Introduction

1. Misdiagnosis of Respiratory Ailments Medical Use of Air Quality Information . Variables Desired Level of Diagnosis When Using Air Quality Data Time Improving diagnosis of respiratory ailments in patients due to air quality issues Russell D Hadan; MAQA/QC Officer Air Quality, Douglas County Health Department, Omaha, Nebraska Expected Conclusions Air pollution exacerbates the condition of people with respiratory and cardiovascular diseases and causes measurable increases in the rates of hospitalization for these diseases.  We do not yet understand the role of air pollution in causing these illnesses because correlations between medical visits and high pollution days are not often reported. I expect in the coming years more advancements in access to air quality data including real time data for almost all common air pollutants in most larger cities. After completing the media campain and University School of Medicine training, I expect a larger pool of regional medical professionals to use ambient air quality data as a tool in diagnosing and treating patients with repiratory ailments. “Physicians are concerned about the negative health effects of harmful air pollutants,” said Dr. Janet Abshire, a general practice physician who sits on the Public and Environmental Health Committee of the Sierra Sacramento Valley Medical Society. “We see patients everyday who suffer from respiratory and cardiovascular illnesses. It is time for physicians to play an increased role in the solutions to this problem.”3 The Douglas County Health Department expects to continue to play a role in the development and training of medical professionals in other avenues of Public Health along with air quality training in the future. Introduction Air quality data used to be remote but new instrumentation allows instantaneous readings of particulates, CO2, SO2, and ozone data for easy publishing. All are common air pollutants which cause many respiratory ailments. The EPA has introduced an Air Quality Index (AQI) system for forecasting and looking at current air pollution conditions. The data is easily available from email or website access. I believe once medical professionals understand the ease of finding air quality data, they will use it as an informative tool in diagnosing respiratory ailments. Physician use of air quality information remains low because the medical field is not properly trained on how to access this data. Change would require more training and outreach which would complicate current Medical curriculum. Reaching current practicing medical professionals will be tougher due to years of using the route of prescribing medication for respiratory ailments. Current physician’s benefit and profit from prescription of medications. Also patients want and expect a result from their visit to the physician’s office which most patients view this result as a drug prescription. Change can only be made by educating our medical professionals on the importance of using air quality data in the diagnosis of patients with respiratory ailments. Information to be presented to Medical Professionals Next Steps Figure 5. EPA email notification system Figure 2. Shifting the Burden behavior of medical professionals Figure 6. DCHD email notification page Figure 4. EPA Air Quality Index chart • How to reach Long term goal in Figure 2 • Have meeting with stakeholders about teaching air quality information to incoming and current medical students through annual seminar • Have air quality information included in the curriculum of medical student training courses • Have air quality information presented to public through media campaign which in turn influences practicing Medical Professionals • Other information to be introduced to Medical Professionals • Common health effects of Air Pollutants • How to read AQI chart and possible health effects for AQI zones • Where and who to contact to find out more data on air quality conditions • Introduce national ambient air quality standards for each pollutant • Literature cited • ALA Lung Disease Data 1996: p3. • Boushey etal. Environmental Health Perspective 1995: 103. Supp6: 229-33 • California Medical Association Supports Efforts to Clean Unhealthy Air Dec. 11, 2008 http://www.medicalnewstoday.com/articles/132669.php • Materials and methods • Events • Establish partnerships with Faculty, Staff and Dean at regional Medical Universities. Include partnership groups such as Nebraska Lung Association and Asthma Alliance. • Activities • Discuss possibility of seminar for Medical Students for credit. • Possible Public Health guest speaker at a scheduled course class for medical students. • Include air quality access information by Faculty member in medical curriculum. • Possible partnership between SOM and Public Health on variety of health related topics for medical students in seminars. • Media campaign on AQI forecast and Enviroflash email Acknowledgments This project was a direct result of EPHLI and the assistance provided by the CDC. The Douglas County Health Department in Omaha, NE is responsible for allowing time to research the project and attend EPHLI where the project started. The project would have not succeeded without the help of my mentor Joy Harris and EPHLI Cohort IV members Lisa Swanson and Kristi Campbell. I would like to thank my wife Molly and two children, Anna and Kyle for accepting the time this project needed. I would also like to thank the numerous stakeholders, reviewers, and staff that trained Cohort IV on the process of making a successful project. Figure 3. Medical behavior over time Changing Medical Behavior The levels of misdiagnosing respiratory problems due to air quality have remained about the same levels over time (Figure 3). Medical professionals are not educated through their curriculum about where to find or use air quality information. Drugs are being prescribed to patients who may be sensitive to their outside environmental conditions. Easy solutions such as cutting back or rescheduling strenuous outside activities may be the only prescription needed to help a percentage of respiratory problems. The recent accessibility of air quality information makes reaching the desired level of diagnosing respiratory ailments easier. When more medical professionals start to use air quality data for diagnosis, correlations between respiratory ailments and air pollution can be prepared. Health Problem Asthma accounts for one in six of all pediatric emergency room visits in the U.S.1 Levels of pollutants which may not interfere with normal breathing affect people with asthma in more profound ways, causing greater inflammation or constriction of airway. 2 While air pollution is not believed to be the single underlying cause of the asthma epidemic, there is strong evidence that it exacerbates the illness and that cleaner air would help prevent a significant number of asthma attacks. The medical profession must be aware of where to find daily air quality information and how to use that information in patient diagnosis. For further information Please contact Russell.Hadan@douglascounty-ne.gov. More information on this project can be obtained at http://www.heartlandcenters.slu.edu:16080/ephli/finalProjects.htm Figure 1. Logistics Model of Input, Activity, Output, and Outcomes