Worsening air quality likely to result in more GP presentations

The ferocity of the 2019–20 bushfire season has been unprecedented, causing deleterious impacts on air quality in a number of Australian communities, including dense population centres such as Sydney and Melbourne. Smoke has drifted as far afield as New Zealand, where it has turned glaciers brown.
 
Earlier this week, Canberra recorded the worst air quality in the world with an air quality index reading of 2843 (200 is considered hazardous) due to bushfire smoke drifting from the east and west of the territory. A few days before these extraordinary readings, an older woman died after going into respiratory distress as she disembarked from a plane in the territory’s capital.
 
Canberra resident Howard Maclean posted on Facebook about the experience of living in a city experiencing such extremely poor air quality.
 
‘There’s no escape, Canberra architecture is not designed to keep out the air or to filter it for pollutants, although indoor pollutant levels are merely bad rather than horrendous,’ he wrote.
 
‘The air indoors might irritate your throat and give you a mild headache. The air outside will literally make your eyes water.’
 
Worsening air quality in Victoria due to smoke from bushfires in the north-east of the state has led to a 51% increase in asthma and pollution-related calls to Ambulance services, according to a spokeswoman for Ambulance Victoria.
 
But RACGP President Dr Harry Nespolon urges people experiencing non-life-threatening health impacts from bushfire smoke to contact their GPs first in order to prevent further strain on emergency services.
 
‘Your local GP [is] best placed to assess your health concerns, review any current treatment and optimise care in the current conditions,’ he said.
 
‘Emergency lines should only be used when there are genuine emergencies, it’s important that they are not tied up.’
 
Dr Kerry Hancock, Chair of the RACGP Respiratory Medicine Specific Interests network, agrees, adding that GPs are also well-placed to pre-identify patients who might need extra assistance during bushfire season.
 
‘People who have current lung or heart conditions, asthma, COPD [chronic obstructive pulmonary disease], people who have ischaemic heart disease,’ she told newsGP.
 
‘The elderly are also generally at risk because they have less capacity to cope with the stresses on the body. The other at-risk groups are young children and pregnant women.’
 
According to Dr Hancock, it can be extremely helpful for GPs to implement action plans for vulnerable patients before disaster strikes.
 
‘Having that conversation with people as a GP beforehand can be quite reassuring,’ she said.
 
‘You give them an action plan, and discuss under what circumstances they can implement some self-management, such as increasing their salbutamol, or start on an antibiotic, or prednisone for patients with COPD.
 
‘But when it gets to a particular stage, then they contact the surgery to come and see you. Or if they have these particular symptoms, then they need to call an ambulance.
 
‘GPs should be able to manage this quite well, and help their patients manage them.’
 
Dr Hancock also emphasised ensuring that patients with asthma and COPD not to lapse in taking their medication, and advising all patients to avoid smoke by restricting time outside and keeping it out of their houses as much as possible.
 
Dr Hancock herself has been experiencing the effects of bushfire in South Australia.
 
‘Even here today, we have the bushfires smoke from Victoria and New South Wales coming over, let alone the smoke that we had from our own fires last week,’ she said.
 
‘It looked like there were fires in our hills when, in fact, the bureau said it was the smoke from the eastern seaboard side.’
 
There are a number of resources available for GPs who want to learn more about assisting with the effects of bushfire smoke, including information from the RACGP and from the NSW Department of Health.
 
But with little relief from high temperatures and drought in sight, the current bushfire season does not look to be ending any time soon – and some healthcare professionals believe the health impacts from the resulting air pollution will not be fully known until further in the future.

asthma Bushfires COPD Disaster medicine Respiratory disease