December 16, 2015

Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear.

The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following a 2-day workshop held in Leuven (Belgium) in March 2008.

Key areas of concern for the respiratory community arising from climate change are discussed and recommendations made to address gaps in knowledge. The most important recommendation was the development of more accurate predictive models for predicting the impact of climate change on respiratory health.

Respiratory healthcare workers also have an advocatory role in persuading governments and the European Union to maintain awareness and appropriate actions with respect to climate change, and these areas are also discussed in the position statement.

It is now widely accepted that climate change is occurring as a result of anthropogenic factors, in particular, fossil fuel combustion and greenhouse gas (GHG) emissions from energy supply, transport, agriculture, industry, forestry, waste, and commercial and residential buildings. Although global approaches are required in order to mitigate the increase in global temperatures, climate change is likely to have many, mostly adverse, effects on health, particularly in low-income countries, which require attention and action. These findings have been well described by the Intergovernmental Panel on Climate Change (IPCC) and the World Health Organization (WHO).

Climate change, and its driver GHG emissions, will thus affect human health and respiratory medicine through: 1) an increased number of deaths and acute morbidity due to heatwaves; 2) an increased frequency of cardiorespiratory events due to higher concentrations of ground-level ozone; 3) changes in the frequency of respiratory diseases due to transboundary long-range air pollution (e.g. related to fires and aerosols); and 4) altered spatial and temporal distribution of allergens and some infectious disease vectors. These impacts will not only affect those with existing respiratory disease but also may influence the incidence and thus prevalence of respiratory conditions.

The impact of climate change on individuals with respiratory disease will vary depending on the degree to which ambient temperatures rise relative to current levels, changes in short-term transboundary long-range air pollutants, the risk of heatwaves, and the risk of flooding and excessive rainfall, as well as the impact of these changes on other health-relevant factors, such as air pollution, allergens and moulds. Adaptive capacity must be expanded beyond simply responding to extreme events as planning for the longer term is needed. Consequently, diagnostic tools and clinical treatments may need to be adjusted with time and clinicians will need to be made aware of changing patterns of disease that will occur in response to changing environmental conditions. This requires better disease surveillance and warning systems.

The Environment and Health committee of the European Respiratory Society (ERS) held a workshop in Leuven (Belgium) in March 2008 in order to explore the specific health issues of climate change in relation to respiratory disease. The present position statement has arisen from that workshop. Although climate change and health have been addressed in the general medical literature, this statement is the first from a specialist medical society and parallels the interest of the American Thoracic Society in climate change. The statement highlights the broad issues facing the medical profession, those pertinent to respiratory disease, how approaches to the likely change in pattern of disease can be managed, gaps in knowledge and how all of this can be used in advocacy, in particular to governments. The statement reflects the Environment and Health Committee’s role in advising both the ERS and the European Lung Foundation on matters of environment and health, and providing information to these and other relevant bodies, as well as the general public.

Within this statement two main themes have been addressed: 1) adaptation: actions designed to reduce the impact of already established climate change on patients with respiratory disease and to protect the public from related exposures known to adversely affect lung health; and 2) mitigation: responsibilities of healthcare professionals and organisations, such as the ERS, to lead by example in reducing dependence on carbon and hence contributing to reducing the influence of climate change and its impact on future generations.