AAAAI: Social Determinants of Health Drive Asthma Risk During Hurricanes and Flooding

In an interview with Pharmacy Times, John Carlson, MD, PhD, FAAAAI, director of the high-risk allergy clinic at Ochsner Health System and pediatrics residency program director, discussed the clinical and public health implications of his session, “Social Determinants of Health and Asthma Outcomes During Extreme Weather,” presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting in Philadelphia, Pennsylvania.

Carlson emphasized that hurricanes, flooding, and severe storms disproportionately affect patients with asthma who live in low-lying, flood-prone communities—often immigrants, communities of color, and individuals experiencing poverty.

He explained that poverty contributes to poor baseline asthma control, which is then exacerbated during extreme weather events. Environmental exposures, including mold, rodents, cockroaches, and viral spread in crowded shelters, significantly increase the risk of exacerbations. Mold exposure is particularly concerning after flooding or wind-driven structural damage, not only due to allergic hypersensitivity but also because mold releases volatile organic compounds and particulate matter that irritate the airways. Patients receiving long-term steroids, immunosuppressive therapies, or biologics may also face increased infectious risk following storm-related exposures.

“The key is to recognize that asthma is more likely to be uncontrolled during an extreme weather event.”—John Carlson, MD, PhD, FAAAAI

Carlson stressed that medication access and continuity of care are critical during evacuations and recovery. As a result, adherence to controller therapies becomes even more essential, and rapid access to rescue inhalers can significantly improve outcomes during flares.

For pharmacists, this underscores the importance of proactive disaster preparedness counseling. Ensuring patients have extra inhalers, maintaining continuity for monoclonal antibody therapies, and reinforcing asthma action plans can mitigate preventable complications. Carlson noted that strong pharmacist–physician collaboration is particularly vital in storm-prone regions to safeguard vulnerable patients before, during, and after extreme weather events.