Presented by Dr. Mitch Grayson, Director, Fight Asthma Milwaukee Allies, at Wisconsin Clean Cities Idle Reduction Workshop on August 21, 2012.

1. Asthma and pollution
Mitchell Grayson, MD
Director
Fight Asthma Milwaukee (FAM) Allies

2. Asthma is a problem
 Every day in America:
 40,000 people miss school or work due
to asthma
 30,000 people have an asthma attack
 5,000 people visit the emergency room
due to asthma
 1,000 people are admitted to the
hospital due to asthma
 11 people die from asthma

3. What is Asthma?
• An immune response in the small airways
of the lungs, characterized by
– Inflammation and edema (swelling)
– Mucus production (snot)
– Bronchospasm (muscle tightness)
Drawings from M. Tsutsumi

4. Asthma triggers
• Asthma can be triggered by
many airborne factors:
– Pollen (trees, grasses, ragweed)
– Mold spores
– Air pollution
• Exhaust from vehicles
– School buses, trucks
– Small engines (eg, lawn mowers)
– Boats and cars
• Factory smoke / exhaust

5. Air Pollution
• Ozone (O3)
– An invisible gas formed through chemical reactions of
nitrous oxides and volatile organic compounds
– Able to chemically react with lung tissue leading to tissue
damage
• Particle Pollution
– A mix of airborne solids and liquids
– Comes from burning fossil fuels in factories, power
plants, steel mills, smelters, diesel/gasoline, wood (even
from residential fireplaces).
– May trigger asthma possibly leading to hospitalization and
death

6. Particle Size
• Size matters
– > 10 µm impact in the nose and mouth
– < 5 µm can impact in the lungs
nose and mouth
trachea (large airways)
bronchioles (small airways)
bronchioles and alveoli
3
From: Heyder J. Proc Am Thorac Soc. 2004;1:315.

7. Why worry about emissions?

8. Health Impact of Diesel Emissions
Data from 2010 Clean Air Task Force

9. Does exhaust really matter to
people with asthma?
A study examined the 1996 summer Olympic games in Atlanta
To reduce traffic for the games:
• Around-the-clock public transportation was provided
• 1,000 buses added to the existing fleet
• Downtown city streets were closed to private cars
• Downtown delivery schedules altered to ease morning rush hour
• Allowed flexible work schedules and telecommuting
These changes resulted in marked declines in ozone and other air
pollutants known to trigger asthma exacerbations.
Friedman MS, et al. JAMA. 2001;285:897-905

10. Results for people with asthma
• When compared to pre-Olympics data, the
frequency of asthma events (emergency room
and/or hospitalizations) decreased by
– 42% (Georgia Medicaid claims)
– 44% (Health Maintenance Organization data)
– 11% (data from two Pediatric Emergency Depts)
– 19% (data from the Georgia Hospital Discharge
Database)
• So, reducing pollutants and ozone reduced the
burden of asthma!
Friedman MS, et al. JAMA. 2001;285:897-905

11. Recommendations
• Check Air Quality Daily:
– 1-866-DAILY AIR
– (1-866-324-5924)
– www.epa.gov/airnow
– Orange level means air quality is
bad for sensitive groups including
older adults, all children, and
people with respiratory illness.
• On bad air quality days:
– Stay indoors
– Do not exercise outside

12. Thank You!