What’s in an Index? The AQI and Kids with Dr. Rosser

In addition to being a lung doctor, I am the mother of three young children. I often struggle with how to understand what the Air Quality Index means for my kids’ health. When the air quality is bad, should I restrict them playing outside? How does pollution affect children differently from adults? How do we balance all these things when we know exercise and outdoor time is vitally important for the health and joy of our children?

I had the pleasure of talking to Dr Franziska J. Rosser to help me wrestle with these questions. She is a pediatric lung doctor at UPMC Children’s Hospital of Pittsburgh and an assistant professor of pediatrics within the Division of Pulmonology at the University of Pittsburgh School of Medicine. She received her medical degree from the University of South Alabama College of Medicine. She completed her pediatric residency at the University of South Carolina Greenville followed by her pediatric pulmonology fellowship at University of Pittsburgh, where she also received her Masters of Public Health.

Her research focuses on the effects of outdoor air pollution on children with asthma. Dr. Rosser’s long-term goals are to develop innovative methods to identify children with asthma most at risk to the unhealthy effects of air pollution. Additionally, while awaiting policy changes to improve air quality for all, she seeks to determine if individual interventions can improve asthma control and symptoms.

She is also conducting a pilot clinical trial to evaluate adding the Air Quality Index to routine childhood asthma care, and is a member of the American Thoracic Society  Environmental Health Policy Committee, which is where we met.

She has published research on the air quality index, children, and hospitalizations, and in our podcast discussion, she provides a truly honest estimation of what we know, what we don’t know, and how she balances these things in her practice. Also, it’s worth a listen to hear an air quality analogy about peeing in a pool, which I am definitely going to use!

Honestly, I am always amazed at my colleagues who can care for sick children. I was volunteering at a COVID vaccination event recently, and we were handing out stuffies to kiddos. One little girl proudly showed me her spacer for her inhaler, which she had just picked up at the pharmacy. My heart sank just a little bit hoping that this young child, visiting a pharmacy in a neighborhood that suffers significantly from air pollution, would not have lifelong severe disease, as many of my patients from that neighborhood have. Those of you familiar with my work will know how the story of patients like Ashia Allen has motivated a great deal of my work with Air Health Our Health. Dr. Rosser was similarly affected by the story of Ella, a young girl who died of air pollution. 

It is hard not to think of the children who grow up breathing invisible pollution that can have such devastating effects on their health. There are many challenges with thinking about risk trade-offs to air pollution exposure for kids- including the key of developmental windows, how kids breathe more than adults and through their mouths, as well as the potential interactions with viruses and pollen.  

Most importantly, I share Dr. Rosser’s perspective that air pollution is not an individual problem, and so asking individual parents and kids to adjust their behavior to accommodate it is really hard- especially when this burden falls disproportionately on lower income communities, communities of color and historically red-lined districts. We must do more to clean up the air we breathe to ensure all kids have brighter futures. 

To Do: (Especially members of the Twitchy Airways Club)

1- Download the AirNow app or become familiar with AirNow.Gov

2- Pay attention to the AQI, and when it is in the yellow or orange category, pay attention to whether you or your child coughs more in the days following. Discuss your observations with your doctor or your child’s pediatrician.

3- Learn more about redlining and impacts by listening to the podcast with Vivek Shandas.

4- Listen about one person’s story with asthma growing up in a previously red-lined district by listening to Ashia Allen, a patient of mine.

5- If you smoke and have kids, do what you can to quit! If you need help, you can find more in the resources on this post, or by listening to the podcast episode with Brandy Carpenter.

6- Donate to the American Thoracic Society, working to fund important research about air quality and health.

TLDR= Don't Light Things on Fire and Breathe them into your Lungs

References:

BBC. “Air pollution: Coroner calls for law change after Ella Adoo-Kissi-Debrah’s death” 21 April 2021. (Source of Ella image)

Cromar KR, Ghazipura M, Gladson LA, Perlmutt L. Evaluating the U.S. Air Quality Index as a risk communication tool: Comparing associations of index values with respiratory morbidity among adults in California. PLoS One. 2020 Nov 17;15(11):e0242031. 

Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014 May 3;383(9928):1581-92. doi: 10.1016/S0140-6736(14)60617-6

Horne BD et al. Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection. Am J Respir Crit Care Med. 2018 Sep 15;198(6):759-766

Nardone A et al. Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study. Lancet Planet Health. 2020 Jan;4(1):e24-e31

Rebuli ME, Brocke SA, Jaspers I. Impact of inhaled pollutants on response to viral infection in controlled exposures. J Allergy Clin Immunol. 2021 Dec;148(6):1420-1429

Rosser et al. “Air Quality Index and Emergency Department Visits and Hospitalizations for Childhood Asthma.” Annals ATS. Jan 2022.

Saxon A, Diaz-Sanchez D. Air pollution and allergy: you are what you breathe. Nat Immunol. 2005 Mar;6(3):223-6

From AirNow 

Using Air Quality Index | AirNow.gov

Using AirNow During Wildfires | AirNow.gov

Asthma and Outdoor Air Pollution, EPA-452-F-04-002 (airnow.gov)