Action plan to help patients with lung disease cope with wildfire smoke

A multidisciplinary team of UC Davis Health experts are calling on health systems to create wildfire preparedness action plans to support patients with preexisting respiratory diseases. They are urging providers to proactively put in place interventions to mitigate the effects of poor air quality from smoke.

Their article, published in the Journal of the COPD Foundation, identifies the needs of high-risk populations when affected by wildfire smoke. It outlines an action plan for health systems to help these groups with the burdens of poor air quality from wildfires.

"Patients being treated for respiratory conditions are at high-risk of exacerbations of symptoms when they are exposed to wildfire smoke," said Reshma Gupta, chief of population health and accountable care at UC Davis Health and co-author of the article. "Unfortunately, wildfire frequency and severity are increasing in the United States and negatively affecting these clinically at-risk and underserved communities. So, there is a significant need for us to install interventions to mitigate the health threat posed by wildfires."

Health impacts of poor air quality

Many components of wildfire smoke can have adverse impacts on health, especially for those with preexisting respiratory diseases.

Currently more than 34 million people living in the United States live with a chronic lung disease like asthma, chronic obstructive pulmonary disease (COPD) or Alpha-1 antitrypsin deficiency (AATD) according to the American Lung Association.

Exposure to wildfire-related air pollutants has been shown to cause and exacerbate diseases of the lungs, heart, brain and nervous system, skin and other major organs.

For patients being treated for preexisting respiratory conditions, poor air quality causes inflammation in the lungs. This can exacerbate symptoms and lead to emergency department visits and hospitalizations.

"Poor air quality can trigger exacerbations -- acute increase in shortness of breath, cough, dyspnea -- even leading to hospitalization," explained Brooks Kuhn, co-director of the Comprehensive COPD Clinic at UC Davis Health and co-author of the article. "The impact is not just transient: Respiratory exacerbations lead to persistent and accelerated worsening of lung function."

And adults are not the only ones at risk for these complications.

"Children also see these impacts when they are exposed to poor air quality from 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 urgency for health systems to outline a response to support patients is pressing."

Wildfire population health approach

The targeted wildfire preparedness action plan adopted by UC Davis Health uses a population health approach. This means care teams with providers from different specialties proactively work with patients who are at higher risk of developing symptoms from poor air quality.

"A population health approach zeroes in on targeted interventions tailored to specific communities or population groups," Gupta explained. "This approach considers a range of determinants, including social, economic, environmental and behavioral factors, which affect the health of these groups."

The team's wildfire preparedness action plan includes:

• Identifying clinically at-risk and underserved patient populations using well-validated, condition-targeted registries
• Assembling multidisciplinary care teams to understand the needs of these communities and patients
• Creating custom analytics and wildfire-risk stratification
• Developing care pathways based on wildfire-risk tiers by disease, risk of exposure and health care access
• Identifying outcome measures tailored to interventions with a commitment to continuous, iterative improvement efforts

"We have seen population health approaches be successfully implemented to support patients with dementia, chronic kidney disease, and cancer," Gupta said. "Using this model, we can adapt to the threat of poor air quality from wildfires and adopt a proactive approach to meet the needs of clinically at-risk and underserved patients."

UC Davis Health experience with wildfires

As the 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. Because of this experience, the health system team has experience caring for patients in the most affected areas.

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Formerly depressed patients continue to focus on negative

People who have recovered from a major depressive episode, when compared with individuals who have never experienced one, tend to spend more time processing negative information and less time processing positive information, putting them at risk for a relapse, according to research published by the American Psychological Association.

"Our findings suggest that people who have a history of depression spend more time processing negative information, such as sad faces, than positive information, such as happy faces, and that this difference is greater compared to healthy people with no history," said lead author Alainna Wen, PhD, a postdoctoral scholar at the Anxiety and Depression Research Center at the University of California, Los Angeles. "Because more negative thinking and mood and less positive thinking and mood are characteristic of depression, this could mean that these individuals are at a greater risk for having another depressive episode."

The research was published in the Journal of Psychopathology and Clinical Science.

Major depression is one of the most common mental disorders in the United States. In 2020, approximately 21 million U.S. adults reported at least one incidence of major depression (8.4% of the U.S. population), according to the National Institute of Mental Health. Defined as a period of at least two weeks of a depressed mood or loss of interest or pleasure in daily activities, major depression can interfere with or limit a person's ability to carry out major life activities.

Despite well-established treatments for depression, relapse rates for major depressive disorder remain high, according to Wen. More than 50% of individuals with a first-time major depressive episode will experience subsequent episodes, often relapsing within two years of recovery. Thus, more insight is needed into the risk factors involved in major depressive disorder to improve treatment and prevent relapse.

For this paper, researchers conducted a meta-analysis of 44 studies involving 2081 participants with a history of major depressive disorder and 2285 healthy controls. All studies examined participants' response times to negative, positive or neutral stimuli. In some cases, participants were shown either a happy, sad or neutral human face and asked to push a different button for each. In others, participants reacted to positive, negative or neutral words.

Healthy participants as a group responded more quickly to emotional and non-emotional stimuli than participants with a history of depression, regardless of whether those stimuli were positive, neutral or negative. But participants who previously had major depressive disorder spent more time processing negative emotional stimuli over positive stimuli compared with controls. While healthy controls showed a significant difference in how much time they spent processing positive vs. negative emotional stimuli compared with those in remission from major depression, that distinction did not appear when comparing time spent processing negative vs. neutral or positive vs. neutral stimuli.

Overall, the findings suggest that individuals with recurrent major depressive disorder not only are less able to control the information they process than healthy individuals, they also display a greater bias for focusing on negative over positive or neutral information, according to Wen.

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