Air quality concerns expected to continue Thursday

After a day of orange haze that cast a pall over New York City, obscuring some of the nation’s best-known landmarks with smoke from Canadian wildfires, New Yorkers and others were in store for another day of bad air Thursday.

The smoke in major metro areas, including Boston, Philadelphia and Washington, D.C., was expected to continue through Thursday and cause air unhealthy for all groups, the National Weather Service said.

Air quality advisories were in place for all five boroughs of the city of more than 8 million people, and Mayor Eric Adams called the situation unprecedented.

Read the full story here.

Biden pledges additional firefighting support to Canada

President Joe Biden offered additional firefighting support to Canada to help suppress the blazes burning across the country.

Biden directed all available federal firefighting assets to assist with the effort, according to a readout of his call with Canadian Prime Minister Justin Trudeau on Wednesday.

The U.S. has deployed more than 600 firefighters and support personnel, as well as other resources, to assist with the fires, according to the readout.

More than 400 fires are burning in Canada, 252 of which are out of control, according to the Canadian Interagency Forest Fire Centre.

New York governor warns of ‘health and environmental crisis’

New York Gov. Kathy Hochul called the wildfire smoke affecting most of her state “a health and environmental crisis” Wednesday, and she urged residents to take it seriously.

The smoke blanketing major metro areas, including New York City, was expected to create dangerous air through Thursday, according to the National Weather Service.

Hochul said that normally the Air Quality Index is around 50 and that Brooklyn measured 413 and Queens 407 on Wednesday.

“Simply stay indoors. Outdoors is dangerous in just about every part of our state,” Hochul said at a news conference. “Not just vulnerable communities, but literally everyone.”

New York City’s Shakespeare in the Park cancels shows amid smoke

The Public Theater in New York City is canceling the first two performances of “Hamlet” in its popular Shakespeare in the Park run because of smoke from Canadian wildfires.

“Hamlet” performances that had been set for Thursday and Friday were called off Wednesday, said the nonprofit organization that puts on the summertime attraction.

"We hope to resume performances this weekend but will continue to closely monitor the ongoing situation in the days ahead," The Public Theater said in a statement.

New York City officials urged vulnerable New Yorkers to stay inside and all other residents to limit their time outdoors because of smoke.

The Broadway League said most shows remained open and were set to perform, but it urged people to check each show or theater's official website to make sure.

More than 20,000 in Canada remain displaced as country conducts 'all hands on deck' effort

More than 20,000 people in Canada remained displaced from their homes Wednesday as hundreds of wildfires burned across the country, officials said.

There were 414 wildfires burning Wednesday, “239 of which are determined to be out of control,” Bill Blair, Canada’s minister of emergency preparedness, said at a news conference.

An estimated 20,183 people remained evacuated from their communities, Blair said, adding that all parts of the government were working together.

"It’s all hands on deck, and it’s around the clock," Blair said.

Hundreds of members of the armed forces have also been deployed to assist in firefighting and other response efforts, officials said.

Prime Minister Justin Trudeau hailed firefighters in Nova Scotia as heroes after they went into a burning community to rescue an elderly man who had been unaware of the fire threat.

"Firefighters are stepping up, first responders are stepping up in harrowing situations to save their fellow citizens," Trudeau said Wednesday.

Blair said there have been more than 2,200 wildfires across Canada this year, which have burned about 3.8 million hectares, or about 9.4 million acres.

New York and other major metro areas to have unhealthy air through Thursday

New York City, Boston, Philadelphia and the nation’s capital are expected to have unhealthy air due to wildfire smoke through Thursday, the National Weather Service said.

Millions of people will be warned to continue limiting their exposure and remain inside. Philadelphia and other parts of Pennsylvania were under a “code red” Wednesday, and New York Mayor Eric Adams told vulnerable people to stay indoors — and everyone else to limit their time outside as much as possible.

Major metro areas were “expected to experience unhealthy air quality levels for all age groups through Thursday, before winds shift more easterly, pushing smoke further west into the interior Northeast and Ohio Valley on Friday,” the National Weather Service said Wednesday.

It named Boston, New York City, Philadelphia and Washington, D.C., in a forecast discussion.

The weather service in Binghamton, New York, said conditions made some areas look like Mars.

Asians in the U.S. say air quality 'feels dangerously like home'

The orange haze suffocating New York City and other U.S. cities is reminding some Asian residents of conditions in their home countries. They’ve taken to social media to describe the familiarity of the smell and the sight of the smoke, which migrated from Canadian wildfires over the past month.

“Feels dangerously like home,” a person tweeted in response to the news that New York City on Tuesday and Wednesday had among the worst air quality in the world, according to IQAir.coma tracking service.

Some Asian cities named in the top 10 for worst air quality were Delhi, India; Lahore, Pakistan; and Jakarta, Indonesia.

Read the full story here.

New York to make 1 million N95 masks available to public

Tuesday's smoke impact was the third worst in U.S. history — and Wednesday could be worse

Tuesday’s smoke impacts rank as the third-worst in the United States since 2006, according to analysis from a Stanford University researcher who tracks wildfire smoke and its impacts.

The analysis calculated the amount of smoke exposure experienced per person in the United States on Tuesday and compared it to other major events, said Marshall Burke, an associate professor of Earth system science at Stanford University

Other regions on the West Coast have experienced much higher levels of smoke exposure, but overall impacts skewed higher in this event because eastern U.S. population centers like New York City were heavily affected, Burke said.

“This is a historic event. We’ve gone back to our smoke data and not seen anything of the same magnitude and size on the East Coast,” Burke said. And for New York City, “it’s by far the worst in the last 18 years.”

Wednesday — once data is analyzed — could be the worst day of smoke in the U.S. in nearly two decades, Burke said.

Levels of particulate matter for New York City on Wednesday doubled the worst days of any previous year, according to charts Burke produced.

Burke’s research is focused on the health impacts of wildfire smoke pollution. He uses satellites and air pollution monitors to evaluate how smoke travels in the U.S. and the severity of its exposures.

Eerie video shows George Washington Bridge swallowed by smoke

How to be safe indoors

Even when you stay inside, some smoke will get in.

There are options to reduce smoke levels of indoor air, according to Linsey Marr, an environmental engineer and a professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol experts. Marr advises: 

1. Keep the windows closed.

2. If you have a portable air filtration unit (HEPA filter, air purifier), run it on high.

3. Most window AC units recirculate indoor air and do not pull in air from outside. This is a good time to make sure the AC unit's filter is installed correctly. It will remove some of the smoke particles from the indoor air that passes through the unit. If you do have a good filter installed, run the fan on high to move as much air as possible through the filter. There are a few types of window AC units that have an adjustment to bring in some outdoor air. You should adjust the lever to use all recirculated air and zero outdoor air.

3. Most residential central HVAC systems do not bring in outdoor air, so if you have a good filter installed (MERV 11 or higher), you can turn the fan to run constantly to circulate indoor air through the filter. This will help remove particles from indoor air.

4. If the smoke is bothering you indoors, you could also wear a good quality mask, like an N95, KN95, or KF94. This will filter out at least 95% of the smoke particles.

National Weather Service says 'not a great deal' of improved air quality expected tomorrow

In a sobering alert this afternoon, the National Weather Service said that forecasters expect "not a great deal" of air quality improvement heading into tomorrow as thick smoke from ferocious Canada wildfires continues to waft southward along the eastern U.S.

The weather service tweeted a map showing that air quality will be particularly poor in New York, the mid-Atlantic region and parts of the Midwest, including swaths of Indiana and Ohio.

Yankees and Phillies games postponed, too

Tonight's games between the Detroit Tigers and the Philadelphia Phillies at Citizens Bank Park (originally slated for 6:05 p.m. ET) and the Chicago White Sox and the New York Yankees at Yankee Stadium (originally set for 7:05 p.m. ET) have been postponed because of the dangerous conditions, the MLB said in a news release.

"These postponements were determined following conversations throughout the day with medical and weather experts and all of the impacted Clubs regarding clearly hazardous air quality conditions in both cities," the league said.

WNBA game between NYC and Minneapolis postponed because of hazardous conditions

Tonight's WNBA game between the New York Liberty and the Minnesota Lynx has been postponed because of the dangerous conditions along the eastern U.S., a spokesperson for the Brooklyn-based team confirmed to NBC News.

The game was scheduled for 7 p.m. at the Barclays Center in Brooklyn.

Grubhub tells drivers they will not be penalized for avoiding areas where they'd feel unsafe

At least one online delivery group is telling drivers they can avoid the most heavily affected parts of their cities without facing consequences on their platform.

In a statement, Grubhub confirmed it had alerted drivers that they would not be penalized "for opting out of blocks if they do not feel safe completing deliveries."

The company added that following New York City’s announcement about air quality deteriorating, it was also "reminding those with pre-existing conditions to stay inside."

Just after 2 p.m. Wednesday, New York City officials said they'd extended the warning to limit outdoor activity until Thursday at midnight.

Biden administration send firefighters to Canada to battle wildfires

WASHINGTON — The Biden administration has deployed over 600 U.S. firefighters and personnel to help battle Canadian wildfires as heavy smoke blankets the northeastern United States, the White House said.

Karine Jean-Pierre told reporters Wednesday that Washington had also sent equipment, such as water bombers, to help put out the hundreds of blazing fires and that officials were in touch with the Canadian government.

She said federal agencies at home were sharing information with local officials about the air quality in areas that have been impacted and urged Americans to “take precautions, especially if you have conditions.” 

Jean-Pierre demurred when asked if President Biden, who dealt with asthma as a child, had been advised to wear a mask outdoors but said he did not wear a mask on Wednesday when walking from his residence to the Oval Office, an outdoor path along the colonnade. 

“No one is wearing a mask. It’s a short walk,” Jean-Pierre said. 

U.N. secretary general calls for more efforts to limit wildfires in a warming world

Google tells employees in New York and along the East Coast to work from home

Google is telling its East Coast employees to stay home as wildfire smoke fills the air in New York and other major cities.

Company site leads in New York wrote in a memo to workers in the area that air quality in many parts of the region had reached “unhealthy” levels, citing the New York state Department of Environmental Conservation. In New York, most employees have been expected to work from physical offices at least three days a week.

“We are advising Googlers to work from home if possible, and limit their exposure to outdoor air,” according to the note, which was obtained by CNBC. “Terraces across our New York campus will remain closed today.”

Read the full story on CNBC.com

Startling images show NYC skyline Monday versus today

Black residents of Detroit brace themselves for rougher conditions

Detroit’s air quality is among the world’s worst due to the Canadian wildfires, potentially exacerbating many health problems that residents of the predominantly Black city have struggled with for generations.  

Detroit resident Sandra Turner-Handy, a retiree of the Michigan Environmental Council, said that before the fires, locals had been breathing high particulate matter and other toxins “on a consistent basis.” She said she is especially concerned about the effects of the fires on those who live near the Detroit River, an area sought for industrial use and which contains high levels of pollution.

She said Detroit’s “asthma rates are three times that of other cities in our state.” 

Read the full story here.

Broadway show starring Jodie Comer briefly halted after star has 'difficulty breathing'

Today's matinee performance of the Broadway production of "Prima Facie" was briefly paused after the show's star, Emmy Award-winning actor Jodie Comer, experienced "difficulty breathing," according to a spokeswoman for the production.

The performance was "halted approximately 10 minutes into the performance after Jodie Comer had difficulty breathing due to the poor air quality in New York City because of smoke from the Canadian wildfires," said a spokeswoman for The Press Room, a theater publicity firm.

The spokeswoman said the performance was set to start again "from the top" with understudy Dani Arlington filling in for Comer in the role of Tessa.

Comer is best known for her co-starring role on the twisty BBC America spy thriller "Killing Eve."

New York City's air quality is officially the worst in the world

The current air quality in New York City hit more than 340 on the air quality index scale this afternoon, making it the worst in the world, according to IQAir, a Swiss monitoring service.

Is it safe to exercise outdoors when the air quality is poor?

As air quality continues to plummet, runners may want to rethink their plans, experts say.

An air quality index over 150 signals that outdoor exercise may be risky, said Dr. Panagis Galiatsatos, a pulmonologist with the American Lung Association.

“It’s like swimming in polluted water,” he said.

“You’re going to get irritated, probably 20 minutes into your jog,” Galiatsatos said. “You’ll develop a cough, some dryness and you may even get a little bit more breathless because what you’re trying to do is some level of endurance, but your lungs aren’t breathing in healthy air, they’re breathing in toxins, they’re breathing in noxious stimuli. You’ll feel that toll.”

Read the full story here.

414 wildfires burning in Canada, more than 200 of them ‘out of control’

There are 414 wildfires burning in Canada as of today, 239 of which are considered “out of control,” Canadian Minister of Emergency Preparedness Bill Blair said in a news conference. 

To date, an estimated 20,183 people remain evacuated from homes and communities. 

“It’s all hands on deck and it’s around the clock,” Blair said of the government response to the blazes. 

Prime Minister Justin Trudeau said hundreds of armed forces members have been deployed to provide additional support to firefighters and affected communities.  

Washington is also lending support, with the U.S. Forest Service providing 648 personnel as of today. 

White House press secretary Karine Jean-Pierre told reporters today that President Joe Biden was briefed on the fires last week and has been regularly updated since then. The U.S. has also sent equipment such as water bombers, she said.

The orange haze is straight out of 'Blade Runner 2049'

Twitter users in New York City and other smoke-shrouded cities in the eastern U.S. evidently feel like they're living in the post-apocalyptic dystopia of "Blade Runner 2049."

In the movie, a sequel to the 1982 cult classic, Ryan Gosling's character hunts bioengineered humans known as "replicants" and treks through barren landscapes bathed in a mysterious orange fog.

The visual similarities between real-life New York and the Oscar-winning cinematography of "Blade Runner 2049" were not lost on cinephiles:

George Washington Bridge barely visible through smoke

A man talks on his phone as he looks through the haze at the George Washington Bridge in Englewood Cliffs, N.J.
A man walks by the George Washington Bridge in Englewood Cliffs, N.J., today. Seth Wenig / AP
A man talks on his phone as he looks through the haze at the George Washington Bridge from Englewood Cliffs, N.J
A man looks through the haze at the George Washington Bridge from Englewood Cliffs, N.J.Seth Wenig / AP

Map: Wildfire smoke has covered the U.S. for more than a month

While tens of millions of people on the East Coast experienced their first bout of poor air quality yesterday, data shows that much of the United States has been dealing with the smoke of a string of northern fires since early May.

Read more here on the spread of smoke across the country.

New York extends air quality health advisory to tomorrow

New York has extended its air quality health advisory to tomorrow.

The move comes as the air quality in the region is forecast to remain at "unhealthy" levels tomorrow.

The advisory was already in place today for the NYC metro area, Long Island, the lower and upper Hudson Valley, eastern Lake Ontario and the central and western New York regions. 

The pollutant of concern is fine particulate matter — which can cause short-term health effects such as shortness of breath and nose, throat and eye irritation. Exposure can also affect lung function and worsen medical conditions such as asthma and heart disease, according to the New York State Health Department. 

Image: Heavy smog covers the skylines of the boroughs of Brooklyn and Manhattan in New York on June 7, 2023.
Heavy smog covers the skylines in Brooklyn and Manhattan today. Ed Jones / AFP - Getty Images

People are urged to stay indoors, use mass transit instead of driving to avoid contributing to emissions, and to conserve fuel and energy.

Image: Pedestrians pass the One World Trade Center, center,  amidst a smokey haze from wildfires in Canada, on June 7, 2023, in New York.
Pedestrians pass One World Trade Center in New York.Julie Jacobson / AP

Livestreams of Manhattan illustrate intense smokiness

Livestreams of various points in Manhattan show just how much smoke is blanketing the city.

One stream offers a look at the Empire State Building, barely visible as of early afternoon. Another of the World Trade Center shows downtown Manhattan barely visible.

Wildfire danger high in central Pennsylvania, governor says

Yes, it's 'Clean Air Day' in Canada

It's June 7, and that just so happens to be "Clean Air Day" in Canada.

"This is a day to recognize how important good air quality is to our health, our environment, and the economy," according to the Canadian government's website. "It was first celebrated in 1999 when Canada declared Clean Air Day an annual celebration during Canadian Environment Week."

Delaware governor issues warning to residents as smoke wafts across eastern U.S.

NASA's forecast for the coming days

A new NASA forecast shows just how much of the country could be cloaked in wildfire smoke over the next four days. The animation, produced by scientists at the Goddard Space Flight Center in Maryland, shows a thick plume swirling over the Northeast today and into tomorrow, with conditions improving slightly heading into the weekend.

In the coming days, the model suggests that a portion of the country stretching from the Midwest into the Southeast could also experience hazy conditions, as tendrils of smoke waft over these regions. The yellow and red colorings in the animation show concentrations of small particulate matter that is commonly found in air pollution from wildfire smoke.

Wildfire smoke affecting air travel, with flights temporarily grounded at LaGuardia

The wildfire smoke creeping across the Northeast is affecting air travel today.

Departures were grounded at New York City's LaGuardia Airport “due to low visibility” until 2 p.m. ET, according to the Federal Aviation Administration. The FAA also paused flights from the Upper Midwest and East Coast bound for LaGuardia.

Newark Liberty International Airport tweeted that “current smoke condition may impact your travel, please check with your airline to determine the status of your flight.” The FAA said it was slowing flights to Newark.

Wind and haze were reported at airports in the New York City area, the Washington, D.C., metro area and Philadelphia, the FAA said Wednesday in a daily air traffic report.

Samuel Ausby with the FAA Command Center said in a video shared on Twitter: “Today we’re dealing with some smoke and haze in the northeast."

"There are some fires in Canada that have been producing some smoke, due to the wind patterns it is now impacting the northeast of the U.S. so from Boston, the NY metro area, Philadelphia and the D.C. metro area — are all experiencing some smoke that could impact travel through the airports,” he said.  

So far, there have been a total of 1,147 flights delayed and 73 canceled, according to FlightAware.com.

Climate change spurs intensifying wildfires in Canada

Climate change is increasing the impact of wildfires in Canada, according to the 2019 Canada’s Changing Climate Report, the country’s national assessment of climate impacts

“It’s not really the number, it’s mostly the size of the fires,” said Xianli Wang, a fire research scientist with the Canadian Forest Service, whose work is cited in the report. “Fires are larger and more intense, and we see a lot more fires burning through the night,” which makes them more difficult to control.

Wang said climate change is increasing the length of the fire season in Canadian provinces and increasing the likelihood of fire weather. Modeling suggests that trend will continue and expand as the climate warms, Wang added. Historic policies that prioritized fire suppression also have allowed fuels — dried vegetation and logs — to build up on the landscape in many areas, increasing fire potential.  

“If you don’t have a lot of dry, windy and hot days, fires will be quiet and fires may not grow as big as they are this year. As soon as the fire weather is ready for the fire to grow, they go crazy,” Wang said. “Climate change is definitely doing its work.”

Air purifiers can reduce indoor particles by up to 85%

Portable air purifiers with HEPA filters can be very effective, reducing indoor particle concentrations by as much as 85%, according to the Environmental Protection Agency.

Choose air purifiers that have a clean air delivery rate — a metric of how effective they are at removing pollutants — of at least two-thirds the size of the room they are intended for, experts say.

For most rooms, a clean air delivery rate equal to 300 or more cubic feet per minute should be enough, said Dr. Barbara Mann, a pulmonologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.

To maximize air purifiers’ effectiveness, change their filters at the recommended intervals, she added. Keep windows closed when using them. When coming in from extended periods outside in areas of poor air quality, change clothes, take off shoes and shower, she said.

Pollutants can come from indoor sources, too, said Dr. Peter Moschovis, a pulmonologist and critical care physician at Massachusetts General Hospital and an assistant professor at Harvard Medical School.

“Don’t generate extra particles indoors if you can,” he said. “So, smoking, vaping, burning incense, aerosolized essential oils — all those things aren’t good for your lungs at baseline.”

Can wildfire smoke make allergy symptoms worse?

While smoke itself is not an allergen, it can irritate the nasal passages and airways.

