The Many Costs of Asthma
It was a cozy, rainy day, and I was contentedly absorbed in a research project, when I suddenly stopped short. What? Argh! My research had led me to yet another infuriating climate change fact – but this one was a personal blow. I read on: Asthma inhalers not only release significant levels of potent greenhouse gases, but the emissions from one inhaler are potentially equivalent to 175 miles of driving.
For me, asthma is a relatively new condition. As a White suburban kid, I grew up with relatively clean air and without lung problems. But after having one of the earlier cases of Covid in March 2020, my lungs didn’t fully recover, and I joined the 25 million Americans with asthma, a group that includes almost 5 million children. Asthma rates are highest for Black adults, as structural racism, residential segregation, and environmental injustice have led to higher exposure to polluted air. Older adults, people with disabilities, and Latinx and Native people are also are at higher risk of developing asthma and experiencing serious effects.
The fact that asthma treatment contributes to climate change is cruelly ironic. There’s a toxic cycle in play. Climate change worsens air pollution through many paths: increased smog from higher temperatures, more particulate matter from raging wildfires and drought-induced dust, more mold from flooding and extreme weather events, and more airborne allergens due to longer pollen seasons. Air pollution causes asthma to develop, and many people require daily medication to reduce symptoms. Meanwhile, wildfire smoke and air pollution cause people with asthma to experience asthma attacks and lung constriction, demanding more medication use. But because the most widely prescribed types of inhalers contain hydroflorocarbons with high global warming potential, their use then feeds back into climate change.
As with other effects of climate change, the suffering caused by this cycle is inflicted most forcefully on people with fewer resources and less political power. Studies repeatedly show that low-income communities of color are forced to breathe more polluted air. An EPA study found that Black people are 34% more likely than other groups to live in asthma risk areas, where increased particulate matter from climate change will lead to the highest projected increases in childhood asthma.
Yet the American healthcare system means that many people can’t afford regular asthma medication, resulting in emergency room visits and sometimes hospitalization and death. For me, the cost of asthma medication was shocking, but manageable. But medication costs can easily amount to thousands of dollars per year, with other costs for lost work and hospital visits. Ten people die every day from asthma in the United States, largely due to lack of regular treatment.
What to do? Studies show that low-emission inhalers are as or more effective in controlling asthma for most patients. I emailed my doctor to try to switch my medication to a more climate-friendly dry powder inhaler. After repeated wrong turns and a year and a half of persistence, I finally got my low emission inhaler. But individual requests are not a solution to the overall problem. Barriers of time, knowledge, priorities, degree of entitlement, and bias in the healthcare system mean that individual action is unavailable for many people and unlikely to create change at the scale we need. We need to address asthma emissions at a systems level, not a personal level.
Looking at the big picture, we need affordable, accessible healthcare for everyone and real action to cut air pollution in environmental justice communities – along with significant climate emissions reductions and adaptation planning. These same priorities should inform our approach to asthma.
Except where medically inappropriate, health care systems need to supply patients with environmentally friendly products, with the goal of providing the best treatment, manageable price, and the lowest environmental cost. Health care systems should prescribe low-emission inhalers as the default option, with other inhalers reserved for those with medical need for them. Health care systems should also be required to facilitate the return of old inhalers for recycling, which can recapture greenhouse gases that otherwise slowly escape from waste packaging. Insurers should be required to cover climate-friendly treatment options and price them affordably. With specific achievable policy and systems change actions, we can make asthma treatment accessible, low cost, and climate friendly.
