asthma
Letter from Melbourne—an Allergist Reports on the Australian Wildfires
Australian wildfires are a daily part of the news cycle. Astronauts in the international space station are watching as smoke circles the earth. Players have withdrawn from the Australian Open, one of the four grand slam tournaments. A billion animals dead. To put a personal face on this catastrophe, we wrote to our friend allergist Dr. John Weiner, who has been contributing to this website since 2011. (His piece on treating US GIs in Alice Springs remains a favorite.) – Henry Ehrlich
Dear Henry,
Thank you for your thoughts. My family and I are well. We live in a rural area 60 kms south of Melbourne on the edge of Bass Strait, which separates us from Tasmania. The main fires are 200kms+ to our east and northeast. Though many communities have suffered badly, thankfully our only problem has been the smoke. At one time this week Melbourne was the most heavily polluted city in the world, with PM2.5 particles* reaching hazardous levels. It has cleared with southerly winds from the Southern Ocean, but will return in the next 48 hours with wind shift.
ED departments in Melbourne and Sydney report about a 30% increase in respiratory-related attendances. In my own patients, over 50% of those with asthma report mild to moderate exacerbations, and many without asthma complain of cough and itchy eyes.
Of course, nothing can compare with the human toll in deaths and injury, and the destruction of homes, and the devastation of landscape and animals. I saw one farmer’s wife interviewed who said she and her husband had shot about 800 injured livestock. The role of pollutants in the smoke, even of asbestos (from some of the older dwellings in the bush) is unknown.
There is no doubt that climate change has worsened Australia’s fire risk, but we have always had fires. Indigenous Australians utilized fire for hunting. The first major Victorian fire in modern history was in 1851. It destroyed 12 million acres and killed a million sheep. The one I remember vividly was the Ash Wednesday Fires on 16 February 1983 (my 35th birthday) when, at our inner suburban Melbourne home with my family and both parents, the atmosphere blackened, and embers fell. Those fires were 100 kms to our west and affected our surf beaches. A family whose son was a mate of mine at Anglesea, on the coast, and where I used to spend every major school holidays, had escaped to the beach with hundreds of others to avoid the fires.
In 2009 the Victorian Black Saturday fires killed 173 people, including a well-respected respiratory physician who taught me when I did a respiratory term at our Veterans hospital in 1974.
About 100 major fire events were recorded in Australia in the last 170 years, and of course innumerable smaller blazes. Eucalyptus forests can burn ferociously, and, as we are warned, in extreme cases the heat will kill you before you see the flames.
Victoria is down south, and our peak fire risk is actually in February. The current conflagration, with major effects in New South Wales, Queensland and South Australia as well as our state, comes after a long drought, years of increasing average temperatures, and probably reduced clearing of undergrowth outside the fire season. The role of fuel reduction as a means of lessening fire risk is currently controversial in the face of climate change. In any case, our Federal Government has announced a Royal Commission for the fires.
I must add the Australians owe a continuing debt to our firefighters, most of them volunteers. Many of them have been killed or injured over the years while protecting other people’s lives and property. And we are so grateful to the international response of money, equipment, and firefighters.
Best wishes,
John
John Weiner is a medical consultant in the diagnosis and treatment of allergic diseases and asthma. After completing his medical degree at the University of Melbourne, John obtained specialist qualifications in internal medicine (clinical immunology and allergy) and pathology (anatomical pathology). John is a Fellow of the Royal Australasian College of Physicians and the Royal College of Pathologists of Australia.
*We have posted on the hazards of 2.5 particles several times, notably in this piece by Elizabeth Mueller of Berkley Earth, entitled Half a Cigarette a Day for Your Asthmatic Child.
Death Toll From Relaxed Restrictions on Coal
By Henry Ehrlich
The New York Times recently put a death tag on new rules calculated to reduce the price tag for coal-fired power plans. “The administration’s own analysis…revealed on Tuesday that the new rules could also lead to as many as 1,400 premature deaths annually by 2030 from an increase in the extremely fine particulate matter that is linked to heart and lung disease, up to 15,000 new cases of upper respiratory problems, a rise in bronchitis, and tens of thousands of missed school days.” The Washington Post puts the body count higher. Either way, the average yearly mortality rates from asthma, which has fallen to around 3000 per year, will likely creep back up to where it was a couple of decades ago.