“If you have allergies on top of that, you've got two different things causing symptoms at the same time,” said Dr. Stokes Peebles, an allergy and pulmonary specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

Symptoms may also worsen depending on what’s burning. If a person is sensitive to an environmental allergen, such as trees or grass, breathing in the smoke that results from burning that allergen may cause a reaction.

What’s more, heat can cause pollen to rise and be airborne for longer periods of time, spreading those particles even hundreds of miles away, Peebles said. “They can travel farther than they would ordinarily because they go higher into the atmosphere.”

An N95 mask can help block those particles for people especially prone to environmental allergens, he said.

Pennsylvania warns of 'code red' air quality

The Pennsylvania Department of Environmental Protection said today was a "code red air quality action day" due to smoke from wildfires.

"Pennsylvania residents should limit their outdoor activities, especially older people, children, those who are active outdoors, and those with lung or respiratory conditions such as asthma, emphysema, or bronchitis," it said in a tweet.

NYC mayor urges 'vulnerable' residents to stay indoors as city's air quality plunges

New York City Mayor Eric Adams offered a stark warning at a briefing this morning about deteriorating air quality in the city, which currently ranks among the worst on the planet.

"We recommend vulnerable New Yorkers stay inside, and all New Yorkers should limit outdoor activity to the greatest extent possible," he said. He added that this was "not the day to train for a marathon or do an outside event with your children."

"Stay inside, close windows and doors and use air purifiers if you have them," Adams said.

The air quality in New York City was 158 on the air quality index (AQI) as of noon, according to IQAir, a Swiss air monitoring company. IQAir labels that air quality reading "unhealthy."

IQAir's real-time air quality ranking shows that New York City currently has the fourth-worst air quality in the world, behind only Delhi, India; Dakha, Bangladesh; and Toronto.

Is poor air quality bad for your pets?

Absolutely, experts say.

“Other mammals, they suffer from many of the same lung conditions that humans do,” said Dr. Purvi Parikh, an allergist and immunologist at the Allergy & Asthma Network.

People should keep their pets indoors as much as possible, said Brady Scott, a fellow at the American Association for Respiratory Care.

“If pets are outside, they’re running around outside or if they’re spending most of their time outside, it seems like it would probably create some irritation in their breathing and their airways and lungs as well,” he said. 

How to scrub pollutants from indoor air

Indoor air filters can help reduce or remove pollutants, including small particulate matter from wildfire smoke. These tiny particles, measuring less than 2.5 micrometers in diameter or roughly 4% of the width of a strand of hair, are small enough to be breathed deep into the lungs and can enter the bloodstream. Studies have found that even short-term exposure to small particulate matter increases the risk of a range of cardiovascular and respiratory diseases.

Health officials recommend that people stay indoors as much as possible when air pollution levels are elevated. Indoor air filtration, including HVAC systems (heating, ventilation and air conditioning) and portable air purifiers can also help scrub pollutants that may have traveled inside homes and other buildings.

People can purchase portable air cleaners with replaceable HEPA filters that strain out small particulate matter, or PM2.5. HEPA filters are also available for homes outfitted with central heating and cooling systems. California’s Environmental Protection Agency recommends using an indoor air cleaner anytime the air quality index hits “unhealthy” levels, or if people see or smell smoke in the air. 

But people can also make their own indoor air cleaners by attaching an air filter to a box fan with tape, brackets or a bungee cord. If window air conditioning units, HVAC systems or portable air cleaners are not available, the U.S. Environmental Protection Agency said “DIY air cleaners” can serve as “a temporary alternative to commercial air cleaners.” The agency cautioned that DIY air cleaners should not be used routinely, and that concerns have been raised about the potential fire or burn risk involved if box fans overheat.

The EPA added that there is limited research on the effectiveness of DIY air cleaners, but a study published in July 2021 in the journal Aerosol and Air Quality Research found that low-cost filtration methods, including attaching a filter to a box fan, “can have significant benefit for filtering submicron smoke particles and may reduce exposure to PM2.5 during wildfire smoke events.”

Washington, D.C., visitors cope with haze amid poor air quality

Vera Zurndorfer, a Los Angeles resident, is no stranger to poor air quality. During California's fire season, "it's always like this," she told NBC News in Washington, D.C.

"I feel for anybody that has to breathe this stuff in," she said. "This is pretty darn nasty."

Washington's air quality, despite still forecast by the Council of Governments as unhealthy, is a respite for some traveling from New York.

"It was more intense there," said Chris Erdos, who traveled to Washington from upstate New York. "I could smell it, and it was really hazy."

Smoke blocks out the sun this morning above Union Station in Washington, D.C.
Smoke blocks out the sun this morning above Union Station in Washington, D.C.Ginger Gibson / NBC News
Hazy skies blanket the monuments and skyline of Washington, D.C. on June 7, 2023 as seen from Arlington, Va.
Hazy skies blanket the monuments and skyline of Washington, as seen from Arlington, Va.Win McNamee / Getty Images

North Carolina issues air quality alert

The North Carolina Emergency Management issued an air quality alert for the entire state today, as smoke from wildfires in Canada continues to make its way down the Eastern Seaboard.

Cities issue 'code red' air quality alerts

Cities across the East Coast are issuing air quality alerts and warnings to avoid time outdoors as wildfire smoke from Canada brings dangerous air pollution levels.

Philadelphia's Department of Public Health issued a code red alert for unhealthy fine particles today, warning, “some members of the general public may experience health effects. Members of sensitive groups may experience more serious health effects.”

New York State’s Department of Environmental Conservation also issued an air quality health advisory for the city, Long Island, the lower and the upper Hudson Valley, eastern Lake Ontario, and central and western New York, warning of fine particulate matter from 12 a.m. today through midnight. 

Such warnings are issued when officials predict levels of pollution, either ozone or fine particulate matter, are expected to exceed an air quality index of 100. 

New Yorkers were urged to save energy by taking mass transit, turning off lights and unused appliances, using fans to circulate air and closing blinds and shades to preserve cooled air. 

In Washington, D.C., health officials also issued a code red air quality alert, saying conditions will be “unhealthy for people with heart/lung disease, older adults, children & teens.” 

Reduced visibility is anticipated from 3 to 6 p.m. and officials encouraged people to wear masks and keep outdoor activity short.

New York braces for another wave of smoke

The National Weather Service warned this morning that New York City should expect another wave of smoke to hit in the early afternoon, as a plume makes its way over central New York and northern Pennsylvania.

NYC had its worst air quality yesterday — and today could be worse

Not only did New York City have the worst air quality in the world yesterday — but it also reported the worst air quality ever measured in the city. 

Reliable monitoring began in 1999 and the previous most polluted days were July 7, 2002, and Oct. 9, 2003, also from wildfire smoke.

An air monitoring station in the Queens borough finished yesterday with a staggering 24-hour air quality index average of 174. This tops the old record of 167 for any air monitoring station in the greater New York City area during the past 24 years. 

It's also worth noting that this station peaked early last evening with an AQI reading more than 350, which at the time categorized the air as “hazardous.” 

This record may be short-lived. AQI readings are still very high today and a thick blanket of smoke over central New York is expected to move over New York City this evening, making the air quality even worse.

NYC’s fine particulate matter concentration 14.5 times more than the WHO guideline

Wildfire smoke can create fine particulate matter in the air, or PM2.5, an air pollutant that causes haze and can lead to lasting health effects. 

As of this morning, New York City’s PM2.5 levels were 14.5 times the World Health Organization annual air quality guideline value, according to IQAir.

Inhaling particulate matter 2.5 can be dangerous as it can travel into the respiratory tract, reaching the lungs. Exposure can affect lung function and worsen medical conditions such as asthma and heart disease, according to the New York State Health Department. 

Particulate pollution can also increase the risk of asthma, lung cancer or other chronic lung diseases, particularly in the vulnerable, such as elderly people, pregnant women, infants and children.

Officials in New Jersey and New York have urged people to stay indoors if they have respiratory issues due to the low air quality.

N.Y. Gov. Kathy Hochul warns about smoke exposure

Masks can help in smoky conditions

If you need to spend time outside in the smoke, a mask can help.

Dr. Purvi Parikh, an allergist and immunologist at the Allergy & Asthma Network, said masks such as N95 respirators can filter out particulate matter in the air.

“Believe it or not, masking just like we did with Covid can be helpful in acting as a barrier between you and reduce the amount of particulate matter that you breathe in,” she said. 

More than 400 wildfires are burning in Canada

and

The smoke taking over swaths of the U.S. is coming from Canada, where more than 400 wildfires are burning, according to the Canadian Interagency Forest Fires Centre

In Quebec, more than 150 forest fires were burning yesterday, with more than 110 considered out of control. The fires prompted evacuation orders in Chibougamau, Quebec, a remote town of about 7,500 last evening.

Emergency Preparedness Minister Bill Blair called the situation “serious” and described images of the wildfire season “the most severe we have ever witnessed in Canada.”

“The current forecast for the next few months indicates the potential for continued higher-than-normal fire activity,” he added.  


NOAA radar shows intense smoke over eastern U.S.

Radar-based analysis by the National Oceanic and Atmospheric Administration taken this morning shows near-surface smoke over the U.S. in the last 24 hours.
Radar-based analysis by the National Oceanic and Atmospheric Administration taken this morning shows near-surface smoke over the U.S. in the last 24 hours.NOAA

N.J. Forest Fire Service warns about a wildfire

The New Jersey Forest Fire Service warned last night about an uncontained wildfire.

The National Weather Service has warned that fire weather had been developing in the U.S., and that it can spark "dry thunderstorms" leading to wildfires.

Smoky haze blankets Yankees game

Chicago White Sox v New York Yankees
Under hazy conditions resulting from the wildfires in Canada, the New York Yankees walk out onto the field before the first inning against the Chicago White Sox at Yankee Stadium yesterday.Sarah Stier / Getty Images

NYC had the worst air quality in the world last night

and

New York City had the worst air quality in the world last night as the Atlantic coast was blanketed in smoke and smog from the wildfires in Canada.

The city reached the top of the worst air quality chart on IQAir, a Swiss air monitoring company, around 9 p.m. yesterday, with levels that exceeded the prior worst air quality event on record for the area in July 2002.

By this morning, New York docked down to second, after Delhi, India.

City dwellers woke up to yet another hazy sky and a sun that blazed more red and orange than usual due to the smoke.

How poor air quality hurts your health

Poor air quality can be caused by any airborne “irritant” — a particle or substance in the air that is harmful to a person to breathe in, according to Dr. Purvi Parikh, an allergist and immunologist at the Allergy & Asthma Network.

Many of the health issues people see from poor air quality, in general, can overlap with health issues seen from wildfire smoke, said Dr. Wynne Armand, a physician at Massachusetts General Hospital and associate director of the MGH Center for the Environment and Health.

Read the full story here.

98 million people under air quality alerts for wildfire smoke, ozone

Much of the nation will grapple with low air quality today as wildfire smoke from Canada continues to spread over the U.S.

Parts of 18 states are under air quality alerts this morning from New Hampshire to South Carolina. Large metro areas under alerts include New York, Boston, Washington, D.C., Philadelphia, Cleveland, Dallas, Houston and Charlotte, North Carolina.

Another surge of significant smoke will move south this afternoon across the Northeast with the worst of the smoke expected in and around New York City from 3 to 9 p.m.

Syndication: The Enquirer
Smoke from wildfires in Canada blanket Cincinnati's skyline yesterday.Kareem Elgazzar / USA Today Network



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Smoke caused by more than 200 out-of-control wildfires in Canada is producing unhealthy and even hazardous levels of air pollution throughout North America.

The smoke is spreading throughout much of the United States, especially the Northeast, Mid-Atlantic, Midwest, and parts of the Southeast. The National Weather Service has described parts of the country as looking like Mars, shrouded in an orange haze that blocks the sunlight and sends temperatures to unexpected lows.

Areas in the northern United States have been most dramatically affected, with New York City briefly ranked by IQAir.com as the most polluted major city in the world and Detroit in the No. 2 spot. “But the smoke and associated pollutants from fires in Northern Quebec are impacting as far south as Charlotte, North Carolina, and even farther because of the wind patterns,” says Rebecca Saari, PhD, assistant professor of civil and environmental engineering at the University of Waterloo in Ontario, Canada. “So you’re seeing air quality at unhealthy levels in many areas.”

Wildfires not only leave a trail of physical destruction in their immediate path, they also create a wave of health problems as harmful particulate matter and toxic gasses are carried through the air.



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As wildfires continue to rage in Canada, the drifting smoke poses potential dangers to areas of the United States. It is crucial to be aware of how to protect yourself from the harmful effects of air pollution caused by wildfire smoke. The smoke contains toxic gases and particulate matter that can adversely impact health.

Respiratory Problems and Health Impacts

Smoke from wildfires primarily consists of fine particles called PM2.5, which are of particular concern for health, according to the Environmental Protection Agency (EPA). Breathing in smoke can trigger short-term respiratory issues such as coughing, wheezing, and difficulty breathing. It can also worsen asthma and cause irritation to the sinuses, throat, and eyes. In more severe cases, exposure to smoke has been linked to heart attacks, stroke, lung cancer, and cognitive impairments.

Increased Vulnerability for Certain Groups

While anyone can be affected by wildfire smoke, certain individuals are at a higher risk. Older adults, pregnant women, children, infants, and those with pre-existing heart or lung conditions, including asthma, are more likely to experience negative health effects if exposed to wildfire smoke.

Monitoring Air Quality and Wearing Masks

Monitoring air quality is crucial in determining the safety of outdoor activities. Pay attention to warnings from the National Weather Service and local public health agencies. Websites such as AirNow.gov provide color-coded indexes indicating hazardous levels of air pollution and suggest appropriate outdoor activity. Utilize apps like AirNow and Air Quality Reader to stay informed about local air quality conditions.Wearing the right mask can offer protection against smoke. The EPA recommends using a "particulate respirator" approved by the National Institute for Occupational Safety and Health (NIOSH) with "NIOSH," "N95," or "P100" printed on it. The mask should have two straps and fit securely around the face. However, masks do not protect against chemicals, gases, or vapors and are primarily designed for low hazard levels. Individuals with heart or lung problems should consult their doctor before using respirator masks.

Improving Indoor Air Quality

While staying indoors can reduce exposure to smoke pollution, outdoor contaminants can still enter indoor spaces. To improve indoor air quality:

  • Ensure doors and windows are closed tightly.
  • Use an HVAC system with high-quality air filters. Consider upgrading to a filter with a MERV rating of 13 or higher during smoky periods.
  • Employ a portable air purifier with a HEPA filter and a large fan to effectively remove particles. Carbon filters can help absorb odors.
  • In the absence of air conditioning or an air purifier, create a DIY air cleaner using a box fan and an air filter.
  • By following these measures, individuals can mitigate the impact of wildfire smoke and protect their health during periods of poor air quality.

FAQs

Q1:What are the long-term effects of smoke from fires?
Exposure to PM2.5 from smoke or other air pollution, such as vehicle emissions, can exacerbate health conditions like asthma and reduce lung function in ways that can worsen existing respiratory problems and even heart disease.

Q2:Can fire smoke permanently damage your lungs?
Wildfire smoke can be extremely harmful to the lungs, especially for children, older adults and those with asthma, COPD and bronchitis, or chronic heart disease or diabetes.

Disclaimer Statement: This content is authored by a 3rd party. The views expressed here are that of the respective authors/ entities and do not represent the views of Economic Times (ET). ET does not guarantee, vouch for or endorse any of its contents nor is responsible for them in any manner whatsoever. Please take all steps necessary to ascertain that any information and content provided is correct, updated, and verified. ET hereby disclaims any and all warranties, express or implied, relating to the report and any content therein.

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Major players in the chronic obstructive pulmonary disease (COPD) treatment market are Almirall S.A., AstraZeneca PLC, Boehringer Ingelheim International GmbH, F. Hoffmann-La Roche Ltd, GSK PLC., Novartis AG, Teva Pharmaceutical Industries Ltd.

New York, June 08, 2023 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Chronic Obstructive Pulmonary Disease (COPD) Treatment Global Market Report 2023" - www.reportlinker.com/p06466548/?utm_source=GNW
, Astellas Pharma Inc., Abbott Laboratories, Chiesi Farmaceutici S.p.A, Mylan N.V., Orion Corporation, Sunovion Pharmaceuticals Inc., Dr. Reddy’s Laboratories Ltd., Circassia Group PLC, Kyowa Kirin Co. Ltd., Circassia Group PLC, and Sanofi S.A.

The global chronic obstructive pulmonary disease (COPD) treatment market is expected to grow from $19.18 billion in 2022 to $20.08 billion in 2023 at a compound annual growth rate (CAGR) of 4.71%. The Russia-Ukraine war disrupted the chances of global economic recovery from the COVID-19 pandemic, at least in the short term. The war between these two countries has led to economic sanctions on multiple countries, a surge in commodity prices, and supply chain disruptions, causing inflation across goods and services and affecting many markets across the globe. The chronic obstructive pulmonary disease (COPD) treatment market is expected to reach $24.52 billion in 2027 at a CAGR of 5.12%.

The chronic obstructive pulmonary disease (COPD) treatment market includes revenues earned by entities by providing services such as oxygen therapy, pulmonary rehabilitation, medication services, endobronchial valve therapy and non-invasive ventilation services.The market value includes the value of related goods sold by the service provider or included within the service offering.

Only goods and services traded between entities or sold to end consumers are included.

Chronic obstructive pulmonary disease (COPD) treatment refers to medical care given to a patient that helps manage the symptoms, slow the progression, and improve the overall quality of life of individuals with COPD. COPD is a progressive respiratory disease characterized by airflow obstruction, chronic inflammation, and damage to the lung tissue.

North America was the largest region in the chronic obstructive pulmonary disease (COPD) treatment market in 2022.Asia-Pacific is expected to be the fastest-growing region in the forecast period.

The regions covered in this report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.

The main types of drugs used for chronic obstructive pulmonary disease (COPD) treatment are combination therapy, bronchodilators, corticosteroids, phosphodiesterase type 4 inhibitors, mucokinetics, and other drug classes.A combination therapy refers to a therapeutic intervention in which more than one therapy is administered to the patient.

Combination therapy includes treatment plans that call for giving patients a variety of tablets, each carrying a specific medication. It used to treat such diseases as chronic bronchitis and emphysema and majorly used by hospitals, clinics, and homecare.

The increasing prevalence of lung disease is expected to propel the growth of the chronic obstructive pulmonary disease (COPD) treatment market.Lung disease is a disorder that affects the lungs and keeps them from functioning properly.

The most common lung diseases are asthma, COPD, and lung cancer.Chronic obstructive pulmonary disease (COPD) treatment is primarily used to treat lung disease, decrease the condition’s progression, control the symptoms, and avoid lung damage by employing inhalers and drugs.

For instance, in September 2022, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), a US-based non-profit organization, lung cancer had caused more than 2.2 million new cases and 1.80 million deaths globally in 2020, accounting for 1 in 4 cancer deaths. And 3.2 million people per year die from the chronic obstructive pulmonary disease (COPD), which affects an estimated 200 million people. Additionally, asthma affected 262 million people globally in 2022. These numbers are expected to rise in the future. Therefore, the increasing prevalence of lung disease is driving the growth of the chronic obstructive pulmonary disease (COPD) treatment market.

Product innovation is a key trend gaining popularity in the chronic obstructive pulmonary disease (COPD) treatment market.Major companies operating in the chronic obstructive pulmonary disease (COPD) treatment market are focusing on developing innovative products to sustain their position in the market.

For instance, in April 2022, GlaxoSmithKline plc (GSK), a UK-based pharmaceutical and biotechnology company, launched Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol), the first single-inhaler triple treatment (SITT) for patients in India with chronic obstructive pulmonary disease (COPD).Trelegy Ellipta is used as a maintenance medication to treat and prevent the signs and symptoms of chronic obstructive pulmonary disease (COPD) in people 18 years of age and older.

It performs similarly to natural corticosteroid hormones, reducing immune system activity by attaching to receptors (targets) on particular immune cell types. Additionally, it helps reduce swelling of the airways in the lungs to make breathing easier.

