in respiratory health that will support the evidence-base needed to address both mitigation and adaptation challenges.

Table 1. Summary of known and potential respiratory hazards associated with climate change and increase climate variability.
Respiratory hazard impacted by climate change	Known adverse health effects	Potential adverse health effects	Ref.
Increased ozone and particulate air pollution (cook fires, industrial, transportation, forest fires and desert sources)	Reduced lung function, asthma and COPD exacerbation	Increased risk of respiratory infection, abnormal lung development and remodeling, lung cancer, cor pulmonale, enhancement of allergic response	Ozone and PM:;[7,37–46] cook fires:[78] forest fires:;[15–22] infection:[48,49]
Increased temperatures	Increased mortality from respiratory and cardiovascular disease	Increased growth of plant and microbial antigens	Known:;[32–37,64] potential:[52–61]
Aero-allergen production	Increased allergic sensitization, emergency department visits and hospital admissions for asthma and allergic rhinitis	Interaction with air pollutants enhances the allergic response	Known:;[7,8,23–31] potential:[107]
Changes in viral and bacterial respiratory disease patterns		Extended influenza season, shift in optimal microbial ecology, increased crowding	[48–52,113–116]
Reduced agricultural production and maldistribution		Malnutrition and increased risk of respiratory infections	[67,90–92]
Decline in fisheries production		Malnutrition and increased risk of respiratory infections	[90–92]
Extreme weather events and floods	Loss of power for life-support	Increased mold growth and endotoxin	[53–61]
Sea level rise	Flooding: increased refugee camp populations	Coastal flooding and loss of agricultural land to salinification of soils, con-tribution to mold growth	[53–61,125,127]
Forced migration	Ease of spread of respiratory infectious diseases	Conflict and disruptions of services	Known:;[121,123] potential:[9]

COPD: Chronic obstructive pulmonary disease.

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Climate Change and Respiratory Health

Current Evidence and Knowledge Gaps

Abstract and Introduction

Abstract

Introduction

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