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The doctor prescribes clean air

By Karen Weintraub
Globe Correspondent / January 16, 2012
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WHO

Dr. Megan Sandel

WHAT

Sandel, an associate professor of pediatrics and public health at Boston Medical Center, is an expert on asthma and air pollution.

Q. What is the connection between air pollution and health?

A. There’s a lot of evidence around how pollution affects respiratory health and cardiovascular health, particularly for vulnerable groups like children, people with asthma, or elders.

Q. What can people do to protect themselves?

A. I always talk about being able to moderate exposures as much as possible. I think air pollution is an example of something you’re not able to modulate easily on your own. You are relying on the federal and state government to regulate it because you have such insufficient alternatives: You can exercise indoors, you can try to reduce your energy use, and you can try to avoid going outside on certain days. But really, changing your environmental exposure is going to require a public health law.

Q. You’re obviously a fan of government regulations like the Clean Air Act.

A. It is really important to protect that law. Even though we continue to see some ill effects from air pollution, we’ve seen much better health [since it was passed in 1970].

Q. Have you seen examples in your practice of kids harmed by air pollution?

A. I think almost any clinician who takes care of kids, particularly in urban areas, has examples where they are having asthma attacks related to say, a hot air alert day. I had a child for whom diesel emissions from the buses [parked outside school] was a significant exposure. To walk in and out of school, the kids had to walk through the smog of idling. The school worked with local advocacy groups to move the buses and limit idling, and the child got better.

Q. Is pollution the main reason asthma rates are rising?

A. There’s probably not one single explanation for why we see the increase. Asthma is probably not one single disease, it’s probably three to four different diseases that have different causes. Once you have asthma, being exposed to air pollution is not good for you, so being able to control it is really important.

Q. We want children to play outside to get exercise and fresh air, but couldn’t that also expose them to more pollution?

A. It’s interesting to think about in this time of obesity that trying to encourage kids to exercise potentially puts them at some risk. Children in California, when they exercised more in high ozone areas, they got more asthma [according to a recent study]. You want to have healthy, well-balanced kids, but you want them to be able to play in clean safe air.

Q. Are you concerned about so-called indoor air pollution?

A. There’s a lot of evidence around volatile organic compounds - many things like paints, or carpets, or pressed wallboard - that off-gas, especially when new. There is good evidence of those being respiratory irritants.

Q. What about smoking?

A. One of the greatest public health impacts [of the last few decades] has been changing our exposure to smoke in our workplace and where we recreate, whether in a restaurant or city park.

Q. Why is a doctor concerned about air pollution?

A. As a pediatrician, I can prescribe many things to help you, but I can’t prescribe the air that you breathe. For me, more and more I can’t just focus on the individual patient, I have to be aware of the public policies that impact health, and advocate for policies to improve the health, particularly of low-income children and families. I need lawmakers to protect the health of my patients.

This interview has been edited and condensed. Karen Weintraub can be reached at Karen@KarenWeintraub.com.

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