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ENVIRONMENTAL
ENVIRONMENTAL ENVIRONMENTAL
MEDICINE MEDICINE
MEDICINE

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nderstanding that breathing polluted air will affect our lung increase of 10 μg/m of PM . This study confirmed a positive associa-
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health is not a mystery. Nevertheless, when pollution comes tion of total cardiovascular and respiratory mortality with short-term
Uwith economic prosperity, our recurring mistake is to be exposure to PM and PM 2.5 increase.
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blinded by the “prosperity” and take in the smoke as part of our lives. A strong association has been demonstrated between household
Not many know what happened in Donora, Pennsylvania in 1948. air pollution and the risk of acute lower respiratory infections around
A town that was proud of its industry with large steel and zinc mills the world. In a meta-analysis of 24 studies, Dherani et al demonstrat-
that provided its residents with work and stability. Heavy smoke was ed that exposure to solid fuel use during childhood increased risk of
the norm, however, on the night of October 29, 1948, a thick smog respiratory infections by 78 percent. Indoor gas stove use for cooking
covered the town for several days impairing visibility and affecting has been associated with an increased risk of asthma among children.
everyone’s lungs. At least 20 people lost their lives that night. After Gruenwald et al concluded that 12.7 percent of current childhood
that event, almost half of the population was not able to breathe like asthma in the United States is attributable to gas stove use. This is a
they used to. preventable exposure and comparable to the burden from secondhand
The World Health Organization (WHO) estimates that every year, smoke exposure.
3.2 million people die prematurely due to household air pollution that There is a large amount of evidence showing more ways in which
is caused by using solid fuels and kerosene used for cooking. Partic- air pollution affects our respiratory health. Efforts made by our govern-
ulate matter (PM) and other pollutants in household air can cause ments on reducing emissions and actions, such as banning gas stoves
continued inflammation of the airways and contribute to significant or supporting clean energy and transportation, spark controversy these
impairment of the immune system. Household air pollution has a wide days. Many choose to have an illusion of prosperity and sacrifice the
range of impact on health that includes ischemic heart disease as well quality of the air we breathe, the comfort of choosing to ignore the
as increased risk of lower respiratory infections, chronic obstructive damage pollution causes our lungs in exchange for money and eco-
pulmonary disease, asthma and lung cancer. nomic growth. We have a choice on the air we breathe; let’s choose to
There are different variables to consider when contemplating how breath air that won’t make us sick.
exposure to air pollution occurs. People in low to middle income coun-
tries, close to 3 billion people in the world, rely on biomass fuels for
daily activities including household heating and cooking. This includes
using solid fuels such as wood, dung, crop waste and coal that are often
burned inefficiently. Combustion of solid fuels produces gases such as References:
nitrogen dioxide (NO2), carbon monoxide (CO) and particulate mat- 1. Raju S, Siddharthan T, McCormack MC. Indoor Air Pollution
ter (PM). Households in high income countries have observed lower and Respiratory Health. Clin Chest Med. 2020;41(4):825-843.
pollutant concentrations. However, even in the United States, about doi:10.1016/j.ccm.2020.08.014
6.5 million people continue to use solid fuels for heating, especially 2. Jacobs ET, Burgess JL, Abbott MB. The Donora Smog Revis-
in rural areas. Urbanization predisposes individuals in high-income ited: 70 Years After the Event That Inspired the Clean Air
settings to other pollutants indoors, that include particulate matter, Act. Am J Public Health. 2018;108(S2):S85-S88. doi:10.2105/
environmental tobacco smoke, toxic cleaning chemicals and gases such AJPH.2017.304219
as nitrogen dioxide (NO2) from cooking and heating. The presence of 3. Liu, C, Chen, R, Sera, F, Vicedo-Cabrera, AM, Guo, Y, Tong, S,
these noxious gases in combination with a poorly ventilated household Coelho, M, Saldiva, PHN, Lavigne, E, Matus, P, et al. Ambient
increases the risk of impaired lung development in children, higher Particulate Air Pollution and Daily Mortality in 652 Cities. N.
risk of pneumonia, risk of asthma, COPD, lung cancer and increased Engl. J. Med. 2019, 381, 705–715
exacerbation of respiratory diseases. 4. Dherani M, Pope D, Mascarenhas M, Smith KR, Weber M,
PM is especially concerning for public health given its widespread Bruce N. Indoor air pollution from unprocessed solid fuel use
human exposure as a pollutant derived from combustion sources. It and pneumonia risk in children aged under five years: a sys-
consists on inhalable particles with an aerodynamic diameter of 10 tematic review and meta-analysis. Bull World Health Organ.
μm or less (PM ) and fine particles with an aerodynamic diameter of 2008;86(5):390–398C. 10.2471/blt.07.044529
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2.5 μm or less (PM 2.5 ). The WHO has established air quality guide- 5. Gruenwald T, Seals BA, Knibbs LD, Hosgood HD III. Popula-
lines recommending upper limit of 24 hour mean concentrations for
tion Attributable Fraction of Gas Stoves and Childhood Asthma
The Air We Breathe and PM 10 of 50 μg/m3 and PM 2.5 of 25 μg/m . Liu et al. published a study in the United States. International Journal of Environmental
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demonstrating ambient particulate air pollution and daily mortality in
Research and Public Health. 2023; 20(1):75. https://doi.
How it Makes Us Sick 652 cities. Using uniform statistical methods, the annual mean daily org/10.3390/ijerph20010075
concentrations found during the entire study sample showed PM of
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of 35.6 μg/m . Results showed that an increase
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56.0 μg/m and PM
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2.5
of 10 μg/m increase in a 2-day period increased the total cardiovascu- Patricio de Hoyos Zambrano, MD, is board certified in Internal
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By Patricio de Hoyos Zambrano, MD
lar and respiratory mortality. For an increase of 10 μg/m3 for PM10, Medicine and Pulmonary Medicine. He is the Medical Director,
the increase in all-cause mortality was of 0.44 percent. An observed Advanced Emphysema Service Line, at Texas IPS, and a member
increased risk of all-cause mortality of 0.68 percent was reported for an of the Bexar County Medical Society.

14 SAN ANTONIO MEDICINE • July 2024