Air Quality is “Double Whammy” – Due to Smog and Ragweed

Air Quality is “Double Whammy” – Affects 4 in 10 Americans

The Natural Resources Defense Council (NRDC) released a report on July 11, 2017, that 4 out of 10 Americans live in counties with unhealthy levels of smog and ragweed pollen. The report can be found at: (

Both smog and ragweed pollen contribute to poor air quality is double whammy

Smog obscures view of downtown Los Angeles.

Kim Knowlton, a senior scientist at the NRDC, who oversaw the project,

D.r Kim Knowlton commented on air quality is double whammy

Kim Knowlton, Ph.D., is Senior Scientist and Deputy Director of Science Center of the Natural Resources Defense Council

said that, “Today, 127 million Americans live where ragweed and ozone can threaten their next breath. This health threat will just get worse if we don’t curb climate change soon.”

The report indicated that burning of fossil fuels such as oil, gas, and coal, worsen ozone pollution and extends the ragweed season. Ragweed was selected instead of other pollens, such as tree and grass, because more people are allergic to it than all the others combined. Ragweed comes out toward late summer when temperatures, and thus smog levels, are highest. It means that air quality is a “double whammy.”

air quality is double whammy

Dr. Perry E. Sheffield, Assistant Professor at Icahn School of Medicine at Mount Sinai

Smog forms on warm, sunny days and is made worse from the chemicals that come of vehicle tailpipes and from power plant and industrial smokestacks. According to Dr. Perry Sheffield, a pediatrician at Mount Sinai in New York, “It worsens respiratory illnesses such as asthma and COPD.”

The report listed the 15 worst states where smog and pollen are bad – meaning that air quality is “double whammy.” Those, listed in order with the worst, are: the District of Columbia, Connecticut, Rhode Island, Illinois, Pennsylvania, Utah, Ohio, Arizona, Michigan, Massachusetts, Delaware, Wisconsin, New Hampshire, Indiana, and Kansas.

What Can Be Done?

Ms. Juanita Constible of the NRDC commented that, “The federal government should focus on limiting smog, curbing power plant pollution, and increasing fuel efficiency.”

I encourage you to view my post on April 23, 2017, that describes a report   from the American Lung Association on air pollution. I listed 5 things that each of us can do to help reduce – air quality is a “double whammy” – so that we can all Breathe Easy.


Air Pollution in United States: 2017 Report from the American Lung Association

Air Pollution in United States: More than 4 out of 10 Breathe “Bad Air”

On April 19, 2017, the American Lung Association issued a report of air pollution in United States during 2013-2015. The “State of the Air 2017” report looked at levels of ozone and particle pollution found in official monitoring sites across the United States in 2013, 2014 and 2015. View my post on August 29, 2016, which describes the different types of air pollution.

Overall Findings The report shows that cleaning up pollution continues to be successful in much of the nation. In the 25 cities with the worst ozone and year-round particle pollution, the majority saw improvements. Many cities reached their lowest levels ever of widespread air pollution.

Worst Cities for Particle Pollution

Worst cities for air pollution in United States

Six of the ten cities with the worst air pollution in United States are in California. Bakersfield again holds the distinction of having the most days of highly polluted air.

Aerial view shows air pollution in United States - Los Angeles

Aerial view of downtown Los Angeles skyline with San Gabriel mountains in background

Key Findings  1. Despite improvements in air quality over the three years, more than 4 of 10 people breathe unhealthy levels of air pollution. 2. Air pollution increases the risk of early death, lung cancer, breathing attacks for those with asthma or COPD, and heart disease. 3. Breathing ozone irritates the lungs resulting in something like a “bad sunburn.” 4. Particles may be smaller than 1/30th of the size of a human hair. When inhaled, they are small enough to get past the body’s natural defenses. 5. People of color and those earning lower incomes are often affected by air pollution.

What Can You Do  1. Check daily air quality forecasts in your area. 2. Use less electricity. Use of electricity creates air pollution. 3. Drive less. Try to share rides and combine trips to reduce total driving. 4. Don’t burn wood or trash as these are among the major sources of particle pollution. 5. Don’t let anyone smoke indoors and support measures to make all public places tobacco free. 6. Make sure your local school system requires clean school buses.                                                                                       


Air Pollution and COPD Hospitalizations and Mortality

Short-term Exposure to Air Pollution Is “Bad” for COPD

Background: Air pollution is a general term for increased particulate matter in the air that we breathe. It consists of microscopic solid or liquid matter suspended in the Earth’s atmosphere. Sources of particulate matter can be man-made or natural. Overall, particulate matter can adversely affect human health.

Particulates are the worst form of air pollution due to their ability to penetrate deep into the lungs causing permanent mutations in DNA, heart attacks, and premature deaths.

If inhaled, particulate matter that is 10 micrometers or less in size (diameter) can reach the lungs.  This is abbrevaited PM10.  Even smaller size particulate matter, like PM2.5, can penetrate deeper into the small breathing tubes (airways) and reach the air sacs (alveoli).

Study: In the February 2016 issue of the journal CHEST,  Dr. Li and colleagues from Tongji University School of Medicine in Shanghai, China, analyzed a total of 18 studies that examined the short-term exposure to particulate matter in the air and COPD outcomes.  They selected studies that had measured PM2.5 in the air and COPD hospitalizations and death for 7 days after exposure in different countries throughout the world.    

