Air Pollution, Lung Health, and the Role of the Pulmonologist

Sustainable Development Goals and Air Pollution

As evidence accumulates on the health ramifications of air pollutants emitted by everything from transportation to agriculture to wildfires, pulmonologists have the power to arm their patients with protective strategies, according to panelists speaking at the session “Air Pollution and Health: From Tailpipes and Smokestacks to Our Patients and Communities” at the CHEST Annual Meeting 2023. These approaches are especially important to communicate to vulnerable populations, including those with existing lung disease and in marginalized communities, speakers said.

Air Pollution and Health

Air pollution, traditionally thought of as the byproducts of industrial activity, transportation, and agriculture, is now also exacerbated by biomass burning in wildfires, all resulting in gaseous and particulate matter (PM) pollutants with serious health ramifications, said Gillian Goobie, MD, PhD, of the University of British Columbia.

Health Impacts of Air Pollution

PM is an amalgamation of particles in the air, and the finer the particles, the deeper they can settle into the respiratory tract. Up to 8.9 million premature deaths per year are attributable to PM less than 2.5 microns in diameter (PM_2.5), and this ultrafine pollution is associated with increased risks of diseases including lower respiratory infection, stroke, chronic obstructive pulmonary disease (COPD), and lung cancer.

“They anticipate that climate change is expected to increase air pollution fatalities by 100% to 300% over the next 30 years,” Goobie said. “This is why it’s imperative for us to act and be advocates as pulmonary physicians and allied health professionals, that this is our lane.”

Research Findings

Research on the overlap between air pollution and lung disease has yielded the knowledge that air pollution is associated with accelerated lung function decline in patients with COPD and gaseous pollutants contribute to airway hyperreactivity and bronchoconstriction in patients with asthma, Goobie explained. Her own work focuses on how air pollutants impact patients with fibrotic interstitial lung diseases, with findings that increased PM_2.5 exposure is associated with increased mortality risk in these patients, making them a “sentinel group” for the effects of air pollution.

Wildfire Smoke and Strategies for Protection

A source of air pollution top of mind for CHEST attendees at this year’s meeting in Hawai‘i is wildfire smoke, noted Erika Mosesón, MD, of Legacy Emanuel Medical Center. PM_2.5 is the primary hazard from this type of smoke, and it can be especially harmful to sensitive groups including children, outdoor workers, and individuals with lower socioeconomic status, as their exposure patterns put them at risk of increased smoke inhalation. Researchers have also identified the importance of what is being burned in a fire, as burning houses and cars release more toxins than biomass alone.

The best time to talk to patients is before a wildfire takes place, Mosesón said. This could look like “having patients get to know about AirNow, telling them that they might be a member of a vulnerable group, encouraging them to make plans for clean air spaces, making sure they get vaccinated, just talking to them about these issues, and obviously it’s always a good time to quit smoking or vaping.” These environmental catastrophes are scary and the science is constantly evolving, but patients need the anticipatory guidance that a pulmonologist can deliver.

Volcanic Smog and Protective Measures

Another type of air pollution faced just a few islands over from the conference site in Honolulu is vog, or volcanic smog, explained Samuel Evans, MD, MS, of the University of Hawaii. The beautiful but unpredictable Kilauea volcano on the Big Island emits incomprehensible amounts of sulfur dioxide and gases, with associated health effects of airway irritation, sore throat, headache, and asthma-like symptoms. Patients with underlying lung disease are particularly at risk, as are those with cardiovascular disease, pregnant people, and older adults or infants.

An insidious route the vog can take into the body is through water, as vog creates acid rain that can settle on fruits and vegetables or cause lead to leach out of rainwater collection systems. Evans reviewed the actionable strategies that clinicians advise their patients to take, including stocking up on medications before a vog event, heeding warnings of increased exposure, using air purifiers, and staying inside as much as possible. The volcano’s location and the island’s wind patterns make the Kona area especially vulnerable, so residents may relocate up to the northern area of the island when the vog is particularly severe.

Environmental Justice and Advocacy

Community organization was also discussed by the final panelist, Adali Martinez, MD, MPH, of the University of California San Francisco (UCSF), who delved into the ideas of environmental justice and advocacy in marginalized neighborhoods. “We see time and time again that air pollution, climate change, and water contamination continue to have the largest impacts on vulnerable communities and communities of color,” she said, fueled by structural racism through forms like redlining and zoning.

The key ingredient in any effort to take action is to involve the people directly affected, Martinez said. Successful examples include an initiative bringing community health workers and families together to weatherize and repair their

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

The article discusses the health ramifications of air pollution and the need for protective strategies to be communicated to vulnerable populations, including those with existing lung disease and marginalized communities. This aligns with SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

SDG 11: Sustainable Cities and Communities

The article highlights the adverse impact of air pollution on cities and the importance of paying special attention to air quality. This relates to SDG 11, which focuses on making cities inclusive, safe, resilient, and sustainable.

SDG 13: Climate Action

The article mentions the anticipated increase in air pollution fatalities due to climate change. This connects to SDG 13, which aims to take urgent action to combat climate change and its impacts.

SDG 15: Life on Land

The article briefly mentions the impact of volcanic smog on terrestrial ecosystems and the need for conservation and restoration. This relates to SDG 15, which focuses on protecting, restoring, and promoting sustainable use of terrestrial ecosystems.

2. What specific targets under those SDGs can be identified based on the article’s content?

Target 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination.

The article emphasizes the health risks associated with air pollution and the need to reduce deaths and illnesses caused by it.

Target 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management.

The article highlights the importance of addressing air quality issues in cities to reduce their adverse environmental impact.

Target 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.

The article mentions the anticipated increase in air pollution fatalities due to climate change, emphasizing the need to strengthen resilience and adaptive capacity to climate-related hazards.

Target 15.1: By 2020, ensure the conservation, restoration, and sustainable use of terrestrial and inland freshwater ecosystems and their services.

The article briefly mentions the impact of volcanic smog on terrestrial ecosystems, highlighting the need for conservation and restoration efforts.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article mentions several indicators that can be used to measure progress towards the identified targets:

• Number of deaths and illnesses attributed to air pollution (Indicator for Target 3.9)
• Ambient air pollution levels in cities (Indicator for Target 11.6)
• Number of deaths and economic losses caused by climate-related hazards (Indicator for Target 13.1)
• Proportion of important sites for terrestrial and freshwater biodiversity that are covered by protected areas (Indicator for Target 15.1)

These indicators can help track the reduction in air pollution-related deaths and illnesses, improvements in air quality in cities, effectiveness of climate resilience measures, and progress in conserving terrestrial ecosystems.

4. Table: SDGs, Targets, and Indicators

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Source: ajmc.com

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