Asthma and pollution

Mitchell Grayson, MD

Director

Fight Asthma Milwaukee (FAM) Allies

Asthma is a problem

Every day in America:40,000 people miss school or work due

to asthma

30,000 people have an asthma attack

5,000 people visit the emergency room due to asthma

1,000 people are admitted to the hospital due to asthma

11 people die from asthma

• An immune response in the small airways of the lungs, characterized by

– Inflammation and edema (swelling)

– Mucus production (snot)

– Bronchospasm (muscle tightness)

What is Asthma?

Drawings from M. Tsutsumi

Asthma triggers

• Asthma can be triggered by many airborne factors:

– Pollen (trees, grasses, ragweed)

– Mold spores

– Air pollution

• Exhaust from vehicles– School buses, trucks

– Small engines (eg, lawn mowers)

– Boats and cars

• Factory smoke / exhaust

Air Pollution

• Ozone (O3)

– An invisible gas formed through chemical reactions of nitrous oxides and volatile organic compounds

– Able to chemically react with lung tissue leading to tissue damage

• Particle Pollution

– A mix of airborne solids and liquids

– Comes from burning fossil fuels in factories, power plants, steel mills, smelters, diesel/gasoline, wood (even from residential fireplaces).

– May trigger asthma possibly leading to hospitalization and death

Particle Size

• Size matters

– > 10 µm impact in the nose and mouth

– < 5 µm can impact in the lungs

bronchioles and alveoli

bronchioles (small airways)

trachea (large airways)

nose and mouth

3

From: Heyder J. Proc Am Thorac Soc. 2004;1:315.

Why worry about emissions?

Health Impact of Diesel Emissions

Data from 2010 Clean Air Task Force

Does exhaust really matter to people with asthma?

To reduce traffic for the games:• Around-the-clock public transportation was provided• 1,000 buses added to the existing fleet• Downtown city streets were closed to private cars • Downtown delivery schedules altered to ease morning rush hour • Allowed flexible work schedules and telecommuting

These changes resulted in marked declines in ozone and other air pollutants known to trigger asthma exacerbations.

A study examined the 1996 summer Olympic games in Atlanta

Friedman MS, et al. JAMA. 2001;285:897-905

Results for people with asthma

• When compared to pre-Olympics data, the frequency of asthma events (emergency room and/or hospitalizations) decreased by

– 42% (Georgia Medicaid claims)

– 44% (Health Maintenance Organization data)

– 11% (data from two Pediatric Emergency Depts)

– 19% (data from the Georgia Hospital Discharge Database)

• So, reducing pollutants and ozone reduced the burden of asthma!

Friedman MS, et al. JAMA. 2001;285:897-905

Recommendations

• Check Air Quality Daily:

– 1-866-DAILY AIR

– (1-866-324-5924)

– www.epa.gov/airnow

– Orange level means air quality is bad for sensitive groups including older adults, all children, and people with respiratory illness.

• On bad air quality days:

– Stay indoors

– Do not exercise outside

Thank You!