Keywords: Asthma health disparities, Environmental Health, Clinician Education 

Background

AltaMed’s servicing areas have higher social vulnerability indexes and face pollution burdens of up to 98%, in contrast to 45% in surrounding affluent areas. This juxtaposition reveals a disparity for patients with asthma who face disproportionate air pollution exposure. Pressurized metered-dose inhalers (pMDIs) dominate as the prescription inhaler by clinicians treating respiratory diseases such as asthma. Paradoxically, pMDIs release potent greenhouse gases, exacerbating the very pollution that worsens asthma symptoms and further perpetuates cycles of health inequity among vulnerable communities like Pico Rivera. This study explores clinicians’ knowledge of two types of inhalers with similar clinical efficacy and their differences in global warming effects. 

Methods

Using a community-based participatory approach, a mixed-methods study was conducted within Los Angeles County’s largest FQHC, Altamed. A gap in clinician knowledge of the environmental impact of inhalers was identified through stakeholder meetings. An intervention during clinicians’ Grand Rounds was completed with a pre- and post-survey to assess baseline knowledge of clinical efficacy and environmental effects of two types of inhalers: pMDIs vs DPIs, including a question assessing the likelihood of change in clinicians’ inhaler prescribing preferences. Descriptive statistics and paired t-tests will be used for analysis. 

Results

We expect clinicians to have little baseline awareness of the environmental impact of their inhaler prescription practices, not recognizing that pMDIs have the greatest global warming potential. We also expect that post-intervention survey results will demonstrate increased knowledge, showing an improved understanding of inhaler-related environmental impact and, in turn, plant the seed for environmental considerations when choosing an appropriate inhaler for their patient.  

Conclusion

The results will inform the development of a digitized patient-centered clinical decision-making toolkit incorporating environmental considerations. Further evaluation may support system-wide adoption at AltaMed, promoting DPIs when clinically appropriate.