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 Region'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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