Meredith McCormack, MD, on What You Need to Know About the American Lung Association's 2020 State of the Air Report

The American Lung Association recently released its 21st annual State of the Air report, which found that nearly half of the United State's population lived with and breathed polluted air. In this podcast, Meredith McCormack, MD, highlights the report’s key findings and suggests how the information can help guide your conversations with patients—especially with those who are at high risk.

Additional Resources:

  1. American Lung Association. State of the Air 2020. Accessed May 29, 2020. http://www.stateoftheair.org/assets/SOTA-2020.pdf
  2. Nearly half of U.S. breathing unhealthy air; record-breaking air pollution in nine western cities. News release. American Lung Association. April 21, 2020. May 29, 2020. https://www.lung.org/media/press-releases/state-of-the-air-2020

 

Meredith C. McCormack, MD, MHS, is an associate professor of medicine and the medical director of the Pulmonary Function Laboratory at Johns Hopkins University in Baltimore, Maryland. She is also a volunteer medical spokesperson with the American Lung Association.


 

TRANSCRIPT:

PULMONOLOGY CONSULTANT: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your moderator, Colleen Murphy, with Consultant360 Specialty Network. 

The American Lung Association recently released its 21st annual State of the Air Report. This year’s report analyzed data from 2016, 2017, and 2018—the 3 years with the most recent quality-assured air pollution data. According to the report, nearly half of the nation’s population—that’s 150 million people—lived with and breathed polluted air. The report found that climate change plays a big impact on the worsened air pollution.

Today I am joined by Dr Meredith McCormack, an associate professor of medicine and the medical director of the Pulmonary Function Laboratory at Johns Hopkins University. Dr. McCormack will be highlighting what you should take away from the State of the Air Report and how the information can help guide your conversations with patients. Thank you for talking with me today, Dr McCormack

Meredith McCormack: Thank you. It’s a pleasure to be here.

PULM CON: So each year, State of the Air reports on the 2 most widespread outdoor air pollutants: particle pollution and ozone pollution. Let’s start with particle pollution. More cities experienced more days with spikes in particle pollution in this year’s report. And more than 21.2 million people lived in counties with unhealthy levels of year-round particle pollution, which is more than the last 3 State of the Air reports. Can you talk about this type of pollution and the potential adverse effects it can have on people, especially among those who are already at a higher risk?

MM: Sure. I think a lot about a particulate solution when I’m taking care of patients in our office setting, or in the hospital, or thinking about air quality and how it affects my family and neighbors. Particle pollution is just what it sounds like: it’s particles that are suspended in the air, and we breathe them in all the time. And they come from sources like car exhaust or factory exhaust, things that we can see in the air when they’re exaggerated, a diesel vehicle and so forth. They also come from sources like if you have a fire burning in your fireplace, they see a plume of smoke outside; that’s an example of particulate matter and particulate solution. Wildfires are a source of particulate pollution. And when we think about breathing and air, when we take a deep breath in and we breathe through our nose, that the hair and mucus that’s in our nose and our upper airway traps a lot of the particles. But some of the particles, especially the very smallest ones, are able to reach the deepest part of our lungs and in that way, we see health effects of particulate pollution.

And as you mentioned, these are even more exaggerated for people that have underlying health problems. And so for children with asthma or with adults with asthma or adults with chronic obstructive pulmonary disease, COPD, people with underlying heart disease, the effects of particulate pollution are especially pronounced. And particulate pollution can cause things like asthma attacks, COPD exacerbations; it’s been linked to heart attacks and strokes. And breathing in more particulate pollution has been shown to decrease our life expectancy, and so for all of those reasons, it’s a pollutant that affects everyone, potentially, but particularly those with underlying respiratory or cardiac disease.

PULM CON: Like I said, the other outdoor air pollutant that was specifically looked at was ozone pollution. Significantly more people experienced unhealthy ozone pollution in the 2020 report than in the last 3 State of the Air reports. Can you touch on ozone pollution and the potential adverse effect it can have on people, again, especially among those who are already at a higher risk?

