Increased wildfire smoke highlights gaps in respiratory care

JOHN YANG: Smoke from the record setting Canadian wildfires is again making the air hazardous to breed this weekend across the Northern Plains and upper Midwest.

Dealing with this summer smoke is a new experience for many outside the western United States where it's all too common.

And as the smoke triggers breathing problems for many it also highlights the fact that more than 5 million Americans don't have easy access to a respiratory specialist.

For Walton Penny Copeland the small town of Hayden, Colorado has been home for five decades, set high in the Rocky Mountains.

They're that much closer to the deep blue skies and puffy white clouds.

WALT COPELAND, Hayden, Colorado: Maybe take a bunch of deep breaths.

WOMAN: Don't cheat, don't cheat.

WALT COPELAND: I don't cheat.

I didn't.

JOHN YANG: Three years ago, they were comfortably settled into retired life when Walt began having breathing problems.

WALT COPELAND: I was having a checkup after my heart valve.

Once a year I'd go for a checkup and they found a little spot on my left lung.

It was kind of cloudy.

JOHN YANG: He was diagnosed with pneumonitis inflammation of the lung tissue also called farmer's lung.

WALT COPELAND: There's hundreds of different types of a farmer's lung which mold, sawdust.

I grew up with parents who smoked and I worked out at the coal mine and I hauled fuel and stuff like that, but no scar.

Nothing showed up.

JOHN YANG: Retired from Long Haul Trucking, Walt thought he was done with long regularly scheduled drives, but from his home in Hayden, going to a pulmonologist every three months for checkups meant a round trip drive up eight to 10 hours.

WALT COPELAND: 10 hours for a 15-minute visit.

That's why we always waited for him to come up.

Let him do the driving.

JOHN YANG: You've done enough driving over the years.

WALT COPELAND: Yeah, I have.

I have.

JOHN YANG: Instead, the pulmonologist comes to him.

DR. JAMES HOYT, Pulmonologist, UCHealth: No sign of a flare up.

WALT COPELAND: Not yet.

Not that I've seen.

JOHN YANG: once a month Dr. James Hoyt of UC Health a not for profit regional health system makes the trek to a medical center in Steamboat Springs from his office in Fort Collins.

During each visit to the ski resort town, he has nine hours of patient appointments over two consecutive days.

180 miles each way with a 1,300 foot elevation change.

Dr. Heights been making this monthly trip for the last decade.

JAMES HOYT: It's about 4000 miles a year.

So 40,000 miles, 50,000 miles.

And I've gotten one new windshield, one new bumper, a whole new front end when I hit a deer but I've only for weather not made it once.

JOHN YANG: For hundreds of Dr. Hoyt's patients across Northwestern Colorado in southern Wyoming, it's a life changer.

Walt Copeland gets to his appointments and just a 30 minute drive, usually combining the trip with other errands.

Many parts of the country especially the rural West have limited access to pulmonologist.

According to telehealth and prescription discount provider GoodRX, more than 5 million Americans are more than a one hour drive from a respiratory specialist living in pulmonology deserts.

Respiratory specialists have been in high demand in recent years as an aging population as a higher risk of COPD.

Then came COVID-19 and the damage it can do to the lungs of those infected with the virus.

Burnout from the pandemic has led to pulmonologist retiring early or changing specialties.

JAMES HOYT: There were two really hard times and the first time was when it first came and 14 or so of us all got in a room and looked at each other and wondered who's going in first because there were no vaccines, there was PPE that we didn't really know for sure if it worked or not.

The second really hard time in COVID was when our healthcare teams were exhausted from 18 months or so of grinding and there were more than enough vaccines for everyone.

And patient after patient after patient we took care of was unvaccinated by choice.

JOHN YANG: Climate change plays a role to helping make wildfires bigger and more intense and the air more hazardous debris.

Last summer, this beautiful vista was obscured by smoke from wildfires in California, Oregon and Washington State.

In fact, wildfires can lead to air quality alerts hundreds of miles downwind.

And as the fine particulate matter in that smoke drifts across the country, it could leave a trail of people headed to doctor's offices, urgent care clinics, and emergency rooms with respiratory problems.

Copeland's wife, Penny has asthma.

PENNY COPELAND, Hayden, Colorado: Smoke is one of the things that I am allergic to.

So when the valley would fill with smoke, I basically had to stay indoors with the windows closed and it would make it difficult to breathe at night.

When you don't get enough air, you can't -- you don't function.

You just basically have to sit on the couch.

And that's it.

JENNIFER STOWELL, Boston University, School of Public Health: Over the last few decades the West has been seeing, you know, this just gradual uptick in the number of fires, how large they are and how severe they are.

JOHN YANG: Jennifer Stoll is a researcher at Boston University School of Public Health.

She says wildfire smoke from Canada and the western United States will continue to affect parts of the country on accustomed to it.

What's the effect on health on public health?

JENNIFER STOWELL: a lot of that depends on you know what is burned and, and how far it gets.

It affects people who already have sensitivities and generally the big one is respiratory that we would expect.

Say for instance, if I had asthma, and I had, you know, a significant exposure to wildfire smoke, the likelihood that I would show up at an ER because of my asthma is probably about 8 percent more likely on a day that I'm exposed to smoke than on day one I'm not exposed.

JOHN YANG: And that Stowell says means more hospital visits.

JENNIFER STOWELL: The important thing for people to know is to remain indoors if you can, especially if you look at the airport malady colors if it's worse than yellow you want to stay indoors.

If you have underlying conditions like asthma or COPD, you want to stay indoors as soon as it gets out of that green area.

And if you have to go outside, definitely wear a mask.

JOHN YANG: Penny Copeland doesn't need a researcher to tell her what the shortage of respiratory specialist means.

Every time her asthma gets bad, she feels it.

PENNY COPELAND: Usually when you have a flare, it's good to be seen by a pulmonologist so they can kind of help you through that and give you more treatment.

But when we have a pulmonologist only here once a month, your asthma flares usually don't come along when he's here.

JOHN YANG: And the asthma doesn't pay attention to Dr. Hoyt's schedule.

PENNY COPELAND: No, it does not.

JOHN YANG: And UC Health's Medical Center in Steamboat Springs, Clinic Operations Director Ryan Larson recognizes the need, he's begun the challenging task of hiring a full time staff pulmonologist.

RYAN LARSON, Clinic Operations Director, UCHealth: We started recruiting in January 2023.

And we're looking to have a full time provider starting next summer, July 2024.

JOHN YANG: And how hard is that?

RYAN LARSON: So far it's been pretty hard.

We've had a few quite a few candidates come through but no one's been a great fit for the community.

WALT COPELAND: I've walked out of the office setting my car and called him for an appointment and we don't have his appointment schedule ready yet so it's okay I'll call back later than when I do they say it's filled up.

JOHN YANG: And as Dr. Hoyt's limited appointments become harder to get, Walt and Penny Copeland hold their breath, waiting for the right candidate to fill the gap.