Q&A: Managing risks of air pollution for people with asthma

Key takeaways:

• A study found that most excess ozone in Houston originated from other parts of the U.S.
• People at increased risk should avoid going outdoors when air quality is poor and should use air filters in their home.

High levels of ozone can be particularly harmful to people with asthma, and it turns out that local pollution may actually be generated from other areas.

Atmospheric scientists at the University of Houston found that during recent periods of excessive ozone in the city, only 37% of it was attributable to local photochemistry. Much of the rest was associated with pollutants transported in air masses from the central and northern U.S., according to models of air movement and atmospheric chemistry.

Elevated ozone levels and other forms of air pollution pose increased risks to “someone in every family,” Liz Scott, national director of advocacy for the American Lung Association’s Healthy Air Campaign, told Healio.

People with asthma face greater risk for health harms, as do children, older adults, pregnant women and smokers.

“Breathing in ozone pollution can cause cellular injury and systemic inflammation that can put additional stress on lungs, heart and other organs already compromised by disease,” Scott said. “This can result in a worsening of symptoms, the requirement for increased medication use or more frequent emergency department visits and hospitalizations.”

Healio spoke with Scott further about what physicians need to know about managing the risks of air pollution, especially for patients with asthma.

Healio: What should doctors know about the circulation of polluted air from other regions?

Scott: It is impossible to contain ambient air to one geographic region. Air pollution that is created in one state or region can end up impacting the health of residents in neighboring states or even states away. When wildfires burn on the West coast, sometimes pollution impacts can be measured as far east as Washington, D.C. Ozone pollution from highly concentrated vehicle traffic in New York regularly impacts the air quality in Connecticut.

Doctors should educate patients, particularly those who have an elevated risk for health harm from pollution exposure, on paying attention to the air quality index. Even if there is not a polluting source in their patient’s neighborhood, air quality could still be at unhealthy levels.

Healio: How can doctors best help patients with asthma prepare for air pollution?

Scott: Encourage patients to check daily air pollution forecasts for their area using credible sources such as www.airnow.gov and to avoid exercising outdoors when pollution levels are high.

People should use airnow.gov to check their air quality forecast. That forecast includes ozone and particle pollution regardless of where it comes from, and lets people know whether they should modify their activities on days with poor air quality to spend less time outdoors.

Healio: Are there any policy changes that might help with the circulation of polluted air?

Scott: A widespread transition to zero-emission vehicles and zero-emission, non-combustion electricity can dramatically reduce air pollution across the country. A report from the American Lung Association found that such a transition would yield $1.2 trillion in public health benefits and avoid more than 2.7 million asthma attacks by 2050.

Individuals who are in sensitive populations, such as asthmatics, can avoid going outside on bad air quality days and use HEPA air filtration devices in their homes. Local governments can purchase zero-emission recycling trucks, transit, school buses and other vehicles. State governments can move to adopt California’s stronger vehicle emissions standards and invest in air quality monitoring to better inform the public. And the federal government can set stronger national air quality standards and require power plants nationwide to clean up their pollution.

Healio: How should people with asthma think about where they live in relation to air pollution?

Scott: If a patient lives near a power plant or other polluting industry, it could be exacerbating their symptoms. It can help to take steps to ensure the air indoors is clean. Patients can learn more at www.lung.org/clean-air/at-home.

Patients living in areas prone to extreme weather events and disasters, such as wildfires or floods, can be prepared before an event hits. Keep the phone numbers for health care providers or medical equipment companies in an easily accessible place along with medical information. Create a plan for power failure by having car adapters and extra batteries for nebulizers and other medical equipment. Learn more at www.lung.org/disaster.

Healio: Is there anything else important to know about ozone pollution?

Scott: The Environmental Protection Agency recently made the decision to abandon the reconsideration of the 2020 National Ambient Air Quality Standards for ozone. The current ozone limits are far too weak to protect health, as determined by the panel of experts that advised EPA to update the standards. It is imperative that EPA move expeditiously through the new ozone review and finalize more protective limits by the statutory deadline of Dec. 31, 2025. Failure to do so will result in years of delay for people to see relief from ozone pollution.

References:

• American Lung Association. Zeroing in on Healthy Air. Available at: https://www.lung.org/getmedia/13248145-06f0-4e35-b79b-6dfacfd29a71/zeroing-in-on-healthy-air-report-2022. Published March 30, 2022. Accessed Oct. 3, 2023.
• Soleimanian E, et al. Sci Total Environ. 2023;doi:10.1016/j.scitotenv.2023.165881.