Doctor's corner Why clean air is important to your health - Part 1

Clean air is an issue that affects all of us, even those of us in perfect health. This is especially true in the summer time, when heat intensifies air pollution issues, causing an increase in ground-level ozone, a significant lung irritant. The concerning thing about ozone is that it is colorless, tasteless and odorless, but it can harm you.

The elderly, children and those with chronic respiratory issues are especially at risk when it comes to air pollution. If you have asthma or COPD, then air pollutants place an extra burden on the lungs. People who work or exercise outdoors, and teens and children who are active with sports and play, are especially vulnerable. Just walking your dog on a day of poor air quality can cause health issues - even for your pets! This is because when you are working, exercising or playing, you are taking deep breaths and breathing faster, thus drawing more air into your lungs. If the air quality is poor, you are breathing in more ozone or particulate matter, both of which irritate your lungs.

Keeping our air clean is critical to our health, but right now, our clean air may be at risk. This is due to possible changes to the Clean Air Act and associated Environmental Protection Agency budget cuts, which are proposed to be voted on in September. This is a health issue, not a political issue, and since we are all concerned about our health and our families' health, worth discussing.

A bit of background ...The Clean Air Act has its roots in the Air Pollution Control Act of 1955, which was the first federal legislation involving air pollution. This Act provided funds for federal research regarding air pollution. The Clean Air Act of 1963 was the first federal legislation to address air pollution control. It established a federal program within the U.S.Public Health Service and authorized research into ways to monitor and control air pollution. Other legislation tweaked these early acts, and then in 1970, President Richard Nixon signed the more comprehensive Clean Air Act into law; later that year, the Environmental Protection Agency was formed.

How does the Clean Air Act work? The modern Clean Air Act of 1970 was revised in 1990; and is administered by the Environmental Protection Agency. It sets criteria to regulate six air pollutants that are considered to have the most negative impacts on public health. These pollutants are carbon monoxide, lead, nitrogen dioxide, ozone, particulate matter and sulfur dioxide. Based on scientific research, the Act also identifies the "safe" standards for each pollutant and what are considered harmful amounts of these pollutants.

Gary Ewart, chief of advocacy and government relations for the American Thoracic Society, notes that it is important to understand that these standards are designed to protect the country's most vulnerable populations--children, the elderly and those with compromised immune systems; the standards are not set based on what healthy adults might tolerate.

Setting standards in this way helps ensure that everyone's health is protected. Ewart emphasizes that the EPA also does not allow the current state of technology to influence how it sets its standards.

"The EPA cannot say that this amount of sulfur dioxide is harmful, but we will change our criteria because the only technology available to achieve this standard will be costly," he explains. "Rather, the EPA sets the standard based on the facts. If these levels are harmful, then the investment must be made to protect ourselves against these pollutants. We must not allow the cost of implementation to keep us from keeping the public safe."

Ewart explains that there is some flexibility in terms of cost when it comes to how the states implement their plans. While states must come up with a viable plan to reduce pollution that does not meet EPA criteria, within that framework, they have some wiggle room. If there are multiple plans that will successfully do the job, they may pick the most cost-effective option. They simply cannot pick a plan that is low budget and does not work.

If a region is found to be in violation of EPA Clean Air standards, it is up to the state where the pollution is occurring to come up with a plan to reduce the pollution and bring the polluter into compliance. The state can determine the most economical way to do this. The federal government does not get involved in developing individual state plans unless the state refuses to comply, or comes up with a plan that is flawed. If either of these situations occur, then the federal government can step in with its own plan and tell the state this is the plan you must adopt. If the state balks, the federal government does have the power, under the Clean Air Act, to withhold that state's federal highway funds. However, Ewart notes that in the decades since the Clean Air Act has been in place, only once has any state lost federal highway funding due to Clean Air Act violations. For the most part, states have worked cooperatively to meet Clean Air Act standards and in fact, the Clean Air Act is considered one of the most effective pieces of legislation in our country's history. Since the Clean Air Act's implementation, air pollution is down more than 70 percent on average across all six criteria (more so with certain pollutants) and numerous studies show that millions of lives have been saved from illness and death due to respiratory and cardiovascular causes. Hospital admissions and illnesses such as bronchitis have also been significantly lowered, saving millions of health care dollars and lost-work time (for more information on the Clean Air Act, visit www.epa.gov/laws-regulations or www.epa.gov/clean-air-act-overview.).

