Changes In The Wind
Not so long ago, you could drive down the Red Mountain Expressway on just about any summer morning, and see a black line of smog hanging over Birmingham. Asbestos was considered a safety feature in new construction. Black lung was just part of the job of being a miner. And it was still considered polite to offer the person next to you a cigarette when you lit up in restaurants, conference rooms, and crowded theaters.
Tuberculosis and polio with its iron lungs had been beaten back, but pulmonologists were dealing with the new plagues of lung cancer and emphysema.
What has changed in the last few decades? Air is not always something you can see now. However, Birmingham still has more than its share of orange and red bad air days thanks to one of the longest average commute times in the nation, lack of public transportation, a continuing heavy reliance on hydrocarbons, and weather that turns hot days into ozone and inversion layers.
Today, growing demographic trends, advances in medicine and technology, and the legal landscape are reshaping the types of pulmonology cases physicians see — and the velocity and direction of that change are likely to shift even faster in years to come.
Changing Care
Patients with several serious pulmonary diseases are living longer, and the advances that allow them to enjoy more years of life are coming through closer cooperation between medical specialties.
Cystic Fibrosis is a case in point. Once a disease of childhood because few patients lived past their teens, now patients are living into their 20s and 30s. To help them make the transition from pediatric care to adult health care—including obstetrics—UAB has established a cystic fibrosis clinic for adults.
Cooperation between pulmonologists and surgeons is allowing some COPD patients to live more comfortably, and new, less invasive surgical techniques for lung reduction are making that option available to more patients and reducing recovery time.
Changing Technologies
While better safety equipment and safer alternatives are helping to prevent future cases of asbestosis, there are new risks to worker lung health ranging from “popcorn lung” in the food industry to the breathing problems developed by rescue workers at ground zero. The good news of lower black lung rates in coal miners has recently swung in the opposite direction, with more and younger workers testing positive in the past few years, now that fewer miners are working longer hours.
On the plus side, there have been tremendous advances in medical diagnostic and treatment equipment. Epidemiologists are using satellite imaging to track conditions favorable to the outbreak of infectious diseases, and this is being used in Birmingham to compare air quality to hospital asthma admissions and school absences.
Between poor air quality and the humidity that fosters Alabama’s lush green landscape and mold, asthma continues to be the number one cause of pediatric emergency room visits in Birmingham. Perhaps in the future, the industrial and transportation technologies that contribute to air quality problems will advance to help find solutions.
Changing Populations, Social Policies and Legal Landscapes
As the population ages, we can expect increases in the diseases of aging—COPD, vulnerability to pneumonia and flu, and pulmonary fibrosis. Municipal laws are reducing exposure to second hand smoke, but consistent statewide legislation has repeatedly failed to get through the legislature.
Energy and transportation policies affecting air quality are in flux. The ups and downs of the economy and new laws are likely to continue affecting access to healthcare, immunizations and the pulmonary health of Alabamians.
Some changes will be positive, and some negative. Where there’s room for change, there’s room for hope.
