Earth Day serves as an important reminder of our responsibility to our planet, but the occasion also presents health care providers with the opportunity to better understand how environmental issues can impact patient health.
 
Pharmacists and pharmacy technicians looking to celebrate Earth Day should consider educating themselves on the negative effects that air pollution can have on them and their patients, including:
 
1. Respiratory Issues
Respiratory issues are perhaps the most well-recognized complication associated with air pollution, but a recent study found that children’s lung function can be affected by even small amounts of pollution.
 
The study published in the American Journal of Respiratory and Critical Care (AJRCC) evaluated data on 614 children, tracking their first year of life, lifetime, and prior-year exposure to fine particulate matter with a diameter of at least 2.5 millionths of a meter (PM2.5) and soot (black carbon).
 
After the participants completed lung function tests at age 8, the research team determined that the lung function of children living within 100 meters of a major roadway was 6% lower on average than that of kids living 400 meters or more away. The researchers also found that recent air pollution seemed to have a particularly notable impact on lung function.
 
“These important findings are from a novel study combining modern modeling of exposures to air pollution with robust measurements of lung function, conducted in a community with pollutant levels now under EPA [Environmental Protection Agency] standards,” wrote Cora S. Sack, MD, and Joel D. Kaufman, MD, MPH, in an accompanying editorial. “This adds to the urgency for more work to understand the impacts of these low-level exposures on human health.”
 
A separate study published in Respirology found that heavy traffic pollution could exacerbate asthma symptoms.
 
Fortunately, reducing pollution could potentially reverse these effects, as the AJRCC study authors reported that children who experienced greater improvements in air quality after their first year of life had better lung function then those whose air quality didn’t see a notable improvement.
 
Additionally, a recent JAMA study linked decreases in ambient concentrations of nitrogen dioxide, ozone, and particulate matter with significant reductions in bronchitis symptoms in children with and without asthma.
 
“While the study design does not establish causality, the findings support potential benefit of air pollution reduction on asthma control,” the JAMA study authors concluded.

2. Brain Damage
Long-term exposure to air pollution could negatively affect brain structure and cognitive function in older adults.
 
In a 2015 study published in Stroke, researchers analyzed the PM2.5 exposure of more than 900 participants aged 60 years and older who were free of dementia and stroke. After measuring the various aspects of the participants’ brain volume, the research team calculated that a 2 µg/m3 increase in PM2.5 was associated with an elevated risk of covert brain infarcts and smaller cerebral brain volume equivalent to approximately 1 year of brain aging.
 
The study authors also found that participants who lived in more polluted areas had the average brain volume of an individual aged 1 year older than those living in less polluted areas, as well as a 46% higher risk of silent strokes.
 
“These results are an important step in helping us learn what is going on in the brain,” said study author Elissa Wilker, ScD, in a press release. “The mechanisms through which air pollution may affect brain aging remain unclear, but systemic inflammation resulting from the deposit of fine particles in the lungs is likely important.”
 
3. Heart Disease
Another potential consequence of air pollution is an increased risk of cardiovascular disease (CVD). While smaller particles have previously been identified as a cause, a recent study suggested that larger pollutants are also to blame.
 
The study, which was published in Environmental Health Perspectives, found that CVD-related hospitalizations among patients aged 65 years and older were more frequent on days when levels of coarse particles were higher, indicating a link between the 2 factors.
 
“We suspected that there was an association between coarse particles and health outcomes, but we didn’t have the research to back that up before,” said lead author Roger D. Peng, PhD, in a press release. “This work provides the evidence, at least for cardiovascular disease outcomes.”
 
Furthermore, air pollution may pose a particular notable CVD risk in woman with diabetes, according to a separate study published in the Journal of the American Heart Association Report.
 
The study, which was led by Jaime E. Hart, ScD, of the Department of Environmental Health at Harvard Chan School, estimated that for every increase of 10 µg/m3 of air pollution, women with type 2 diabetes experience a 44% increase in CVD risk. These effects tended to be more pronounced in women older than 70 years, as well as in obese patients and those living in the Northeast or South.
 
“Continuing to identify subgroups that are most susceptible to the effects of air pollution is critically important for setting pollution standards and regulations so that those who are most vulnerable can be protected,” Dr. Hart stated.
 
4. More Mortality
Perhaps most alarmingly, air pollution may ultimately shorten patients’ lives, even among those who live in areas that meet current EPA standards.
 
A 2015 study also published in Environmental Health Perspectives used satellite data to evaluate particle levels across New England while analyzing health data on 2.4 million patients aged 65 years and older who resided in this region.
 
The research team determined that short-term exposure to PM2.5 was associated with a 2.14% increase in mortality per 10 μg/m3 increase in PM2.5 concentration, while 1-year exposure was linked to a 7.52% increase.
 
These findings held true even after the researchers limited their analysis to zip codes where annual exposures were below EPA maximums.
 
“Particulate air pollution is like lead pollution; there is no evidence of a safe threshold even at levels far below current standards, including in the rural areas we investigated,” said senior author Joel Schwartz, PhD, in a press release. “We need to focus on strategies that lower exposure everywhere and all the time, and not just in locations or on days with high particulate levels.”