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Having a Bad Air Day?

The air we breathe can endanger lives—and older people are especially susceptible to pollution-related health problems

A new report from the American Lung Association finds that 60 percent of Americans live in areas where air pollution endangers lives and that those areas are especially harmful for women over 50 and all people over 65.

Studies have found that dirty air can increase heart attacks and deaths from respiratory and cardiovascular disease, especially in older people.

Bakersfield, Calif., Pittsburgh and Los Angeles have the dirtiest air in the country, depending on the type of pollution measured, but cities across the country don’t escape bad grades from the association’s national air quality report card.

The association rates cities based on three of the most widespread types of pollution: ozone; long-term, annual particle pollution; and short-term, 24-hour particle pollution levels. Even though overall air quality has improved nationwide, many counties saw a drop in their grades because of new, stricter standards.

Norman Edelman, M.D., the association’s chief medical officer, says scientists aren’t sure why women over 50 have higher incidence of cardiovascular disease and death when exposed to fine-particle air pollution, but it may be related to the large number of older women with chronic obstructive pulmonary disease. He added that those over 65 tend to have more of the lung and heart diseases that are exacerbated by air pollution.

“Old lungs don’t defend themselves as well, and of course they don’t recover as well,” Edelman says.

In the past year scientists at Harvard University and at California’s state Air Resources Board independently tripled their previous estimates of the risk of premature death in U.S. cities from fine-particle pollution. Fine-particle pollution—a mix of tiny particles from vehicle exhaust and other pollutants—is especially harmful to older people.

“Fine particles have been associated with a lot of health effects in the elderly, especially in cardiovascular disease,” says Fernando Holguin, M.D., a pulmonologist and assistant director of the University of Pittsburgh Medical Center’s Asthma Institute. Holguin says the tiny particles increase inflammation in the body, make the blood more prone to clot and can cause blood vessels to constrict.

“That doesn’t mean every time air pollution goes up, everyone is going to the emergency room with problems, but there is a group of people that are more susceptible,” he says, adding that when particle levels spike, emergency room visits for heart attacks, strokes or heart failure increase the same day or the day after.

A breath of good news

The news that 60 percent of Americans are breathing dangerously dirty air isn’t as bad as it sounds. Overall, air pollution has decreased in the United States over the past decade. Last year’s American Lung Association “State of the Air” report found that 42 percent of U.S. residents live in counties with unhealthy levels of ozone or particle pollution.

Then the Environmental Protection Agency established more stringent ozone standards, so the jump to 60 percent this year largely reflects that change.

The stricter standards caused some counties to drop from A’s to F’s for ozone pollution, even though their ozone levels hadn’t changed significantly. But the new standard was necessary because research now shows that even lower levels of pollution pose significant health risks, says Janice Nolen, the lung association’s vice president of policy and advocacy and a clean-air expert.

In fact, in many areas of the country, ozone levels have improved, Nolen says. “For ozone, you can see significant improvement across the country.” Nolen, who wrote the report, added that particle pollution has shown gradual improvement overall, with some areas getting worse and others better.

The cleaner air does seem to make a difference. In January, a study in the New England Journal of Medicine found that when particle pollution dropped from 1980 to 2000, life expectancy in 51 U.S. cities increased by an average of five months.

Better? Worse? Best?

A number of cities, such as Washington, Baltimore, Charlotte, N.C., New York and Atlanta have improved their air quality over the past year. Even though smog-famous Los Angeles still topped the list for ozone pollution, Nolen says, the city has seen steady improvement in the last few years.

Pittsburgh, another perennial leader among the most polluted cities, has also improved—the city reported its best year-round levels of particle pollution since the association started tracking air quality six years ago, as did Cincinnati, Atlanta, York, Pa., and Lancaster, Pa.

Sixteen cities on this year’s top 25 had worse ozone—or smog—problems than last year. A few regions, including Dallas-Fort Worth and Las Vegas, have higher ozone levels than 10 years ago.

Cheyenne, Wyo., got the top honor for the least amount of long-term particle pollution, followed by Sante Fe, N.M., and Honolulu. Port St. Lucie, Fla., and Laredo, Texas, are among those with the lowest ozone levels, while Oklahoma City and Tucson, Ariz., made the list for low short-term particle pollution. But only one city made all three lists for best air quality: “The cleanest city in the country is Fargo, North Dakota,” Nolen says. So Fargo residents breathe clean, if frosty, air.

The Dirty Air Cocktail

Ozone: This is the most widespread air pollutant and the main ingredient of smog. Lung experts liken inhaling ozone to a bad sunburn for the lungs. Breathing ozone pollution can cause wheezing, coughing and asthma attacks. About 60 percent of people in the United States live in unhealthy areas for ozone, according to the new EPA standards.

Year-round particle pollution: This toxic mix of soot, diesel exhaust, chemicals and aerosols and its tiny particles causes the haze we see over cities. Although we sneeze or cough out the larger particles, we breathe in the tiniest particles and they get trapped in our lungs. Most particle pollution comes from cars and trucks, factories, power plants and steel mills. Scientists study health problems linked to both long- and short-term particle pollution. One in six U.S. residents lives in an area with unhealthy particle pollution.

Short-term particle pollution: Twenty-four hour spikes in fine-particle pollution send more people to the emergency room for respiratory problems, and they increase the risk of death from heart attacks, strokes and lung disease. Nearly 93 million Americans live in counties with too many days of unhealthy spikes of particle pollution, according to the American Lung Association.

How to Handle Bad Air Quality Days

* Ozone levels peak in the afternoon, but particle levels can be worse in the morning. Minimize time you spend outside on Code Orange days or worse. Air conditioning and air filters help, so run the AC if it’s warm enough.

* Stay away from highways on your daily walk or run.

* Keep your lungs healthy. If you smoke, stop. Eat well and exercise regularly. Some small studies have found that vitamin D and omega-3 fatty acids may be good for lung health.

* Listen to warnings. Inhaling too much ozone causes specific symptoms: chest pressure and burning in the nose, eyes and mouth. And particulates can make any underlying diseases worse.

Sources: Norman Edelman, M.D., chief medical officer of the American Lung Association, and Fernando Holguin, M.D., assistant director of the University of Pittsburgh Medical Center’s Asthma Institute.


Elizabeth Agnvall is a contributing editor at the AARP Bulletin.

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