The three founders of this website have always been divided on politics (hint, the two with the same last name agreed with one another) but all of us agreed that cleaner air is better for asthmatics and everyone else than dirty air. We have published articles on the deleterious effects of carbon, small particle pollution, sulfur dioxide, and others probably. We don’t name names and take sides but hope that the facts speak for themselves.
But while we’re on the subject, this administration also proposes to cripple fuel efficiency and emission standards for cars and trucks that had been put in place by the previous one. The rationale presented as presented by the Times would be funny if it weren’t so dangerous to the nation’s lungs, arguing that the relaxed standards would save 13,000 road fatalities per year:
The Trump administration uses three dubious assumptions to reach its conclusion. First, it asserts that people who buy more fuel-efficient cars would drive more — about 1.3 trillion miles more than previous estimates — because it would be cheaper to do so and they would, thus, be at greater risk of accidents. This is what experts call the rebound effect, but few researchers say the effect is this strong. One scholar, Kenneth Gillingham, a Yale economist, whose work the government relied on to come up with its numbers, told The Times that the administration ignored more recent work that showed a much smaller effect.
Next, the administration says that because more fuel-efficient cars would be more expensive, fewer people would buy them and they would choose to keep driving older cars that tend be less safe than newer models. This argument is belied by the fact that car sales have been strong in recent years, even as fuel economy improved to 25.1 miles per gallon in 2018 models, from 21.8 miles per gallon in 2011, according to the Consumer Federation of America. On average, Americans bought 17 million cars annually over the last five years while about 13 million older models went off the road.
Finally, Trump officials claim that automakers would have to make their vehicles lighter to meet the Obama standards, which would make them less safe. This is bunk. Lighter-weight aluminum, which many automakers have turned to as a replacement for steel, protects motorists better because it crumples and absorbs the impact of crashes better than heavier materials, said Daniel Becker, director of the Safe Climate Campaign at the Center for Auto Safety. Further, newer models tend to have more sophisticated safety features, like automatic braking and lane-departure warnings, that over time should make American roads safer.
Anyone in your family have asthma? You have a job to do in November.
Chronic Urticaria: the Omalizumab (Xolair) Difference
By Dr. Paul Ehrlich
Back when we wrote our book Asthma Allergies Children: a parent’s guide, Dr. Chiaramonte and I both expressed our exasperation over the dismal state of treatment for chronic urticaria—the fancy name for hives—by recalling our training. Larry remembered, “My teacher at Johns Hopkins said, ‘I’d rather have a tiger come into my office than a patient with chronic hives.’”
My version was from my fellowship at Walter Reed Army Hospital. We learned that 80 percent of the cases we would evaluate would never reveal a cause. My professor, Colonel Richard Evans, told us, “For those of you who are going into practice and will treat urticaria I would suggest having an office with two doors to the outside. You’ll need one door for your patient to enter and the other for you to sneak out.” His point was that many cases defy diagnosis, it often takes a while before the right treatment is determined, and patients are rarely satisfied with it.
That book was published in 2010 and it’s still very good—I give copies to my patients and young doctors who spend month-long rotations in the practice, although some bits need updating (that’s at least part of the mission of this website). I was particularly struck by this paragraph:
FUTURE TREATMENT?
A case recently came to our attention of a chronic asthmatic who had the good fortune (financially as well as medically, because the stuff costs $1,000 a month) to use Xolair. It helped not only with his asthma, but with his cold-induced urticaria. We can only speculate that this anti-IgE drug is functioning in the skin as well as the lungs. It makes sense to us, because cold can induce asthma in twitchy lungs. We doubt that this off-label use of Xolair will be transformed into an on-label use any time soon, not at current prices. p.110, 2010 edition
Here it is eight years later and we hardly use omalizumab for asthma in my practice but we use it for urticaria all the time. More important, we hardly hear from our patients in the intervals between their shots, where once we would have heard from the same patients all the time. Chronic urticaria like its cousin atopic dermatitis, or eczema, is a cause of active suffering day to day. Quality-of-life scores are much lower than for chronic diseases such as diabetes. Not only are the skin conditions intensely uncomfortable, they are disfiguring. Many years ago I had a 14-year-old girl patient who was hospitalized for suicidal depression because of her hives. It was a formative experience for me as an allergist.
