An unfamiliar noise roused Lynn Henderson from a sound sleep one night two years ago.
“What is that?” she wondered. “Is it my daughter?”
She listened for a while in the dark, but all was quiet. So she settled back onto her pillow and fell asleep. But soon, there it was again.
“I couldn’t figure out what it was,” Henderson told The Greenville News. “Come to realize it was me wheezing.”
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After a trip to the doctor, the Easley woman was diagnosed with asthma.
And along with seasonal pollen, she’s discovered that her lung condition is aggravated by vehicle exhaust, wood burning and high ozone levels.
Those and other components of air pollution are increasingly being linked to human health problems.
“Air pollution can kill people,” said Janice Nolen, assistant vice president for national policy with the American Lung Association, which Wednesday will release its newest State of the Air report, an analysis of air quality in counties and cities across the nation.
Besides asthma and other lung ailments, new research shows air pollution is implicated in heart disease, high blood pressure and cancer.
Last October, the World Health Organization declared air pollution to be a carcinogen, saying its link to lung cancer is clear and that it’s also associated with an increased risk for bladder cancer.
Particulate matter — which consists of acids like nitrates and sulfates, organic chemicals, metals, and soil or dust particles, according to the U.S. Environmental Protection Agency — was classified separately as carcinogenic by the WHO, which reports that air pollution caused 223,000 lung cancer deaths worldwide in 2010.
“The air we breathe has become polluted with a mixture of cancer-causing substances,” Dr. Kurt Straif, head of WHO’s International Agency for Research on Cancer Monographs Section, said at the time. “We now know that outdoor air pollution is not only a major risk to health in general, but also a leading environmental cause of cancer deaths.”
The research keeps piling up. A new University of Florida study shows that outdoor air pollution may cause dangerously high blood pressure in pregnant women, according to the researchers, who also want to look at its effect on fetal development.
And another new study in the American Journal of Respiratory and Critical Care Medicine showed that high levels of air pollution from traffic are associated with damage to the right ventricle of the heart.
Greenville County got a “C” on last year’s State of the Air report. But county officials say they have been working to improve air quality for more than a decade — and continue to do so — and that it meets current federal standards for pollution levels.
Efforts to improve the air include “smart growth, transit-friendly transportation projects, commuter programs, use of alternative fuel vehicles and buses, diesel retrofit, and anti-idling programs,” according to a county State of Air Quality report issued last month.
And Jim Beasley, spokesman for the state Department of Health and Environmental Control, said that while the lung association’s evaluation system differs from the EPA’s, overall air quality in the nation — and in South Carolina — has improved greatly since 2001.
“In fact, all of our monitors statewide show compliance with national standards for both ozone and particulate matter,” he said. “We remain committed to working in collaboration with our partners — including industry, local governments and air quality coalitions — to enable strides toward improving air quality, which improves our public’s health.”
The most widespread pollutants, Nolen said, are ozone — which forms when chemicals from vehicle exhaust, industry and commercial processes react with sunlight and heat — and particulate matter. And while health effects can vary from shortness of breath to cancer, a scientific review last year found that ozone also may be linked with low birth weight in babies and even central nervous system damage, she said.
“We used to think that it was concentrating in the lungs and heart,” she told The News. “We’re learning now that these pollutants can have much more wide-ranging harm than that.”
When the WHO report and the link between air pollution and heart disease became clear, Dr. Joanne Skaggs, an internist with Cross Creek Internal Medicine in Greenville, said she had a moment of panic.
“You’re thinking, ‘Oh my goodness, we have patients who are walking around who already have a risk for heart disease ... (and) this is an added risk for them,” she said. “And what do we do about it? That’s the hardest thing.”
Reducing the exposure to the pollutant, or trigger, helps, but that’s not always possible.
Many people must burn wood to heat their homes in the winter, for example, because they have no other source of heat, she said. Others work in jobs that expose them to the very things that make them sick.
In the air
Dr. Amy Treece, a pulmonologist and critical care specialist with Greenville Health System, worries about a patient who has a hard time controlling his asthma because of the diesel fumes on his job.
“You can’t treat patients in isolation. They live in this world. And I spend a lot of time finding out where do they work, what have they been exposed to in the past, were they in the military? It all factors into my care of the patient” she said.
“I often have very hard discussions with patients about changing jobs because of what they work around,” she adds. “There are so many things that go into the air we breathe every day. It all contributes.”
Sometimes patients have to wear masks to protect themselves, she said. Others do what they can to reduce exposures by changing air conditioner filters regularly and getting vacuum cleaners with a HEPA filter at home.
“I have construction workers, who work on the highway, who do sinus rinses at night, and rinse out all this black tarry stuff they’ve identified as a trigger,” she said. “And it’s not just asthma. It’s asthma and COPD (Chronic Obstructive Pulmonary Disease), and interstitial lung disease, and chronic bronchitis. There’s a whole spectrum of diseases impacted by the environment.”
And sometimes even the best medical control isn’t enough if the trigger hasn’t been identified, Treece said.
About half of all Americans live in counties that have unhealthy levels of ozone or particle pollution, according to the lung association.
Most at risk are children, adults over 65, people with health conditions like asthma or heart disease, and low-income people who tend to live in areas with higher pollution levels and less access to medical care, Nolen said.
Dr. Ahmad Boota, a pulmonologist with Palmetto Pulmonary & Critical Care of Bon Secours Medical Group, said the trend he’s seen in the past decade has been an increase in the number of people exposed in different environments, such as the workplace, commuting, disasters or military service like the wars in Iraq and Afghanistan. Preventing exposure, he said, is key to reducing the chance of disease.
“Once the damage has happened,” he said, “it’s hard to prevent progression in the disease process.”
The nation has done a good job of reducing air pollution since the passage of the Clean Air Act in 1970 — cutting the six most widespread pollutants by more than 70 percent over that time, even as the economy has more than doubled, Nolen said.
“We’ve seen progress over four decades,” she said. “But this is an ongoing process.”
Just last month, the EPA announced cleaner fuel and vehicle standards beginning in 2017, she said, which will mean lower ozone levels.
And earlier this month, a U.S. Appeals Court upheld federal standards that require power plants to limit their emissions of mercury and other heavy metals as well as acid gases. That should prevent 11,000 premature deaths, almost 5,000 heart attacks and 130,000 asthma attacks every year, according to the Southern Environmental Law Center.
Asthma alone affects one in 11 children and one in 12 adults, according to the U.S. Centers for Disease Control and Prevention. Nearly 19 million adults and 7 million children had asthma in 2010. Nine people die from asthma every day, CDC reports, and it costs the nation $56 billion a year.
And adult-onset asthma like Henderson’s is quite common, said Treece.
“We see a lot of patients in their 50s, 60s and even 70s with new onset asthma. Some had childhood asthma that resolved. But for some, it’s their first experience with asthma,” she said. “And usually, some exposure brings it on.”
Henderson, 55, now takes medications for her asthma, has an inhaler for the toughest days and uses a nasal rinse a few times a week as well. She avoids going outdoors in the hottest part of the day when ozone levels are highest, and limits her outdoor activities in general.
A surgical technologist at GHS, she gets her activities out of the way early in the morning, has a HEPA filter on her vacuum cleaner, and her husband changes the filters on the air conditioning every month. She’s switched to more natural cleaners at home too.
But she’s still bothered by the exhaust fumes from the cars that line up to drop off and pick up children at the school near her house.
“The car fumes. When you smell wood burning. The ozone,” she said. “I’m very leery about staying outside.”