In July 2020, PAOG, a US-based biopharmaceutical technology company, acquired Resprx for $200 billion.With this acquisition, PAOG has the opportunity to strengthen its long-term medicinal cannabis goal by entering the cannabis biopharmaceutical sector.

Resprx, a US-based biopharmaceutical technology company, that provide cannabis-based COPD treatment.

The countries covered in the chronic obstructive pulmonary disease (COPD) treatment market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

The chronic obstructive pulmonary disease (COPD) treatment market research report is one of a series of new reports that provides chronic obstructive pulmonary disease (COPD) treatment market statistics, including chronic obstructive pulmonary disease (COPD) treatment industry global market size, regional shares, competitors with a chronic obstructive pulmonary disease (COPD) treatment market share, detailed chronic obstructive pulmonary disease (COPD) treatment market segments, market trends and opportunities, and any further data you may need to thrive in the chronic obstructive pulmonary disease (COPD) treatment industry. This chronic obstructive pulmonary disease (COPD) treatment market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.
Read the full report: www.reportlinker.com/p06466548/?utm_source=GNW

About Reportlinker
ReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.

__________________________

CONTACT: Clare: [email protected] US: (339)-368-6001 Intl: +1 339-368-6001

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New York, June 08, 2023 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Chronic Obstructive Pulmonary Disease (COPD) Treatment Global Market Report 2023" - www.reportlinker.com/p06466548/?utm_source=GNW
, Astellas Pharma Inc., Abbott Laboratories, Chiesi Farmaceutici S.p.A, Mylan N.V., Orion Corporation, Sunovion Pharmaceuticals Inc., Dr. Reddy’s Laboratories Ltd., Circassia Group PLC, Kyowa Kirin Co. Ltd., Circassia Group PLC, and Sanofi S.A.

The global chronic obstructive pulmonary disease (COPD) treatment market is expected to grow from $19.18 billion in 2022 to $20.08 billion in 2023 at a compound annual growth rate (CAGR) of 4.71%. The Russia-Ukraine war disrupted the chances of global economic recovery from the COVID-19 pandemic, at least in the short term. The war between these two countries has led to economic sanctions on multiple countries, a surge in commodity prices, and supply chain disruptions, causing inflation across goods and services and affecting many markets across the globe. The chronic obstructive pulmonary disease (COPD) treatment market is expected to reach $24.52 billion in 2027 at a CAGR of 5.12%.

The chronic obstructive pulmonary disease (COPD) treatment market includes revenues earned by entities by providing services such as oxygen therapy, pulmonary rehabilitation, medication services, endobronchial valve therapy and non-invasive ventilation services.The market value includes the value of related goods sold by the service provider or included within the service offering.

Only goods and services traded between entities or sold to end consumers are included.

Chronic obstructive pulmonary disease (COPD) treatment refers to medical care given to a patient that helps manage the symptoms, slow the progression, and improve the overall quality of life of individuals with COPD. COPD is a progressive respiratory disease characterized by airflow obstruction, chronic inflammation, and damage to the lung tissue.

North America was the largest region in the chronic obstructive pulmonary disease (COPD) treatment market in 2022.Asia-Pacific is expected to be the fastest-growing region in the forecast period.

The regions covered in this report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.

The main types of drugs used for chronic obstructive pulmonary disease (COPD) treatment are combination therapy, bronchodilators, corticosteroids, phosphodiesterase type 4 inhibitors, mucokinetics, and other drug classes.A combination therapy refers to a therapeutic intervention in which more than one therapy is administered to the patient.

Combination therapy includes treatment plans that call for giving patients a variety of tablets, each carrying a specific medication. It used to treat such diseases as chronic bronchitis and emphysema and majorly used by hospitals, clinics, and homecare.

The increasing prevalence of lung disease is expected to propel the growth of the chronic obstructive pulmonary disease (COPD) treatment market.Lung disease is a disorder that affects the lungs and keeps them from functioning properly.

The most common lung diseases are asthma, COPD, and lung cancer.Chronic obstructive pulmonary disease (COPD) treatment is primarily used to treat lung disease, decrease the condition’s progression, control the symptoms, and avoid lung damage by employing inhalers and drugs.

For instance, in September 2022, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), a US-based non-profit organization, lung cancer had caused more than 2.2 million new cases and 1.80 million deaths globally in 2020, accounting for 1 in 4 cancer deaths. And 3.2 million people per year die from the chronic obstructive pulmonary disease (COPD), which affects an estimated 200 million people. Additionally, asthma affected 262 million people globally in 2022. These numbers are expected to rise in the future. Therefore, the increasing prevalence of lung disease is driving the growth of the chronic obstructive pulmonary disease (COPD) treatment market.

Product innovation is a key trend gaining popularity in the chronic obstructive pulmonary disease (COPD) treatment market.Major companies operating in the chronic obstructive pulmonary disease (COPD) treatment market are focusing on developing innovative products to sustain their position in the market.

For instance, in April 2022, GlaxoSmithKline plc (GSK), a UK-based pharmaceutical and biotechnology company, launched Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol), the first single-inhaler triple treatment (SITT) for patients in India with chronic obstructive pulmonary disease (COPD).Trelegy Ellipta is used as a maintenance medication to treat and prevent the signs and symptoms of chronic obstructive pulmonary disease (COPD) in people 18 years of age and older.

It performs similarly to natural corticosteroid hormones, reducing immune system activity by attaching to receptors (targets) on particular immune cell types. Additionally, it helps reduce swelling of the airways in the lungs to make breathing easier.

In July 2020, PAOG, a US-based biopharmaceutical technology company, acquired Resprx for $200 billion.With this acquisition, PAOG has the opportunity to strengthen its long-term medicinal cannabis goal by entering the cannabis biopharmaceutical sector.

Resprx, a US-based biopharmaceutical technology company, that provide cannabis-based COPD treatment.

The countries covered in the chronic obstructive pulmonary disease (COPD) treatment market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

The chronic obstructive pulmonary disease (COPD) treatment market research report is one of a series of new reports that provides chronic obstructive pulmonary disease (COPD) treatment market statistics, including chronic obstructive pulmonary disease (COPD) treatment industry global market size, regional shares, competitors with a chronic obstructive pulmonary disease (COPD) treatment market share, detailed chronic obstructive pulmonary disease (COPD) treatment market segments, market trends and opportunities, and any further data you may need to thrive in the chronic obstructive pulmonary disease (COPD) treatment industry. This chronic obstructive pulmonary disease (COPD) treatment market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.
Read the full report: www.reportlinker.com/p06466548/?utm_source=GNW

About Reportlinker
ReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.

__________________________


        

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Americans in several parts of eastern U.S. looked up at the sky this afternoon to see the same alarming haze that first appeared Tuesday night. There were more than 400 wildfires burning in Canada on Tuesday, according to the Canadian Interagency Forest Fire Centre, causing unhealthy smoke conditions from New York to Michigan.

As of Wednesday June 7, New York City was the city with the worst air quality on Earth, according to IQAir.

"If exposed to the current air quality in NYC for 24 hours, it would be equivalent to smoking about 6 cigarettes," Colin McCarthy, an atmospheric science student who provides extreme weather updates, shared on Twitter.

For New York residents, an air quality advisory was shared in multiple regions. It indicates that fine particles in the air have reached an unhealthy level, especially for sensitive groups.

"This is not going to go on for months. It's going to pass. This is not going to last. This is not a pandemic," says Dr. Adrian Pristas, a pulmonologist at the Hackensack Meridian Bayshore Medical Center.

"This is going to go on for days, maybe a week. I wish I knew that for sure, but it all depends on what happens in Canada so people should pay attention to that."

Everything you need to know about air conditions, given the Canada wildfires

Will the smoky air affect your health?

"Secondhand smoke from any fire carries with it some risks," says Pristas, with the greatest risk being for vulnerable populations.

Some symptoms that people may experience from secondhand smoke exposure, according to Pristas, are:

  • Difficulty breathing
  • Scratchy throat
  • Irritated eyes
  • Fast heart rate

Exposure to particulate pollution can also raise your risk of developing "asthma, lung cancer and other chronic lung diseases," especially for people with certain conditions, according to NBC News.

Should you wear a mask outdoors?

The best move is to stay indoors. "Be smart about why you're outside. Don't underestimate the importance of what this can do to your lungs. Any exposure can be a significant and serious one," says Pristas.

"An N95 mask could be of some help, but I wouldn't count on that being the absolute solution to the problem," he adds.

If you have to go outside and you're more at risk, "a mask is going to be an option to help. Anything is better than nothing," he says. And an N95 mask would offer the most protection, Pristas says.

Who's most at risk?

Certain groups who are more at risk to severe outcomes, include:

  • Anyone with heart and lung disease, including heart failure or high blood pressure
  • People with asthma
  • Pregnant people
  • Young children
  • Older individuals

"All of the particulate matter and smoke is going to be around awhile, and there's not a lot we're going to be able to do about it, but just protect ourselves," Pristas says.

'Don't go outside unless you really have to'

Thankfully, there are choices you can make to stay safer, says Pristas. Here are some recommendations that he has for those living in affected areas:

  • Stay indoors: "Don't go outside unless you really have to."
  • Don't fry food, or smoke, to avoid polluting the air in your home.
  • Use an air filter or purifier.
  • Pay attention to weather reports in your area.
  • Avoid outdoor physical activity: "When you're exercising, you're breathing harder, breathing faster. It's more of an opportunity to bring these pollutants into your lungs."
  • Contact your doctor if you're feeling sick.
  • Consider over-the-counter medications and cough drops for scratchy throat and other symptoms.

'It's not practical to travel to work'

As much as you can, avoid outdoor tasks that can be put off for a few days, like putting gas in your car or grocery shopping, Pristas says. If you can work from home, he strongly recommends doing so.

"This is no different than other circumstances like a snow day, with two feet of snow out there. It's not practical to travel to work," he says.

"Maybe you have to take a day off. Hopefully we learned some things from what happened [in] the last few years and understand that we can survive at home for awhile without going outdoors."

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As the smoke from Canadian wildfires blows through the U.S. East Coast, millions of people are forced to stay indoors due to poor air quality alerts.

Wildfire smoke contains fine particulate matter, called PM2.5. Experts say it is ten times more harmful than the smoke from any other combustion activity and is likely to affect the health of people irrespective of their vulnerability.

"The top offender here is these fine particles. The size is really important because it can penetrate really deeply and wreak havoc on the body," Vijay Limaye, a climate and health scientist at the National Resources Defense Council, told ABC News.

The vulnerable populations, including children, the elderly, pregnant women and those with pre-existing conditions such as cardiovascular issues or respiratory illnesses, are asked to take extra caution as even short-term exposure can irritate the respiratory tracts, causing serious health hazards.

"The particulate matter that's in this haze is significant because it does irritate the bronchioles, the small tubes that go down into your lungs and connect to the alveoli, which are the sacs that allow you to breathe," Dr. Bob Lahita, a rheumatologist, told CBS News.

Although the wildfire smoke itself is not an allergen, it can cause reactions in people who have allergies to things like trees or grass. The most common symptom that immediately strikes anyone after smoke exposure, especially the vulnerable group, is breathing difficulty. Exposure to wildfire smoke even for a short time can cause symptoms such as irritation to the eyes, nose, throat and lungs, and can increase the risk of respiratory infections.

Long-term exposure can cause serious health issues such as stroke, lung cancer, asthma, preterm birth, dementia, heart disease and lower IQ in children. According to a recent study, exposure to air pollution during the first and second trimesters of pregnancy can cause gestational diabetes.

Tips to stay safe

1. Check air quality alerts regularly: You can keep a watch on the pollution in your area at AirNow.gov.

2. Stay indoors: It is better to limit outdoor activity and stay indoors while keeping the doors and windows closed.

3. Wear N95 outdoors: Avoid outdoor activities such as exercise even if you are not vulnerable as it can cause inflammation and symptoms such as headache and fatigue. If there is a need to step out, it is advisable to wear an N95 mask as they can lower the exposure to the smoke.

4. Watch out for symptoms: People with respiratory issues such as asthma should monitor their symptoms and seek help if the condition worsens. Those with breathing difficulties need to keep their inhalers and medicines ready.

5. Use air filters: Indoor air purifiers can help reduce the amount of pollutants, including small particulate matter from wildfire smoke. According to the California Environmental Protection Agency, air purifiers should be used whenever the air quality levels indicate "unhealthy" levels, or when the smoke can be seen or smelt indoors.

Wildfire Smoke Posing Increasing Health Threat
Americans will face an increasing health threat from wildfire smoke, scientists say.
CC By 2.0

Published by Medicaldaily.com

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CNN
 — 

From Maryland to the Canadian capital, a mammoth-size cloud of smoke spewed by Quebec’s wildfires has forced children to stay indoors, grounded flights in New York City and left millions of residents at risk of breathing unhealthy air.

More than 75 million people in the eastern US are under air quality alerts Wednesday due to the smoke, which made iconic skylines disappear behind wafting orange fumes.

Heavy smoke shrouds buildings around Times Square in New York City on Tuesday.

The heaviest smoke Wednesday is expected to hit the Northeast through the mid-Atlantic and down to the Carolinas. Smoke conditions in those regions could last through at least Thursday.

air qualitly index map wednesday morning

Major metro areas in Pennsylvania, New York, New Jersey and Connecticut have air quality indexes (AQIs) above 150 – which is considered “unhealthy,” according to the government website AirNow.gov.

Philadelphia had an AQI of 205 as of Wednesday morning, which is classified as “very unhealthy.”

New York City; Jersey City, New Jersey; and New Haven, Connecticut all had “unhealthy” AQIs ranging from 155 to 171 on Wednesday morning.

“Yesterday, New Yorkers saw and smelled something that has never impacted us on this scale before,” New York City Mayor Eric Adams said Wednesday.

“This is not the day to train for a marathon or to do an outside event with your children. Stay inside, close windows and doors, and use air purifiers if you have them.”

Hundreds of miles away, Montgomery County Public Schools in Maryland canceled recess and all outdoor activities for Wednesday and Thursday due to the “influx of smoke” outside that could pose a health risk, the school district said.

Live updates on the smoke’s spread

And the Canadian capital of Ottawa is getting hit with some of the worst air quality, according to AirNow.gov, a partnership of the US Environmental Protection Agency, the National Oceanic and Atmospheric Administration, the US Centers for Disease Control and Prevention and other agencies.

A woman walks her dog Tuesday along the Ottawa River in Ottawa as smoke obscures Gatineau, Quebec.

While New York City, Philadelphia and Washington, DC, are expected to see their air quality improve throughout the day, the air in Boston, Pittsburgh and Raleigh, North Carolina, is expected to get worse Wednesday.

Interactive: Track the air quality across the US

Philadelphia issued a “code red” alert Wednesday, warning certain residents should stay indoors.

The elderly, young children and those who are pregnant or have heart or lung conditions could experience serious health effects from the smoke, said James Garrow, spokesperson for the Philadelphia Department of Public Health.

“For those who are not considered to be in a sensitive group, we are asking those folks to avoid strenuous activities outdoors like jogging or exercising,” Garrow told CNN Wednesday.

“We are asking folks to avoid unnecessary time outdoors,” he said. “But if they need to be outdoors, they should be masked and head inside as often as they need.”

The enormous cloud of pollution could cause long-term health effects, depending on the person and amount of exposure, said Dr. Purvi Parikh, an allergist and immunologist with NYU Langone Health and Allergy & Asthma Network.

“A healthy person may be able to withstand a day or two without too many issues, but at these levels, even they are at risk,” Parikh said.

“But someone who is vulnerable has much higher risk. Most vulnerable include (the) elderly, children, those with underlying lung issues like asthma, COPD, lung cancer, heart disease and pregnant women.”

If people develop and keep having symptoms after the air quality returns to normal, “then they may have developed asthma or COPD as a result, and that can become chronic,” Parikh said.

Experts say wearing a face mask can help – but the type of mask is important.

“N95s protect very well from the smoke particles, which are the most hazardous component of the smoke,” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech university.

“You may still smell smoke gases through the mask, but it’s still doing its job blocking particles as long as it’s a high-quality mask that fits well,” Marr said.

“You definitely want an N95 or KN95 or KF94 to get the best protection. Surgical and cloth masks will provide a small benefit, better than nothing, but if you really want to protect your health, you should wear a ‘respirator’ such as an N95, KN95, or KF94.”

Air quality in the US Northeast deteriorated this week as more than 150 wildfires keep raging in Quebec, according to the Canadian Interagency Forest Fire Center.

The entire Quebecois town of Chibougamau – population 7,000 – is under a mandatory evacuation order Wednesday as fast-moving wildfires wreak havoc across the region.

“Given the current situation, the mayor of Chibougamau, Manon Cyr, has declared a state of emergency and announced the mandatory evacuation of the entire town, including the resort area,” the town posted on Facebook Tuesday night.

So far this year, Quebec has endured more than 400 wildfires – twice the average for this time of year.

More than 9 million acres have been charred by wildfires in all of Canada this year – about 15 times the normal burned area for this point in the year.

And human-induced climate change has exacerbated the hot and dry conditions that fuel wildfires.

Scientists recently reported that millions of acres scorched by wildfires in the Western US and Canada – an area roughly the size of South Carolina – could be traced back to carbon pollution from the world’s largest fossil fuel and cement companies.

New York City had the worst air pollution of any major city in the world at one point Tuesday night, before dropping to second-worst behind New Delhi, India, according to air quality tracker IQair.

Heavy smog Wednesday covers the skylines of Brooklyn and Manhattan in New York City.

The nation’s largest public school district canceled all outdoor activities Wednesday, but will remain open. At least 10 school districts in central New York state canceled outdoor activities and events Tuesday.

New York City’s mayor said the situation is expected to improve Wednesday, but will likely worsen Thursday.

“Air quality conditions are anticipated to temporarily improve later tonight through tomorrow morning, but they are expected to deteriorate further tomorrow afternoon and evening,” Adams said.

On Wednesday afternoon, the Federal Aviation Administration ordered a ground stop for flights bound for New York’s LaGuardia Airport due to the smoke.

Flights bound for LaGuardia were kept at their departing airports until 2 p.m. ET, according to an FAA bulletin. The FAA said the chance of an extension is “low,” but delays could follow.

All flights bound for Newark Liberty International Airport were delayed from taking off from their departing airports until 11:59 p.m. ET. An FAA advisory cites “low visibility” as the cause.

Aviation weather reports showed Newark Liberty International Airport is among the East Coast airports where visibility is the lowest – just two miles as of 11:51 a.m. ET.

As of 2:45 p.m. ET, airlines in the US have canceled 120 flights and delayed another 1,928, according to data from tracking site FlightAware.

“Boston, the New York metro area, Philadelphia and the DC metro area are all experiencing some smoke that could impact travel to the airports,” Sam Ausby, an FAA national traffic management officer, said in a video posted on the agency’s Twitter account Wednesday.

But smoke does not necessarily pose a major safety hazard for commercial flights, which can operate normally without visual reference to the ground or horizon.

Wildfire smoke is particularly dangerous because it contains tiny particulate matter, or PM2.5 – the tiniest of pollutants.

When inhaled, it can travel deep into lung tissue and enter the bloodstream. It comes from sources like the combustion of fossil fuels, dust storms and wildfires, and has been linked to several health complications including asthma, heart disease and other respiratory illnesses.

And the impacts could be deadly: In 2016, about 4.2 million premature deaths were associated with fine particulate matter, according to the World Health Organization.

“If you can see or smell smoke, know that you’re being exposed,” said William Barrett, the national senior director of clean air advocacy with the American Lung Association.

“And it’s important that you do everything you can to remain indoors during those high, high pollution episodes, and it’s really important to keep an eye on your health or any development of symptoms.”



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Air quality warnings are in effect for up to 100 million people in the US.

Thick smoke from Canadian wildfires to the north descended on New York this week, causing some to mask up. In some areas, people can smell the smoke in the air and the skies are hazy.

Air quality levels throughout the city are 'very unhealthy', according to the US government online platform AirNow, which also warned against outdoor activities.

An online calculator suggested breathing in the air in New York yesterday for 24 hours was equivalent to smoking six cigarettes.

