This post is sponsored by Chiesi USA, Inc.
Most people with asthma have the allergic type — in which pollen, smoke, and other environmental factors can trigger attacks. But while these patients usually know what their triggers are, knowing when they’re a problem is much less clear.
That may be because tools like the air quality index and pollen counts, valuable resources that they are, aren’t discussed enough at doctor’s visits. Nor are topics like the importance of outdoor activity when conditions are good — or more generally, how to find, evaluate, and act on environmental data to stay allergy-safe.
These are all cornerstones of so-called “environmental health literacy,” or EHL. It’s an acronym that hasn’t gotten much attention among providers, much less patients. But Chiesi, along with advocates from the American Lung Association (ALA), Allergy & Asthma Network (AAN), Asthma & Allergy Foundation of America (AAFA), and others, hope to change that.
Together, they’ve developed a new survey report highlighting the lived experiences of people with asthma. Finding that only 44 percent of women and 61 percent of men felt “very confident” managing environmental triggers, the authors point to EHL as the missing link between people and empowerment.
An overlooked part of guidelines-based care
Far from just a buzzword without clinical backing, EHL is evidence-based, noted Cindy Trubisky in a recent STAT Brand Studio virtual event. She’s senior director of nationwide asthma programs and health promotion at the ALA, and a member of the steering committee for the asthma report.
“Environmental health literacy specifically focuses on environmental factors that impact your health,” she said. “Improved health literacy has been identified as a way to improve those outcomes and quality of life for people living with asthma. And for asthma, this is also an important part of the best practices in the U.S. asthma clinical guidelines for optimal care.”
Even so, EHL isn’t in the vernacular or routines of most physicians, added Anju Peters, M.D., another steering committee member. Peters, a board-certified allergist at Northwestern Medicine, said even she wasn’t familiar with the term until she became involved in the multi-organizational report.
“We as clinicians don’t have the time, don’t have the resources, don’t have the support system to tell our patients about environmental health literacy,” she said in the event. “Unfortunately, many of us, even clinicians, are not aware … We lack the tools or training to understand all these air quality indices, humidity warnings, etc.”
Those gaps in asthma care have tangible consequences. Many people not only expose themselves to triggers unknowingly, but also unnecessarily limit outdoor activity. In fact, about one in three survey respondents said they stay indoors even when air quality is good — missing out on the physical and mental benefits of greenspaces to avoid risks that aren’t there.
“EHL is just not embedded in our everyday care,” Peters added. “We really need system-level strategies to make the information clear, not just for clinicians but our patients as well, so we can help our patients understand the risks so they trust these resources and they make these changes.”
Providers don’t have to structure the entire patient-doctor encounter around EHL, but they can make it a more prominent part. For Peters, this means integrating education and support into the workflows clinicians are already using.
“We should put EHL into our electronic medical records,” she said, adding later that she even puts information about how to look up pollen counts in discharge notes. “We should train our staff to teach our patients about it, make it an everyday part, and bring it up at each visit. We see patients back in three to six months; we should ask about this [then].”
Another opportunity is to focus on simple actions that providers can take individually to foster EHL. Trubisky recommended three:
- Visit lung.org/air to learn more about asthma, environmental factors, and the impacts that indoor and outdoor conditions have on patients. Other resources include ALA’s lung health navigators and State of the Air reports, AAFA’s Asthma Capitals reports, and AirNow.gov.
- Discuss EHL with at least five patients this week to see how easily EHL can fit into patient-provider encounters.
- Get involved in provider-focused organizations, such as joining the ALA’s Health Professionals for Clean Air and Climate Action newsletter.
“Empowerment involves the health care professional working together with the patient in a shared decision-making model,” Trubisky added. “We’ve heard already that people with asthma are aware that triggers are important, but they need a little push; they need to be empowered.”
“Environmental health literacy is overlooked, and we need to do more.”
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