Correspondence |
Why do older patients die in a heatwave?
Sir,I was interested in the recent Commentary by Flynn, McGreevy and Mulkerrin,1 which contained some thoughts on why elderly people are vulnerable in a heat wave.
However, they did not mention the important confounding factor of elevated ambient ozone levels, which commonly occur at the same time as the heat wave. Recent reports2–4 have suggested that a significant proportion of the additional deaths in recent heat waves might well be due to elevated tropospheric ozone. This extremely irritant gas causes changes in the lungs that might very well be dangerous to those with congestive heart failure or other circulatory conditions.
The authors noted that others have recommended the opening of windows as a precautionary measure. This reminded me that when I was a clinical assistant at the Brompton Hospital in 1953, there was a printed card of advice for us to give asthmatic patients. This stated that if an attack occurred at night, the bedroom window should be opened, and deep breaths taken. In the light of the ambient air-borne pollution then prevailing, this was a dangerous procedure, as it ensured that the patient got a good dose of the highly contaminated ambient air.
‘Plus ca change’, etc.
Vancouver Canada
References
1. Flynn A, McGreevy C, Mulkerrin EC. Why do older patients die in a heatwave? Q J Med 2005; 98:227–9.
2. Stedman JR. The predicted number of air pollution related deaths in the UK during the August 2003 heatwave. Atmosph Environ 2004; 38:1087–90.[CrossRef]
3. Fischer PH, Brunekreff B, Lebret E. Air pollution related deaths during the 2003 heat wave in the Netherlands. Atmosph Environ 2004; 38:1083–5.[CrossRef]
4. Schwartz J. How sensitive is the association between ozone and daily deaths to control for temperature? Am J Resp Crit Care Med 2005; 171:627–31.
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