Air pollution can cause breathing difficulties, as well as irritation to eyes, nose, throat and lungs. Long-term exposure to air pollution can result in chronic health issues such as severe asthma, preterm birth, heart disease, stroke, lung cancer, dementia and a lower IQ in children. 

Smog can be particularly bad for young children, older adults, pregnant women and those with asthma or other respiratory conditions

Smog can be particularly bad for young children, older adults, pregnant women and those with asthma or other respiratory conditions

The risk of respiratory infection is also increased due to the air pollution

The risk of respiratory infection is also increased due to the air pollution

Smoke originating from Canadian wildfires caused hazardous levels of air pollution across the Northeast. Pictured is a map showing Air Quality Index levels on Tuesday night. Purple areas are where levels were between 201 and 300. Red areas were between 151 and 200

Smoke originating from Canadian wildfires caused hazardous levels of air pollution across the Northeast. Pictured is a map showing Air Quality Index levels on Tuesday night. Purple areas are where levels were between 201 and 300. Red areas were between 151 and 200

Smog can be particularly bad for young children, older adults, pregnant women and those with asthma or other respiratory conditions. The risk of respiratory infection is also increased.

The Environmental Protection Agency uses the Air Quality Index on AirNow to report air quality. 

It varies from zero to over 300, with levels 50 and below thought to be the healthiest. 

When levels go above 150, the general population may start to experience symptoms.

Today's air quality in New York City is 170, which is deemed 'unhealthy'.

Inhaling this for 24 hours is the same as smoking almost five cigarettes, the online calculator claimed.

It works by using PM 2.5 particle concentration — the number of particles in the air that are a certain size.

The health impact of a particle concentration of 22μg/m3 per 24 hours is equivalent to about one cigarette.

The monitor recommends that people with heart or lung disease, older adults, children and teens should reduce their exposure by avoiding strenuous outdoor activities, keeping outdoor activities short and thinking about moving physical activities indoors or rescheduling them.

Brady Scott, a fellow at the American Association for Respiratory Care, a professional organization for respiratory therapists, told NBC he advised that people stay indoors as much as possible and keep doors and windows closed.

People should do this even while exercising, as it causes stress on the lungs.

Those with asthma should watch their symptoms closely and make sure they have medications to hand.

Mr Scott said: 'People know their bodies really well. If they see some changes they believe are related to bad air, perhaps they need to contact a physician or advanced practice provider.'

Dr Purvi Parikh, an allergist and immunologist at the Allergy & Asthma Network, an advocacy group for people with asthma, allergies and related conditions, said that smoke can be especially bad for pregnant women as their lung capacity is already reduced due to their growing stomachs.

She also said that people should keep their homes well-ventilated, and those who need to go out can wear a mask or N95 respirator.

Dr Wynne Armand, a physician at Massachusetts General Hospital and associate director of the MGH Center for the Environment and Health, said people should not dust or mow the lawn when the air quality is low.

Burning candles or using a gas stove can also make it worse.

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Introduction

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world and is associated with increasing economic costs and social burdens.1,2 Although spirometry is the gold standard for the clinical measurement of COPD, it does not provide sufficient essential information on exacerbation, leading to worsening respiratory impairment and prognosis.3

Exacerbation of COPD decreases the quality-of-life, causes respiratory dysfunction, and adversely affects prognosis. Numerous studies have discussed exacerbation and risk factors. The prognostic factors of COPD vary between smoking status, degree of dyspnea, severity of airflow limitation, degree of emphysema, exercise tolerability, and physical inactivity.4–6 Recent reports have also described the impact of the neutrophil-lymphocyte ratio (NLR)7 and the existence of asthmatic components.8

The nutritional status of a patient has also been established as a prognostic factor for various chronic diseases.9 Since Japan and Western countries have entered the era of an unprecedented ultra-aging society,10 there has been a focus on nutritional status as a risk factor for chronic diseases, especially in elderly patients.11 For example, malnutrition is common in elderly patients with heart failure, with evidence showing that nutritional status is strongly linked to their prognosis.12

In 1980, Buzby et al suggested the concept of the prognostic nutritional index (PNI).13 Subsequently, Onodera et al proposed that PNI could be calculated easily using serum albumin level and total lymphocyte count and showed that the index was a risk indicator for postoperative complications and prognosis for patients undergoing gastrointestinal cancer surgery.14 Subsequent studies reported a relationship between PNI and clinical outcomes in various other malignant diseases.15–17

Nutritional status has also been reported to be a significant prognostic indicator in patients with COPD.18 Previously, the body mass index (BMI) was the health indicator mainly used to assess prognosis in COPD.19 It remains unclear, however, whether the PNI is related to COPD exacerbations and prognosis of elderly patients.

Therefore, the aim of the present study was to elucidate whether PNI was associated with exacerbation and to clarify the clinical value of assessing the immune-nutritional status in elderly patients with COPD.

Methods

Subjects

This prospective, observational study enrolled 139 subjects who presented to Chiba University Hospital from March 2014 to June 2019 for management of COPD. The subjects were required to meet all of the following inclusion criteria: (a) ≥ 40 years; (b) smoking history ≥ 10 pack-years; (c) COPD diagnosed or suspected to have COPD based on subjective symptoms/other findings/pulmonary function tests/imaging findings; (d) no history of acute exacerbation or hospitalization within 2 months. Exclusion criteria were any of the following: (a) obvious respiratory diseases other than COPD; (b) any malignancy within the past 3 years; (c) severe heart failure; (d) currently receiving oral systemic corticosteroids; (e) deemed unsuitable for inclusion by investigators for any other reason.

At enrollment, eight subjects were excluded for the following reasons: one never-smoked without a history of smoking; three with malignant neoplasms; one prescribed a steroid and an immunosuppressive agent; one with severe heart failure; and one with a tracheostomy. During the follow-up period, one subject was excluded as they decided to withdraw from participating in the study. 40 subjects were excluded by the end of follow-up due to discrepancies in each data set, such as a discontinuation of hospital visits, confirmation of worsening symptoms, COPD assessment test (CAT), pulmonary function tests, and chest CT scans. Finally, 91 subjects with COPD were enrolled in the study (Figure 1).

Figure 1 Flow chart of the study subjects.

The diagnosis of COPD was made comprehensively by respiratory specialists according to the recommendations of the American Thoracic Society (ATS) and European Respiratory Society (ERS),20 that included the subject’s smoking history, respiratory symptoms including dyspnea, cough and sputum, physical examination, spirometry results. Pulmonary function tests (PFTs) were performed using a Fudac-60 (Fukuda Denshi, Tokyo, Japan) and included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), which were expressed as their predicted values based on the Japanese Respiratory Society (JRS) guidelines.21 The subjects underwent a CAT, PFTs, laboratory tests, and multidetector computed tomography (MDCT) at the time of enrollment. The CAT is a simple tool for comprehensively evaluating the clinical symptoms of subjects with COPD,22,23 and consists of eight items rated on a scale of 0 to 5, and is an excellent indicator for assessing respiratory and extrapulmonary symptoms.

This study was conducted in accordance with the Declaration of Helsinki. The Ethics Committee of the Chiba University School of Medicine approved the study protocol (approval number, 857). Written, informed consent was obtained from all the study subjects.

Calculation of the Prognostic Nutritional Index

As an immune-nutritional index, the PNI was calculated as follows, in accordance with the original description of Onodera et al14 10 x serum albumin level (g/dL) + 0.005 x total lymphocyte count (×103/μL). Originally, the PNI was used to assess surgical risk for gastrointestinal malignancies, with a resection anastomosis contraindicated in subjects with PNI values ≤ 40.

MDCT Scanning and CT Measurements of Low Attenuation Volume

All CT studies were performed on a 64-MDCT Aquilion ONE and Aquilion PRIME (Canon Medical Systems, Otawara, Tochigi, Japan) at full inspiration, with no contrast medium being used. The CT parameters used were as follows: collimation 120kV; CT-AEC; gantry rotation time, 0.5s; and beam pitch, 0.70–0.83. All the images were reconstructed using standard reconstruction algorithms, with a slice thickness of 0.5 mm and a reconstruction interval of 0.5 mm. The reconstructed CT images were transferred to a commercial workstation (Ziostation2, Ziosoft Ltd., Tokyo, Japan). Total lung volume (LV) and low attenuation volume (LAV) were measured based on a threshold of −950 Hounsfield units (HU). LAV% was calculated as 100%×LAV/LV.24

Clinical Events

We investigated the clinical events during a two-year observation period. The clinical events were identified as COPD exacerbations. An exacerbation was defined as a worsening of COPD requiring a change in therapy, the use of antibiotics or steroids, and/or hospital admission.25

Statistical Analysis

The results were expressed as means ± standard deviation (± SD) or as medians (interquartile range [IQR]) as appropriate. Categorical data were expressed as the number (%). After confirming the normality of the study parameter data, the correlations between PNI and CAT, and LAV%, and FEV1%pred were assessed by Spearman rank correlation analysis, as appropriate. For clinical outcome, comparisons between the subject groups with or without an exacerbation requiring treatment changes were performed using the Mann–Whitney U-test for continuous variables and the chi-square test or Fisher exact test for categorical variables.

For the selection of variables in the multivariate analysis, we used those that showed a causal relationship with COPD exacerbations based on previous reports7,25–27 and those that were significant in our univariate analysis. The association of selected variables with clinical outcome was assessed by univariate logistic regression analysis, and significant variables in this analysis then entered into a multivariate logistic regression analysis.

The variables selected were age, CAT as a comprehensive indicator of subjective symptoms, NLR as an indicator of the level of inflammation, PNI as an indicator of nutrition and immunity, FEV1% pred as an indicator of airflow limitation to measure disease severity, and LAV% as an imaging indicator to determine the degree of emphysema. In accordance with previous reports, CAT was treated as a continuous variable in the analysis.28,29

In the group with subjects aged > 75 years, we also calculated the areas under the receiver operating curve (ROC) analysis for using PNI and CAT to predict COPD exacerbation, with the optimal cut-off of the PNI and CAT determined by the Youden index. In addition, based on Akaike’s information criterion,30 we examined whether PNI improved the predictive accuracy of the analytical model for exacerbations in the elderly group. The original model was constructed with items that were significant in the univariate analysis. A statistically significant increase in the global chi-square of the model was interpreted as indicating an increase in prognostic value.31,32 All the statistical analyses were performed by JMP Pro version 14.0 software (SAS Institute, Cary, NC, USA). For all the statistical analyses, the level of significance was set at p <0.05.

Results

Subject Characteristics

The clinical characteristics of all the subjects are presented in Table 1.

Table 1 Characteristics of the Total Subjects (Comparison of the Group Aged<75 Years vs the Group Aged ≧75 Years)

In the total subjects (n=91), 34 subjects were aged ≥75 years (33 males and 1 female; mean age, 78.3 ± 3.2 years) and 57 subjects were aged < 75 years (54 males and 3 females; mean age, 67.2 ± 6.2 years). There were no differences between the two groups for sex, body weight, height, BMI, and CAT score. For the pulmonary function tests, VC and FVC were lower in subjects ≥75 years than in those aged <75 years. LAV% in the group aged ≥75 years was also lower than that measured in subjects <75 years. For nutritional status, there was no significant difference in PNI between the two groups, although albumin was slightly lower in the group aged ≥75 years. An exacerbation occurred in 21 of 57 of the younger subjects (36.8%) compared to 10 of the 34 older subjects (29.4%). The median duration of follow-up was 735 days.

Comparisons of the clinical indices in subjects aged ≥75 years with or without an exacerbation are shown in Table 2. In the exacerbation group, the CAT score was significantly higher and PNI was significantly lower compared to those measured in the non-exacerbation group. The serum albumin levels were also significantly different between the two groups.

Table 2 Characteristics of COPD Subjects in the Group Aged ≧75 Years (Comparison of the Exacerbation and Non-Exacerbation Groups)

Comparisons of the clinical indices in subjects aged <75 years with or without an exacerbation are shown in Table 3. In the exacerbation group, the CAT score, LAV%, WBC count, and neutrophil count were significantly higher than those measured in the non-exacerbation group. The BMI was significantly lower in the exacerbation group than in the non-exacerbation group. Obstructive impairment was also significantly more severe in the exacerbation group compared to that observed in the non-exacerbation group.

Table 3 Characteristics of COPD Subjects in the Group Aged <75 Years (Comparison of the Exacerbation and Non-Exacerbation Groups)

Associations Between the Prognostic Nutritional Index and Airflow Limitation and Pulmonary Emphysema

The associations between the PNI and other clinical indices in the entire cohort of subjects are shown in Figure 2. The PNI showed no significant association with CAT (r= −0.20, p=0.06). Similarly, there was no significant correlation between PNI and either FEV1%pred (r= 0.03, p=0.78) or LAV% (r=0.03, p= 0.75).

Figure 2 The relationship between PNI and CAT and FEV1%pred and LAV% in all the subjects.

Abbreviations: PNI, prognostic nutritional index; CAT, COPD assessment test; FEV1, forced expiratory volume in one second; LAV%, low attenuation volume percentage.

Notes: The associations between the PNI and other clinical indices are shown for the entire cohort of subjects (n=91).

Clinical Factors Associated with Exacerbation Events

The results of the univariate and multivariate analyses for exacerbation in the two groups grouped according to age are shown in Table 4 and Table 5.

Table 4 Results of the Logistic Analysis of COPD Exacerbation in the ≧75 Year Age Group

Table 5 Results of the Logistic Analysis of COPD Exacerbation in the<75 Year Age Group

In the group aged ≥75 years, univariate analysis showed that CAT (OR = 1.15, 95% CI = 1.03–1.29, p = 0.013), NLR (OR=1.70, 95% CI=1.01–2.86, p =0.046), and PNI (OR = 0.74, 95% CI =0.58–0.96, p = 0.023) were associated significantly with exacerbation. Multivariate analysis identified CAT as an independent factor for exacerbation (OR = 1.15, 95% CI = 1.00–1.33, p = 0.047), while PNI showed a trend of being associated with exacerbation (OR = 0.73, 95% CI =0.52–1.02, p = 0.063).

ROC curve analysis was performed for the group ≥75 years of age to evaluate the accuracy of CAT and PNI and to identify the value of the cut-off points. ROC curve analysis in the group ≥75 years of age demonstrated that the optimal cut-off values for CAT and PNI to predict events were 14.0 (sensitivity, 0.80; 1-specificity, 0.21; area under the curve [AUC], 0.79; Figure 3a) and 48.85 (sensitivity, 0.90; 1-specificity, 0.33; AUC, 0.82; Figure 3b), respectively.

Figure 3 Receiver operating characteristic curve (ROC) analysis of CAT and PNI in the group ≥75 years of age.

Abbreviations: PNI, prognostic nutritional index; CAT, COPD assessment test.

Notes: ROC curve analysis was used to evaluate the sensitivity and specificity of CAT (a) and PNI (b) for COPD exacerbation in the group ≥75 years of age. (n=34).

In the group aged <75 years, univariate analysis showed that CAT (OR = 1.083, 95% CI = 1.00–1.17, p= 0.038), FEV1% pred (OR = 0.957, 95% CI = 0.931–0.986, p = 0.003) and LAV% (OR = 1.077, 95% CI = 1.032–1.123, p = 0.0007) were associated significantly with exacerbation. Multivariate analysis identified LAV% as an independent factor for exacerbation (OR = 1.074, 95% CI = 1.003–1.149, p = 0.031).

Incremental Value of the PNI in Elderly Subjects with COPD

The incremental value of the PNI in the group ≥75 years of age is shown in Figure 4. CAT was selected as the conventional variable for the prognostic model from Table 4 (Model 1). The addition of PNI to the conventional variable significantly improved the prognostic utility of the model (Model 2, p = 0.0084).

Figure 4 The incremental benefit of adding PNI to the CAT, to predict exacerbation events in the group ≥75 years of age.

Abbreviations: CAT, COPD assessment test; PNI, prognostic nutritional index.

Notes: Model 1, based on CAT, was improved significantly by the addition of the PNI (model 2) in the group ≥75 years of age (n=34).

Discussion

The key findings of this study were as follows. There were differences in factors related to COPD exacerbations between subjects aged ≥75 years and those aged < 75 years. High CAT values were associated with exacerbation in elderly subjects with COPD, while a combined model of CAT and PNI more accurately predicted COPD exacerbations. In other words, a low PNI in combination with a high CAT increased the risk of an exacerbation in elderly subjects with COPD.

The PNI was calculated using serum albumin levels and the total circulating lymphocyte count. The PNI score has been validated and reported to correlate significantly with subjective global assessment (SGA), a well-established nutritional index and also other nutritional screening tools.33–35 While the SGA is a simple, inexpensive, and quick assessment, it is a subjective assessment that requires skill and experience. In contrast, the PNI is based on the results of peripheral blood tests, thereby allowing a physician to easily and objectively assess the immune-nutritional status of their patients.

Many earlier studies have described that nutrition and immune status are associated closely with tumor progression and prognosis. The PNI reflects both the nutritional and immunological status of patients with a variety of malignancies.36,37 In the respiratory field, the PNI of pretreatment in patients with non-small cell lung cancer has been shown to have prognostic value.38 Recently, it was reported that a lower PNI at the time of admission was related to the risk of mortality in subjects with severe COVID-19.39,40 Regarding chronic respiratory diseases, the present study has shown that the PNI score raised the risk of exacerbation in elderly with COPD.

The CAT is a simple tool for comprehensive evaluation of the clinical symptoms in COPD patients.22 The CAT consists of eight items and is an excellent indicator for assessing respiratory symptoms, such as cough, phlegm, and dyspnea associated with exercise, and extra-pulmonary symptoms, such as activity, insomnia, and energy level. The CAT scores were increased by greater than five points during exacerbations.26 In the present study, the PNI was not associated with CAT in all the subjects. Yoshikawa et al reported that nutritional status using the Mini-nutritional Assessment Short-form predicted COPD exacerbations independently of CAT.41 The present study also showed no significant relationship between PNI and either FEV1%pred and low attenuation volume percentage (LAV%). These findings might indicate that PNI may be an independent predictor from CAT, the degree of obstructive impairment, and emphysema, which have conventionally been reported as predictive factors.42

A cut-off value of 40 for the PNI has been proposed for perioperative evaluation of gastrointestinal cancers.14 In the current study, the cut-off value for PNI for the presence of exacerbations in subjects aged ≥ 75 years was set at 48.85, a value higher than that used for other diseases. A prognostic pretreatment cut-off of 45.5 was used for lung cancer patients receiving immune checkpoint inhibitors.43 Recently, a lower cut-off value of 33 was used for survival in patients with severe COVID-related pneumonia.39 Since COPD is a gradually progressive disease, the serum albumin levels and lymphocyte counts were obtained at the time of consultation, and we speculate that this may be one of the reasons for the higher cut-off values compared to those used for other diseases. Therefore, patients with COPD should be cautioned against exacerbations even if the initial PNI value is higher than previously reported for other diseases.

In the group aged < 75 years, the conventional variables, such as emphysema and the degree of airflow limitation, contributed to exacerbations.25 Most previous studies have focused on relatively young to middle-aged patients, with only a minority carried out in older subjects.44

In the present study we identified prognostic factors for elderly subjects and showed that the complex of subjective symptom scores and immune-nutritional status contributed more to exacerbations than the severity of COPD. The prognosis of elderly patients with chronic diseases is not necessarily determined by the severity of the underlying disease.45 Poor nutritional status is associated with a poor prognosis and exercise intolerance in elderly patients with COPD.41,46 More severe subjective symptoms are associated with a worse prognosis.22 We propose that the combination of CAT and PNI would allow assessment of the risk of exacerbation more accurately in elderly patients with COPD.

Serum albumin level is a conventional marker of nutrition and has been reported to be associated with a poor outcome in many different diseases. On the other hand, the NLR is a reliable indicator of systematic inflammation and has also been investigated as a diagnostic and prognostic marker in COPD.47 Chronic inflammation causes recruitment of the main white blood cell populations, neutrophils and lymphocytes. These factors participate actively in the pathophysiological mechanisms of COPD. A higher NLR has been reported widely to be associated with poor survival in patients with various diseases.48,49 However, the NLR only reflects the inflammation status. In recent studies, the PNI was shown to be superior to the NLR as a prognostic marker in many cancer patients.36,50 PNI as a nutrition plus immunity indicator may therefore be more useful in the evaluation of COPD than either nutrition or immunity alone.