Results: Short-term exposure was associated with an increase in COPD hospitalizations (+ 3.1%) and mortality (+2.5%) from 0 – 7 days after exposure.

My Comment: The authors point out that PM2.5 is more harmful to health than is PM10 because the smaller particles can be inhaled more deeply into the lungs.  Particulate matter causes oxidative stress and inflammation.  It is likely that this process caused worsening of symptoms (called an exacerbation) that led to the increases in hospitalization and death in some with COPD.

Particulate matter coming out of smokestacks in city

Particulate matter coming out of smokestacks in city

What can you do to avoid inhaling PM?  Each day check  the air quality where you live or where you are visiting.  If the air quality is “bad,” try to stay indoors if possible and use air conditioning if it hot. If you go outdoors, limit the time and wear a mask to block inhaling some of the particulate matter.

Woman wearing barrier mask

Woman wearing barrier mask to reduce inhaling particulat matter

Wild Fires Affect Lung Health

Wild Fires in California – Will These Fires Affect My COPD?

Dear Dr. Mahler:

I have moderate COPD and worry that the wild fires here in northern California are making it harder for me to breathe. The drought in the west has enabled wild fires to start, and the local papers report air pollution. I try to stay inside as much as possible, but I notice that my breathing has been more difficult the past week or so. What do you think? 

Will  from Sacramento, CA

Dear Sam:

Sorry to hear of your problem with the wile fires. As you know, the blazes are  a direct result of the prolonged dry heat, and increase particulate matter (particles) in the air. The byproducts of smoke can drift for hundreds of miles as shown in the photos.

The particles in the air can be  quite small at 1/30 the size of the diameter of hair. Their tiny size means that they can  bypass the nose and mouth and reach the lower parts of the lungs. This can cause the breathing tubes to narrow or constrict making it harder to breathe and cause coughing. Dr. James  Brown, a pulmonary physician who works at the VA in San Francisco, has reported an increase in the respiratory complaints brought on by the drought and wild fires.

wild fire in California

Wild fire in Lower Lake, California

I encourage you to pay close attention to reports of air quality where you live. If the pollutants are high in the air, take precautions like staying inside, rolling up car windows, make sure to take your inhalers regularly, and don’t hesitate to use albuterol as needed.

Hopefully it will rain soon in these drought areas. Best wishes,

Donald A. Mahler, M.D.

Smog in the Air – What are the Health Risks for Breathing?

Smog in the Air – Is it Safe for Breathing?

Dear Dr. Mahler:

I am travelling to Shanghai and Beijing for business in a few months. and am concerned about the smog in China. I have stable, but moderate COPD and don’t want to have any breathing problems on the trip.  My COPD medications are Spiriva and Advair Diskus. What are your thoughts?  I can’t have someone else go in my place because I work for a small company which is trying to expand business in China.
Thank you.

Bob from Sacramento, CA

Dear Bob:

Do you have any breathing problems with smog or air pollution living in northern California? Is your COPD under good control at the present time? Have you had a COPD “flare up” (exacerbation) in the past 3 months?  If the answers to these questions indicate that you are doing fine, then here are some things to consider on your trip to China.

As you probably know, smog develops in the atmosphere when certain gases are produced when fossil fuels like gasoline, oil, and coal are burned. Nitrogen oxide is emitted from power plants, motor vehicles, and other sources of high-heat combustion.   Volatile organic compounds come from motor vehicles, chemical plants, refineries, and factories. Carbon monoxide is emitted mainly from motor vehicles. When these gases are exposed to sunlight, they react and form ozone smog.

Smog in city.

Smog in city.

Breathing in ozone can cause shortness of breath, wheezing, and coughing and can also increase inflammation (redness and swelling) in the airways of your lungs. The risks are greater if ozone levels are high, if you are breathing faster because of exerting yourself outdoors, and if you spend a lot of time outdoors.

I suggest that you discuss the following with your host in China  before you leave on the trip:

  1. Let the host know that you have well controlled COPD and need to avoid inhaling smog and other airborne irritants (such as cigarette smoke).
  2. Ask to spend as little time as possible outdoors, and request either a taxi or car service to travel from your hotel to the place of business.
  3. Make sure that you will not be expected to participate in any sightseeing that requires spending time outdoors.

I suggest that you discuss the following with your doctor before you leave on the trip:

  1. Ask your doctor if he/she considers it safe for you to travel to China for business.
  2. Ask your doctor to prescribe both an antibiotic and prednisone to have available in case you need either of these medications. Ask you doctor to write down when, if at all, to take these medications.
  3. Ask your doctor whether you are up to date on influenza (depending on the time of year that you are travelling) and pneumococcal vaccines.
  4. Ask your doctor whether it is advisable to wear a mask that covers the nose and mouth when outdoors.

    Mask to reduce inhaling smog in China

    Woman wearing mask to prevent inhaling smog in the air.

In preparation for your trip:

  1. Make sure to hand carry all of your medications with you on the plane, including your rescue albuterol inhaler. Do not pack these medications in checked baggage.

Safe travels,

Donald A. Mahler, M.D.