Heatwaves and High Pollution: Dr Munaf Siyamwala on Challenges Patients With COPD Face During Summertime

Munaf Siyamwala, MD, a pulmonary critical care and internal medicine physician at Centerpoint Medical Center in Independence, Missouri, explained that summertime heatwaves and increased pollution significantly exacerbate symptoms for patients with chronic obstructive pulmonary disease (COPD).

To mitigate these symptoms, he suggested that patients with COPD consistently take their medications, avoid outdoor exertion, and wear loose clothing.

This transcript was lightly edited.

The American Journal of Managed Care^® (AJMC^®): Why is summertime particularly challenging for patients with COPD?

Siyamwala: It’s not just a simple answer. Summertime, especially the heatwave that we are having, with the increase in temperature and the increase in pollution; all that matters. If you look at it more technically, when there is very hot, dry air, and when you breathe it in, it causes significant inflammation to your lung lining. So, if you already have damaged lungs, or if you already have allergies, you will become more sensitive to inflammation.

If you have COPD and other kinds of chronic lung diseases, you actually have more secretions and more bronchospasms, which can cause more symptoms. Not only that, but when we have a lot of ozone smog because of pollution, climate change, and high temperatures, it can cause significant lung inflammation. That also increases the exacerbation for patients with chronic lung disease, including COPD, and it can actually make you more susceptible to developing COPD, more susceptible to having more asthma problems, during the hot weather climate.

AJMC: Could you explain further how inhaling hot air affects patients with COPD?

That is still a question we cannot answer for sure, but all the data and studies suggest so far that hot air can cause significant damage to the lung lining.

Whether it’s major bronchial airways, or the smaller areas, damaging the lining can cause a lot of secretions, and cause the smooth muscles around those linings to contract more, which causes the narrowing of your airways and more difficulty breathing in or out.

So, if you’re already susceptible to that, with lung disease and asthma patients, specifically, it causes more trouble.

AJMC: Could you continue discussing how the elevated smog-related ozone levels during summertime worsen COPD symptoms?

Siyamwala: The important thing is how the ozone is formed during the hot weather. Basically, all the volatile organic compounds and other pollution, especially nitrogen oxides, which are produced by buses, cars, all transportation, and factories, the conversion of gas in the hot weather causes a chemical reaction, which produces more ozone.

This ozone, again, causes significant inflammation in the lung. That inflammation is the most common reason for all these flare-ups, which can cause shortness of breath, wheezing, and increased cough.

Especially during summertime, it’s very hot outside, so our body tries to get rid of the heat by breathing faster. So, when you breathe faster and more often, that means you’re inhaling more of those substances, and it’s causing more damage.

AJMC: What do you recommend patients with COPD do to manage their symptoms during the summer?

Siyamwala: During the summer, a couple of studies suggest that the best humidity index for patients with COPD is 40 and the temperature is 70 degrees Fahrenheit. If it goes above 90, I mean, you have to avoid going outside, you have to wear loose clothing, try to keep your surroundings less than 80 to 75 degrees Fahrenheit, try to avoid exercising or doing any exertion outside, and make sure that you are taking your medication regularly.

As I said, all the patients with COPD are in all different stages. So, it could be mild COPD who could have worsening symptoms during this time compared to very severe COPD who already have bad symptoms, to begin with. So, for them, even going out for a little bit can cause a lot of problems and probably ER visits or hospital admissions.