There has been a focus on the role of the asthma-COPD overlap (ACO), including eosinophilia in COPD, and the impact of asthmatic components on the clinical course of COPD.51 Recent studies have reported that eosinophilia in COPD does not affect the clinical course, however, this view is controversial.52 The present study also showed no relationship between eosinophilia and clinical outcome. In recent years, the clinical significance of personalized treatment in COPD has been proposed, with some studies showing that appropriate treatment, such as triple therapy in patients with asthmatic components, decreases symptoms and the risk of exacerbations, thereby contributing to an improved clinical course.53

Limitations

Our study had some limitations. First, the study only enrolled a relatively small number of subjects and was a preliminary and exploratory investigation conducted at a single institute. Second, the observational period was relatively short. Third, because of the small number of subjects we could not fully evaluate the differences in gender, each treatment, or the rate of smoking cessation. Fourth, we could not perform nutritional intervention. Nutritional intervention may be important for preventing COPD exacerbations, especially in elderly patients.54 And finally, previous papers reporting an association between PNI and prognosis used unadjusted multivariate analyses.43,45 The present study also performed unadjusted multivariate analysis of each item. However, this was a single-center, small-group, exploratory study and therefore a larger cohort is needed to confirm the results of the current study that would also require more rigorous examination and exclusion of confounding factors. Further prospective studies on larger study populations and a longer observational period are therefore required to confirm our results.

Conclusions

In elderly subjects with COPD, CAT was associated significantly with the risk of COPD exacerbation, with PNI also a potential predictor. The combined assessment of CAT and PNI may be a useful prognostic tool in patients with COPD.

Abbreviations

BMI, body mass index; CAT, chronic obstructive pulmonary disease assessment test; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; FEV1/FVC, forced expiratory volume in 1 second per forced vital capacity; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Pulmonary Obstructive Lung Disease; ICS, inhaled corticosteroid; LAA, low attenuation area; LABA, long-acting β-2 agonist; LAMA, long-acting muscarinic antagonists; LAV, low attenuation volume; LAV%, low attenuation volume percentage; LV, lung volume; MDCT, multi-detector row computed tomography; MRI, magnetic resonance imaging; NLR, neutrophil-to-lymphocyte ratio; PFT, pulmonary function testing; PNI, prognostic nutritional index; TLA, total lung area; VC, vital capacity; %VC, vital capacity percentage; WBC, white blood cell.

Data Sharing Statement

The data sets analyzed during the current study are available from the corresponding author upon reasonable request.

Acknowledgment

The abstract of this paper was presented at the 2020 European Respiratory Society (ERS) International congress in session “Respiratory viruses in the”pre-COVID-19 “era”, with interim findings. The poster’s abstract was published in “Poster Abstracts” in European Respiratory Journal 2020; 56: Suppl. 64, 5114. erj.ersjournals.com/content/56/suppl_64/5114.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

This research was partially supported by the Ministry of Education, Science, Sports and Culture, Grant-in-Aid for Scientific Research (C) (19K12816 and 22K12836), and the Chiba Foundation for Health Promotion & Disease Prevention (No.1272). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosure

The author reports no conflicts of interest in this work.

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22. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34(3):648–654. doi:10.1183/09031936.00102509

23. Kwon N, Amin M, Hui DS, et al. Validity of the COPD assessment test translated into local languages for Asian patients. Chest. 2013;143(3):703–710. doi:10.1378/chest.12-0535

24. Shimada A, Kawata N, Sato H, et al. Dynamic quantitative magnetic resonance imaging assessment of areas of the lung during free-breathing of patients with chronic obstructive pulmonary disease. Acad Radiol. 2022;29(Suppl 2):S215–S225. doi:10.1016/j.acra.2021.03.034

25. Tanabe N, Muro S, Hirai T, et al. Impact of exacerbations on emphysema progression in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2011;183(12):1653–1659. doi:10.1164/rccm.201009-1535OC

26. Mackay AJ, Donaldson GC, Patel AR, Jones PW, Hurst JR, Wedzicha JA. Usefulness of the chronic obstructive pulmonary disease assessment test to evaluate severity of COPD exacerbations. Am J Respir Crit Care Med. 2012;185(11):1218–1224. doi:10.1164/rccm.201110-1843OC

27. Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57(10):847–852. doi:10.1136/thorax.57.10.847

28. Lim JU, Kim EK, Lim SY, et al. Mixed phenotype of emphysema and airway wall thickening is associated with frequent exacerbation in chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis. 2019;14:3035–3042. doi:10.2147/copd.S227377

29. Huang Y, Ding K, Dai Z, et al. The relationship of low-density-lipoprotein to lymphocyte ratio with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2022;17:2175–2185. doi:10.2147/copd.S369161

30. Akaike H. A new look at the statistical model identification. IEEE Trans Autom Control. 1974;19(6):8. doi:10.1109/TAC.1974.1100705

31. Mochizuki Y, Tanaka H, Matsumoto K, et al. Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus. Cardiovasc Diabetol. 2015;14:37. doi:10.1186/s12933-015-0201-8

32. Xu B, Kawata T, Daimon M, et al. Prognostic value of a simple echocardiographic parameter, the right ventricular systolic to diastolic duration ratio, in patients with advanced heart failure with non-ischemic dilated cardiomyopathy. Int Heart J. 2018;59(5):968–975. doi:10.1536/ihj.17-475

33. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status?. JPEN J Parenter Enteral Nutr. 1987;11(1):8–13. doi:10.1177/014860718701100108

34. Hu Y, Yang H, Zhou Y, et al. Prediction of all-cause mortality with malnutrition assessed by nutritional screening and assessment tools in patients with heart failure: asystematic review. Nutr Metab Cardiovasc Dis. 2022;32(6):1361–1374. doi:10.1016/j.numecd.2022.03.009

35. Zhang Q, Qian L, Liu T, et al. Prevalence and prognostic value of malnutrition among elderly cancer patients using three scoring systems. Front Nutr. 2021;8:738550. doi:10.3389/fnut.2021.738550

36. Mirili C, Yılmaz A, Demirkan S, Bilici M, Basol Tekin S. Clinical significance of prognostic nutritional index (PNI) in malignant melanoma. Int J Clin Oncol. 2019;24(10):1301–1310. doi:10.1007/s10147-019-01461-7

37. Ge K, Fang C, Zhu D, et al. The prognostic value of the Prognostic Nutritional Index (PNI) in radically resected esophagogastric junction adenocarcinoma. Nutr Cancer. 2021;73(11–12):2589–2596. doi:10.1080/01635581.2020.1841252

38. Matsubara T, Takamori S, Haratake N, et al. The impact of immune-inflammation-nutritional parameters on the prognosis of non-small cell lung cancer patients treated with atezolizumab. J Thorac Dis. 2020;12(4):1520–1528. doi:10.21037/jtd.2020.02.27

39. Wei W, Wu X, Jin C, et al. Predictive significance of the Prognostic Nutritional Index (PNI) in patients with severe COVID-19. J Immunol Res. 2021;2021:9917302. doi:10.1155/2021/9917302

40. Liu G, Zhang S, Mao Z, Wang W, Hu H. Clinical significance of nutritional risk screening for older adult patients with COVID-19. Eur J Clin Nutr. 2020;74(6):876–883. doi:10.1038/s41430-020-0659-7

41. Yoshikawa M, Fujita Y, Yamamoto Y, et al. Mini Nutritional Assessment Short-Form predicts exacerbation frequency in patients with chronic obstructive pulmonary disease. Respirology. 2014;19(8):1198–1203. doi:10.1111/resp.12380

42. Shimizu K, Tanabe N, Tho NV, et al. Per cent low attenuation volume and fractal dimension of low attenuation clusters on CT predict different long-term outcomes in COPD. Thorax. 2020;75(2):116–122. doi:10.1136/thoraxjnl-2019-213525

43. Shoji F, Takeoka H, Kozuma Y, et al. Pretreatment prognostic nutritional index as a novel biomarker in non-small cell lung cancer patients treated with immune checkpoint inhibitors. Lung Cancer. 2019;136:45–51. doi:10.1016/j.lungcan.2019.08.006

44. Beauchamp MK, Ellerton C, Kirkwood R, et al. Feasibility of a 6-month home-based fall prevention exercise program in older adults with COPD. Int J Chron Obstruct Pulmon Dis. 2021;16:1569–1579. doi:10.2147/copd.S309537

45. Kawata T, Ikeda A, Masuda H, Komatsu S. Changes in prognostic nutritional index during hospitalization and outcomes in patients with acute heart failure. Heart Vessels. 2022;37(1):61–68. doi:10.1007/s00380-021-01888-x

46. Matsumura T, Mitani Y, Oki Y, et al. Comparison of Geriatric Nutritional Risk Index scores on physical performance among elderly patients with chronic obstructive pulmonary disease. Heart Lung. 2015;44(6):534–538. doi:10.1016/j.hrtlng.2015.08.004

47. Pascual-Gonzalez Y, Lopez-Sanchez M, Dorca J, Santos S. Defining the role of neutrophil-to-lymphocyte ratio in COPD: a systematic literature review. Int J Chron Obstruct Pulmon Dis. 2018;13:3651–3662. doi:10.2147/COPD.S178068

48. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6–e12. doi:10.1016/j.jinf.2020.04.002

49. Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review. J Surg Oncol. 2017;115(4):470–479. doi:10.1002/jso.24523

50. Wang J, Liu Y, Mi X, Shao M, Liu L. The prognostic value of prognostic nutritional index (PNI) and neutrophil to lymphocyte ratio (NLR) for advanced non-small cell lung cancer treated with platinum-based chemotherapeutics. Ann Palliat Med. 2020;9(3):967–978. doi:10.21037/apm.2020.04.31

51. Leung JM, Sin DD. Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets. BMJ. 2017;358:j3772. doi:10.1136/bmj.j3772

52. Suzuki M, Makita H, Ito YM, Nagai K, Konno S, Nishimura M. Clinical features and determinants of COPD exacerbation in the Hokkaido COPD cohort study. Multicenter study observational study research support, Non-U.S. Gov’t. Eur Respir J. 2014;43(5):1289–1297. doi:10.1183/09031936.00110213

53. Park SY, Kim S, Kim JH, et al. A randomized, noninferiority trial comparing ICS + LABA with ICS + LABA + LAMA in asthma-COPD overlap (ACO) treatment: the ACO Treatment with Optimal Medications (ATOMIC) study. J Allergy Clin Immunol Pract. 2021;9(3):1304–1311.e2. doi:10.1016/j.jaip.2020.09.066

54. Sugawara K, Takahashi H, Kasai C, et al. Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD. Respir Med. 2010;104(12):1883–1889. doi:10.1016/j.rmed.2010.05.008

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A version of this story was originally published by 100 Days in Appalachia.

A 45-minute drive northwest of Asheville, Hot Springs, North Carolina, is an iconic Appalachian Trail town – in fact, the trail weaves through the heart of downtown. Hot Springs is rarified air in a Blue Ridge Mountain valley, open-armed, embracing. 

But as the temperature rises on a mid-June Saturday morning, in the back parking lot of the Dollar General, corner of Bridge and Lance, a litany of interactions is conducted with utmost discretion.

Ainsley Bryce is here, as she or a colleague is each Saturday morning, to distribute life-saving assets. Bryce has arrived well-stocked. The free items she offers are numerous:

  • Syringes, naloxone, fentanyl test strips, Covid-19 test kits, saline, vitamin C, Band Aids…
  • Cotton, condoms, Epsom salt, soap, antibiotic ointment, Tegaderm, medicated patches…
  • Gauze, sharps containers, Pedialyte, heating pads, alcohol, gum, lip balm.

Bryce can also provide information, referrals, a smile, a hug, non-judgment, and kindness.

Bryce is the director of Holler Harm Reduction, based 15 meandering-mountain miles southeast in Marshall, a town of just under 1,000 tucked into the eastern bank of the French Broad River.

Though these interactions are entirely legal, discretion is wise. Most of the folks visiting Bryce are, after all, in active drug use; they’d prefer to remain unobserved by law enforcement and the judging eyes of the community. Many struggle with shame. Among Bryce’s objectives is easing it.

Every Saturday, people from Newport, Tennessee, where a syringe exchange program was shut down, drive 25 miles to Hot Springs to receive supplies from Holler. (Photo by Stacy Kranitz)

Jared, 35, is a resident of Newport, Tennessee, 25 miles northwest of Hot Springs. He’s carpooled down this morning with several members of his immediate community, folks he refers to as brothers and sisters. He found his dad hanging in the backyard at age 19 and began self-medicating with drugs soon after. “I thought, ‘Well if I do some kind of drug, it will erase that vision in my head.’ But it didn’t.” He began injecting at 22 and has since.

Asked what it would take to quit, he says, “I wish I knew. … A lot of support. A lot of support.”

The numbers are now frighteningly familiar: More than a million Americans died from a drug overdose in the past two decades. More than 100,000 of those deaths came in 2021, in the middle of a global health crisis.

Americans are now more likely to die of an accidental opioid overdose than in a car accident. But cars would kill 15,000 more people a year were it not for seatbelts – something required by the federal government to be placed in every new car since 1968. 

Seatbelts, helmet laws and airbags are what are known as harm reduction strategies. They reduce the negative consequences of risky behavior and have been almost universally accepted in the U.S. as ways to save lives.

For decades, drug policy experts have recommended that we embrace the seatbelts of drug use: overdose-reversing medicine like naloxone, kits that make it easy to test drugs for fentanyl – a synthetic opioid estimated to be up to 50 times stronger than heroin and now found in everything from methamphetamine to weed and crushed into pills – and clean syringes that reduce the spread of deadly diseases associated with intravenous drug use. 

Joe Biden is the first president to embrace harm reduction as an essential part of the nation’s drug policy. He put $30 million into the American Rescue Plan to support community-based overdose prevention programs, syringe services programs and other harm reduction services. Last May, the Department of Health and Human Services promised $1.5 billion for state and local initiatives to combat addiction, including harm reduction services.

Harm reduction doesn’t abet drug use, says Judith Feinberg, a professor of infectious diseases and behavioral medicine at West Virginia University. “It’s about reducing the attendant harms of drug use, supporting people in the community and trying to keep them alive and healthy.”

“If you’re not breathing,” Feinberg says, “you’re not getting into recovery.”

A Godsend

Newport is home to most of those who’ve traveled here today. Choice Health Network used to operate a syringe exchange in Newport, but the owner of the property on which it was held rented it to someone who doesn’t support harm reduction. Holler is now the closest option. And for these folks, it’s a godsend.

Business is brisk this morning. Bryce dispenses her wares from the back of her truck. Folks linger a while to chat. Many are her regulars and now friends. By the end of the day, she will have handed out more than 2,000 syringes.

Jack, 44, of Del Rio, just outside Newport, found Holler on the internet and connected his community. (Jack’s name and the names of other active drug users in this story have been changed to protect their privacy.) 

“Thank god for these people,” he says. Jack lost his wife to an overdose; she died on the bed beside him. He believes his drug use is now manageable and takes every possible safety precaution. He rises each morning and heads to work. 

Save A Life Day was organized by SOAR across all 55 counties in West Virginia. Corbin Parker takes boxes of Naloxone and Fentanyl test strips. (Photo by Stacy Kranitz)

“The science is conclusive,” harm reduction services save lives, says Feinberg’s WVU colleague Robin Pollini, a substance misuse and infectious disease epidemiologist. Research shows that naloxone access laws have resulted in a 14% decrease in opioid overdose deaths nationwide. And a Seattle study of people who used injection drugs found that new participants in a syringe exchange program were five times more likely to enter treatment than those who weren’t in the program.

Syringe service programs are also proven to reduce transmission of HIV and hepatitis C.

Notably, some of the best data we have on just how effective harm reduction can be was facilitated by former Vice President Mike Pence. In 2015, rural Scott County, Indiana, was experiencing one of the worst recorded outbreaks of HIV among injection drug users – an incidence rate more than 50 times the national average. Then-Governor Pence reluctantly approved the state’s first syringe exchange program. 

A team of epidemiologists worked with Scott County’s department of health on a study gathering local data and found that discontinuing the program would result in an increase in HIV infections of nearly 60%. Nevertheless, in 2021, local officials voted to shutter it. 

Central Appalachia has suffered disproportionately from our crisis of addiction. But over the past five years, politicians throughout the region have put policies in place that counter the research in addiction science, limiting communities from implementing proven policies. 

Choice Health Network runs a syringe service program in Knoxville, TN. Several times a month they bring supplies to an unhoused encampment in downtown Knoxville. Greg Stafford, the ourtrach RN, assists a client with supplies.

Meanwhile, nationwide, the promise of a new era of drug policies is being countered with conservative backlash – this despite the fact that it was Republicans, including Kentucky Senator Mitch McConnell, who advocated in 2016 to remove a federal ban on funding for syringe exchanges

Heightened hysteria took root in 2022 when conservative media ran with a story that the government planned to use American Rescue Plan money to “distribute crack pipes.” Though research indicates glass pipe exchange is a solid harm reduction strategy, the Biden administration’s flat-footed response to the stigmatizing report ignited a media firestorm. During the ensuing outrage, Senator Joe Manchin – a Democrat from West Virginia, the state with the nation’s highest rate, by far, of fatal overdoses – joined with Republican Senator Marco Rubio to introduce a bill prohibiting the use of federal funds for syringe and other exchange services

‘Regardless of Anything’

Holler Harm Reduction operates on a tight budget: one grant through AIDS United, another from an Asheville-based health trust. They haven’t applied for a grant through the federal Substance Abuse and Mental Health Services Administration. With a staff of three, two of whom are part time, they just don’t have the resources to slog through the federal application process, Bryce says. 

Meanwhile, they experienced a 4,000% increase between April 2021 and April 2022 in the number of people they serve, partly due to the closure of the syringe exchange in Newport, but also to growing awareness that their services are available. 

In addition to scheduled drop-in days, they deliver supplies anywhere in the county, assisted by a few people in active drug use who extend Holler’s reach. 

Bridget, 33, is among them. She lives outside the town of Mars Hill with her boyfriend and a menagerie that includes her goats – Big Dote, Alice (because he looks like Alice Cooper) and Wenne (Wednesday Adams and Winifred Sanderson mashed together) – on a peaceful plot of land in a snug valley.

Bridget, 33, grew up around addiction. Today, she lives outside the western North Carolina town of Mars Hill with her boyfriend and a menagerie that includes her goats – Big Dote, Alice (because he looks like Alice Cooper) and Wenne (Wednesday Adams and Winifred Sanderson mashed together) – on a peaceful plot of land in a snug valley. (Photo by Stacy Kranitz)

Bridget grew up around addiction. “My dad, that’s all he wanted was a needle,” she says. “He picked it over me and picked prison over me for years.” 

She was diagnosed with ADHD as a kid, and she self-medicates the disease. She says small doses of meth allow her to function. “I could put it down, but I’d have to really want to put it down.” For now, she doesn’t. Bryce says she’s a careful user. “She really takes care of herself.”

“They’re my friends,” Bridget says of Bryce and Holler coworker Alonza Lasher. “They’ve pulled me out of places that I’d been stuck in for a long time.” They listen to her and answer her questions. “I like to ask questions. I want to know it all.”

Fifty-five-year-old Daisy also provides outreach. She tried cocaine at 18 – “Scared the devil out of me” – and then nothing more till she was 42, in the course of a very bad year in which she got divorced and lost custody of her kids. She was suddenly alone. Then it was “cocaine, methamphetamine, pills” to cope with the overwhelming sense of loss.

Daisy overdosed on heroin three times in August 2012, was in recovery for five years, then started using again after contracting lung cancer. She no longer injects, but she smokes meth. “I don’t get high anymore. It’s more like just maintaining the feeling of being okay.”

