Asthma+Air Pollution: What To Do? I Have A Dream…

As you know, last week’s air quality in Beijing was seriously unhealthy, for all ages and all health levels. At that highest level, most AQI warning systems would recommend that all children and any sick people should have stayed inside, and all school-related outdoor sports should have been cancelled. In my clinic this week, I continue to see asthmatic patients with flareups, pneumonia and bronchitis. Given our local conditions, it’s crucial that asthmatic patients try to prevent that initial pro-inflammatory cascade into a flareup. I wanted to review a couple options, as well as discuss a more proactive community-based approach.

Breathing Technique Can Cut Down on Inhaler Use?

The New York Times has an interesting review about the Buteyko method of breathing. This is a simple way of breathing exercises which has potential to cut down on an asthmatic’s overall use of both steroid and rescue inhalers. I honestly had never heard about this until this article, but there’s enough evidence for the British Thoracic Society’s 2008 recommendation that “Buteyko breathing technique may be considered to help patients to control the symptoms of asthma.” And since it does no harm, I think any asthmatic with persistent symptoms could try this.

You can find a description of the technique here, and I hear there are videos online as well.

Using Inhalers Correctly

The Buteyko method may work for some, but it’s likely far more important that asthmatic patients take their medicines properly. A large percentage of patients, especially kids, have trouble keeping up with the daily doses of steroid medicines. Also, many also don’t use the inhalers exactly right and therefore don’t get the medicine deep into their lungs. I have a link here to a very funny clip from the “House” TV show, which shows a woman using her asthma inhaler in a very improper way. Sure, it’s over the top, but actually it’s not such an easy thing to do as you’d think, especially for children. A good doctor should periodically review and watch the patient use the inhaler, and coach them on proper technique. There are some great instruction videos from familydoctor.org as well as from the Asthma Society of Canada and the Ventolin company.

Can Our Communities Do More?

Last week, during the peak days when the PM2.5 was tilting machines over their max of 500 AQI, was any local school district aware of the danger? I fear that our current system of pollution warnings is not effective, and I hope we Beijingers can start a productive dialogue. In an ideal world, there would be real-time data from multiple monitors with results available on the internet; somehow, certain cutoffs would automatically trigger a warning system. That could include automatic SMS to phones; or phone calls to school nurses; or emails to parents. The message could easily say something like “API>300. Hazardous. Cancel all outdoor sports” (which is exactly what should’ve happened all late last week here). Unfortunately, the current published API is not helpful because not only is it only stating the previous day’s results, but it’s also an average of the entire city for the previous 24 hours. A far better system would be to have the neighborhood monitors publishing their hourly data online; this would be far more relevant to each local school. This is not a pipe dream; it is already in place in Hong Kong via the Hedley Environmental Index real-time air quality tracker as well as Greenpeace’s interactive Google Map Real Air Pollution Index (scroll to the bottom of this Cleartheair webpage for map). This is wonderfully progressive stuff that all Beijingers — not just expats — would benefit from. Here’s an example map:

hkmap


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