ATS Breathe Easy - Reducing Emissions in Health Care

[00:00:00] You are listening to the ATS Breathe Easy podcast brought to you by the American Thoracic Society. Erika: Welcome to the Breathe Easy podcast. I'm your host, Erika Moseson from Portland, Oregon. This is our series, things you may have missed at ATS 2025. We're here to discuss a networking event we just came from, called Strategies to Reduce Pulmonary and Critical Care Practice Emissions. Why don't you Sunil: introduce yourself? Hi, Erica. My name is Sunil Kapoor. I'm a pediatric pulmonologist at the Medical College of Georgia in Augusta, Georgia. I've been in ATS multiple times for the first time in a little while. Erika: Yeah. And you and I were both newcomers to this, I think over the last few years, starting to recognize, hey, you know every, every sector of the economy needs to work to get their own emissions down, and healthcare is no different. Why don't you [00:01:00] share a bit about your journey and how you came to be part of this networking center session with me? Well Sunil: happy to. So I've been a practicing pediatric pulmonologist for over 20 years. I started off in the private world and about three to four years ago came over to the academic side and over the. Uh, recent past, just reading a little bit more about the climate impact on respiratory health and then to be quite honest finding out how blind I've been to what we are doing in terms of the healthcare sector and what our role is not only to advocate for more changes in terms of that, but also how we can modify our own practice in terms of things. And as a pediatrician, it, it is particularly near and dear to my heart because of the. The impact that climate change and, and warming and climate impacts have on not only acute issues with pediatric respiratory health, but chronic ones, lung development, lung growth, [00:02:00] this, the the kids that we're passing over to you as adults, we want, we want to be passing them over and as, as as great shape as they can be in, and this is one of those ways where we can be just a little bit better. Erika: Absolutely. I think you and I were talking after the session about what you're even seeing with climate change and change. In seasonal allergies no longer being seasonal. Sunil: Yeah. You know again, the benefit of, of some gray hair is I practiced for a little while and I've seen changes just in a, in a 20 year time span where I used to be able to tell families, all right, well, our allergy season is X and, and we can maybe take a break and. Therapies and come back in another season. But now anyone who lives in a, in a pollin area can attest that it's, that those patterns are have just changed and we don't get the break that we used to. And so much of that has to do with change in pollination seasons due to temperature changes. And has tremendous impact on on respiratory health in children. Erika: Absolutely. You know I think a lot of the times there's [00:03:00] this tendency when people are talking about, you know, improving the environment and. Everything for, you know, people who work in transportation or an energy generation to feel like, you know, those of us in healthcare are pointing the finger at them. But you know, every sector of our economy has some necessity to it, right? Like, we need transportation to bring us the medicines that we use. And so I think it's only fair that, you know, we as healthcare professionals reduce the, you know, impact of our own practice. And it's been so refreshing to learn how much low hanging fruit there is and how many things we can do, and also how many healthcare systems are already kind of interested. In tackling this, and I learned a lot at our session today. You know, it was interesting to meet somebody who was, you know, working for industry trying to reduce, you know, emissions from their inhalers on their own. It was interesting to hear from, you know, medicine residents who came to the table and said that they were trying to figure out how to get this into their curriculum. Already. I've been recently started working with our own healthcare system and was able to look at [00:04:00] some lifecycle analysis that was really helpful 'cause it can help bring science to, okay, is it better to use a reusable gown or a disposable gown? And actually looking at all the emissions that go into that. And learning that we can actually analyze these things rationally. Save money, which is also really great given healthcare costs in America and reduce our practice emissions. Was anything surprising coming outta your discussion group? Yeah. You know, I, I Sunil: think the I wouldn't use the word surprising to start. I think what was was reassuring was that the struggles that I feel that I see I'm not alone in. Mm-hmm. And that there other people are trying to navigate similar sort of questions and we all feel sometimes that we're on an island, but. We're not. And if we can, if we can do things like a networking session where we start banding together to share ideas and, and come across come up with strategies that can potentially help us all get through the same issues. It was very intriguing to speak to an [00:05:00] international provider who has access to a lot of things that we don't have and some of the defaults that I've made in terms of what delivery system is, is best for. Other children. I think I'm a little bit of a product of my own inertia that I, I got some, I got some experience early on and some wins, and I, and I haven't evolved as much as maybe I should have. And and learning from people who have had to do to systems adjust and, and learn how to use different devices specifically about dry powder devices versus MDIs, I think is a it's, it's sort of a wake up call and, and that's. non: Did you miss the ATS 2025 International Conference in San Francisco? We've got you covered with the ATS conference Highlights package. You can access inspiring presentations as well as valuable clinical insights from pulmonary critical [00:06:00] care and sleep sessions. Members get a discount, so become an at s member or renew your membership. To take advantage of these savings, go to conference.thoracic.org today, Erika: and I think we're learning. You know regrettably in pulmonary medicine, especially about the outsized climate impact from our metered dose inhalers and our HFAs, which do have, you know, very potent greenhouse gas you know, chemicals. And we obviously, we always do what is right for the patient, right? So we're never not gonna give the right inhaler for the right patient. And certainly not gonna have our patients who are already afflicted by climate change, extra burdened by someone not prescribing the best inhaler for them. But it was interesting to learn that, you