Daisy plays an important role in Holler’s network: She’s a link to people otherwise unlikely to find their services. She takes in young people who have no place to go. “If they need somewhere to lay down, they sleep at my house – and if they need food or a shower or whatever.” She brings home Holler’s supplies and hopes that with her small interventions she might change the course of someone’s life. 

“It’s wrong for somebody who’s making bad decisions when they’re young to have to deal with it for a lifetime when you can give them what they need to be safe, and hopefully get out of it and move on,” Daisy says.

Daisy, 55, did a shot of cocaine at 18 – “Scared the devil out of me” – and then nothing more until she was 42, in the course of a very bad year that her marriage ended and she lost custody of her children. She used drugs she says to cope with the overwhelming loss. Now she says her drug use never actually gets here high, but is largely just to keep withdraw symptoms at bay. (Photo by Stacy Kranitz)

Back at the Holler office (just a couple doors down from Madison County Republican Party headquarters), Lasher reflects on how so many of their participants “come to us carrying so much shame.” She and Bryce assure them, “You deserve an unused syringe, you deserve wound care, you deserve a friendly ear and love and support, regardless of anything.”

“And when they get that,” Lasher says, “it may be the first time anybody’s ever extended it to them.”

‘On My Heart’

There are encouraging signs in the region of growing acceptance of at least some harm reduction measures. 

In Tennessee, legislation went into effect in July 2022 that allows health care providers and community groups to distribute naloxone under standing orders. The hope is that this will make naloxone much more accessible in rural communities. 

But advocates argue Appalachian communities must be more proactive.

Syringe exchange efforts have been stymied in West Virginia by changes to local laws. HIV continues to spread throughout Kanawha County, even after a 2021 Centers for Disease Control investigation called it the most concerning HIV outbreak in the country, warning that the reported numbers could be just “the tip of the iceberg.” Research indicates that the closure of syringe exchange programs will result in an increase in HIV infections

As epidemiologist Robin Pollini put it, the “science is conclusive.” And, she added, “What the science also tells us is that when you open these programs, it does not result in an increase in syringe litter or a rise in crime.”

Judith Feinberg is “terrified that we won’t have the humanity and the generosity of spirit and the political will to see that this is somebody’s mother, somebody’s brother, somebody’s uncle, somebody’s son and daughter.”

On that day in Hot Springs, North Carolina, Nicole, 27, is Holler’s last arrival. She’s traveled over from Newport. Having gathered her supplies, she’s sharing with Bryce her hopes of soon entering treatment.

“Three months ago,” Nicole says, “this wasn’t in my heart. You couldn’t have made me stop if you wanted to. But it’s on my heart so strong.” 

Nicole isn’t sure where she’ll sleep tonight. Bryce urges her to be safe. 

“It’s good to see you,” Bryce tells her. “Can I give you a hug before you go? Thanks for coming, dear.”

Nicole knows where to find her.

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Introduction

Patients with chronic obstructive pulmonary disease (COPD) report high levels of anxiety symptoms, and anxiety disorders (eg, panic disorder, generalized anxiety disorder, social anxiety disorder) are among the most prevalent psychiatric comorbidities in patients with COPD.1–3 Clinically relevant anxiety symptoms in patients with COPD are often unidentified and therefore not managed; and potential anxiety disorders are underdiagnosed and therefore not adequately treated.4 A review of the literature from 1994 to 2009 shows that the estimated prevalence of anxiety symptoms and anxiety disorders among patients with COPD varies markedly across existing studies (6–74%),5 potentially due to difficulties in differentiating between symptoms of COPD and symptoms of anxiety.6

For patients in general, anxiety is a natural, adaptive psychophysiological response to a real or perceived threat, which is experienced as passing emotional states that the patient feels capable of coping with alone or with social support from significant others.7 However, for many patients with COPD, symptoms of anxiety are persistent over a longer period of time and can be associated with maladaptive behaviors, such as avoidance of activities that are expected to trigger dyspnea.8–10 This can lead to isolation, deconditioning, symptom progression, and reduced quality of life and eventually result in the development of an anxiety disorder, per se.1,11

Furthermore, COPD is associated with social and economic disadvantage,12 and patients with COPD often suffer from multiple comorbid diseases, such as cardiovascular diseases, lung cancer, and osteoporosis,13 with overlapping physiological (eg, dyspnea, pain, and fatigue) and psychological (anxiety and depression) symptoms and risk factors. In clinical practice, it can be difficult to differentiate psychological symptoms originating from specific life circumstances, physical symptoms or diseases, and there is a need for identification of patient experiences of anxiety that are specifically related to life with COPD.

Terms such as fear and anxiety are often used interchangeably in the literature, but there are several definitions of the concepts as well as potentially different underlying neurobehavioral mechanisms.6,14 From the patient perspective, the subjective experience of anxiety is multifaceted, and patients themselves describe states of anxiety using many different terms, including fear, worry, being afraid, anxiety, panic attacks, etc. Altogether, this adds to the confusion around the concept of COPD-related anxiety.

Taken together, the current understanding of COPD-related anxiety is generally limited, and research summarizing the concept from the patient perspective is lacking. Therefore, with the purpose of exploring the complexity of COPD-related anxiety, the present review aims to synthesize the available qualitative research on patients’ experiences with COPD-related anxiety and to propose a model of the concept.

Materials and Methods

The present study is a systematic review of qualitative studies identified in a larger systematic review of quantitative and qualitative studies of COPD-related anxiety (PROSPERO ID: CRD42021261124; www.crd.york.ac.uk/prospero/) and adheres to the PRISMA 2020 guidelines.15 The analysis of the quantitative studies is currently ongoing and will be presented elsewhere. The synthesis of qualitative study findings in the present study is based on Thomas and Harden’s thematic synthesis approach.16 The themes and their interrelations were discussed among the group of authors as well as other clinicians and researchers, on the basis of which a conceptual model was proposed.

Search Strategy and Study Selection

The literature search was performed in April 2023 by block search (Supplementary Material, Section 1) in the databases of PubMed (MEDLINE), CINAHL (EBSCO), and PsycInfo (APA). Danish, English, Norwegian, and Swedish-language articles describing qualitative studies of anxiety among people diagnosed with COPD were eligible for inclusion. Interview-based and focus group studies were selected as we were interested in patients’ own narratives about their experiences. References were imported to and managed using Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia (available at www.covidence.org).

The screening process was performed independently by two researchers (CFC and IFV). Conflicts were discussed and solved in agreement. If agreement was not reached, a third researcher (AL) reviewed the conflicts and made the final decision. Initially, relevance of the identified references was assessed by reviewing titles and abstracts. Full-text of the remaining references were screened based on the inclusion and exclusion criteria (Supplementary Material, Section 1). Quality appraisal was performed, and studies of low quality were excluded.

Quality Appraisal and Data Coding

Critical Appraisal Skills Programme Checklist for Qualitative Research (CASP) checklist, recommended by the GRADE working group,17 was used to assess quality and rigor by identifying strengths and weaknesses of the studies. The studies were assessed by one researcher (CFC) and afterwards discussed with another researcher (IFV).

Data extraction and thematic synthesis were conducted using Thomas and Harden’s approach.16 The thematic synthesis contained three steps: 1) coding text line-by-line, 2) developing descriptive themes, and 3) generating analytical themes. An example of the synthesis is shown in Supplementary Material, Section 2.

Results

For an overview of the results of the study selection process, see Figure 1. A total of 7004 references were identified in the systematic search.

Figure 1 PRISMA flow diagram of the study selection process. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. Creative Commons. For more information, visit: www.prisma-statement.org/.

After removal of duplicates (n=1582), the titles and abstracts of the remaining references were assessed and references irrelevant to the aim of the study were excluded (n=3763). Full-text references (n=1659) were reviewed and assessed for eligibility. A total of 44 studies met the inclusion criteria, but after quality assessment, three studies were excluded due to lack of ethical considerations, lack of ethical approval, and/or not using a qualitative design. The remaining 41 studies were considered rigorous with relevant aim, method, and study population and deemed relevant for inclusion in this review.

Study Characteristics

An overview of study characteristics is presented in Table 1. The majority of studies recruited patients from single countries, while one study18 recruited participants from five different countries. All studies used qualitative analysis methods including grounded theory, phenomenology, hermeneutics, and social constructivist approaches. In 39 studies, both men and women were included, while one study19 included women only, and one study included only men.20 Number of interviewed patients ranged from 5 to 125 across the included studies. All studies included participants with COPD of varying illness severity.

Table 1 Study Characteristics

Main Results

In total, four analytical themes described COPD-related anxiety from the patients’ perspectives: initial events; internal maintaining factors; external maintaining factors; behavioral maintaining factors. The distribution of the themes by study is shown in Table 2. Based on the identified four themes, a conceptual model of COPD-related anxiety from the patient perspective was proposed (Figure 2).

Table 2 Data Supporting Themes

Figure 2 Conceptual model of COPD-related anxiety from the patient perspective.

The four themes in the conceptual model of COPD-related anxiety are interrelated, which is indicated by the arrows in the model. According to the model, COPD-related anxiety is a process that begins with the initial triggers and develops over time through maintaining factors that can be either internal (eg, inner states, thoughts, and feelings), external (eg, physical and social environment), or behavioral (eg, fear-induced avoidance).

Theme 1: Initial Events

Initial events refer to specific experiences that trigger first episodes of COPD-related anxiety: 1a) when the patient is diagnosed with COPD or realizes what the prognosis can be; 1b) the first experience of symptom progression or exacerbation; 1c) the first experience with loss of specific abilities or functions.

The Diagnosis and Realization of Prognosis

Patients described being diagnosed with COPD as a major life transition, followed by a period of psychological crisis with worry, fear, and anxiety.31,34,39 The impact of the diagnosis left patients feeling anxious about both living with and dying from COPD, and the uncertainty of the prognosis further contributed to anxiety.11,22,23,43 Being offered palliative care as a part of patients’ COPD care pathway increased anxiety, due to the realization that death was part of the prognosis.43,44,50

The First Experience of Disease Progression or Exacerbation

Patients expressed worries and fear related to the symptoms and progression of COPD.18,23,26,28,31,40,47,52 The experience of a severe exacerbation induced panic and constant fear and worry of rehospitalization.18,32 Patients described medication as “life-saving” in the event of an exacerbation. Being without it or misplacing it caused anxiety.11,46 Thoughts about potential ineffectiveness of medical treatment and having difficulty judging when inhalers (medicine) were empty led to increased anxiety during an exacerbation.18,28,37,52,56 Emergency admissions often involved quick medical decisions and immediate treatment, which at times could be overwhelming and anxiety provoking.21 When experiencing progression, patients expressed fear of dying – not of being dead but of the dying process involving suffocation.21,28,36,42,43

First Experiences with Loss of Abilities

COPD-related anxiety was described as a vicious circle, a downward spiral, and an uncontrollable force of nature,11,24,26,35,46 which had a debilitating effect on daily life and led to feelings of worry and grief due to lost abilities.19,26,48,53 Patients struggled to manage daily activities due to uncertainty related to physical activities, which increased breathlessness and panic attacks. For example, feeling breathless walking around town with their families and having to stop due to fear of collapsing, or when eating or drinking, which could trigger fear or breathlessness, coughing, or choking.24 For some patients, anxiety also resulted in profuse sweating and incontinence, which made them embarrassed and subsequently avoid social situations.11,19,21,23,29,32,52,55

Theme 2: Internal Maintaining Factors

Internal maintaining factors refer to patients’ inner processing of 2a) breathlessness; 2b) exacerbation, disease progression, and dying; 2c) uncertainty and the overlapping symptoms of COPD and anxiety.

Inner Processing of Breathlessness

Breathlessness was a central part of all patients’ experiences and was identified as the most troublesome symptom of COPD.22,23,25,26,29,30,55 Metaphors used to describe breathlessness, eg, fear of breathlessness, were compared to fighting a war without weapons30 and as an iron ring across the chest.26 Breathlessness was experienced as an attack, feeling of suffocation, shortness of breath, lack of air, and smothering.21,24,26,34,39,47,49,51,52,55 Breathlessness led to feelings of potentially life-threatening situations, fear of dying, and uncertainty of when it was the last breath.19,20,23,24,28,35,42,43,47,51,55 Breathlessness and thoughts of suffocation were described as the worst, horrible, dramatic experience ever experienced.51

Inner Processing of Exacerbation, Disease Progression, and Dying

Patients’ descriptions of inner processing related to exacerbation, disease progression, and dying were divided into two thought directions: the memories of previous experiences (thinking back), and the fear of having another similar experience in the future (thinking ahead). Experiences of breathlessness, panic, and anxiety had a long-term impact, and former experiences were frequently revisited as flashbacks. Flashbacks to previous attacks acted as a trigger for further attacks in a vicious cycle of events.11 As an example of fear of future events, patients described being afraid of infections due to potential life-threatening consequences. Being breathless and running out of oxygen without access to help led to feelings of fear and panic.19,22,25,38,41,44 Patients, who had never experienced episodes of severe breathlessness, still felt anxiety and fearful, imagining future episodes of breathlessness.11,30,34,38,49,57 Patients were affected by the COPD diagnosis and prognosis and the realization that they had to live with COPD for the rest of their lives. These thoughts initiated worry and fear of the future.22 Patients used metaphors such as fear of ending their days as a vegetable, fading away slowly, or being pronounced dead prematurely and buried alive.43 The inner processing was described as fear of the process of dying; the long struggle of breathlessness, struggling for air, and painful suffocation.18,19,25,36,41,43,53

Inner Processing of Uncertainty and Symptom Overlap

Patients described episodes of anxiety as idiopathic and easily triggered without warning.11,33,46 The uncertainty increased feelings of losing control and resulting in panic.11,55 Their daily life was affected by meta-worry (worry about worry) about previous panic attacks, which caused escalating fear, worry, and new panic attacks.44,46 Moreover, patients were continually considering an array of possible causes for future attacks.18–20,23,33,35,46,57 Patients described how they had been living with anxiety for years without being aware of it, due to the confusing overlap of COPD and anxiety symptoms.11,46

Theme 3: External Maintaining Factors

External maintaining factors refer to patients’ surroundings that can intensify feelings of anxiety in the patient: 3a) social roles and reactions from network; 3b) the societal stigma towards having COPD; 3c) being faced with the condition of other patients; 3d) being in an unsafe environment.

Social Roles and Reactions from Network

Patients described feeling lonely when experiencing COPD-related anxiety, as they believed their symptoms were distressing for their families, and they expressed fear of becoming a burden to their network. At the same time, patients expressed anxiety of separation and leaving relations behind.11,21–23,43,53 Patients felt that relatives had difficulties understanding their situation and feelings.36,45,57 Loss of role within the family, including loss of intimacy in personal relationships due to embarrassment of breathlessness, was perceived by patients as an increase in social distancing from others.25,45,55

Societal Stigma

Patients were affected by what they perceived as societal stigma and feelings of not being taken seriously in the healthcare system,19,23,25,27,28,53 based on the assumption that causes of COPD are self-inflicted and that COPD could be compared with human immunodeficiency virus (HIV) or addiction.19,23,25,26,28,45,54

Witnessing Other Patients’ Suffering

Patients’ perception of COPD and progression worsened by speaking to and/or witnessing the condition of other patients with COPD. This self-other-awareness gave a feeling of being vulnerable, as it increased feelings of anxiety due to the imagination that their self-efficacy slowly would decrease as COPD progressed.22,36,52

Unsafe Environment

Patients feared or dreaded not being able to speak to others or call for help during an exacerbation, especially during the night.22 When feeling a small change in the quality of breathing or during the first signs of an exacerbation, patients would seek hospital intervention instead of relying on self-management or coping.33,35,41

Theme 4: Behavioral Maintaining Factors

Behavioral maintaining factors refer to behaviors that are initiated by patients with the purpose of protecting themselves, but which ends up maintaining COPD-related anxiety: 4a) avoiding physical activity, 4b) social distancing, and 4c) seeking hospital admission instead of self-management as common behavioral strategies.

Avoiding Physical Activity

Avoidance was a common coping mechanism resulting in limited ability to perform adequate self-management actions during anxiety attacks, due to the lack of exposure to anxiety-related situations or events.24,35–37,43 COPD-related anxiety was a barrier for meaningful activities due to fear of situations that were out of their control. Patients further elaborated barriers such as fear of being too far away from home, worry about collapsing due to breathlessness, and anxiety related to unfamiliar places.23,24,34,48,49,52,54,57 Physical activity revealed the illness in front of others, which further contributed to making physical activity a source of distress.23 Fear of experiencing a panic attack was described as disabling, and patients were anxious of being too breathless, which ultimately limited their activities.23,24,34,46

Social Distancing

As examples of memories of earlier experiences leading to fear of future events, patients described an exacerbation as a traumatic life-changing crisis or attack that affected their relationships with others and led to isolation during an exacerbation.18,46 Fear of dependency and becoming an additional burden to their network led to further social distancing.23,45,57 Patients expressed that relatives had difficulties comprehending their situation, which led to social distancing.36,45,57 Patients were affected by societal stigma and feelings of not being taken seriously in the healthcare system, which led to not seeking help for mental health issues.19,25,27,28,53 The stigma and blame were external barriers for patients seeking help from others.19,25,45

Seeking Hospital Intervention Instead of Self-Management

Patients misinterpreted their panic attacks as an acute exacerbation of COPD, which resulted in needless hospital admissions.11 Patients would often seek hospital intervention instead of relying on self-management or coping.33,35,41 Patients were afraid that they would be discharged from the hospital too soon, and they felt safe in the hands of health-care professionals at the hospital.26

Discussion

Our study summarized the findings from 41 existing qualitative studies of patients’ experiences of COPD-related anxiety. Four themes were identified in the analysis: initial events; internal maintaining factors; external maintaining factors; and behavioral maintaining factors. Altogether constituting a conceptual model of COPD-related anxiety from the patient perspective. According to the model, specific initial events can trigger COPD-related anxiety, ie, realizing the diagnosis and/or prognosis, experiencing exacerbation/symptom progression for the first time, and loss of function and/or abilities due to COPD. Multiple studies have explored the psychological effect of specific events in other illness trajectories,58,59 and the psychological burden of receiving a cancer diagnosis has been extensively studied.60,61 Meanwhile, it is not common to consider these events in the COPD illness trajectory as potential anxiety provoking experiences, and the psychological burden of receiving a COPD diagnosis has not been given the same degree of attention in the literature. One possible explanation for this lack of focus might be related to the consideration that smokers should expect to be ill from smoking, which is a widespread understanding of COPD, despite also being the case for certain cancers and cardiovascular disease.62 Another explanation may be the relatively slow progression of the disease, often resulting in several visits to the doctor with symptoms and declining lung function before the diagnosis is confirmed by the physician and disclosed to the patient.63 Nonetheless, cancer and COPD may have similar disease burden and survival rates,61 and patients’ reactions to this should be explored more extensively in the future – clinically and empirically.

Results of our study indicated that as soon as COPD-related anxiety had been triggered, it was maintained and potentially worsened over time by internal, external, and behavioral maintaining factors. The anxiety-maintaining effect of the inner processing of breathlessness, for example in the form of breathlessness catastrophizing, has been more extensively studied,10,64,65 and a number of questionnaires have been developed to assess this specific aspect of COPD-related anxiety, eg, the Breathlessness Catastrophizing Scale,66 and the Interpretation of Breathing Problems Questionnaire.67 Other internal factors maintaining anxiety in COPD have been largely overlooked in COPD-specific anxiety questionnaires. For example, the results of the present review showed that patients were troubled by thoughts of death and the process of dying. Patients alluded that even shortly after being diagnosed with COPD and understanding the prognosis, death became a near reality, which affected their internal processes. Results elucidated that patients were not afraid of being dead, but feared the process of dying. While it is intuitive to think that death-anxiety refers to the absence of life or missing out, patients described that they were afraid of how they were going to die, ie, through suffocation. Other studies have found that patients with COPD want information on what dying might be like for them in order to prepare themselves.68,69 Patients described thoughts and fear of death as having a great impact early in the course of illness and not only towards end-of-life.70 In spite of being aware of patient needs, many health-care providers feel inadequately prepared for discussing end-of-life issues and might therefore tend to avoid bringing up the subject.71 Moreover, appropriate timing of these conversations can be challenging, due to the unpredictability of the general illness trajectory in COPD compared to cancer.70

The results of the present study indicated that patients were suppressing information about mental health, believing that their network and health-care providers could not understand or comprehend their situation, and therefore refrained from asking for help. Avoidance and social distancing were initiated by patients for protective purposes, but most likely ended up maintaining and/or worsening the symptoms, because they remain largely unidentified in a clinical setting.6,72 Studies have shown that non-pharmacological interventions, such as pulmonary rehabilitation programmes psychological interventions, improve exercise capacity, dyspnea, emotional functioning, health-related quality of life, general anxiety symptoms, and COPD-related anxiety.73–75 However, lack of attendance for such activities is common,76,77 which is in line with the findings of our study, where patients try to protect themselves by avoiding physical activity.