What causes poor air quality? There are multiple factors at work in reducing air quality. In the summer, one of the major factors is ozone, which as we mentioned, tends to be higher in hot weather. The second is an increase in particulate matter (PM), such as from the burning of fossil fuels, and the third is an increase in pollen. Particulate matter is essentially pollution, so to make this topic more easily understandable, from now on, we will refer to PM simply as pollution. Where you live also determines your air quality. For example, if you live in the Northeast, the westerly winds bring air pollution from the high concentration of Midwestern power plants and urban centers, so your air quality is affected by pollution that is not necessarily produced in your region.

When ozone is found high in the atmosphere, it helps protect us from the sun's harmful rays, but when ozone is found at ground level, it causes a damaging chemical reaction in the lungs. Ozone at ground level is formed when the gases (nitrogen oxide, volatile organic compounds) emitted from vehicle exhausts, smokestacks used in manufacturing, and fossil fuel power plants, come in contact with the sun's rays.

Is air pollution directly connected to respiratory issues and general health? Yes, numerous studies of both large and small populations have been conducted by a wide range of scientists around the globe, and all confirm that air pollution is harmful to respiratory health. In areas where pollution is high, there are increased numbers of people with asthma, COPD and other respiratory issues. This is especially true of children. Dr. George Thurston is a leading scholar in the area of human health effects and air pollution, a professor of Environmental Medicine and Population Health at the New York University School of Medicine, and chair of the American Thoracic Society'sEnvironmental Health Policy Committee. According to Dr. Thurston, studies by the New England Journal of Medicine and the Global Burden of Disease Study, all found air pollution to be one of the biggest threats to public health. "Not only is ozone a major lung irritant, but it causes an inflammatory response which makes your lungs more reactive to other substances," says Thurston. "This means that if your lungs usually only react moderately to pollens, exercise or the cold, but are then exposed to ozone, that reaction is now magnified. Studies have also found that pollution is one of the most critical influences on cardiovascular health. As a result, in areas of higher air pollution, we can expect to see shorter life expectancy."

Dr. Mary Rice, pulmonary and critical care physician at Beth Israel Deaconess Medical Center in Boston and assistant professor at Harvard Medical School, says that there is extensive evidence showing that air pollution affects the respiratory and cardiovascular systems.

"On days of bad air quality, even in areas where regular pollution is not as bad, you will see an increase in hospital admissions for respiratory issues, cardiac issues and even an increase in mortality," she says.

Both Rice and Thurston point out that the damage from air pollution to one's health is also cumulative. This means that the longer you are exposed to air pollution, the more harm is done to your respiratory and cardiovascular system. By the same token, people who were removed from areas of poor air quality, or who saw the air quality in their regions improve, also benefited from an improvement in respiratory health.

Even relatively brief improvements in air quality can benefit respiratory health.

"During the Atlanta Olympics, local automobile traffic was greatly reduced to avoid congestion," Rice explains. "During that same time, air quality monitors showed a significant decrease in pollution because there were fewer cars on the road. And, that same time period showed a matching decrease in hospital admissions for asthma among the children of Atlanta. After the Olympics were over, and normal traffic numbers resumed, the hospital admissions for asthma went back up again."

Part II of our discussion of the importance of clean air, and the Clean Air Act, will look at why the Clean Air Act is at risk, its impact on climate change, and what can be done to ensure clean air for the future.

-Dr. Mark R. Windt is an aller gist, immunologist and pulmonologist who has been treating allergies, including food allergies, and respiratory illnesses, for more than 30 years. He is the medical director for the Center for Asthma, Allergy and Respiratory Disease in North Hampton, a facility he started in 1985. Dr. Windt is also an adjunct professor at the University of New Hampshire'sSchool of Nutrition and founder of the Probiotic Cheese Company (www.theprobioticcheesecompany.com). For information, visit www.caard.com or call 964-3392.

Crystal Ward Kent is a free-lance writer and owner of Kent Creative, an award-winning writing, design and marketing firm in Dover. For information, call 742-0800 or visit www.kentcreativeweb.com.