Scott Webb (Host): The summer months are a time for many of us to get outside and enjoy the hot and humid weather. But for folks who suffer from asthma or COPD, the heat, humidity, and air quality can cause flare-ups. My guest today is here to explain and provide some tips so these patients can enjoy summer too. I'm joined today by Dr. Aliaksandr Ramaniuk. He's a pulmonary and critical care physician with Summa Health.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Doctor, it's nice to have you here. As we approach the summer months, it's a good time to talk about heat and humidity and how it can make asthma and COPD worse. So when we talk about extreme heat and high humidity, which is coming, of course, what actually is happening inside the lungs of someone who has asthma or COPD?
Dr. Aliaksandr Ramaniuk: So at Summa Health here, our pulmonary team sees how asthma and COPD affects real people every day of their lives. When heat and humidity rise, our breathing can become harder very quickly. And for people that already have sensitive and diseased lungs, this can be quite a challenge. Today, our goal is to help understand what is happening inside your lungs, to recognize the early signs and some practical approaches before symptoms become an emergency. We do not want the patients to feel afraid to reach out or to be afraid of the weather that's currently impacting it.
During high humidity and high heat, your lungs are already doing a lot of work. They're moving air in and out, they're absorbing oxygen, but they're also providing improved conditioning. In the summer, we're asked to do additional job. We're asked to clear moisture, to clear pollen, ozone smoke all at once, and it puts extra stress on top of your lungs that may or may not already have some sensitivity and reactivity.
In addition, heat itself, high heat in the environment doesn't just make people tired. It actually raises your oxygen demand inside your whole body. We usually have to breathe faster to cool off and compensate for all that's happening inside of our bodies while the temperature is going up. Breathing hot and humid air actually increases the ability and the resistance of the air coming in and outside of your lungs by about 112%. And heat increases your hospitalizations and your flare-ups requiring sometimes even acute evaluations and ER visits by over 30%.
Host: Sure. Yeah, it's interesting. And as you say, we don't want folks to be afraid of the heat and the humidity. We don't want folks to be afraid of summer. But I'm sure a lot of us, including me, you know, laypeople like me, don't realize that humidity itself is a trigger. Wondering, like, why does the humid air make breathing harder for people, especially those with chronic lung disease?
Dr. Aliaksandr Ramaniuk: It's a complex question. A lot of studies are being done about it. But humidity by itself is an additional accomplice to the stress that air and breathing hot air causes. It causes more growth of mold in our environment. It feeds dust mites and traps the ozone and other small particles that we're breathing in, and it really impacts your body's ability to cool it down. Think of the lungs like an air filter or an air conditioner. On a normal day, it's working and it's doing okay. But when those days become hot and humid and polluted, sometimes the system becomes overwhelmed
Host: Yeah, you mentioned polluted. You used that word, and I wanted to ask you about that because I'm sure that in addition to the heat and the humidity, air quality probably is a contributing factor, as you said, and an accomplice. I love that. So, they kind of work together, right, to increase flare-ups during the summer months.
Dr. Aliaksandr Ramaniuk: Absolutely. And together this causes sometimes a perfect storm and is recognized by the societies in pulmonary medicines. And what I recommend is people check in the summer, in the hot summer month, the heat index, the air quality index. We do know that when that AQI or air quality index goes over 100, and this is something you can look up easily on your phone or on a weather app, it really impacts people with underlying lung disease.
So, I recommend people before they're planning outdoor activities, potentially reduce their intensity of activities, to take breaks, to make sure they have their quick relieving and their maintenance asthma or COPD medications, and to really keep an eye on the air quality index around us. We do know that even a 1% increase in the temperature around an environment increases your risk of having an asthma hospitalization by 1%. And the guidelines recommend keeping indoor humidity down as well to less than 50% to prevent mold and fungal spores to also impact our breathing.
Host: Yeah. It's really interesting, because I think a lot of us check our phones for the UV index, right? But those with COPD or asthma really should be checking the air quality as well, not only the sun rays and how much sunscreen to use. Wondering, Doctor, like what are some of the maybe early warning signs that heat or humidity is starting to trigger asthma or a COPD flare-up, and when do we take action? What do we do?
