The first thing Julie Franks-Marchese does each morning is click an app on her phone that gives her an air-quality report for Valencia, Pa., where she lives with her husband, Michael Marchese, and their sons, Jesse, 11, and Tyler, 15. Then she plans her kids' days, prepares their medications and braces herself for disappointments caused by their asthma.
"It's heartbreaking to tell your kids they can't play outside," said Franks-Marchese. "Except in the winter, Jesse can only go out in the morning, when the dew on the ground keeps pollen down." Tyler's asthma is less severe, so he can head outside on good-air days. Defined by chronic inflammation of the lungs, asthma causes shortness of breath and wheezing.
From more tick bites to more salmonella, our health is affected by current climate changes in many ways, according to the National Climate Assessment, released in May by the U.S. Department of Commerce. The biggie, though, is the impact on our respiratory systems.
Longer, hotter summers and shorter, warmer winters give us bumper crops of pollen, which aggravates asthma, allergies and other respiratory diseases. Warm air traps ozone (smog), which is invisible but deadly. Record-setting rains in the East cause floods, which increase mold, a common allergen. Droughts in the West cause more wildfires, spreading smoke for hundreds of miles. The results are missed work and school days, plus misery all around.
Save for 2010-2012 (when there were heat waves), the American Lung Association's (ALA) 2014 State of the Air Report said our air has fewer pollutants overall than it did 10 years ago. But more of us — nearly half of U.S. residents — live where the air is so polluted it is "too often dangerous to breathe," said the report.
The two major contributors to "bad air" are particle pollution (visible from tailpipes and smokestacks) and ozone, which forms when gases meet sunlight. "Because of our warmer temperatures, ozone is our greatest challenge now," said Janice Nolen, ALA assistant vice president. "Now we have cities that make the 'clean list' for particle pollution but are high-ozone."
Seniors, diabetics and people who work outside are at the greatest risk. Children are especially vulnerable because their lungs are still developing.
Bad air affects healthy people, too, said Nolen, by increasing rates of heart attacks and strokes. "Even if you live in a 'healthy area,' you're at much greater risk from unhealthy air if you live within 300 meters of a major roadway because you're breathing vehicle emissions," she added.
"Asthma is the canary in the coal mine," said Dr. Sumita Khatri, pulmonologist at Cleveland Clinic in Cleveland, Ohio. "When there's more ozone, asthmatics know it." Asthma usually starts in childhood, as it did for Jesse and Tyler, but can strike at any age. Twenty-six million Americans have it, compared to 6.8 million in 1980, according to the American College of Allergy, Asthma and Immunology (ACAAI). It causes 4,000 deaths a year.
"We live in a constant state of alert," said Franks-Marchese, whose county gets a double-whammy of pollution from plants in Pittsburgh and Cleveland and from Midwestern pollen. "I do everything possible to keep the kids safe, but I can't control the air quality."
The increased prevalence of asthma means others understand the behavioral problems caused by medications, said Franks-Marchese. "When I was growing up, there was one kid in my grade with asthma," she said. "Now, 4 of 20 kids in Jesse's class alone have it. So when Jesse gets irritable, the other adults 'get' it." Kids, not so much, she said.
Between the kids' doctor appointments and activities missed due to asthma complications, Franks-Marchese's days are full. A massage therapist, she sees clients in the evening. "We could move, but where to, other than the Arctic?" she said. "Most major metro areas in the U.S. have bad-air days. And our families and jobs are here."
Excellent health insurance anchors Dr. Karen Jakpor to her Riverside, Calif., home, even though the ALA lists the area as No. 1 in ozone pollution and No. 3 in particle pollution.
"When I came here to interview for a job, it was February and beautiful," said the obstetrician, whose asthma forced her to quit practicing. "I didn't know then what I know now about pollution. It's so bad, the ALA had to cancel a 'clean air' meeting here because of dirty air."
Riverside gets diesel emissions from the trucks that carry imports east from the nearby ports, while warehouses emit smokestack pollution. "On windy days, pollutants blow away but pollen blows in," said Jakpor. "And wildfire smoke is so common, we're used to orange skies."
Jakpor may move in the future, but feels tethered by her children's schools, supportive friends, her husband's job and, most of all, her insurance through a plan with her former employer. She volunteers for the ALA and rallies for California's clean-air initiatives. She worries about proposed additional warehouse development.
"Some politicians tell us it's either more jobs or our health," said Jakpor. "But with smart policies, we can have both."
Although allergic rhinitis (hay fever) is less deadly than asthma, it is also affected by climate changes. Allergists report a "pollen vortex" this spring, thanks in part to our extreme winter, which yielded a bumper crop of weed pollen. On May 13, the Gottlieb Allergy Count in Illinois reported the highest weed pollen count in 20 years.
Fifty million Americans have hay fever, said the ACAAI. Seasonal or year-round, it causes sneezing, runny noses and itchy eyes. It accounts for 13.4 million emergency-room visits a year.
In addition to medicine, Khatri suggests lifestyle changes to minimize exposure to allergens. Recruit someone else to mow your lawn. Don't hang your laundry out to dry because pollen clings to it. Send cigarette smokers outside. Avoid exercising outside during early morning, when pollen counts are highest. Use an air conditioner. Take off your shoes so you don't track in allergens. Remove carpeting, which traps allergens. "Take an evening shower to wash off allergens, or you'll be sleeping with the enemy," she added.
Asthma-inducing pollution is harder for individuals to control, explained the ALA, but individuals can make a difference. We can ditch wood-burning stoves and use cars less.
We can buy cars with cleaner emissions, but most trucks and heavy equipment were built before the standards took effect, said the ALA. Urging our legislators to support vehicle retrofitting can help. More test sites near highways would give politicians — and voters — reality checks.
Or, we could head north. Franks-Marchese was close when she suggested the Arctic. Consistently topping the clean-air lists is Anchorage, Alaska.