Moderate increases in ambient PM2.5 and ozone are associated with lung function decreases in beach lifeguards.

OBJECTIVE: Exposure to pollutants would adversely affect lung function of healthy athletes. METHODS: Pulmonary function was recorded on beach lifeguards at three different times during the day. Daily and average peak pollutant levels were calculated. Linear regression analyses were made comparing lung function changes in response to pollutant levels. A multivariate model was constructed to explain the combined effects of pollutants. RESULTS: Afternoon forced vital capacity (FVC) and forced expired volume in 1 second (FEV1) decreased significantly compared with morning values and decreased with increasing fine particulates (PM2.5). FEV1/FVC decreased with increasing ozone (O3) levels. CONCLUSION: The deleterious effect of PM2.5 and O3 were transient and occurred at pollutant levels far below national standards. At low levels of exposure, PM2.5 was associated with reduced lung volumes, while increasing O3 levels were associated with airway obstruction.

Addressing asthma in Texas: development of a school-based asthma surveillance program for Texas elementary schools.

To address asthma in the state, in October 2000, the Texas Department of State Health Services (DSHS) and the American Lung Association of Texas held a joint meeting of asthma professionals from across the state, with a primary purpose of identifying major issues and potential strategies and actions to be taken. These discussions became the basis of the 2001 Texas State Asthma Plan, which has since been adopted to guide state efforts in asthma surveillance, management, education, and advocacy. The primary purpose of this project, which was conducted with and funded by the DSHS and the Centers for Disease Control and Prevention, has been to develop and implement an asthma surveillance program for Texas school-aged children. The program has been implemented with a sample (n = 42,409) of students from the Texas Education Agency's region IV. An important goal has been to determine the feasibility of conducting school-based statewide asthma surveillance and assist with establishing a network for ongoing, systematic collection, analysis, interpretation, and dissemination of asthma data. This project is expected to become part of a wider asthma surveillance network that will include mortality, hospital discharge, and Behavioral Risk Factor Surveillance System (BRFSS) data. It will also provide information not typically captured by surveillance programs, including the BRFSS, which rely heavily upon a previous diagnosis of asthma to determine both lifetime and current prevalence of asthma. Results from this project indicate that such reliance on a previous diagnosis may considerably underestimate the prevalence of disease-particularly in the Latino population

Clearing the air: a model for investigating indoor air quality in Texas schools.

This pilot project focused on the assessment of indoor air quality at a local high school in Galveston, Texas, using methods based on guidelines for the U.S. Environmental Protection Agency's Indoor Air Quality Tools for Schools program. Tools for Schools, developed for evaluating and ensuring acceptable air quality for schools, takes a low-cost, minimal-involvement, primarily educational approach. The authors also compared the findings from this approach with the results of an air-sampling program. The overall goal was to determine if use of Tools for Schools was sufficient to identify conditions with the potential to cause adverse health effects. The primary objectives were to 1) establish an indoor air quality committee for the school to implement Tools for Schools assessments and management strategies, 2) collect air quality data in high-risk areas identified within the school by the indoor air quality committee, 3) collect outdoor air quality data at or in close proximity to the school, and 4) develop methods and instruments for assessing environmental risks associated with daily school attendance. Data were gathered on levels of formaldehyde and other volatile organic compounds (VOCs), ozone, particulate matter (PM10), mold, relative humidity, and temperature. Data values for each sampled pollutant were compared with federal standards, recommended values established by the American Conference of Governmental Industrial Hygienists for non-industrial populations, and effects screening levels developed by the Texas Commission on Environmental Quality. Levels of all VOCs except formaldehyde were found to be well within guidelines, as were ozone and particulate-matter levels. Mold, however, was widespread, including both common species and species associated with allergy and asthma, such as Aspergillus and Alternaria. In general, Tools for Schools provides an excellent foundation for a school indoor air quality program, although the authors did find it necessary to streamline data collection and did find that mold with the potential for adverse health effects was present, albeit not visible in some areas.

Asthma epidemiology: risk factors, case finding, and the role of asthma coalitions.

Asthma has no cure, and given that clinicians still do not understand what causes it in the first place, it is not preventable. With implementation of environmental control measures to minimize exposure to allergens and irritants, appropriate pharmacologic therapy, and patient and health care provider education, the disease can be managed successfully. Health care access and appropriate case management are essential components of any plan to address asthma as a public health problem. Asthma is now one of the most important diseases of childhood in developed countries. In the International Study of Asthma and Allergies in Childhood (ISAAC) study, the highest asthma prevalence was observed in westernized English-speaking countries (e.g., the United Kingdom, Australia, and New Zealand), with much lower prevalence rates in Eastern Europe, India, China, other countries in Asia, and Africa [18]. This observation has led to the belief that the rapid increases in asthma prevalence are more likely to be attributable to environmental than genetic factors. The rising prevalence in the United States and worldwide seems to be correlated with modern industrialization, suggesting that changes in the ambient environment may contribute to this increase in morbidity and mortality. Indoor factors that have been suggested to influence asthma pathogenesis include allergy to house dust mite and cockroaches, poor heating and ventilation, and exposure to cigarette smoke and other irritants. Scientific evaluation of the links between indoor and outdoor air pollution and asthma is incomplete, however. Much work remains to be done in defining the environmental factors that may cause asthma and that may trigger asthma exacerbations in individuals with the disease. Until then, clinicians must focus on developing a hard-hitting, comprehensive, interdisciplinary asthma program and work toward its successful and broad-based implementation. It is the only way to win the "war against asthma."