Air Quality (for Health Professionals)

Air pollution is among the top environmental health threats in the United States. Children are uniquely vulnerable to air pollution because their brains, lungs and other organs are still developing. They breathe twice as fast as adults, often by mouth, taking in more pollutants than adults in the same environment. Air pollution can also worsen health conditions in children such as asthma and bronchitis. Some researchers are concerned that chronic exposure during periods of heightened vulnerability may impact long term cognition (1). Most people spend about 90% of their time indoors, where air can be 2-5 times as polluted as outdoor air (2).

Air pollution in the US specifically is estimated to cause 100,000-200,000 premature deaths per year (3). Associated costs estimates range from $100 billion to $820 billion per year (4, 5).

Because of policy and interventions like the Clean Air Act in the United States:

In 1999, nearly 75% of all children in the US lived in areas with at least one priority toxic air pollutant over the national air standards, by 2021 this number was down to 59%. During that same time, children living in areas with annual PM2.5 exposures over national guidelines decreased from roughly 33% to only 8% (6).

The Good News: Health professionals can play an important role in protecting children from air-pollution-related illnesses. Being prepared and knowing steps to reduce exposure to air pollution can help keep your patients safe. Let them know they have the power to make meaningful change in their homes and schools, often at relatively low cost. Some areas have home visit services to help guide families with children who have asthma in making these changes. Subsidized air purifiers or other materials may be available.

What to Look For

Actions to Take

What Can Health professionals Do to Lower their Patients’ Exposure to the Harmful Health Effects of Air Quality?

Health professionals play an important role in protecting children from air-pollution-related illnesses. In addition to encouraging families to follow the prevention recommendations in the family page, professionals can identify potential indoor air pollution triggers (see Additional Resources section) and conduct an environmental health history for patients with environmental concerns, especially those with respiratory conditions like asthma. You can then add air quality concerns to your patient’s asthma action plan, council on trigger reduction, discuss the benefits of using MERV 13 air filters in HVAC systems and/or portable HEPA air cleaners with patients, and advocate for healthy indoor school or daycare environments for children.

What Can Patients Do to Lower their Exposure to Unhealthy Air Quality Outside?

Patients can look up average annual air quality levels in their neighborhoods using the UCSF Health Atlas mapping tool (see Additional Resources section). If levels are at or above the 40-60 range near the home, consider adding air pollution to their asthma action plan. Consider recommending extra precautions, such as the actions below.
Patients can look up the air quality forecast each day by using AirNow.gov to see if it’s a good air day. If the AQI is around 50-90, advise avoiding or significantly reducing heavy outdoor exercise for their child that day. If AQI is around or above 100, patients should avoid heavy outdoor exercise altogether and limit time outdoors. If outdoors during high pollution days, and/or wildfires, have patients use a N95 mask, for child patients, make sure it’s fitted for kids (see Additional Resources section).

What Can Patients Do to Lower their Exposure to Unhealthy Air Quality Inside?

The best way to protect patients from indoor air pollution is to prevent or minimize the release of pollutants in the first place. Patients should:

Switch from indoor appliances that run on gas to those that run on electricity. This may reduce indoor air pollution up to 50% (Stanford, 2022).
Avoid burning candles and incense indoors and get rid of scented air fresheners.
Quit smoking! If they can’t keep cigarette smoking, vaping, and marijuana smoking to outdoor areas and away from doors and windows. Wash hands after use.
Use unscented EPA Certified Safer Choice cleaning products. Or, make their own DIY products!
Avoid using pesticide sprays or “pesticide bombs”, use gels or traps instead. The best approach is to eliminate leaking water and unsealed foods that attract pests and use integrated pest management practices (see Additional Resources section).
Reduce existing indoor pollution:
- On good air days, advise that they open windows and doors as weather permits, especially if using products that may generate pollutants.
- Recommend extra precautions if patients live near heavy industry or busy shipping routes like train tracks, warehouses or near seaports.
- If patients have a central heating and cooling system, “HVAC”, use high efficiency filters:
- Filters rated as MERV 13 or higher are best for reducing small particles that may impact health. Change air filters more often when there’s more smoke or pollen in the air (see Additional Resources section).
- Consider recommending portable indoor air purifier/filter with a HEPA filters in the rooms patients spend the most time in, especially if they live near heavy industry. Avoid those with “ionizers” as these can create more pollutants. Patients can also make fairly effective low cost filters by taping a MERV13 filter onto a box fan (see Additional Resource section). For safety reasons, make sure the box fans used are from 2015 or later.
- Encourage patients to advocate for similar actions at their children’s schools.