Doctors meet in Fresno to discuss air pollution and climate change

A conversation with Fawn Olvera includes a lot of pauses for her to catch her breath – and a lot of coughing.

Olvera has asthma. And this week has been bad for breathing. She’s had to use a nebulizer machine every two hours to help open her lungs, and also inhales whiffs of medicine from a fast-acting inhaler quite a bit.

Olvera, 68, of Clovis, says pollen is part of the problem. It is spring. But she blames another source for her discomfort. “It’s just the quality of the air, the pollutants that are there. Even in the winter time. It’s just being out and in the air.”

Dr. Jose Joseph Vempilly, director of the asthma education and respiratory care programs and lung function lab at Community Regional Medical Center, says patients have educated him about the polluted San Joaquin Valley since he moved here in 2005.

“I had patients who were coughing, but they were taking all their medicine. I asked ‘what’s going on,’ and they said ‘oh doctor, it is the Valley air.’ ”

Vempilly, a professor of medicine at UCSF-Fresno, developed a research interest in air quality and effects on health. On Saturday he is presenting the overview at the second annual Air Pollution & Climate Change Symposium at the University of California at San Francisco-Fresno Center for Medical Education and Research.

In recent years, doctors across the United States have begun voicing concern about health problems they associate directly or indirectly with climate change, including an increase in chronic diseases such as asthma, more heat-related emergency room visits, the spread of infectious diseases by mosquitoes and ticks, and health problems from contaminated water.

Last month, doctors representing 12 medical societies in the U.S. that have a combined membership of 450,000 launched The Medical Society Consortium on Climate & Health to inform the public and policymakers about the health risks associated with climate change.

Climate change remains a hotly debated political topic. But the consortium said in a report released last month, “Medical Alert! Climate Change is Harming Our Health,” that 97 percent of climate scientists have concluded it is happening. The report said it’s concerning that only 32 percent of Americans are able to name a way in which climate change is harming health.

“We want people to know the greater danger of climate change is that it’s a health threat to all of us,” said consortium director Mona Sarfaty.

Sarfaty said doctors report that lung and heart conditions – associated with air pollution – are among the most common experienced by patients.

The consortium report said warmer and drier conditions lead to an increase in wildfires, and the smoke can travel hundreds of miles downwind, exposing people to harmful pollutants and increasing emergency room visits, hospitalizations and treatment for asthma, bronchitis, chest pain and other heart and lung conditions. And warmer temperatures extend the pollen season, making allergies and asthma worse.

The Valley has some of the worst air pollution in the country.

The region consistently ranks among the most polluted for two types of air pollutants – ozone in the summer and particulates in the fall and winter. The toxins become trapped in the bowl-shaped Valley, building up over days.

The Valley has among the most varied sources of pollutants in the world, says Judith Chow, a research professor of atmospheric sciences at the Desert Research Institute in Reno, Nevada. Chow will be speaking at the Fresno symposium.

The Valley air can be a swirl of soot from residential wood burning, smoke from wildfires, diesel exhaust from trucks and aerosoled particles from dairies. This complexity of sources creates a toxic air mixture that can be difficult to clean up, Chow says.

But although there has been progress in reducing air pollution, they need to look for more controls to reduce the pollution levels,” she says.

From Modesto to Bakersfield, about 200,000 adults have been diagnosed with asthma and about 100,000 with chronic obstructive pulmonary disease. And about 75,000 children have asthma, Vempilly says. They are all at risk from bad air, he says.

Vempilly says a study in Fresno found worsening asthma symptoms were associated with a higher concentration of microscopic particles of soot, chemicals and other debris known as PM 2.5. And research has shown that long-term exposure to traffic emissions is associated with a decline in lung function, he says.

Other studies have found health effects, including damage to the heart from exposure to diesel exhaust. And a new study out of Southern California found people in highly-polluted areas who were exposed to ultrafine particles had an increased risk of dementia, he says.

Dr. Daya Upadhyay, an associate professor of medicine at UCSF-Fresno, is speaking at the Fresno symposium on Saturday. She says that on bad-air days about 80 percent of her patients experience difficulty breathing. Upadhyay is medical director of the Lung Nodule Program at Community Regional Medical Center.

And the health impacts aren’t limited to just the Valley: one in eight deaths globally is related to air pollution, she says. “No one escapes. In utero to older people, every generation, every step of the way the air that we breathe, if it is not pure, it affects our health.”

Valley asthma patients say when the air quality is bad, they know it because their lungs tighten. But is climate change to blame?

Laura Daugherty, 62, a Fresno office manager, was diagnosed with asthma as a child. Lately, the asthma symptoms have gotten worse, and she’s been diagnosed with an allergy to mold. The air quality affects her breathing, she says, but she doesn’t know if climate change has made the environment worse. Her husband, Dennis Daugherty is also not convinced. “Everything happens in cycles. It’s possible that things are changing, but personally I don’t believe in global warming.”

The Daughertys point to factors they say are likely culprits: They live in a 100-year-old house near the San Joaquin River that they think has mold; crop duster planes frequently fly overhead to spray almond orchards; dust storms are common; and they’re close enough to Highway 99 for diesel exhaust to waft over.

Laura Daugherty struggles to talk without coughing during a telephone interview from her home, where she says “it seems like I have a harder time breathing here than I do at work.”

The Central California coast is an easier place to breathe for many Valley asthma patients.

Kathy Kegel, 67, a retired Fresno school teacher, says she can walk outside and breathe fresh air at the coast. She’s not an outdoorsy person, but in Fresno she has to curtail activities outside. But moving to the coast is not an option. “I wouldn’t be able to leave my kids and grandkids and sisters and brothers.”

Asthma patients say they have learned to adapt and adjust to the air quality.

Olvera takes her inhaler with her to walk to her mailbox. She keeps a portable nebulizer in each of her vehicles. She checks the air quality before going outdoors and sometimes she wears a mask. “When you take it off, you can see the brown particles,” she says. “You can see where it has filtered what you would have breathed.”

Vempilly says the Valley has a significant problem with ozone and particulate pollution. “I can only plead on behalf of my patient population for changes to improve the environment,” he says.

He would like every house to have solar panels, no one to burn wood in fireplaces or wood stoves, and for people to drive electric cars. “We need to do whatever we can to incentivize these types of activities,” he says. “This carbon-based economy needs to be slowly phased out.”

This story was originally published April 7, 2017 at 3:01 PM with the headline "Doctors meet in Fresno to discuss air pollution and climate change."