Health care professionals should inform sensitive patients about the risks of exposure to air pollutants

If you have some form of lung or cardiovascular disease, has your doctor told you how to check today's "AQI", and what to do if it's over 100?

Health care professionals should inform sensitive patients about the risks of exposure to air pollutants and recommend avoidance strategies for days when air quality is low, according to a special report in The American Journal of the Medical Sciences , published by the Southern Society for Clinical Investigation by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"Increased recognition of the hazards of air pollution, coupled with simple common sense recommendations from clinicians, may provide the basis for reducing exposure to outdoor air pollution," concludes an article by Scott Shofer, MD, PhD, of Duke University School of Medicine. The article appears in a special section of the April issue of The American Journal of the Medical Sciences and is also available on the journal website, http://www.amjmedsci.com.

The special section includes an overview and historical perspective on the problem of outdoor air pollution, along with updated reviews of the health effects of three specific categories of air pollutants:

• Particulate matter, linked to increased rates of illness and death from heart and lung (cardiopulmonary) disease—probably by promoting inflammation within the airways. Particulates may also increase lung cancer risk, but more study is needed.
• Ozone, a respiratory irritant that decreases lung function in healthy people as well as patients with asthma. Short-term increases in ozone level may also lead to increases in illness and death from cardiopulmonary disease.
• Nitrogen dioxide, sulfur dioxide, and carbon monoxide, which are highly toxic at high concentrations. Although they contribute to poor air quality, it remains unclear whether these pollutants cause health problems at the "ambient" levels associated with air pollution.

The report encourages health care professionals to develop a "clear, strong, and personalized" approach to educating high-risk patients on how to monitor daily air quality, and what steps to take when pollutant levels are unusually high. Targeted groups include patients with various cardiopulmonary diseases, such as asthma, chronic obstructive pulmonary disease, coronary artery disease, and peripheral vascular disease.

These at-risk patients should know about available sources of information on daily air quality. The AIRNow website, http://www.airnow.gov, provides daily, community-specific air quality "forecasts." Other sources of information include the Weather Channel, USA Today, and local media. Patients should look for the Air Quality Index (AQI), which estimates the effects that patients might experience within a few hours or days after breathing polluted air. When the AQI is higher than 100, the risk of adverse health effects is elevated for patients with cardiopulmonary diseases and other sensitive groups.

On those days, some simple avoidance strategies may help to reduce pollution-related health risks. A reasonable approach is to limit prolonged or heavy exertion outdoors on days when air quality is unhealthy. If outdoor activities are unavoidable, they should be performed in the morning, when air quality tends to be better; and avoided in the late afternoon. For people who want to be outdoors and exercising, walking may be a better choice than jogging. Areas where pollutant levels are likely to be especially high, such as busy highways, should be avoided.

Patients are also advised to watch for symptoms possibly related to air pollution exposure, such as chest pain or tightness, cough, wheezing, and shortness of breath. Those with respiratory diseases such as asthma should be sure to carry their "rescue" inhalers.

"We believe these simple actions may help reduce the risk of adverse events due to air pollution in sensitive patient populations," Dr. Shofer and coauthors conclude. They also call for revised air quality standards to lower ambient levels of air pollutants—especially small particles and ozone.

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