MM: Sure. I think particulate pollution is a little bit more intuitive. You see it, and it’s kind of easier to understand. Ozone ,in some ways, is a little bit more complicated. Ozone is a pollutant that is not directly emitted. It is formed in the atmosphere, and the formation of the ozone requires sunlight; and so things like volatile organic compounds, VOCs, as well as nitric oxides and other pollutants, they form a chemical reaction in the presence of sunlight, and that’s how we get ozone.

Ozone can also travel through the atmosphere. So an area that’s generating a high proportion of ozone isn’t necessarily that same region that’s most impacted. And so wind patterns and so forth means that the transport of ozone can affect communities even that aren’t right near the source of the of the primary generation of the pollutant.

Ozone has some overlapping health effects with the ones that I just described for particulate pollution and has been shown to decrease life expectancy. [It] has also been linked to exacerbations of underlying lung disease like COPD and asthma, as well as increased risk for cardiovascular disease like heart attack.

PULM CON: Short-term particle pollution, year-round particle pollution, and ozone pollution have all increased since previous State of the Air reports. In response to those findings, the American Lung Association president and CEO, Harold Wimmer, has said that the nation needs stronger limits on ozone and particle pollution to safeguard health, especially for children and people with lung disease. Of course, a practitioner can become politically active and advocate for the patients in that way. However, let’s talk about what a pulmonologist can do in their direct, everyday practice based off the information that has come out of this report. What should pulmonologist take away from the report, how can they implement the key takeaways into their management and treatment plans?

MM: So that’s a really important point, in thinking about how we can take larger, looming issues and really try to act at a local level. And so, one, the State of the Air Report I look forward to coming out every year—and this year is especially notable and special because it comes out at the 50th anniversary of the Clean Air Act. And, as you mentioned, it’s really important that all of us as citizens try to be advocates for upholding the Clean Air Act and the standards that protect our air quality. And over decades we’ve really seen a lot of improvement in air quality, and we’re at risk of losing some of those safeguards that protect our air. So at a local level, what can any of us do—and particularly, what can pulmonologist do? One is really promote just knowledge and education about the importance of air quality. And that can be done in interactions with our patients, with our community, with our family. And the State of the Air Report is actually a really good tool. It’s available on the web. The website is really user-friendly, and so patients that may have questions, we can use that as a resource that’s quick and has a lot of good messages and bullet points so that people can understand their local air quality.

And then when we talk about local air quality and we point people towards such a resource, it really allows you to understand what’s going on in your neighborhood. You can put in your ZIP code and really become a little bit more connected with your environment and with your surroundings. And I think empowering people to do that is one step towards affecting greater change.

PULM CON: That’s a great point that you bring up that practitioners can even use the report itself as an information resource for patients. And good to know that the website is user-friendly.

MM: I think the use of local air quality alerts and making sure that patients are aware of public messaging that provides information about poor air quality days and good air quality days. And so for high ozone days, educating our patients that these are conditions that may have health consequences and they should be used caution and potentially alter their behavior on those days is another thing that’s really important and that can be actionable in an individual patient encounter.

PULM CON: That actually kind of brings me to my next question of: What kinds of conversations should pulmonologist be having with their patients about pollution? And how can this report help guide those conversations, what should be talked about?

MM: Yeah, we’re going into the summer months now, and so thinking about for patients—for me, I see a lot of patients with asthma and COPD—and talking to them about on hot days, they may have increased symptoms and then thinking about the occurrence of high-pollution days. And making sure that patients know where they can find this information, which could be the newspaper, it could be websites, it could be messaging through the news or daily air quality alerts. And then talking to them about what their plans are. Some patients live in homes or environments where they may have high levels of indoor air pollution, so we want to be careful about the message of retreat indoors if indoors isn’t always a great environment. So really understanding our patients’ indoor and outdoor environment so we can help them make plans to really protect their lungs by exposing their lungs to the best air quality.

PULM CON: That’s great insight, and I hope our listeners have found what you presented here helpful. Dr McCormack, thank you so much for joining me.

MM: Thanks very much for having me.

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