A key milestone was a 2013 article in the New England Journal of Medicine that found dramatic improvements from omalizumab. There were the usual hurdles of further studies and insurance reimbursement along the way, but here we are in 2018 and omalizumab is pretty much standard of care. Genentech is also generous for those patients who struggle with the cost.
Omalizumab is so effective in treating hives that I find it bewildering to encounter physicians who still don’t use it. One prominent dermatologist I know still clings to the cycles of more steroids, topical and systemic, antihistamines, baths, and emollients. It should surprise me, but it doesn’t. In his book How Doctors Think, Dr. Jerome Groopman cites Douglas Watson, former president and CEO of Novartis (which helped develop omalizumab) to the effect that research shows that most physicians regularly prescribe around two dozen drugs, most of which they learned about during their training, although their training may have taken place many years earlier.
Along the way this anti-IgE drug has had its share of public relations and medical problems. There was alarm over a statistical association with cancer, although I am convinced it was just data noise. There are those who are allergic to the drug itself, complete with instances of anaphylaxis. That’s one advantage to giving shots in a clinical setting—the tools and the personnel are on hand to treat adverse events. The FDA has also raised concerns of risks to blood vessels supplying the brain and heart.
Regardless, my patients are happy with their Xolair–costs, inconvenience, and all because of the profound relief they have achieved. And if they’re happy, I’m happy. I even got rid of the back door to my consulting room.
(Note: we received no financial or other consideration from Genentech and Novartis for publishing this piece. It is based entirely on Dr. Ehrlich’s appreciation of a drug that has produced tremendous benefits for his patients.)
Clinical Trial for New Combination Asthma Therapy
By Henry Ehrlich
This website likes to feature new technologies for various allergic conditions, particularly to help patients comply with their asthma medication regimens. We do this because, as we were recently reminded, asthma represents a huge and still-growing threat to public health.
Today we’re doing something new—partnering with a company called Antidote to publicize a clinical trial for a combination asthma therapy for children aged 5-17. The investigational study drug (fluticasone furoate/vilanterol) is administered by an inhaler. This study will investigate whether a treatment option already approved in the U.S. for adults is safe and effective for children and teens. This a phase-3 study, which means that the study drug has been taken by other participants under the supervision of medical professionals.
Key Eligibility Criteria:
- Age: 5-17 years of age
- Have had asthma for at least 6 months
- Currently are treated with a daily and rescue inhaler
- Cannot have been hospitalized for asthma symptoms in the past 6 months
- Cannot have type 1 or type 2 diabetes
TO FIND OUT MORE AND A LOCATION CONVENIENT TO YOU CLICK HERE!
This study comes at a good time. In December, we were treated to this on FDA.gov:
FDA’s most prominent warning, the Boxed Warning, about asthma-related death has been removed from the drug labels of medicines that contain both an ICS and LABA. A FDA review of four large clinical safety trials shows that treating asthma with long-acting beta agonists (LABAs) in combination with inhaled corticosteroids (ICS) does not result in significantly more serious asthma-related side effects than treatment with ICS alone.
Another First for this Website
We launched this website in 2010. In that time we have never taken in a penny of revenue except for sales of our book, Asthma Allergies Children: a parent’s guide and those sales have never compensated us for the cost of designing or maintaining the site, let alone the editorial time involved. If, however, anyone becomes part of this study via our website, we will get paid.
Asthma Price Tag–$82-Billion and Rising
By Dr. Paul Ehrlich
The last figure we had for the overall cost of asthma to the US economy covering years 2002-2007 was $56-billion annually measured in medication costs, emergency room visits, and days lost to school and work. Now we have new numbers and they are stunning. New analysis derived from federal government data covering the years 2008 to 2013 brought an estimate of $82-billion, encompassing about 15.4 million people treated annually. The annual per-capita medical cost of asthma was $3,266.
As published in the Annals of the American Thoracic Society Jan. 12 and reported in WebMD,
“$1,830 was for prescriptions, $640 for office visits, $529 for hospitalizations, $176 for hospital outpatient visits and $105 for emergency room care. Asthma-related deaths cost $29 billion a year, with an average of 3,168 deaths a year.”
Other CDC statistics released late last year show that among children and adolescents from 5-17 years old, asthma accounts for a loss of 10 million school days annually and costs caretakers $726.1 million per year because lost work days.
