Why Should You Care About the Air?

Medscape Family Medicine
Why Should You Care About the Air?

Linda Brookes, MSc
Disclosures | September 10, 2015


Ambient Air Pollution and Health

The adverse effects of ambient air pollution on health, especially of the lungs and heart, are acknowledged as a continuing problem in developed as well as developing countries.
In the United States, nearly 138.5 million people—almost 44% of the population—currently live in areas where levels of air pollutionare deemed dangerous to heath, according to the "State of the Air 2015" report issued by the American Lung Association (ALA).[1] Although this shows some improvement over the 2014 report, in which the comparable figure was 147.6 million people (47% of the population), it does not represent progress since 2013 (131.8 million people, 42% of the population).

People who are especially susceptible to the health effects of ambient air pollution include the elderly (a rapidly growing population), infants, pregnant women, people with lung or heart disease or diabetes, and people who work or are active outdoors.

Numerous studies have shown an association between acute and chronic exposure to ambient air pollution and an increased risk for respiratory disease (asthma, chronic obstructive pulmonary disease, lung cancer) and cardiovascular disease (myocardial infarction, heart failure, stroke),[1-3] but more recent evidence has also linked ambient air pollution with a diverse range of other diseases, including diabetes,[4-7] obesity,[5,8,9] cognitive decline,[10-15] and anxiety.[16]

Prenatal exposure has been associated with preterm birth[17,18] and low birth weight[18-20] and early exposure with neurodevelopmental problems.[21] Exposure in children and adolescents has been shown to affect lung function growth.[22-25]

Overall, people living in areas with poor air quality have consistently been shown to be at increased risk for premature death from cardiopulmonary and other diseases.[1,2] The latest US findings suggest that the number of preterm deaths linked to reduced air quality caused by road transportation exceeds the number of fatal accidents by up to 30%.[26]

To understand current thinking about the health effects of air pollution in the United States and what healthcare professionals can do to mitigate them, Medscape spoke with John R. Balmes, MD, professor of medicine in the Division of Occupational and Environmental Medicine, University of California, San Francisco, School of Medicine; professor of environmental health sciences at the University of California, Berkeley, School of Public Health; and director of the Northern California Center for Occupational and Environmental Health.

Dr Balmes has been studying the health effects of air pollutants for 30 years. He is the physician member of the California Air Resources Board (ARB) and chair of the American Thoracic Society (ATS) Environmental Health Policy Committee.

"Over the past few years, there has been increasing recognition of the importance of air pollution as a contributor to certain chronic health outcomes, in particular cardiovascular disease and cerebrovascular disease, as demonstrated by the statements issued by the American Heart Association (AHA) about the importance of air pollution as a risk factor for heart attacks and stroke," Dr Balmes points out.[3,27]

"So general practitioners, whether they are in internal medicine or family medicine, should learn about air pollution and its effects on health in adults," he urges. He also stresses the need for more professional education about the health effects of pollution. " In general, medical students and house officers in training post medical school don't get much education about environmental and occupational exposures—it is a neglected area of health in US medical education."