As California’s wildfires grew, so did the number of calls into the pediatric clinics at Community Medical Centers this fall. “Unfortunately, all the fires right now have made the air quality very bad,” said Dr. Paul Do, a pediatric pulmonologist and UCSF faculty member. “I’m getting a lot of families with children who have asthma and other chronic lung disease calling about increased problems breathing. They’re really coughing and wheezing.”
First Dr. Do takes a look at their medications and makes adjustments. Then he talks to parents about other ways to help their children stay away from things that trigger their breathing challenges – and could possibly result in a trip to the emergency room.
Fresno County leads the state in asthma-related hospitalizations for children aged 5 to 17. The county also comes in second for overall childhood asthma hospitalizations, even though the county ranks fifth in the percentage of children diagnosed with asthma. Two things drive the Valley’s high hospitalizations—a shortage of pediatric experts specializing in lung issues and pollution levels that are among the worst in the nation.
Increased access to pediatric specialty care
Having access to a pediatric specialist like Dr. Do reduces hospital stays, complications and healthcare costs and improves the quality of life for children with complex and chronic health conditions. Statewide, children have access to three times as many subspecialists as they do in the Central San Joaquin Valley. There’s one pediatric specialist for every 10,000 – 18,000 children in the Valley compared to 1 pediatric specialist for every 5,460 children statewide, a UCLA Center for Health Policy Research found.
Community has been working to fill that gap with its 40-year partnership with UCSF Fresno to train more pediatric specialists, and through a 10-year agreement with UCSF Benioff signed in 2015 to expand specialty medical care for our region’s children. Under that agreement, Community has added 38 pediatric sub-specialists to its downtown Fresno campus, built a 12-bed pediatric intensive care unit and set up telemedicine access to even more pediatric specialists at UCSF Benioff Children’s Hospital, ranked among the nation’s top 20 children’s hospitals.
Telehealth access for complex conditions
Dr. Do is seeing patients both in person and through telehealth virtual visits. With a phone call and/or video chat Dr. Do said, “I’m able to make sure patients are on top of their medication and I’m having them take preventive medications to avoid further exacerbations of their asthma.
“In addition to asthma we have patients with cystic fibrosis or chronic lung disease from prematurity, being born too early, that make them susceptible to getting more symptoms at these times,” he added. “We treat them in the same way and ask them to increase their medication.”
Bad air and smoke worsen lung conditions
But the Valley’s wildfire season and smoke-filled air are challenging the usual medication steps. “Even people who have never had asthma are having symptoms of asthma because of the air this year,” Dr. Do observed. “We tell everyone to not wait, but talk to their doctor about getting on an inhaler with a cortical steroid to deal with the inflammation that’s caused by particulates, at least until the air quality is better.”
Wildfire smoke differs from the particulates in usual bad-air days. Scientists say burning wood, leaves, buildings and vehicles can create smoke that is similar to tobacco smoke and can be even more irritating and damaging.
Dr. Do is advising his patients to also stay inside with air conditioners running and try to seal up windows and doors in older houses. “Also avoid smoking in the house and try not to fry things or burn candles or incense in the house that can increase the problem,” added Dr. Do. He recommends getting a MERV 13 rated filter for air conditioners which will filter out 90% of the fine particulates that can damage lungs.
And if patients must go out, Dr. Do said, “Set the air conditioner in your car to recycle so you aren’t bringing that bad air into the car.”
This year, more than any other wildfire season, Dr. Do said patients are calling with concerns about coughing or struggles with breathing: “The issue is when people are sick this year, it could be the flu or coronavirus or just due to bad air. But with air quality issues you shouldn’t have symptoms of fever or aches like a fever.”
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