Bad as those numbers are they only account for treated asthma. We don’t know how many are untreated. Parents should look for behavioral cues: nighttime wakefulness and daytime lethargy, lack of energy at play, teacher complaints of inattentiveness at school.
And they don’t account for asthma under the age of five, when patients are hospitalized at twice the rate of older children. This is not only because their airways are smaller and block more easily but because children can’t express discomfort and their parents are not attuned to spotting symptoms. (For more on this please check our archived publication of Dr. Thomas Plaut’s signs-based asthma action plan.)
Asthma isn’t going away anytime soon. It’s more complex than we have traditionally acknowledged, and it must treated on an individual basis. But the toll it takes falls on everyone.
photo from marketwatch.com
“Wormwood” on Netflix–Strangest Allergist Story Ever
By Henry Ehrlich
Once you start studying a relatively obscure subject like allergies, you see it pop up in the darndest places. A new one is a Netflix production called “Wormwood,” which tells the story of one Frank Olson, a microbiologist employed by the United States Army to work on biological weapons during the Korean War. In November 1953, he was slipped a dose of LSD by contacts in the CIA, which was investigating the drug’s potential value as a truth serum for a program about mind control–code name MKULTRA. Olson committed suicide, or so the official version said. Even before the acid trip, according to his family, Olson had been suffering pangs of guilt over his work, which would on a “good day” kill all the monkeys used in an experiment. His darkest doubts were over whether these poisons had been used in combat in Korea as claimed by the Chinese. His other major agony was suspicion about use by the military of what are now euphemistically called enhanced interrogation techniques.
These events are imagined and dramatized by master documentarian ErroI Morris, interspersed with newsreel and TV footage, and interviews with son Eric Olson and others. The narrative by Eric, who was nine when his father died, holds the sprawling story together, in part by relying on apt references to Hamlet, who also had a problem with the mysterious death of a father. He was a Harvard graduate student when his life was virtually taken over by his decision to take arms against his own sea of troubles and search for the truth. As drama: gripping. As history: deeply disturbing, with events and characters that ring doorbells from the beginnings of the cold war to the present day.
All that and allergy, too, in the form of Dr. Harold A. Abramson.
In between the dose and plunging from a hotel window in New York nine days later, Olson was sent to see a doctor about terrible anxiety and self-doubt purportedly brought on by the LSD. The doctor turned out not to be a psychiatrist, as he told his wife before he left Virginia, but Abramson, an allergist who dabbled in psychiatry. He had been an early promoter of the use of acid as a therapeutic tool, which he contended was no more dangerous than any other drug if administered by trained physicians as opposed to recreational use. He died in 1980.
Olson had worked with Abramson at Fort Dietrick, where much military and intelligence research took place. As an allergist, Abramson was interested in the distribution of pollen and other particulates in the air. Airborne allergens and airborne toxins are cousins. Dr. Chiaramonte wrote in our book that the instruments he used to collect ragweed pollen for research were developed by the military for capturing fallout from nuclear tests. They could as easily be used to study the movement of, say, anthrax spores, and probably were.
Abramson graduated from Columbia College in 1919, and received an MD from Columbia in 1923. He specialized in allergy and pediatrics. In 1941 he joined the staff at Mount Sinai, where he was the first ever to use aerosolized penicillin, and concentrated on asthma and pulmonary disease. Hence the basis of his usefulness to the CIA and Army. His publications in the early 1940s, as recorded in the Journal of Allergy and Clinical Immunology (JACI), range from a review of a portable respirator to protect against pollen inhalation through use of gelatin in preparing epinephrine for injection to “Preseasonal treatment of hay fever by electrophoresis of ragweed pollen extracts into the skin.” Later in his career he co-founded of the Journal of Asthma Research with another prominent allergist Dr. Murray Peshkin, who also died in 1980.
How did Abramson go from being a professional allergist to an amateur psychiatrist? More important, how did he go from giving allergy shots to complicity in the death of an American scientist? Was he bored? Did he have a mid-life crisis? What were the small steps and incremental ethical choices he made in between?
