Children’s asthma rates appear tied to ozone levels

By LeRoy M Graham Jr., M.D.

“Caution: Code Orange Smog Alert.” We see this too often during summer months in Atlanta, and it means that Atlanta’s air quality is unhealthy for sensitive groups, including all children and particularly those with heart and lung disease. When ozone reaches these levels, limiting outdoor exertion is recommended, especially during the afternoon or early evening. Code Orange days also mean that we will see more young patients coughing and wheezing with asthma exacerbations.

Metro Atlanta has a long-standing problem with ozone pollution. Levels have improved with the Clean Air Act, but current limits still allow our children to be exposed to levels that research shows to be clearly harmful. According to the American Lung Association “State of the Air 2015” report, we are among 138 million Americans who live in counties where ozone or particle pollution levels make the air unhealthy. This report card for America’s air gave Fulton, Gwinnett, DeKalb and Cobb counties an “F” for having too many days where levels of ozone made the air unhealthy to breathe.

Ozone causes shortness of breath, wheezing, coughing, asthma attacks and an increased risk of respiratory infections. High levels of ozone have also been linked to cardiovascular harm and risks to the central nervous system. Even low levels of ozone can be deadly, with research finding that ozone at these levels is still associated with deaths from strokes, respiratory causes and cardiovascular disease.  The lungs of our children are uniquely at risk due to smaller airway diameter, increased airway reactivity and resistance, and still developing anti-oxidant and detoxification airway defense systems, which are too easily overwhelmed. Children also have extra exposure to school bus traffic and during outdoor school activities. And let’s face it, children want to play outdoors – as well they should.

Asthma is still the No. 1 reason for admission to the hospitals and emergency rooms of Children’s Healthcare of Atlanta;,just as it is at a large number of other children’s hospitals. Minority status, living below 200 percent of the federal poverty level, inner-city residence along traffic corridors in cities with poor air quality, overcrowded living conditions and residence in neighborhoods with high rates of violent crime have all been documented to be associated with a higher prevalence of pediatric asthma, with higher asthma admission and death rates. The direct cost for asthma-related hospitalizations among children in Georgia amounts to more than $27.8 million, and the human cost is incalculable.

Interestingly, efforts to reduce downtown traffic congestion in Atlanta during the 1996 Olympic Games resulted in decreased traffic density and ozone levels, especially during the critical early morning. Peak daily ozone concentrations decreased 27.9 percent, and peak weekday morning traffic counts dropped 22.5 percent. This was associated with significantly reduced rates of childhood asthma events. The number of acute asthma events during the Olympics decreased 41.6 percent in those with Georgia Medicaid, 44.1 percent in an HMO, 11.1 percent in two pediatric emergency departments, and 19.1 percent in the Georgia Hospital Discharge Database. This data provides support for efforts to reduce air pollution and improve health via reductions in motor vehicle traffic.

The EPA needs to heed the scientific consensus and set stronger ozone standards based on the scientific evidence available. Every child deserves the opportunity to play outside and breathe clean air. Our children should not continue as “canaries in the coal mine,” serving as our early warning system as our air quality deteriorates. As physicians and parents, we must put the health of our children first and strengthen standards to reduce ozone pollution.