Community Air Pollution: What a Pulmonologist Should Know

Abstract

From both the clinical and public health perspectives, air pollution remains a relevant topic for pulmonary physicians. Under the requirements of the Clean Air Act, the Environmental Protection Agency has set standards for six specific pollutants, often referred to as “criteria” pollutants. Although dramatic air pollution episodes associated with evident excess mortality are now unlikely in much of the world, outdoor air pollution continues to be linked with an increase in cardiorespiratory events, particularly in susceptible populations. Analyses for many cities in the United States and other countries have shown that daily mortality counts are associated with indexes of particulate matter in outdoor air; there is supporting evidence from studies of morbidity, including rates of hospitalization and of visits to emergency moms. Ozone and acidic aerosols may be responsible for acute and chronic respiratory morbidity, and questions remain regarding the relationship of nitrogen dioxide exposure and the risk of respiratory infections. Low levels of carbon monoxide can lead to worsening of anginal symptoms, perhaps ventricular arrhythmias, and possibly increased hospital admissions for congestive heart failure. Approaches for limiting the health risks of breathing polluted outdoor air in sensitive individuals have received little study. Current understanding of the determinants of exposure suggests that modifying activity patterns to limit time outside during episodes of pollution represents the most effective strategy. Pulmonary physicians should be able to advise their patients and their communities concerning the risks of outdoor air pollution and on approaches for reducing these risks