Health effects of heat exposure and air pollution in general medical practice

Abstract

Heat exposure and air pollution are no longer peripheral public health concerns; they are routine clinical exposures that affect patients seen in general medical practice. Adults with cardiovascular disease, chronic respiratory disease, chronic kidney disease, diabetes, frailty, severe mental illness, pregnancy, outdoor work exposure, poor housing, and limited access to cooling are at particular risk. Heat can precipitate heat exhaustion, heatstroke, dehydration, electrolyte disorders, acute kidney injury, syncope, falls, myocardial infarction, arrhythmia, heart failure decompensation, stroke, respiratory deterioration, and medication-related harm. Air pollution, especially fine particulate matter, ozone, and nitrogen dioxide, contributes to cardiovascular events, respiratory exacerbations, daily mortality, asthma attacks, chronic obstructive pulmonary disease exacerbations, and wider cardiometabolic risk. The combined exposure of hot weather and polluted air is clinically important because heat can increase ozone formation, wildfire smoke can raise particulate exposure, and physiological stress from heat may lower the reserve needed to tolerate cardiorespiratory insults. This review examines the health effects of heat exposure and air pollution in general medical practice, with emphasis on climate-sensitive illness, cardiovascular events, respiratory exacerbations, kidney injury, and medication safety during heatwaves. PubMed-indexed evidence from systematic reviews, meta-analyses, cohort studies, clinical reviews, and pharmacoepidemiological studies was reviewed. A practical clinical approach should include seasonal risk identification, anticipatory counselling, medication review, kidney and electrolyte risk assessment, respiratory action planning, cardiovascular safety advice, and clear thresholds for urgent assessment. Heat and air pollution should be treated as modifiable exposure risks in routine care. General practitioners are well placed to identify vulnerable patients before extreme weather occurs, rather than only managing the clinical consequences after exposure.