One clue concerns a book Abramson edited, published in 1951, called Somatic and Psychiatric Treatment of Asthma. It was greeted without enthusiasm in a JACI review, which criticized misguided and contradictory classifications and recommendations on the somatic side of the equation. As for the psychiatric side, the reviewer wrote, “Despite the title, psychiatric treatment is not given a predominant position. The existence of purely psychogenic asthma is questioned, and psychic factors are considered contributory causes of asthma which is associated with an antibody mechanism. The section on psychotherapy comprises less than one-tenth of the text.” Pretty dismal. A pity because despite the nasty treatment at the hands of the JACI reviewer, it looks like he was trying as an allergist to grapple with a heterogeneous disease that we still haven’t gotten right, and whose nature does show a good deal of overlap of the body and the mind. Maybe the bad review had caused him to sour on mundane research and publication.
Somewhere along the line his interest in psychiatry led to an infatuation with lysergic acid diethylamide and its potential for altering the mind. In 1953 Abramson proposed an $85,000 study to the CIA for exploring the use of this wonder drug. There was a great deal of interest in the idea of “brainwashing” as practiced by our Chinese foes in Korea, which inspired the great Cold War thriller “The Manchurian Candidate,” which is excerpted briefly in “Wormwood.” The US needed its own tools: thus MKULTRA. After that most of his medical achievements were concerned with LSD instead of asthma and included a book called The Use of LSD in Psychotherapy and Alcoholism.
Abramson has emerged in this Netflix depiction as a version of Albert Finney’s character Albert Hirsch in The Bourne Ultimatum, the third Jason Bourne movie, someone who, along with others in this real-life tale of intrigue, started out with patriotic intentions and went off the rails. Who knows? Abramson may have been a model for Hirsch. Like Bourne, Olson knew things he would have been better off not learning in the first place and it made him dangerous. Abramson, according to “Wormwood,” was complicit in Olson’s probable murder.
I asked two New York allergists old enough to have intersected with Abramson if they had ever heard of him. Negative. By complete chance I was at a breakfast at a leading medical institution this morning to greet some visitors from another country who are collaborating on research. One of the local collaborators is an eminent pulmonologist at Columbia so I mentioned the name Harold Abramson and asked if he was someone they were proud of. She said no. Who was he and what did he do? So I explained. I mentioned his book. She had never heard of it. Finally she said, “At Columbia they only talk about Nobel Prize winners and people like that.”
Can’t say as I blame them. I would love to know the whole story.
Air Quality in Reno Craps Out Again
By Caroline Moassessi
(This is our fourth report from Caroline in five years about smoke and air quality in Reno, Nevada.)
That familiar smell began creeping into Reno today. A sick feeling started in my stomach and made its way down to my toes. I realized this wasn’t just annoying poor air quality wafting into my town. Other years the smell comes from points southwest. A year ago it was the Southern California Sobranes and Sand fires. Now, horrific fires are blazing in Northern California some 200 miles away as a state of emergency has been declared. These were particles of destruction and death, the remnants of a good lives led in the wine country, dreams reduced to smoke. I wanted to lock myself in a closet and cry.
Earlier today, Catalytic Pure Air Filter, lent me a hospital grade air purifier for pals who fled the California fires to Reno. Knowing the air quality here was going to take a turn for the worse, I wanted these friends, who manage severe asthma, to be ready. Within hours of their arrival, the air quality predictably dropped into the Unhealthy for Sensitive Group range (USG), per the Environmental Protection Agency’s (EPA) Airnow.gov website tracking.
As the haze moved across the Truckee Meadows sports practices were cancelled. Social media lit up with questions about where to buy air purifiers and questions keeping kids indoors. We have learned the hard way about kids with asthma so those with little ones will send reminders to teachers tomorrow. When our cherubs are not experiencing wheezing, it is far too easy to forget about their asthma and 504 plans.
While schools turn to our local health district for guidance regarding if students should be kept indoors, the reality is that a gust of wind can push dangerous air into a community within minutes – well before administrators have time to make decisions. This is where our asthmatic children can fall through the cracks and be inadvertently sent outdoors.
The best strategy I learned from a dear friend with a severely asthmatic son, was to
check Airnow.gov on the way to school and then immediately contact the teacher and administrator reminding them of my child’s protocol. Even if air quality levels are looking decent, in the moderate range, I look at the forecast and make the decision for the school. Is my child is fighting a cold? On a good day, moderate air quality might be fine, but not if they are fighting off a cold or hay fever. These are the times when ten extra minutes can mean the difference between a trip to the Emergency Room or not.
