Public Health – Environment and Health: By Alan Abelsohn M.D.
02
September

By Adem Lewis / in , , , , , , , , , /


Many patients you see will have been affected
by the environment where they live, work and play; but the environmental factors are not
visible or obvious when the patient presents. For example, an asthma exacerbation case seen
in the ER is related to exercising in an area with air pollution. To investigate this, use an Exposure History
using the mnemonic CH2OPD2: C: Community
What was the health risk from air pollution that day or on the preceding day? The Air Quality Health Index for communities
across Canada can be found online at airhealth.ca. Was she exercising outdoors, thus increasing
minute volume and pollutants delivered to the alveoli. Was she exercising near a busy road, or an
industrial smoke stack? Is it allergy season? H: Home
Are there indoor allergens e.g. a new cat or dog, cockroaches, mould from a flood in
the basement? Is there a woodstove or fireplace (particulate
matter), or are they using a poorly vented gas stove for cooking (nitrogen dioxide)? Might there be off-gassing from a new carpet
or in-door painting? Is someone smoking (environmental tobacco
smoke)? H: Hobbies
Is she affected by off-gassing from glues, solvents or paint? O: Occupation/ School
There might be poor ventilation with build up of dust, mould, cleaning products etc.
in the school. If she is working, there are many occupational
exposures that might exacerbate pre-existing asthma, and also sensitizers and irritants
that can induce asthma. P: Personal habits
Is she smoking? D: Diet
Is this an allergic reaction to food e.g. nuts or shellfish? D: Drugs
What prescription, non-prescription and alternative medications and supplements does she take? More detailed forms for a full Exposure History
are available.


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