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Breathing Pollution

February 26, 2018

Asthma attacks can come on suddenly and can be triggered any time of year by ozone or particulate air pollution. I have been a practicing emergency
physician since 1983 and have seen firsthand the negative health consequences of our polluted air. I recall the last asthmatic patient I took care of two months ago in the ER. This 30-year-old gentleman was breathing at 30 times per minute (twice normal). There were visible muscle contractions of his chest. He was also using his abdominal muscles to breathe. He could barely speak. He was terrified. This had come on so fast. His heart rate was about 140. His oxygen level was below normal.


Our job as emergency physicians is to conjure up the worst possible outcome and prevent it from happening. Two nurses started an intravenous line, putting him on a heart monitor and oxygen, giving him fluids and two breathing treatments. We gave him intravenous magnesium and intravenous steroids reserved for the very worst asthmatics. We nebulized epinephrine after two conventional nebulizers. I wondered what it would be like to put a tube into his trachea while he was still awake. Over 99 percent of folks who get a breathing tube are asleep. It is rare for me to have an asthma patient this serious. This was scary for me as well. I have only intubated two awake patients in my 33 year career.

 

All of our treatments worked. He didn’t need a tube but spent a couple of days in intensive care. This could happen to him again. These situations make me ponder social justice. If some of our legislators watched this gentleman’s treatment in the emergency room, they would consider keeping coal in the ground, and think about what’s coming out of our tail pipes.

 

While it has been common knowledge that air pollution could cause exacerbations of asthma and chronic obstructive pulmonary disease, I was shocked to find out that particulate air pollution could be responsible for a person’s heart attack or stroke. In fact, it has been shown that in vulnerable populations, there is a straight line correlation between the number of heart attacks and strokes on a given day and the concentration of PM2.5 particulates. Of course, this results in marked increases in emergency room visits with increased patient suffering and death directly attributed to particulate air pollution.

 

Particulate pollution concentrations typical of the Wasatch Front increase mortality rates about 10 percent according to data the American Heart Association published in May 2010. A subsequent study suggests that number should be 14 percent. That means between1,000 and 2,000 Utahns die prematurely every year due to our air pollution. A recent MIT study indicates that the annual number of premature deaths in the U.S. due to air pollution is 210,000, and that the average premature death represents a loss of ten years of life.

 

I don’t just treat those who suffer from the air pollution. I also experience the negative consequences myself. When outdoor air pollution levels in the Salt Lake Valley exceed 35 ug/m3 of PM2.5, I am forced to avoid all outdoor activities, including riding my road bike, due to health concerns. About eight years ago, I noticed that during and after one of our Wasatch Front winter inversions, my endurance and ability to climb mountains on my skis was impaired. I could only climb about 80 percent of the vertical that I would normally climb when the air is good. After a few days of exposure to particulate air pollution, I could actually measure a 15 to 20 percent diminution of peak expiratory flow rate (using a simple device that can be purchased at any pharmacy for $25.) I have also noticed at the health club that my maximal heart rate is notably reduced on days when particulate pollution is high, a known effect of air pollution. I am discouraged that my athletic performance is significantly harmed by air pollution. Because of the health effects of particulate air pollution, I purchased a portable indoor air filter that runs in my home when particulate levels are high. This filter has improved the reduced athletic performance.

 

My parallel career has been that of a professional nature photographer. Poor air quality reduces visibility, mars the scenery, and impairs my ability to work as a photographer. I would estimate that the clarity of my view of the Wasatch Mountains is impaired by air pollution approximately 50 percent of the time in the winter. This makes photography in the Wasatch Front difficult or impossible on these days.

 

I am harmed by air pollution in the Wasatch Front from its adverse effects on my health, athletic performance, and artistic expression. I find it unacceptable that we have made such insufficient progress in ensuring that everyone breathes clean, healthy air.

Howie Garber has been an emergency physician since 1983 and has worked with Utah Physicians for a Healthy Environment since 2007. He is also a photographer and has won national and international awards including the BBC Wildlife Photographer of the Year contest. b. 1950

 

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