Now that we are facing horrible air quality again, I’ve loaded Airnow.gov back onto my smartphone. It was there all summer and we struggled through weeks of poor air quality. It got so bad, we started carrying extra spacers and face masks in the car. My daughter, doing her best to be fashionable, opted for a few K-pop mouth masks. They filter out a little smoke, but one needs a true facial mask to block out dangerous particles.
Even though I am dreading the next several days of smoke settling in our town, I am grateful for every minute that I am able to simply turn on our air filters, keep my daughter indoors and take precautions. I can’t shake thinking about our friends in Northern California, who are not only dealing with terrible air quality, they are losing their homes, businesses and health. Nothing matters when you can’t breathe, but after the air clears, you can miss the things you lost.
Caroline Moassessi is the founder and author of the International food allergy and asthma blogsite Gratefulfoodie. She recently received a FARE vision award and is a Huffington Post Blogger. Caroline’s passion as a food allergy and asthma advocate included being the lead advocate for mandated stock epinephrine in Nevada. She presented the need for laws protecting people with life threatening anaphylaxis at the National Conference of State Legislators along side past president Senator Debbie Smith.
Caroline sits on the American Lung Association (ALA) National Social Media Work group, and is the past regional Advocacy Chair, past National Advocacy Work Group member, past Secretary/Treasurer for the ALA of the Southwest region, past president of the Board of Directors for the American Lung Association in Northern Nevada, and was a founding member of the National Allergy and Anaphylaxis Council. Caroline discusses food allergies on her local ABC affiliate network, works as a food allergy liaison with her local school district, contributes to Allergic Living Magazine, and has spoken at the Food Allergy Blogger Conference, Minnesota Food Allergy Conference, Salt Lake City Food Allergy Conference, and the American Thoracic Society’s International Conference. She is a co-group leader and co-founder of the Northern Nevada Asthma and Food Allergy Education Group
Two Steps Back on Asthma Control
By Paul Ehrlich MD
For all the headlines garnered by food allergies, asthma remains the larger threat to public health. While we like to think we know enough about this set of symptoms and how to treat it with the limited tools we have, current research shows otherwise. For example, an upcoming article from In Practice tells us that the guideline recommending a spacer for use with pressurized extra-fine-particle (QVAR) or fine-particle (Flixotide) inhaled corticosteroids (ICS) is not only ineffective but perhaps counterproductive.
This is an important article for me because while it deals only with patients 12 and up, I prescribe small-particle steroids for children. The small particles navigate the tiny airways of children better than those with larger particles. I need to know that I am doing the right thing.
Key results as reported by Univadis include:
- No difference in rates of severe exacerbations between spacer and no-spacer groups in both ICS cohorts.
- Rates of acute respiratory events and odds of risk-domain asthma control were similar with spacer and no-spacer.
- Unadjusted results showed no significant difference in hospitalizations with spacers.
- In unadjusted analysis, patients prescribed spacers had significantly lower odds of achieving overall asthma control, meeting treatment stability criteria.
- Treatment changes were more common in patients prescribed spacers.
So, are spacers a good thing or not?
Let me describe what a spacer does. A pressurized metered-dose inhalers (pMDI) releases the gas at about 60 miles per hour. A spacer captures the dispersed gas so that the patient can inhale at something approaching his own speed instead of inhaling precisely at the time it is being jetted out. I’ve tried that and it’s not easy. Fail to coordinate and the active ingredients stay in your mouth where most patients just rinse them out. It’s difficult for kids but adults often get it wrong, too. Allergists and pulmonologists should take pains to instruct them, but I’m guessing that in the current assembly line medical environment we have today, it doesn’t get done. With internists doing a good deal of the prescribing, I’m betting it happens even less.
I am looking forward to the full article, but for the moment I am curious about the specific language of the above bullet points. Namely, the use of the word “prescribed.” Inadequate compliance is an issue plastered all over chronic disease management. We know that large numbers of patients never fill their first prescriptions and many more fail to renew them. Are these subjects using the spacers as prescribed? Do they purchase them but not bother to use them? Just as no medicine is effective if you don’t take it, no apparatus is effective if you don’t use it, or don’t use it right.
Image by www.amcal.com.au
Half a cigarette a day for your asthmatic child
By Elizabeth Muller
Parents with children who have allergies and asthma are used to checking the pollen count and ozone levels, much in the same way that other parents check the daily weather. These things may impact how they organize their day, and how much time they’ll let their children spend outdoors. But there is another pollutant, less commonly known, that they should be checking too. It is called PM 2.5, and is now recognized as the most deadly type of air pollution.
