5 Things to Know About the Environment and Respiratory Health

Air pollution is a known factor for respiratory diseases like asthma, pneumonia, and others. It has also been linked to lung infections, especially in small children. So when the Environmental Protection Agency (EPA) announced a proposal to curtail clean air standards set by the Clean Power Plan during the Obama administration, replacing it with one that would give states more latitude in how to manage greenhouse emission, health organizations were quick to condemn the move.

Here are 5 things to know about respiratory health, including diseases like asthma and chronic obstructive pulmonary disease (COPD), and the environment, both the external and the internal.

1. The EPA's own report noted health concerns.

Greenhouse gas emissions are known to cause climate change, and the EPA’s own internal analysis of the change in the proposed rule said that implementation “is expected to increase emissions of carbon dioxide (CO₂) and increase the level of emissions of certain pollutants in the atmosphere that adversely affect human health.”

The report predicts an excess of 1400 deaths a year from the change in a chapter called “Estimated Forgone Climate Benefits and Forgone Human Health Co-Benefits.” It notes that the “emissions include directly emitted fine particles sized 2.5 microns and smaller (PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO_X), and mercury (Hg). SO₂ and NO_X are each a precursor to ambient PM_2.5, and NO_X emissions are also a precursor in the formation of ambient ground-level ozone.”

According to the EPA report, likely effects from respiratory illness will include nonfatal heart attacks, hospital admissions, emergency department (ED) visits for asthma, missed work days due to asthma, and missed school days due to asthma.

The American Public Health Association (APHA), the American Academy of Pediatrics, and others denounced the move.

2. Climate change is another source of health disparities.

A recent APHA report highlights some of the ways that states can proactively try to mitigate some of the effects of climate change, noting that the environmental risks disproportionately threaten vulnerable populations like children, pregnant women, low-income communities, or those with mobility or cognitive limitations. Some communities will not be as resilient as others, and additional resources need to be allocated.

Researchers also predict that climate change will decrease the nutritional quality of staple crops, thereby increasing diseases like anemia and diarrhea.

3. The indoor home environment matters, too.

Medications for asthma have little effect if the home environment is filled with asthma triggers. That is one takeaway from a recent report detailing efforts in Philadelphia, where researchers compared licensing and inspection violations with the residences of children who were hospitalized for asthma. The Home Preservation Initiative for Healthy Living sought to reduce asthma-related ED visits and hospitalizations by combining home repairs with a home visit program that would include asthma education and environmental remediation. Using outcome data, researchers sought to make a case for Medicaid reimbursement for home repairs by showing healthcare cost savings from keeping kids healthy and out of the hospital.

4. Secondhand smoke from childhood affects lung function as an adult.

Researchers are tracking risk factors for COPD back to the environment a child grew up in, specifically as it pertains to smoking. Earlier this year, the Lancet Respiratory Medicine published 2 studies indicating that early childhood exposure to maternal smoking affected their lung function as adults and also predisposed them to more rapid lung decline if they, too, took up the habit.

This week, another study found a link between exposure to secondhand smoke as a child and death from COPD in adulthood.

5. The return of black lung for coal workers.

The announcement by the EPA to reduce regulations on coal-fired power plants fulfills a campaign promise made to industry by President Donald Trump. But earlier this year, a study published in the American Journal of Public Health found that coal worker’s pneumoconiosis (CWP), commonly called black lung, is making a return, especially in central Appalachia.

The study’s authors predicted current black lung prevalence estimates will likely worsen in terms of severe and disabling disease, including progressive massive fibrosis. They also said that enhancement and enforcement of 2014 safety standards for coal workers remains critical for reversing the rising trend of this progressive disease, but the Trump administration has signaled that those may be on the table as well.