With the purpose of strengthening the identification of COPD-related anxiety in the future, there are a number of potential barriers among health-care providers that need to be overcome, such as not recognizing the scale of the problem, not considering anxiety as part of the remit, and lack of knowledge about or access to appropriate interventions.78 Both health-care providers and patients can benefit from implementing systematic, psychological screening processes, because it can potentially increase confidence in assessing and managing psychological symptoms.79

The questionnaires most often used to assess anxiety symptoms in COPD, eg, the Hospital Anxiety and Depression Scale (HADS)80 and the Hamilton Rating Scale for Anxiety (HAM-A),81 do not include questions about the internal (eg, fear of dying), external (eg, unsafe environments), and behavioral (eg, fear-based avoidance) factors that appeared to be characteristic of anxiety in patients with COPD. Even disease-specific anxiety questionnaires like the COPD-Anxiety-Questionnaire (CAF)82 and the Anxiety Inventory for Respiratory Disease (AIR)83 do not contain questions assessing the central aspects of COPD-related anxiety that were described in our study. If patients are not questioned on fear-inducing and difficult to cope with topics, the severity of anxiety may be underestimated or unidentified in clinical settings. This could potentially explain why the estimated prevalence of anxiety levels in COPD varies markedly across studies and should prompt a reconsideration of the sensitivity of existing questionnaires to identify aspects of anxiety in patients with COPD. Not addressing COPD-related aspects of anxiety leads to poorer identification, and leaves patients to deal with anxiety themselves.

When interpreting the results of our study, it is important to bear in mind that experiencing COPD-related anxiety does not necessarily mean fulfilling the criteria of an anxiety disorder. Theoretically, not all patients with COPD and a comorbid anxiety disorder will experience COPD-related anxiety and vice versa. Furthermore, it is also important to differentiate COPD-related anxiety from episodic, passing experiences of anxiety that can be normal reactions to events such as diagnosis or symptom exacerbation.84 According to the conceptual model of our study, COPD-related anxiety involves persistent anxiety symptoms that are related to an individual’s processing of COPD-related internal and external factors, as well as accompanying fear-induced behavior, such as avoidance of physical activity, social distancing, and seeking hospital intervention instead of self-management. Consequently, COPD-related anxiety should be described neither as a momentary feeling nor as a mental disorder, but as a biopsychosocial pattern that develops over time and reduces an individual’s functional capacity, quality of life, and ability to cope with the illness. Additionally, comorbid physical diseases and specific life circumstances that are not directly related to COPD symptoms could also impact patients’ experience of anxiety, and it may be difficult for the individual patient and the clinician to differentiate between anxiety symptoms emerging from one or the other condition. Participants in the included studies of the present review were recruited on the basis of their COPD diagnosis, but a certain proportion may also be diagnosed with other diseases, which may have influenced their narrative. It is therefore important to differentiate between COPD-related anxiety and COPD-specific anxiety, the latter being exclusively caused by or associated with COPD diagnosis. Future studies directly comparing anxiety narratives in COPD and other physical diseases are needed with the purpose of expanding our knowledge of COPD-specific anxiety.

Strengths and Limitations

The present review was protocol-based and systematically adhered to existing guidelines for review and analysis of qualitative studies. It represents one of the first attempts to systematically review the existing literature on COPD-related anxiety from the patients’ perspective and to propose a conceptual model of COPD-related anxiety.

A number of limitations should be considered when interpreting the results of the study. First, the results were based on study samples that were heterogeneous in terms of participants’ sociodemographic characteristics and symptom level as well as the geographical location where studies were conducted. Based on the present study, it is not possible to draw conclusions in terms of potential variation in the experience of COPD-related anxiety related to age, gender, symptom severity, or cultural norms. Second, caregivers’ and health-care providers’ experience of COPD-related anxiety was not included in the present review. Their observations are highly relevant in fully understanding the concept of COPD-related anxiety and should be explored in future studies. Third, exploring COPD-related anxiety was not the primary focus of all of the included studies; hence, patients were not asked specifically to describe their experience of COPD-related anxiety. With the purpose of studying the subjective specificity of the concept in the future, there is a need for studies directly prompting patients to describe their experiences with COPD-related anxiety and asking them to differentiate between COPD-related fears, fears associated with comorbid diseases, and other types of fears.

Conclusion

The present review synthesized the results of existing qualitative studies of COPD-related anxiety from the patients’ perspective. According to our proposed conceptual model, patients’ experiences of COPD-related anxiety are initially triggered by specific events in the illness trajectory and thereafter maintained by COPD-related internal, external, and behavioral factors. The present study represents one of the first steps towards understanding the complexity of COPD-related anxiety. In the future, there is a need for work that aims to 1) improve the identification of anxiety symptoms in patients with COPD, 2) differentiate between subclinical anxiety patterns and comorbid anxiety disorders, and 3) develop and deliver targeted treatment. Future research should focus on the development of a COPD-specific anxiety questionnaire for research and clinical purposes and could preferably draw on the conceptual model proposed in the present study with the purpose of assessing domains of COPD-related anxiety that are in line with patients’ experiences.

Acknowledgments

The authors wish to thank Allan Klitgaard Staal, Andreas Arnholdt Pedersen, Kristina Kock Hansen, Louise Muxoll Grønhaug, and Melina Gade Sikjær for their valuable comments and suggestions along the way.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

This work was supported by the Innovation Fund at Lillebaelt Hospital.

Disclosure

The authors report no conflicts of interest in this work.

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Human Lung Organoids Art Illustration

Researchers have developed a cutting-edge technology that uses microchips to cultivate miniaturized “cloned” human lungs from human embryonic stem cells (hESCs), aiming to better understand lung infections like COVID-19. The stem cells self-organize into complex “micro lungs,” replicating the intricacy of human lung tissue. This allows for an unprecedented high-throughput analysis of lung tissue infection, eliminating variable factors that typically occur when using different patient samples. This platform can also be used to study other diseases and screen for new drugs, and it is primed for swift response to future pandemics. (Artist’s concept of lab-grown mini lungs.)

Scientists have developed a cell culture technology that creates “cloned” miniature human lungs on microchips from stem cells, offering a new method for studying lung infections like COVID-19. This technology reveals alveoli cells’ vulnerability to SARS-CoV-2 and shows that blocking a certain signaling pathway reduces infection susceptibility. This platform also has potential applications in studying other diseases, screening drugs, and quickly responding to future pandemics.

When we’re driving to a new destination, we often turn down the stereo as we follow the directions. What had been music suddenly sounds like noise, and it interferes with our focus.

Our understanding of how infectious diseases like COVID affect human lungs has been similarly confounded by noise. Data from patient lung tissues greatly varies from person to person, obscuring the basic mechanisms of how, exactly, SARS-CoV-2 first infects lung cells. It’s also an after-the-fact analysis—as if we’re trying to map the route the virus took three states back.

Turning down the noise of variability by studying genetically identical tissues from the first moment of infection could light up the route the pathogen takes. Which cells are infected, and when? What is the level of infection, and how does it differ depending on cell type? How does it change in different conditions?

And what if it were possible to track thousands of these infections at once? It might revolutionize our understanding of both infections and the drug treatments used to combat them.

That’s the hope for new advanced tech capable of growing mini-organs on microchips. The labs of Rockefeller’s Ali Brivanlou and Charles M. Rice collaborated to refine a cell culture technology platform that grows genetically identical lung buds—the embryonic structures that give rise to our breathing organs—from human embryonic stem cells (hESCs). Their findings were recently published in the journal Stem Cell Reports.

Human Mini Lungs

SARS-CoV-2 (magenta) infects alveolar and airway tissues (blue) of human mini-lungs derived in vitro from human pluripotent stem cells. Credit: Laboratory of Synthetic Biology at The Rockefeller University

When placed on an array of microchips and carefully dosed with a custom cocktail of signaling molecules, the hESCs rapidly organize themselves into “micro lungs” that have full tissue complexity. These buds can be cultured by the thousands, allowing for an unprecedented high-throughput analysis of lung tissue infection without all the noisy variables.

The result is unlimited, fast, and scalable access to lung tissue that has the key hallmarks of human lung development and can be used to track lung infections and identify candidate therapeutics.

“These lungs are basically clones,” says Ali Brivanlou. “They have the exact same DNA signature. That way we don’t have to worry about one patient responding differently from another. Quantification allows us to keep the genetic information constant and measure the key variable—the virus.”

Building a better mini lung

Embryonic stem cells are the Ur-cells of the human body. They can infinitely divide to create more stem cells or to differentiate into any other tissue. Brivanlou’s Laboratory of Synthetic Biology has long explored their potential.

Brivanlou joined forces with Rockefeller colleague Charles M. Rice during the COVID pandemic: his lab had the microchip technology to grow lung buds, and Rice’s lab had the necessary biosafety clearance required to infect them with SARS-CoV-2 and study the outcome.


Virus particles (blue) infecting alveolar and airway tissues (red). Credit: Laboratory of Synthetic Biology at The Rockefeller University

In 2021, first authors Edwin Rosado-Olivieri, a stem cell biologist in Brivanlou’s lab, and Brandon Razooky, then a postdoc in Rice’s Laboratory of Virology and Infectious Disease, began coaxing the cells to organize into more specialized forms. Stem cells don’t just organize on their own. They need a confined space—such as a microchip well—and stimuli to spark change. The stimuli come from four main signaling pathways that induce stem cells to differentiate into specific cell types.

After about two weeks, the group’s lung cells had formed identical buds whose molecular profiles closely matched those seen in the earliest stages of fetal lung development—including the formation of airways and alveoli, structures known to be damaged in many people with severe COVID-19.

Identifying a key culprit

Since then, they’ve used the platform to understand how SARS-CoV-2 infects different lung cells.

Alveoli are tiny sacs at the end of the lung branches that manage the gas exchange performed with every breath: oxygen in, carbon dioxide out. By studying cloned alveoli cells en masse, the researchers discovered that alveoli were more susceptible to SARS-CoV-2 infection than airway cells, which are the guardians of the organ—the first defense against all inhaled threats. If the virus got past them, the alveoli were sitting ducks.

Another view of virus particles (blue) infecting alveolar and airway tissues (red).

They also hit upon a winning combination of signaling proteins for creating the most robust batches of lung buds—a mix of keratinocyte growth factor (KGF) and bone morphogenetic protein 4 (BMP4). Both contribute to cell differentiation and growth.

Interestingly, the BMP pathway has a downside. When they compared infected lung buds to postmortem tissue of COVID patients, they found that the BMP signaling pathway was induced in both and rendered the tissues more vulnerable to infection. Blocking the BMP pathway made the cells less vulnerable.

Beyond COVID

The researchers note that the platform can also be used to investigate the mechanisms of influenza, RSV, pulmonary diseases, and lung cancer, among other diseases. Moreover, it can be used to screen for new drugs to treat them.

And lungs are far from the only organ of interest. “The broader focus of our work is understanding cellular development to make synthetic organs and tissues that we can use to model diseases and find therapeutic mechanisms,” says Rosado-Olivieri. The liver, kidney, and pancreas are all likely next targets.

“The platform will also allow us to respond to the next pandemic with much more speed and precision,” Brivanlou adds. “We can quickly capitalize on this platform to make a virus visible and develop therapies much faster than we did for COVID. It can be used to screen for drugs, compounds, vaccines, monoclonal antibodies, and more directly in human tissue. This technology is ready to confront all kinds of threats that may hit us in the future.”

Reference: “Organotypic human lung bud microarrays identify BMP-dependent SARS-CoV-2 infection in lung cells” by E.A. Rosado-Olivieri, B. Razooky, J. Le Pen, R. De Santis, D. Barrows, Z. Sabry, H.-H. Hoffmann, J. Park, T.S. Carroll, J.T. Poirier, C.M. Rice and A.H. Brivanlou, 20 April 2023, Stem Cell Reports.
DOI: 10.1016/j.stemcr.2023.03.015



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Climate change: Canadian wildfires impact air quality in USAs Midwest. AFP/File
Climate change: Canadian wildfires impact air quality in USA's Midwest. AFP/File

Millions of people in the Midwest of the United States are currently facing a serious problem with their air quality. This is because smoke from wildfires in eastern Canada has traveled across the region, causing hazy skies and poor air conditions. The smoke has spread from the Ohio Valley all the way down to the Carolinas, affecting a large area.

The wildfires in Canada, specifically in the provinces of Quebec and Nova Scotia, have been particularly severe this year. Over 6.7 million acres of land have already been burned, and the situation is still ongoing. In Quebec alone, around 14,000 people had to evacuate their homes, and more than 150 fires are still active.

The smoke from these wildfires has been drifting over the northeastern United States and settling in the Midwest. As a result, air quality advisories have been issued in many areas, especially for vulnerable groups such as children, older adults, and people with respiratory conditions like asthma. Breathing in the tiny particles found in the smoke can lead to cardiovascular problems and increase the risk of respiratory diseases like asthma and lung cancer.

This issue highlights the long-term risks associated with wildfires, especially in the context of climate change. Warmer and drier conditions caused by climate change contribute to the increase in wildfires and their severity. The impacts of these fires are not limited to the areas where they occur but can affect regions far downwind.

The Environmental Protection Agency in the United States, along with other agencies, provides an interactive map called AirNow, which allows users to monitor air quality and track the locations of active fires. This helps people assess local conditions and potential risks.

It is crucial for both the United States and Canada to address this air pollution crisis together, as the wildfires and their consequences do not recognise borders. Cooperation in tackling climate change and adopting measures to prevent and manage wildfires is necessary to protect the health and well-being of people in both countries.

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Monday, June 5th, 2023 04:20 | By

air-pollution

As the World marks its 50th World Environment Day today, the ambitious goal to end environmental pollution appears to be a far-fetched dream with close to zero chances of being realised.

Despite efforts to get rid of  environmental menace, 90 per cent of the world’s population breathes air that is polluted beyond World Health Organisation’s (WHO)targets.

While some people know the clear effects of environmental pollution, it is impossible for them to separate themselves from such surroundings.

For Amos Wasike, his relocation to Nairobi was an attempt to escape from a polluted working environment, only to land in a more polluted environment.

In 2019, Wasike moved from Kericho where he had been working in a flower farm to Nairobi, with a hope of landing himself a safer working place.

“Working in a flower farm had its challenges such as chemicals, which then made me always wear a mask for protection. I got tired of that environment and realised I needed a new environment where all this was not necessary,” he says.

But his moving was more like jumping straight into the fire since he landed a job within a more polluted area.

Air Pollution

Wasike is a street vendor along Mombasa Road, one of the major highways in Kenya. He sells soft drinks, sweets, and snacks at a bus stop where the air is fully polluted with exhaust fumes from passing vehicles. Next to him are food kiosks, which use firewood and charcoal to prepare their food, adding more pollution to the air he breathes. The area also experiences noise pollution from the honking of horns from vehicles and constant traffic, which makes it difficult to communicate effectively even with his customers.

But despite all these challenges, Wasike cannot afford to move away from this place again in search of a cleaner environment because this is where he gets his daily bread.

“Sometimes I am forced to wear a face mask to protect myself, but most of the time I am without a mask. Though I would like to stop working in such a polluted environment,  I cannot because this business is where I earn a living. Apart from that, getting a less polluted area where a business can thrive is challenging,” he says.

Alice Mutuku,another roadside vendor says she has been experiencing some health issues but it has never crossed her mind that they might have been caused by her working conditions. “Day in and day out, I have been experiencing severe colds, and chest infections, but I cannot say that it is because of working in a polluted environment. I think it is due to being exposed to the morning cold for  long and also prolonged exposure to biomass fuel,” she says.

While millions of Kenyans, especially street vendors face one or more forms of pollution every day, many have  limited understanding on air pollution and its impact especially on their health.

Glaring dangers

According to Maurice Kavai, Deputy Director, Air Quality and Climate Change Nairobi County Government, most of these health complications vendors are experiencing are due to continuous exposure to polluted air from several sources, which include traffic or automotive emissions, dust from unpaved roads, construction sites, industrial processes, and biomass fuel.

“Though outdoor air pollution affects everyone, women are the most affected because they dominate the informal trading sector. Available research shows that using biomass fuels often and being exposed to air pollution from traffic increases the chance of negative reproductive challenges on women,” he says.

According to WHO, the health effects of air pollution are so serious that a third of deaths from stroke, lung cancer, and heart disease are due to air pollution. Its effects are equivalent to those of smoking tobacco.

WHO’s recent research  shows that breathing air is becoming dangerously polluted with nine out of 10 people breathing polluted air. Exposure to polluted air in both the ambient environment and in the household causes about seven million premature deaths each year.

“Pollutants can be physical, chemical, or biological, but the pollutants of concern are particulate matter also known as PM2.5 and PM10, ozone, carbon monoxide, sulfur dioxide, nitrogen dioxide, lead, and greenhouse gases. Particulate matter is the main pollutant. These tiny particles come from many sources, including burning fossil fuels for lighting and transportation, chemicals in mines, burning garbage in open areas, burning forests and fields, using indoor stoves as well as heating oil,” says Kavai.

Despite its effects, WHO says no one is safe from the polluted environment including those residing in wealthy neighborhoods, which ideally, are considered to have a clean environment. Microscopic pollutants in the air can slip past our body’s defenses, penetrating deep into our respiratory and circulatory system, and damaging our lungs, heart, and brain.

“Air pollution is a major environmental health threat globally. It is because of it that in Kenya we are losing about 27,000 people annually. Another health effect of air pollution is that it has reduced life expectancy by 1.6 years,” says George Mwaniki, Head of air quality at the World Resources Institute Africa.

According to Mwaniki, despite these horrifying statistics, there is little focus on this public health crisis by both the governments and other health players. The reason is, unlike other sources of pollution, which are visible and kill fast, this one is not visible and kills slowly. Apart from that, polluted air has no smell and most people think that bad odour is what can be considered as air pollution.

“In Nairobi for example concentration of particulate matter in the air is five times higher than the recommended levels by WHO, which is five microgrammes per cubic metre. Though data is there to show how bad the situation is, nothing has been done,” adds Mwaniki. 

According to Dr Paul Njogu, Nairobi Air Research and Data Committee Chair, Kenya’s ambient air pollution (air pollution in outdoor environments) continues to worsen even though there are various air pollution standards such as Air Quality Regulation 2014, Nairobi City County Air Quality Act among others that exist to enhance the quality of ambient air for the sake of securing an environment that is not harmful to the health and well-being of people.

Respiratory infections

“What is happening in Kenya is happening because of investment gaps and not policy gaps. Technologies to measure air quality are there, but limited resources hinder the country from buying these technologies. That is why this country continues to suffer from lack of data and thus fewer interventions,” reveals Njogu. 

Sammy Simiyu from Vital Strategies and a Public Health Specialist at Nairobi Metropolitan Services says poor air quality has doubled up cases of upper respiratory tract infections in Nairobi County for the last four years; from 379,250 in 2017 to 768,415 in 2021.

Apart from the higher rates of infections, air pollution is also among the top five risk factors for death.

