Asthma is the primary diagnosis in nearly 2 million visits to emergency departments (EDs) per year. The number of diabetes-related ED visits now exceeds 12 million annually.
During the summer months, various factors may result in ED visits by asthmatics and diabetics, said Rosemarie Ramos, Ph.D., M.P.H., of the School of Medicine at The University of Texas Health Science Center at San Antonio. She is assistant director of research in the Department of Emergency Medicine.
Children are protected by tight standards of cleanliness at school and their play time is structured. At home, allergens such as pet dander and dust mites lurk, and children may be outside for long periods of unsupervised play, at risk of exposure to pollen or other allergens.
“The school is a very tightly controlled environment for asthma triggers, and most homes are not,” Dr. Ramos said.
Parents should remind children to do everything in moderation during the summer, and this is particularly important for children with asthma because of the potential loss of control. “Summer is not a time to lose track of taking their asthma medications,” Dr. Ramos said.
Although most asthma triggers are found in the home environment, living along major streets or highways also increases risk, especially in the summer, Dr. Ramos said. Eighteen-wheelers and other vehicles emit ozone precursors — particulates from diesel and other exhaust that promote the formation of ground-level ozone.
“People who live along Interstate 35 and other roads are very close to vehicular source pollutants,” Dr. Ramos said. “It’s heavy-volume industrial traffic on a non-stop basis.”
Heat puts stress on the body, and it takes longer to stop sweating after playing or working outside. The lungs have to work harder. “It’s no secret that emergency department visits by children increase in the late afternoons, the hottest part of the day,” Dr. Ramos said. “Parents should make sure that all children drink plenty of fluids and come in during the hottest part of the day.”
Diabetes is another chronic disease that deserves special attention during the summer, no matter your age. The peril or long-term threat from diabetes is a heart attack or other cardiovascular event. Chest pain, shortness of breath and other symptoms can send a diabetic to the emergency department.
“You don’t have to be old; people who come into the emergency department with complications are often under the age of 50,” Dr. Ramos said. “They wouldn’t have landed there if they had been monitoring their symptoms a bit better.”
One in seven adults in Bexar County (14 percent) has diabetes and another 12 percent have pre-diabetes, according to data from the U.S. Centers for Disease Control and Prevention’s 2014 Behavioral Risk Factor Surveillance System.
Aside from cardiovascular symptoms, other reasons for emergency department visits among diabetics include:
— Inadequate monitoring of blood sugar levels and eating too much food or the wrong foods
— Not drinking enough water or other hydrating fluids, which stresses the kidneys. Those with diabetes have more problems with their kidney filtering out their body’s waste. Drinking extra water when it is hot helps compensate for this.
— A feeling of general malaise including a nagging headache, which may be caused by elevated blood pressure and elevated blood sugar
“Have enough episodes of not taking care of yourself by the age of 50 and you’re set up to not age well and be disabled by the age of 65,” Dr. Ramos said.
Individuals with diabetes should drink lots of water during the summer and structure their activities to take frequent breaks and stay cool. If they start to feel bad, don’t wait to seek medical help.
“Heat can dangerously impact diseases such as asthma and diabetes, ultimately landing people in the emergency department,” Dr. Ramos said. “Take your risk by the horns and learn to manage your health, rather than end up in the emergency room this summer.”
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 U.S. Centers for Disease Control and Prevention, http://www.cdc.gov/nchs/fastats/asthma.htm
 Healthcare Cost and Utilization Project, https://www.hcup-us.ahrq.gov/reports/statbriefs/sb167.jsp