know, that industry's trying to reduce the. In-house gas emissions. Hopefully that will come to fruition. But I also was just thinking over and over again of the common refrain that we hear of reduce, you know, reuse and recycle. And so, you know, what we really wanna do is reduce the need for inhalers, right? So, you know, helping with not having, that's where addressing climate change [00:07:00] is a root cause, is not having so many allergies, not having so much air pollution, not having so many heat events, which is so hard on our asthmatic patients. And also so that they're not needing as much having good clean air in the home. So, you know, I think sometimes we're focused very much on the device. And we wanna give the right device to the right patient, but how can we also just make sure that they don't need as much of that device is also part of being doing sustainable healthcare, and it's also just better for everyone's health. Sunil: You know, I, I couldn't agree more with you. In, in pediatrics we all focus on prevention and growth. And development is sort of core to who we are. And when you think about prescribing inhalers or respiratory disease, so much of it can be modified at the get go. I mean, one of the things with climate, p, which is really significant, is an increase in premature deliverance. So once you already start with that, I mean, just think about if we decrease that, the neurodevelopmental benefit, that cognitive benefit, the respiratory benefit, the burden on the healthcare system and all those things from just [00:08:00] premature birth could be so much different. And I'll tell you the patient population that I see, we're seeing more and more kids born earlier and earlier and earlier, and neonatology does a great job of, of, of. Saving these babies, but the healthcare burdens that we are now doing and the problems that we're seeing in terms of young, young children is just going up and it's it's harder to, to get a handle on that nutrition, air quality, all these things can, are, are so important in terms of overall health and it's really just not so much of a focus as much of it should be. Erika: Yeah, absolutely. You know, I was also just struck by how much of you know, being my. Mindful of your own practice Emissions really dovetails nicely with the Choosing Wisely campaign. You know, in the intensive care unit, we're always trying to balance the less is more, right? So you don't wanna be just putting central lines in every single person who needs pressors for a little bit, right? 'cause then you're exposing them to the risk of these procedures you know, and putting plastics in their bloodstream [00:09:00] all the way down into their vessels, around their heart for just a few hours of, you know, pressors, which, you know, our anesthesia colleagues have been doing for hours and the, you know, or just fine through a peripheral iv. So we're starting to recognize, no, not putting Foley catheters in, doing our best to not intubate. Patients, you know, being mindful of how many drugs and beds we're giving them. Actually all of that can treat, not only reduces emissions, you know, it's also just good patient care. So it's also kind of encouraging to realize that we can reduce our practice emissions just by being good doctors. Sunil: And, and I think looking critically at what we do, and again, I, I'll I'll say, say it again in terms of just, I think oftentimes we are creatures of inertia. Mm-hmm. And we follow into, into practice patterns that we don't look critically at. And, and I'll say I'm guilty of that. When it comes to this space. But again, it's, it's these sort of reawakening that allow us to change and re focus. And I think we have to, we have to evolve in, in, in how we practice medicine. Not only is it better for the planet, it's better Erika: for our patients. And that's Sunil: really where [00:10:00] it comes down to. 'cause again I've been practicing for a little while and I, I always tell residents and medical students that, you know, at the end of the day with all this stuff going on in medicine and all this stuff going on in healthcare, but at the end of the day when I put. I head down at night, I could say I help the kid breathe better today. It doesn't suck. Erika: No, that's great. And it's like, you know, again, I think people just get paralyzed by the scale and the scope of the problem. But you know, if everybody just does their part, like your corner. Yeah, exactly. Butter is good. Better is. You know and one of the things that I'm really excited about is we actually, the American Thoracic Society actually has a whole workshop report coming out that's going to, you know, dive deeply. And I was honored to be able to participate in that whole project into, you know, the practice admissions that we generate as pulmonary and critical care physicians. So of course we will be highlighting that on the Breathe Easy podcast when it's available. And in the meantime, what are three top three things that you think a pediatric pulmonologist can Sunil: do? Yeah, I think a couple things. I think the first. First thing I would [00:11:00] say is, is rethink about how we practice, you know, rethink our default that X kid can't do y therapy. Hmm. We have to customize what we do for each child and, and, and assess them individually. And yes, there are some children who cannot do a dry powder device. Mm-hmm. But there are some who can. And looking at that critically is one thing. I think another thing that that I think we need is communicate with them. I think we need to get out of our silos and start thinking about how we can improve. Pack things as a community. 'cause one voice isn't very strong, but but working collaboratively together, I think that is a a major, a major strength of ours. And I think the last thing that we need to, to do, and I would just say really focus on what are we leaving for our children. Kids are outside running a plane. They're inheriting what we do and putting them as a priority rather than as a secondary factor is. The number one [00:12:00] thing that I would say would benefit all, all of us. Absolutely. Erika: Well, thank you very much for your time for having, and thank you for, you know, contributing and practicing pulmonary medicine and being a pediatrician because as the mother of three kids, I love our pediatricians and we need more of you. And so thank you for all you do. Sunil: Well, thank you. Thank you. It's a pleasure getting to know you better and, and and being a part of this session. non: Thank you for joining us today. To learn more, visit our [email protected]. Find more ATS Breathe Easy Podcasts on transistor, YouTube, apple podcasts and Spotify. Don't forget to like common and subscribe, so you never miss a show.