According to Simiyu about 124 deaths in every 100,000 are due to air pollution. Also, about 22 per cent of neonatal deaths are caused by air pollution.  The menace has long term effects on human health such as cancer risks, central nervous system diseases, cardiovascular diseases as well as some impacts on one’s liver. Pollution further has effects on  the human’s reproductive system  as it is likely to cause fertility problems, miscarriage among pregnant women, slow foetal growth, premature birth and also low birth weight. According to the expert, short term effects include frequent headaches, coughing, pneumonia, bronchitis and even skin irritation.

“This is why we need to prioritize clean air action for health. We need to identify and address leading air pollution sources. This will be possible if we invest in prevention rather than cure,” said Simiyu.

He says people need to know  that air pollution affects all other body organs and not only the respiratory system. Air pollution also affects health throughout life.

Purity Munyambu, Gender Specialist at World Resources Institute, Africa says that government policies and effective enforcement are critical. However, air pollution mitigation measures will be more sustainable, equitable, and likely to achieve better results if gender considerations are included throughout the planning and implementation stages.



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Smoke from raging wildfires in Nova Scotia and New Jersey has spread to much of the Northeast and Mid-Atlantic over the last week, prompting Pennsylvania and New Jersey to issue air quality warnings.

Hazy skies distant from the wildfires may be easy to overlook since the immediate threat of fire is not present, but exposure to the air could cause short- and long-term health issues.

Wildfire smoke contains a mixture of gases and microscopic particles from the materials consumed by flames, according to the U.S. Centers for Disease Control & Prevention. That includes vegetation, building materials and other matter that may be harmful when burned and carried long distances by the jet stream.

When the National Weather Service issues Code Orange Air Quality Alerts, as happened in much of the Delaware Valley this week, that means air pollution in the atmosphere may be dangerous for sensitive groups. People diagnosed with heart disease, lung disease and asthma are particularly at risk since wildfire smoke can aggravate their conditions.

The most common symptoms from inhaling wildfire smoke are coughing, wheezing, shortness of breath, headaches and stinging eyes. Some people may experience exhaustion, sinus issues and rapid heartbeat.

The CDC says that older people, pregnant women, children and others with respiratory and heart conditions are most likely to feel the effects of wildfire smoke. Even among healthy people, exposure can lead to reduced lung function and inflammation.

The Environmental Protection Agency says particle pollution — the mixture of solid and liquid droplets suspended in the air, also called particulate matter — is the most dangerous component of wildfire smoke. Some of these pollutants are so tiny that they can easily enter indoor settings.

Particle pollution is defined based the on size of the particles, most commonly PM2.5 and PM10. Fine particulates are invisible to the eye but exist within the plumes of smoke and haze seen during wildfires. PM2.5, the main pollutant emitted during wildfires, can be in the atmosphere for a variety of reasons unrelated to a fire, but it tends to be more toxic when spread by wildfires due to the materials that are burned; this is especially true when homes and public infrastructure are destroyed.

The fire in Nova Scotia that started last Sunday tore through about 200 structures, and the smoke from the wildfire reached parts of Massachusetts within a day. The effects of the chemicals released into the air may linger beyond the duration of a wildfire, keeping people at higher risk to experience symptoms even as air quality improves.

In places where wildfires are common, including California and large parts of Canada, research shows that repeated exposure to wildfire smoke increases the risk of developing lung cancer and brain tumors.

“Many of the pollutants emitted by wildfires are known human carcinogens, suggesting that exposure could increase cancer risk in humans,” said Jill Korsiak, a McGill University researcher who studied the long-term effects of wildfires on more than two million Canadians.

There is also growing evidence that short-term and long-term exposure to wildfire smoke can lead to cognitive issues, including "brain fog" and difficulty paying attention, especially among young people.

Due to the emerging scientific evidence on health risks related to wildfire smoke, the EPA has proposed changes to the maximum recommended exposure to PM2.5 and other particulate matter covered by the National Ambient Air Quality Standards.

How to limit exposure to wildfire smoke

There are a number of tips people can follow to reduce how much wildfire smoke they inhale.

For those who are high-risk, it's recommended to stay indoors as much as possible during air quality alerts. It's also suggested to keep windows and doors closed and to run an air conditioner if AC is available.

People who are in the immediate vicinity of a wildfire should heed evacuation warnings when they are issued. Paying attention to public health messages and air quality warnings will help guide how much outdoor time should be restricted during these events, even when the wildfires are happening at great distances.

If smoke is clearly visible in the air, it's best to remain inside as much as possible. Keeping an air purifier at home can be useful during wildfires. Masks designed to filter out particulate matter, like N95 masks, are also good to have available.

When exercising, it's best to do so indoors rather than going for a run outside or playing outdoor sports. People inhale air at much higher rates during exercise, which increases the amount of particle pollution taken into the lungs.

Anyone who is concerned about wildfire smoke or experiences troubling symptoms should contact a health care professional. This includes reaching out to ask questions about medications taken for conditions that increase smoke inhalation risks, like asthma and cardiovascular disease.

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Patients who use inhaled corticosteroids (ICS) to treat chronic obstructive pulmonary disease (COPD) have higher rates of tuberculosis and pneumonia than those who do not use ICS, according to study findings published in the International Journal of Chronic Obstructive Pulmonary Disease.

Tuberculosis and pneumonia are recognized as serious side effects of ICS in patients with COPD, yet overprescription of ICS appears common for this population. Investigators in South Korea sought to examine the real-world impact of ICS on COPD prognosis. Mortality, acute exacerbations, and pneumonia were primary endpoints. Secondary endpoints were heart failure, arrhythmia, hypertension, diabetes mellitus, osteoporosis, lung cancer, cerebrovascular stroke, ischemic heart disease, and tuberculosis were secondary endpoints.

The researchers conducted a retrospective observational study using the Korean National Health and Nutrition Examination Survey (KNHANES) database (including survey data from about 10,000 individuals each year) linked to Health Insurance and Review Assessment (HIRA) data (comprehensive health-care treatments, procedures, pharmaceuticals, and diagnoses for about 50 million beneficiaries in South Korea). The current study included data on 978 patients (4.1% women) with COPD from January 2009 through December 2012; based on their ICS use status, these patients were assigned to the ICS cohort (n=85; mean [SD] age, 66.7 [8.9] years) or the non-ICS cohort (n=893; mean age, 63.7 [9.7] years). The 85 eligible patients using ICS all had a prescription for inhaled respiratory medication for at least 120 days during the observation period (ICS, 13 patients; ICS/long-acting beta-agonists [LABA], 42 patients; ICS/LABA/long-acting muscarinic antagonist [LAMA], 30 patients).

All participants smoked currently or formerly, had a 10 pack-year smoking history with no history of cancer, had a pre-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) less than 0.7, and were at least 40 years of age. Cox proportional hazard regression analysis was used to identify variables significantly associated with the occurrence of mortality, acute exacerbation, and pneumonia development.

Our data demonstrated that the ICS users had a higher rate of pneumonia and tuberculosis and the concomitant pneumonia was independently associated with higher mortality, highlighting the importance of cautious and targeted administration of ICS in COPD.

At study enrollment, common comorbidities included hypertension (33.2%), diabetes mellitus (12.2%), and hypercholesterolemia (6.5%), and those using ICS had lower FEV1, lower FEV1/FVC ratio, and higher smoking levels than those who did not use ICS upon enrollment.

In comparing the ICS and non-ICS cohorts, the researchers found the ICS cohort had higher rates of acute exacerbations, tuberculosis, and pneumonia as well as hospitalization due to respiratory causes (all P <.05).  Multivariate analyses further showed that: (1) acute COPD exacerbations were independently associated with the development of pneumonia (P <.05); (2) pneumonia, ICS therapy, FEV1, and older age were independently associated with acute exacerbation occurrence (P <.05); (3) concomitant pneumonia (hazard ratio, 3.353; P =.004) was independently associated with higher mortality (P <.05); and (4) mortality rates did not differ between patients who used ICS vs those who did not.

Study limitations include the underpowered sample size of patients using ICS and the fact that the observation period for this study occurred prior to implementation of current therapeutic standards for COPD.

“Our data demonstrated that the ICS users had a higher rate of pneumonia and tuberculosis and the concomitant pneumonia was independently associated with higher mortality, highlighting the importance of cautious and targeted administration of ICS in COPD,” investigators concluded. They wrote “The number of subjects enrolled in our study is not big enough to conclude the harmful side effects of ICS in subgroups of COPD.”

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Dr Ameera Patel, CEO of TidalSense, explains how AI could completely change diagnostics in respiratory care.

Respiratory diseases affect one in five people. Already the third biggest cause of death in the UK, the number of people impacted by these conditions is rising. The latest NHS figures show that hospital admissions for respiratory illnesses are very close to pre-pandemic levels. Furthermore, analysis by Asthma and Lung UK also highlights a direct link between admissions and deprivation, due to factors like increased exposure to air pollution, dampness and mould.

Against a backdrop of NHS pressures – most notably, rising numbers of patients with long-term health conditions, and widespread staff shortages – diagnosis of respiratory diseases is not keeping pace with the growing prevalence of respiratory conditions.

If we take chronic obstructive pulmonary disease (COPD) as an example, around two thirds of people with the disease in the UK are undiagnosed, with one third only identified once they are admitted to hospital, when it is likely their disease is already significantly advanced and their symptoms severe. This goes a long way to explaining why the UK has the second highest death rate from lung disease in Europe, second only to Turkey.

For lung conditions, starting treatment early is critical. For asthma and COPD effective treatment reduces symptoms and exacerbations, reducing healthcare visits – including emergency hospital admissions. But the current clinical pathway for respiratory conditions is ineffective, inefficient and expensive – many patients are misdiagnosed and aren’t escalated into appropriate treatment quickly enough. COPD alone is the second most common reason for an emergency hospital admission and total admissions for COPD are estimated to cost the NHS £491 million annually.

This contributes significantly to the NHS’ financial burden – all lung conditions (including lung cancer) cost the health service around £11 billion annually. COPD and asthma, the two biggest chronic respiratory conditions which affect one in five people in England, cost the NHS around £5 billion each year.

Doing away with misdiagnosis

Early and accurate diagnosis is critical to easing the mounting pressure on our health service, eliminating unnecessary patient appointments while enabling earlier interventions for those who urgently need them.

But current diagnostic methods present a significant barrier to this goal. For example, the current test for COPD and asthma is spirometry, an early-Victorian technology that can be unpleasant for patients and requires specialist training to operate. Not only is this 180-year-old approach complex to perform, but it is also dependent on patient technique. What’s more, abnormal results can be challenging to interpret, meaning that misdiagnosis is rife.

Access to spirometry tests is patchy at best and diagnostic testing completely shut down during the pandemic. Conservative estimates predict there are around 27,000-34,000 people currently awaiting a diagnostic test.

Integrating new technologies – such as AI – is needed to get to grips with the backlog, and open the possibility of accurate, fast diagnoses.

It’s perhaps not surprising, therefore, that The NHS Long Term Plan prioritises accurate early diagnosis and access to testing for chronic respiratory diseases as a way to create efficiencies for the NHS, and improve the quality of treatment and care for patients.

More than the human eye can see

Thanks to its ability to analyse and understand large quantities of clinical information, AI has huge potential to pave the way to highly accurate diagnoses. AI-led technology is already being applied to the assessment of everything from stroke detection through to retinal screening, using trained algorithms and deep learning to quickly detect signs of disease that may not have been visible to clinicians.

There have already been successful demonstrations of identifying respiratory conditions using existing clinical data. For example, AI has been applied to aid the diagnosis of lung cancer and pulmonary fibrosis to help clinicians identify at-risk patients, speed up decision-making and reduce unnecessary procedures.

If applied to respiratory diagnostics, AI could mean that patients with chronic respiratory diseases would be spared the ordeal of spending weeks or months moving between clinicians to secure a diagnosis, instead giving them access to the right treatment, medication, and dosage at the right time. Better disease management could also deliver significant savings to the NHS.

Going beyond diagnostics

AI-led technologies are also opening powerful predictive and forecasting capabilities. For example, these technologies could be used to predict a patient’s future disease development, helping guide clinical decision making and opening access to early medical or lifestyle interventions. AI can even be used to predict the people within populations who are most at risk of developing chronic respiratory disease, ensuring they are prioritised for diagnosis or screening programmes.

At the same time, AI has considerable potential for improving the patient experience – empowering patients to self-monitor and manage their condition outside of the healthcare environment, resulting in a better quality of life for the patient, and further efficiencies for the health service.

In Greater Glasgow and Clyde, 500 COPD patients are being monitored at home to enable earlier interventions while also relieving pressure on the NHS. The scheme combines patient records with real-time data from fitness trackers and at-home breathing equipment, and users can directly message doctors with any health concerns via a smartphone app. A new trial later this year will also apply AI to this data, immediately flagging up patients who might be experiencing more severe symptoms. Early results are positive, suggesting that the scheme has already reduced hospital admissions by over half.

Saving time, saving lives

As the number of patients with chronic respiratory conditions continues to grow, it will be impossible for the NHS to meet its objectives to improve the quality of life and health outcomes of people with respiratory disease, unless the hurdle of diagnosis is overcome first.

Technology will be critical in bridging the gap between patient demand and clinical supply, with AI enabling faster, more accurate diagnoses and opening access to diagnosis outside of the traditional clinical setting. The increased capabilities of digital technologies are paving the way for more effective treatment plans, reducing the likelihood of frequent hospitalisations, and generally contributing to a better quality of life. 



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Major players in the oxygen therapy market are Smiths Medical Inc., Hersill SL, Fisher & Paykel Healthcare Corporation Limited, Invacare Corporation, Teleflex Incorporated, Koninklijke Philips N.V., Drive Devilbiss International, Allied Healthcare Products Inc.

New York, June 01, 2023 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Oxygen Therapy Global Market Report 2023" - www.reportlinker.com/p06464234/?utm_source=GNW
, Becton, Dickinson and Company, General Electric Company, Getinge Group, Essex Industries Inc., Chart Industries Inc., Drägerwerk AG & Co. KGaA, GCE Group, Thermo Fisher Scientific Inc., OxyBand Technologies Inc., and Nidek Medical Products Inc.

The global oxygen therapy market is expected to grow from $23.70 billion in 2022 to $25.89 billion in 2023 at a compound annual growth rate (CAGR) of 9.3%.The Russia-Ukraine war disrupted the chances of global economic recovery from the COVID-19 pandemic, at least in the short term. The war between these two countries has led to economic sanctions on multiple countries, a surge in commodity prices, and supply chain disruptions, causing inflation across goods and services and affecting many markets across the globe. The oxygen therapy market is expected to reach $36.53 billion in 2027 at a CAGR of 9.0%.

The oxygen therapy market consists of sales of pulse oximeters, oxygen flow meters, portable oxygen supply devices, nasal cannulas, simple masks, non-rebreather masks, continuous positive airway pressure, BiPAP, bag valve mask (ambu bag), endotracheal intubation, and mechanical ventilator.Values in this market are ‘factory gate’ values, that is the value of goods sold by the manufacturers or creators of the goods, whether to other entities (including downstream manufacturers, wholesalers, distributors, and retailers) or directly to end customers.

The value of goods in this market includes related services sold by the creators of the goods.

Oxygen therapy refers to using additional oxygen as part of sickness management in people suffering from respiratory problems who can’t naturally breathe in sufficient oxygen due to various diseases and ailments. Oxygen therapy provides persons with lung disorders or breathing difficulties with the oxygen their bodies require to operate.

North America was the largest region in the oxygen therapy market in 2022. The regions covered in oxygen therapy report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.

The main types of oxygen therapy products are oxygen delivery devices and oxygen source equipment.Oxygen delivery devices refer to secondary oxygen-providing equipment for people who cannot maintain a safe level of oxygen saturation and are used in oxygen therapy are controlling and monitor respiratory failure devices including nasal or transtracheal catheters, and nasal cannula.

The various types of portability include stationary devices and portable devices that are used in various applications such as pneumonia, chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, respiratory distress syndrome, cystic fibrosis, and others. These are used in hospitals, clinics, home care, and post-acute care settings.

The rising prevalence of respiratory disorders is expected to propel the growth of the oxygen therapy market going forward.A respiratory disorder is a condition that impacts the respiratory system’s lungs and other organs, often known as lung diseases which include tuberculosis, lung cancer, mesothelioma, cystic fibrosis, and asthma.

Oxygen therapy is used in the treatment of people suffering from respiratory disorders condition by providing an additional supply of oxygen that relieves shortness of breath.For instance, in February 2023, according to the report published by American Lung Association, a US-based voluntary lung health and preventing lung disease, a chronic lung illness, such as asthma or COPD, which also includes emphysema and chronic bronchitis, affects more than 34 million Americans.

Additionally, more than 25 million Americans, including more than 4 million children, have breathing difficulties due to asthma. Therefore, the rise in the prevalence of respiratory disorders is driving the growth of the oxygen therapy market.

Technological advancements are a key trend gaining popularity in the oxygen therapy market.Companies operating in the oxygen therapy market are adopting new technologies to sustain their position in their market.

For instance, in July 2022, Omron Healthcare, a Japanese-based electrical equipment manufacturer company, launched a portable oxygen concentrator to assist home care providers in addressing the therapeutic and lifestyle needs of COPD and respiratory patients.This portable oxygen concentrator includes PSA (Pressure Swing Adsorption) technology that provides a continuous supply of oxygen (5L per minute).

Additionally, it employs medical molecular sieves to assure the efficiency and purity of the oxygen while maintaining the device’s mobility, making it easier to transport.

In January 2023, CAIRE Inc, a US-based medical equipment manufacturing company acquired MGC Diagnostics for an undisclosed amount.With this acquisition, CAIRE Inc aims to strengthen its portfolio in diagnostic technologies and to serve patients with pulmonary disease.

MGC Diagnostics is a US-based company involved in the manufacturing and sales of oxygen therapy tools such as pulse oximeters.

The countries covered in the oxygen therapy market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

The oxygen therapy market research report is one of a series of new reports that provides oxygen therapy market statistics, including the oxygen therapy industry global market size, regional shares, competitors with an oxygen therapy market share, detailed oxygen therapy market segments, market trends, and opportunities, and any further data you may need to thrive in the oxygen therapy industry. This oxygen therapy market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.
Read the full report: www.reportlinker.com/p06464234/?utm_source=GNW

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Residents of the Virgin Islands are reminded of the dangers of smoking as the Territory observes World Tobacco Day 2023.

Public Health Officer in the Ministry of Health and Social Development Ms. Renee Leonard said that smoking is one of the major risk factors for the development of chronic non-communicable diseases. 

“Among the greatest concerns are heart and lung disease and various forms of cancer,” Ms. Leonard said, adding, “We want to advise persons to refrain from this practice and encourage smokers to quit.”

According to Ms. Leonard, there are many benefits to smokers quitting including improved circulation in the hands and feet, improved blood pressure, easier breathing, and a decrease in the risk of lung cancer.

“The bad habit of smoking can reduce your life expectancy, diminish your quality of life  and ultimately kill you, so do not think about doing it and if you are already doing it stop,” the Public Health Officer said.

The community is also reminded that the Tobacco Products Control Act 2006 prohibits smoking in public places including office buildings, restrooms, elevators, stairways, health and educational institutions, any premises in which children are cared for a fee, restaurants, bars, nightclubs, beaches accessible to the public and any other facilities.

“We are reminding proprietors and other occupiers of public places that ‘no smoking’ signs must be placed in a prominent area, clearly indicating that the establishment is smoke free and any infractions should be reported to the authorities,” Ms. Leonard said.

The Public Health Officer stated that "No Smoking" signs must be flat and rectangular at a minimum size of eight and a half by eleven inches; must display the symbol for no smoking and carry the message in English, "It is unlawful to smoke in this location".

Owners or managers of public places who fail to prominently display the prescribed signs that clearly indicate smoke-free zones will be liable to pay a fine of $125.

Each year, the World Health Organization (WHO) holds World No Tobacco Day on May 31. Their goal is to spread awareness about the risks of tobacco use and what can be done to make the world tobacco-free. The day is being observed under the theme, “Grow Food not Tobacco.

The Ministry of Health and Social Development is committed to ensuring that all aspects of the environment with the potential to negatively impact the health of the population are managed efficiently to enable all persons in the BVI to attain and maintain optimal health and well-being.

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