Treat pollution as serious health risk, report warns

Primary care physicians should view air pollution the same way they do tobacco smoke and obesity — as a risk factor for illness and disease in their patients, said the chief medical officer of the American Lung Assn.

“I want doctors to know that they will see variations in the health of their patients with cardiovascular or respiratory disease as [air] pollution levels vary,” said Norman H. Edelman, MD, chief medical officer of the lung association.

“If doctors are cognizant of that, they will be able to prepare themselves for their daily practice better” and prevent possible health complications in at-risk patients, he said. Health complications due to elevated levels of particulate matter and ozone — two common air pollutants — include asthma attacks, heart attacks and premature death, the association said.

Dr. Edelman's recommendation comes as the lung association issued its annual State of the Air report on April 24. The report assessed levels of ozone and particle pollution detected at official monitoring sites nationwide in 2009, 2010 and 2011.

The findings show that the nation's overall levels of ozone and particle pollution continue to decline. But some of the most polluted cities recorded even more unhealthy ozone days on average during the three-year study period than during the 2008-10 period, which was assessed for the 2012 State of the Air report.

For instance, 12 of the 27 cities with the highest levels of ozone pollution experienced more unhealthy ozone days during the study period than in the 2008-10 period, the report said. Baltimore, Cincinnati, Dallas, Houston, Las Vegas and Washington are among the 12 cities.

“The state of our air is much cleaner today than when we started the State of the Air report 14 years ago,” said Harold Wimmer, president and CEO of the American Lung Assn. “But the work is not done.”

Dr. Edelman encourages physicians to regularly monitor their local air quality so they can offer patients guidance on ways to avoid pollution-related health problems. The lung association's State of the Air app enables doctors to keep track of their local air quality. The app can be downloaded for free on an Android or iPhone.

Doctors should advise patients not to bike or jog along busy roads where smog and particulate levels are higher, Dr. Edelman said. If it's warm enough, physicians should encourage patients to use an air conditioner, which removes some particulate matter from indoor air, he said.

Physicians should consider advocating for cleaner air in their communities, said Todd Rambasek, MD, an allergist and immunologist in Cleveland. He previously sat on the city's air quality board. He encourages doctors to get involved with an environmental group or a local organization where they can work to improve air pollution levels.

“Even simple things can make a big difference,” he said.

Pollution's impact on health

More than 131.8 million people (42% of the nation) live in communities where air pollution levels often are dangerous to breathe, the lung association said. Ozone, often called smog, aggressively attacks lung tissue by reacting chemically with it and thus creates breathing difficulties in people with chronic lung disease, including asthma, the report said.

Inhaling pollutants also might affect the heart, according to a 2006 study of 203 Boston adults with an implantable cardioverter defibrillator. The study, which was published in the journal Environmental Health Perspectives, linked exposure to high ozone levels for as little as one hour to a particular type of cardiac arrhythmia that increases the risk of premature death and stroke.

Particle pollution negatively affects health by getting trapped in the lungs and diminishing lung function, the lung association report said. Very small particles can pass through the lungs to the bloodstream and increase risk of myocardial infarction.

For the report, researchers examined data on the nation's air quality that was collected by the Environmental Protection Agency's Air Quality System in 2009, 2010 and 2011. The EPA system has thousands of air quality monitoring stations across the country.

Researchers assessed the hourly average ozone concentration. They also looked at average year-round particle pollution and short-term levels of particle pollution. Short-term levels indicate a 24-hour spike in particulate matter, which can occur during the winter when people use wood stoves for heat, the report said.

Researchers found that the nation's most ozone-polluted metropolitan area is the Los Angeles-Long Beach-Riverside area in California. Yet the area reported its fewest unhealthy ozone days since the State of the Air report began.

More cities than in any previous year made the list of the cleanest cities, meaning they had no days in the unhealthy level for ozone or short-term particle pollution and very little year-round particle pollution. They include Bismarck, N.D.; Cape Coral-Fort Myers, Fla.; Palm Bay-Melbourne-Titusville, Fla.; and Rapid City, S.D.

“Counseling patients on how to avoid excess exposure to these pollutants will make them better and keep them out of the emergency room,” Dr. Edelman said.