PM 2.5 refers to particulate matter 2.5 microns in size and less, and the greatest source is coal, though vehicles, forest fires, and desert dust are also sources. There is a growing body of evidence that PM 2.5 increases the risk of heart attacks, stroke, lung cancer–and asthma. Most Americans still haven’t heard of PM 2.5. The US Environmental Protection Agency (EPA) only started systematically reporting PM 2.5 levels in 1998.
The United Nations recently released a report stating that approximately 300 million children around the world breathe highly toxic air. The impact of such air pollution on children is especially bad, since their lungs are still developing.
A few days ago, much of India celebrated Diwali, and the impact of the resultant air pollution was catastrophic. The grey areas in the image below show pollution areas that are far worse than “hazardous”, and are actually so bad that they are “off scale” (the light grey areas have no available data).
While pollution levels are much better in the United States , and the corresponding map (see below) is mostly green for “good” air, we now know that the levels of PM 2.5 are sufficiently high that the average level of this pollution in the US shortens the average life by about the same amount as smoking a half cigarette per day. While nobody wants their kids smoking half a cigarette per day, asthmatic kids are especially at risk from this regular dose of air pollution. The EPA calculates that the number of deaths in the United States from PM 2.5 is around 75,000 every year, far less than in Europe or Asia, but far more than the number of automobile accident deaths in the United States. We have been studying PM 2.5 at Berkeley Earth, and we obtain a similar number. PM 2.5 is arguably the greatest environmental problem in the world today.
Europe too, is suffering from poor air pollution at this time of year. The map below shows PM 2.5
air pollution in Europe at the time of writing. It is not nearly as bad as air pollution in India, but still bad enough to kill more than 400,000 people a year, according to the European Environmental Agency. Compare that to less than 100,000 deaths per year for ozone and nitrogen dioxide combined, pollutants that more people are familiar with.
The Clean Air Act treats PM 2.5 as a serious pollutant, and is one of the major reasons that power plants are increasingly switching from coal to natural gas. A switch from coal to natural gas reduces PM 2.5 by a factor of 400. Switching from coal to renewables or nuclear power essentially eliminates PM 2.5 from power production.
And as with pollen, daily variations can be much worse. National averages camouflage the large regional and seasonal disparities across the United States. The Berkeley Earth website now updates a map every hour showing PM 2.5 levels across the US. (It is available here: http://berkeleyearth.org/air-quality-real-time-map/.) We’ve been doing this for only a few months, so we do not yet know what patterns are likely to emerge. We do know that in much of the world, PM 2.5 is worse in the winter months – so parents may wish to monitor levels carefully during this time.
On bad pollution days in the United States, called “Spare the Air Days”, it is illegal to burn wood, manufactured fire logs, pellets, or any other solid fuels in your fireplace, woodstove, or outdoor fire pit. We are asked to carpool, take public transportation, walk, or ride a bike to work. Ironically, walking or riding your bike on such days (or any sort of outdoor exercise) will actually increase your exposure to air pollution, by increasing the amount of air you breathe. A recent paper published by the Columbia University Medical Center shows that active kids are more exposed to pollution, and that the higher pollution exposure may offset some of the benefits of being active. It is certainly not wise for kids or asthmatics to walk or bike to work on bad pollution days.
Tomorrow, when you check the pollen and ozone levels, as well as the chance of rain, you might want also to check the local PM 2.5 levels.
Elizabeth Muller is the co-founder and Executive Director of Berkeley Earth, a non-profit research organization. Elizabeth guided the strategic development of Berkeley Earth from global warming data analysis, to climate communications, to global warming mitigation, and now, PM2.5 and global air pollution. Elizabeth has authored numerous scientific and policy papers, as well as Op Eds in the New York Times and the San Francisco Chronicle, and made numerous TV and radio appearances. Prior to co-founding Berkeley Earth, Elizabeth was Director at Gov3 (now CS Transform) and Executive Director of the Gov3 Foundation. From 2000 to 2005 she was a policy advisor at the Organization for Economic Cooperation and Development (OECD). In these positions, she advised governments in over 30 countries, in both the developed and developing world, and has extensive experience with stakeholder engagement and communications, especially with regard to technical issues.
All graphics courtesy Berkeley Earth (www.BerkeleyEarth.org)