Air pollution in Alabama, primarily caused by traffic and industry emissions, is taking a toll on the health of citizens, especially people who suffer from asthma and other respiratory conditions. Particle pollution and ozone are two of the most problematic causes of unhealthy air.
According to GASP, a local anti-pollution group (GASP.org), Birmingham is non-attainment for particle pollution, which means, according to the Environmental Protection Agency (EPA) and numerous scientists around the country, the city's air is considered unhealthy to breathe. "Studies have documented that air pollution has a detrimental effect on respiratory airways and can produce changes in lung function. It can also increase emergency room visits in people with asthma and lead to a higher risk of death," says Carol Smith, MD, of Birmingham Allergy and Asthma Specialists, PC.
Growing research supports that not only is pollution aggravating existing respiratory problems, but it may also have a role in the development of these diseases, according to a report in the Journal of Allergy and Clinical Immunology. Organogenesis of the lung begins in fetal life and is rapid in early childhood. The number of alveoli in the human lung increases from 24 million at birth to 257 million at age 4, and changes in the lung continue through adolescence. "Exposure to air pollution alters the normal process of lung development which is guided by a complex and precisely timed sequence of chemical messages. This suggests that air pollution might have a lasting effect on respiratory health," the report states.
Scientists say the risk of dying from respiratory problems is more than 30 percent higher in metropolitan areas with the highest ozone level concentrations. Harvard researchers recently tripled the estimated risk of premature death based on new evidence from fine particle monitors in 27 U.S. cities. In 2011, the American Lung Association ranked metropolitan Birmingham the eighth worst city in the U.S. for particle pollution ahead of larger cities like Detroit and Atlanta. This is problematic for everyone, especially children and the elderly. Children, the elderly and persons with preexisting respiratory conditions, such as asthma, are among those most affected by air pollution. Children generally spend more time outdoors and exercise more so they breathe a greater amount of pollution per pound of body weight than adults.
"Airborne contaminants are taken up by pulmonary macrophages and dendritic cells in the small airways," Smith says. "The antigen is presented to T lymphocytes and leads to the production of TH2 inflammatory cytokines."
A GASP report cited studies showing that chronic exposure to particle pollution has been linked to increased hospitalization for asthma attacks in children living near roads with heavy truck traffic and that the pollution slowed lung function growth in children and teenagers. The study also revealed that the pollution can cause significant damage to the small airways of the lungs and increased risk of death from lung cancer and heart disease.
Ground-level ozone is not emitted directly into the air, but is created by chemical reactions between emissions of nitrous oxides and volatile organic compounds in the presence of sunlight. Such emissions include motor vehicle exhaust, gasoline vapors, chemical solvents, and emissions from industrial facilities and electric utilities.
In 2008, a committee of the National Research Council concluded that short-term exposure to ozone can contribute to premature death. According to GASP, many areas of the country, including Birmingham, produce enough ground-level ozone during the summer months to cause health problems that can be felt immediately. These problems, in addition to increased risk of premature death, include shortness of breath, chest pain when inhaling, wheezing and coughing, asthma attacks, increased susceptibility to respiratory infections and pulmonary inflammation, and increased medical treatment for respiratory ailments.
A report in the Journal of Allergy and Clinical Immunology says that the treatment of symptoms and the use of medication should be based on the usual clinical indications, although some patients might benefit by having their anti-inflammatory asthma medications increased on high-pollution days. Recent studies also indicate that the preventive use of asthma medications might reduce these acute adverse effects of air pollution on those with asthma.
Smith says it will take an effort from everyone in Alabama to solve the pollution problem, but in the meantime, physicians can join local clean air groups in warning of the dangers of dirty air. "Physicians can recommend ways for asthma patients to avoid potentially adverse effects of air pollution. Patients and parents of children with asthma should be aware of the ozone alert forecast (www.epa.gov/airnow) and stay indoors on high-pollution days" she says. "We need to tell people at risk that air pollution is aggravating their health problems, and it is also aggravating the airways of healthy people. Everyone should pay attention to air quality alerts even at their lowest, because even at low levels the air is already unhealthy."
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Carol Smith, MD