Dr. Aliaksandr Ramaniuk: That's an excellent question. So, early signs could be variable from person to person. Some people may experience some chest tightness, and that could be a sign of your airways starting to narrow and we're starting to feel more tight. Sometimes people can experience cough, and that could be irritation by the mucus and inhaled substances in there. Some people start wheezing, and that can tell you that the airways are already starting to be narrow and starting to whistle. Some people will say they need their inhaler more often. And that can tell us that the baseline, the maintenance control may be slipping and we need to escalate and come up with an asthma or COPD action plan for you. Some people have more mucus or change in their mucus, and that could be an important trigger for an exacerbation. It's important to keep an eye on your nighttime symptoms as well. If you're waking up multiple times a night gasping for air or your oxygen drops or you're feeling that something is wrong, especially at night, this could be a sign that a flare is coming, and I recommend you reaching out to your Summa Health pulmonary team early on or seek appropriate emergency care
Host: Right. If you have to, you know, call 911, get to the ED. But if it can wait till the next morning, obviously get ahold of the team. And just wondering, Doctor, like about practical steps that patients can take, right? Because we can't avoid the high heat and the high humidity if we want to be outside, and some folks have to work outside, right? So, like, what can they do to help themselves and maybe protect their breathing when they still have to be outside and still have to work in those rough conditions?
Dr. Aliaksandr Ramaniuk: Oftentimes with our patients here in pulmonary, we come up with kind of a five-part summer plan solution, so you're not afraid of that July heat or that moisture. I recommend a couple things.
One, I recommend the patient and the person checks the day before you go out the air quality index, the ozone, the pollen. Some of the apps will tell you is that level—especially if that HQI, the quality index, is over 100, it can give you a red mark to say, "Hey, be careful with this high index."
Time the outdoor activities. Point two is time the outdoor activities strategically. Maybe plan for earlier morning activities, especially considering the pollutants and the ozones and other factors in the environment. Avoid the hottest parts of the day.
Pre-plan is step three. Pre-plan your inhalers and your oxygen if that's needed. Do not leave your house without your rescue inhaler or that extra tank of oxygen. And if you notice that the oxygen requirements are increasing, try to reach out to your team earlier on. Hydrate before you feel thirsty, especially if you're exerting yourself. Because, again, there's an air conditioner inside your lungs, you're increasing your work of breathing during those hot months. And then, cool the body, not just the room. Loose clothing, shades, breaks, indoor cooling, air-conditioned spaces are very important, especially during the hottest, most humid periods of our time. If you have lung disease and you work outside, the goal is not to avoid work. The goal is to engineer breaks and have a plan with your team so you can go into and avoid crisis.
Host: Right. And, Doctor, I would love to believe that we live in a world where everybody has air conditioning, especially in the humid Ohio, you know, nights. But the reality is not everybody does. So, what can folks do at night, especially during heat waves when they don't have air conditioning?
Dr. Aliaksandr Ramaniuk: There's certainly a lot of options, and the key goal is to make sure that you're maintaining an indoor temperature optimally, convenient 70 degrees or so. Obviously, fans are available, but some of the evidence shows that fans that are blowing high humidity and high temperature over 90 degrees can actually warm your body up.
So, be cognizant about the temperature in your environment. Try to reduce the humidity to less than 50% with a dehumidifier or a fan. When the cool days are there, try to cool the room or air it out and try to put yourself in an environment that if you feel overheated, to put yourself in an environment where you can avoid your whole body becoming overheated.
Host: Yeah, just some practical tips there. Obviously, you know, it'd be great to live in a world where everybody has air conditioning, but that's not reality. And some folks do suffer from asthma and COPD, so you gave us some great, you know, suggestions, tips. Always great to have an expert on.
Let's just finish up here. What's your biggest piece of advice for patients and caregivers, let's say, when it comes to managing asthma or COPD during the extreme summer weather that we know unfortunately is coming?
Dr. Aliaksandr Ramaniuk: As a pulmonologist and an ICU physician, my biggest advice is that heat and humidity are not just minor inconveniences for people living with asthma and COPD. They're true recognized physiological stressors, and they make your body work harder. They inflame the airways, they pollute the environment, and we need to have a caution about approaching the times of day and environments they work in.
So, I want the patients to think ahead. I want you to check your environmental air quality indexes, to have an action plan with your family doctor, your nurse practitioner, or your pulmonary team, to have your medications available, to stay cool and hydrated, and to act early when symptoms change. The earlier you respond, the earlier we recognize, they're more likely to stay out of the hospitals and stay healthy. And that is my biggest takeaway for you after this discussion.
Host: That's perfect. Yeah, when you're kids, you just open the door and you run out and you be a kid. But us adults with these fancy phones, we can check the air quality, the UV index. We can, you know, be prepared, have a plan, know what we're going to do if our asthma or COPD acts up. So, as always, appreciate your time, your expertise. Thanks so much.
Dr. Aliaksandr Ramaniuk: Thank you very much.
Host: And for more information, go to summahealth.org/lung. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.
