The Health Hazards of Air Pollution-Implications for Your Patients.

Air pollution has many deleterious health effects (Table 1). The International Energy Agency recently released a report attributing an annual 6.5 million premature deaths to air pollution worldwide.1 Although the Clean Air Act has done a great deal to improve air quality in the United States since 1970, some of these gains are being eroded in part because of changes in the climate. In fact, many localities have never even been able to meet the Environmental Protection Agency’s air quality standards.2 This poor air quality becomes even worse as temperatures continue to rise. Greater warmth and sunlight interact with exhaust to produce more ground-level ozone, a common pollutant and powerful lung irritant.3 Air pollution is associated with a greater risk of chronic obstructive pulmonary disease, independent of smoking history, and increased airway reactivity to allergens in patients with atopic asthma.4-6 Warming temperatures can aggravate the effects of air pollution.7 Increased levels of particulates exacerbate preexisting respiratory conditions and lead to higher rates of hospitalization and death.8 Air pollution is also associated with cardiovascular disease, including stroke and hypertension.9,10 One study also found a link between air pollution and high levels of anxiety.11 In addition, air pollution may contribute to low birth weight, onset of preterm labor, and other negative perinatal outcomes.12,13 Children are more vulnerable to poor air quality than adults. College-aged persons who grew up in areas with poorer air quality had worse lung function compared with their less-exposed peers.14 In longitudinal studies, cohorts of children who lived in areas where air quality improved showed greater improvements in lung capacity on repeat testing than cohorts of children who lived in areas with less improvement.15 Other vulnerable groups include persons who are older, who have preexisting heart and lung disease, and who are poor.16,17 Socioeconomically disadvantaged groups often live in areas with high traffic, areas in proximity to power plants, and in neighborhoods where there are fewer trees to filter pollutants and mitigate high temperatures by providing shade. Although physicians have no direct control over air quality, they are increasingly called on to help their patients by addressing the environment in which they live. One health system recently took a three-pronged approach to combating local air pollution.18 First, the organization created a working group to study the health impact of air pollution on the community. Second, the group arranged to reduce its own system’s contribution to air pollution by installing solar panels, increasing employee reliance on public transportation and clean vehicles, and curtailing medical waste. Third, the group educated their physicians about air quality and developed recommendations to help them counsel patients on limiting outdoor activities in response to different levels of air pollution. Physicians should advise patients with asthma or lung disease to prepare to step up fast-acting inhaler use and limit outdoor