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Article of Interest - Asthma/The Environment

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Bridges4Kids LogoRegion's Kids Left Gasping for Air
Higher asthma rates tied to increase in exhaust.
by Charles F. Bostwick, Los Angeles Daily News, February 23, 2004
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Asthma among children is rising -- affecting an estimated 390,000 youngsters in Los Angeles, San Bernardino, Riverside and Orange counties -- and exhaust from a growing number of cars and trucks is among the suspected causes.

Air pollution is known to hinder lung development, increase asthma among athletes and cause coughs and runny noses, but experts say many other factors could be causing the asthma epidemic.

While smog and ozone levels have fallen sharply in Southern California over the last three decades, there has been no progress in the last five years and in some ways air pollution is getting worse. Pollution from diesel engines is increasing -- fed, in part, by major expansion of shipping at the ports of Long Beach and Los Angeles and the truck traffic that comes with more international trade.

"We always thought air pollution had acute effects: If you breathed bad air one day, you felt crappy that night," said University of Southern California professor James Gauderman, a researcher in a landmark $10 million study that watched 5,600 California youngsters over 10 years. "Long-term exposure, day-in, day-out, in an area like Los Angeles, really appears to have detrimental effects on kinds of chronic conditions."

Even when parents don't notice smog is particularly bad, it can sicken their children. A 20 parts-per-billion increase in ozone increases school absences 83 percent within a few days due to coughs, asthma attacks and runny noses, the USC researchers found.

In communities with high ozone levels, like much of the Inland Empire, youths who play three or more team sports are three or four times more likely to develop asthma than youngsters who spend more time watching TV inside, where ozone levels are lower.

Asthma itself is increasing among youngsters for reasons that aren't entirely clear, since what causes childhood asthma is not entirely clear. In the 1980s and 1990s, children's hospitalization due to asthma went up 70 percent, while all other age groups' asthma hospitalization rates went down.

"It's hard to breathe. I squeak when I try to talk," said San Bernardino 8-year-old Jonah Ramirez, who suffered his first asthma attack a year ago while skateboarding.

"We didn't know what was going on. Nobody in our family has asthma. Nobody smokes," said his mother, Tresa Ramirez.

Jonah is the most active of her three sons, Ramirez said. He plays roller-hockey and soccer, skateboards and in-line skates, and is outside until sundown every day. Smog is particularly bad at the family's house because it backs up against the nearby San Bernardino Mountains.

"If the heat's too high or we've having a really smoggy day, I have to keep him inside," she said.

Besides traffic, possible causes for the increase in asthma cases could be exposure to weedkillers, pesticides or cockroaches in the home before age 1 or expectant mothers smoking.

Even starting day care before age 4 months could be a cause because of exposure to the respiratory syncytial virus (RSV).

One idea is that modern life's cleanliness could be a culprit. The human immune system -- which used to be busy fighting off parasitic worms and amoebas -- goes into imbalance and results in asthma and allergies.

"If I understood exactly how asthma was caused in kids, they'd give me a Nobel Prize," said Dr. John Balmes, an American Lung Association of California volunteer and a professor of medicine at the University of California, San Francisco, and of environmental health science at the University of California at Berkeley.

Still the worst in the nation, Southern California's air pollution has become worse the last two summers, mainly because of weather conditions. There's been no improvement for five years, although progress before that had been great.

Stage 1 smog alerts -- linked mostly to ozone, the pollutant that causes eyes to burn and lungs to ache -- decreased from 120 in 1979 to zero from 1999 to 2002, and there was just one last summer. The last Stage 2 smog alert -- of which there were 17 in 1979 -- was in 1988.

"There's been some clear success," Gauderman said. "Ozone has been a huge success story."

But the Southland's air still falls far short of meeting federal standards.

While ozone has been under regulation for decades, for example, regulation of tiny airborne particles has just been stepped up in recent years. The crackdown on particulate emissions was driven by studies showing that high-particulate days brought more deaths of older people with heart and lung ailments.

Nitrogen dioxide, another common air pollutant, may worsen the reaction of asthmatic youngsters' allergies to other substances, like dust mites, and allergies are strong risk factors for asthma, Balmes said.

European studies have shown that children living next to busy roads have more asthma.

"There is no doubt in my mind that his asthma was definitely caused by the air quality here," said Long Beach resident Britt Rios-Ellis of her asthmatic 3-year-old son, Quique. "Had we been living someplace else, this probably wouldn't have happened."

The Rios-Ellis home is near the San Diego Freeway. Rios-Ellis said she must clean black soot off tables in the back yard.

"Had I known what I know now, I never would have moved that close to a freeway," Rios-Ellis said.

Ozone, nitrogen dioxide, diesel-exhaust particles and ultrafine particles all are capable of causing something called oxidative stress in cells and tissues. Lung cells exposed to those substances release "messenger molecules" that turn up the inflammatory response, a bad thing in asthmatic youngsters' already inflamed lung passages.

"Cells have to sort of work harder to protect themselves from damage," Balmes explained.

Looking into children's lung development in communities from Atascadero to Lancaster, Long Beach and Upland, the USC researchers expected ozone to harm lung development.

Ozone was linked to more asthma in athletic youths, but lung development rates were affected by nitrogen dioxide, fine particles and vapors of nitric, formic and acetic acids, which come from gas- and diesel-powered vehicles and industrial plants.

"We have the port. We have the refinery. We have the trucks. I think that's why this area is so bad," said West Long Beach resident Evangelina Ramirez, no relation to Tresa Ramirez, whose 6-year-old daughter, Lorena, has had asthma since infancy.

When youngsters moved out of Southern California, their lung development improved -- if they moved into a community with lower particulate pollution. If particulate pollution was worse, their lung development slowed.

That finding is actually reassuring, researchers say, because it means lung damage from pollution is reversible, at least for children, whose lungs are still growing.

The USC researchers are continuing their study of the youngsters into adulthood to see what further changes they have. They also are recruiting more youngsters to study the effects on lungs of genetics and of eating fruits, vegetables and antioxidants.


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