Air Quality Alerts: Why You Should Care with Neha Solanki, MD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host.

When wildfire smoke colored the sky orange earlier this year, it seemed pretty obvious that air quality might not be at its best. There are other days when the sun is shining, the sky is blue, and you still hear about an air quality alert for your area. Is that really something you need to worry about? The answer is yes, and some of the reasons why may surprise you.

Pulmonologist Neha Solanki is with us today to talk about air quality and how it can affect your body. Dr. Solanki is one of the many trusted experts at Cleveland Clinic who joins our weekly podcast to offer deeper insight into the daily health issues. With any luck, what she has to say will help you breathe a little easier in the future.

Welcome to the podcast, Dr. Solanki. Thanks so much for working us into your busy schedule.

Dr. Neha Solanki:

Yeah, thank you so much for having me. This is quite an honor.

John Horton:

Well, we appreciate that. We're talking about air quality today, which I know is a topic that just seems to be getting so much increased attention given everything that's kind of happening on this planet of ours right now. So, I get the sense, though, that we are just now becoming aware of a danger that you've known about for a long time.

Dr. Neha Solanki:

Yes, we have known about particulate matter and nitrogen dioxide and ozone for quite some time, pollution related to vehicular emissions. But recently, we're hearing about this a lot more in the context of wildfires, in the context of construction and so forth. So, I do think people are paying a lot more attention to air quality. This morning, in my clinic, I overheard someone say, "Oh, the AQI is moderate today." And I was very proud of that individual, they had gotten up and checked.

John Horton:

Let's start with the basics when it comes to talking about air quality alerts and the air quality index, what exactly is being measured to set these warnings and get that number?

Dr. Neha Solanki:

So, you're measuring particulate matter, for one, and its particulate matter of different sizes. They tend to be smaller, way smaller than a strand of hair. So, you can't see a lot of this matter with your eyes. And it includes particles from exhaust fumes and so forth and so on. The two sizes are 2.5 micrometers and 10 micrometers. So very, very teeny tiny. In addition to this, it includes ozone, nitrogen dioxide and other gases.

John Horton:

Now when you talk about those particulates, I always thought one of the big concerns with that is that they're so small that your body has trouble dealing with that, right?

Dr. Neha Solanki:

Yeah. So, they're so small that you breathe them in, they get into your lungs, and they can actually diffuse into your bloodstream and be carried around your body can get into your lymphatics. They can get into your system and cause inflammation, and persistent inflammation can cause asthma, cardiovascular issues such as strokes, heart attacks - sometimes can trigger autoimmune conditions. So, though they're tiny, they're very toxic.

John Horton:

Well, yeah. Sounds like they do a lot of damage. You breathe in this garbage, and it's just kind of littering your whole body.

Dr. Neha Solanki:

Just garbage. You're just breathing garbage in; you're littering your body. That's exactly correct. But I don't like to think about it very much, and I think a lot of people also don't like to think about that very much because you have to live your life. You have to go to work, you have to go to school, you have to live your life.

John Horton:

What causes the air to suddenly change? You brought up wildfires, which I mean, they've been in the news the last few years. It seems like we get that time of year, and everything gets dry and these start up, and I think we're learning so much more about that through that. But what other factors kind of come in there that just make those numbers skyrocket?

Dr. Neha Solanki:

We see air quality being affected by cars and trucks on the road. We call this traffic-related air pollution, or TRAP. So, if you live near a major road, you're going to have more exposure to traffic-related air pollution. And we find that people that live near major roads also have more inflammation in their bodies, more cases of asthma, more cases of COPD, more cardiovascular risks. So that's one cause.

Other causes - changes in weather, changes in pressure - this can cause shifts in the atmosphere that can bring things like smog pollution from other places. So, if there's a wildfire on the West Coast, that wildfire will actually reach the East Coast. If there's a wildfire on the eastern board of Canada, that smog can actually reach Europe. The smog from the wildfire can actually travel quite a long distance. What happens on one coast affects the other coast, which is what is a little frightening, but it's an effect we're having to live with.

John Horton:

I'd imagine manufacturing has got to be a big add, a lot to that, too. What other sort of things might work in there?

Dr. Neha Solanki:

Industrialization is definitely a cause of it. Cities tend to have a higher burden of air pollution than the countryside. Any place that has a high amount of manufacturing will also have a good bit of pollution associated with it.

John Horton:

I know there's a rating system for that air quality index, or I guess a value system is what they call it. Can you kind of walk us through the different levels and the numbers and kind of what they mean for the average person as you go outside?

Dr. Neha Solanki:

So, the numbers go up to 500, the AQI goes up to 500 basically. Anything under 100 is considered good air quality, generally. It's considered under the guidelines for where we should be. So that's good air quality. You can go outside, you can go around, you can do whatever you want to do, don't worry about it. As you get over 100, the air quality starts becoming more harmful and that's where you have to really worry. Over 300 is the worst air quality, everybody is going to be affected at that range.

John Horton:

In looking at the numbers now, you had mentioned that 100 lines, and I think under that is usually, it's OK. But I know in the 101 to 150, it says it's unhealthy for sensitive groups. Who would that include?

Dr. Neha Solanki:

So that group is going to include people who are prone to having respiratory exacerbations. So, this can include people with asthma, people with COPD, people with cystic fibrosis and other lung conditions. In that group, we would also include our aging population because their immune system is not as strong as it should be to combat air pollution.

John Horton:

That garbage that's coming in.

Dr. Neha Solanki:

Right. It's garbage. And infants have developing lungs, so they're also going to be at risk in this situation, infants and small children. And I would also like to include pets in that because if you have puppies or ageing animals, you also have to think about those populations.

John Horton:

See, and I never even think about that with my dog, Charlie, and he's 12, so he would be an elderly dog at this point. So, I'll have to watch when the AQI levels get to a certain level with them.

Dr. Neha Solanki:

You do. The day the AQI levels got very high here, I called my dog's daycare because — yes, my dog goes to daycare — and I told them to please watch out for the air quality in their dogs. And so, they actually kept their dogs inside that day due to the smog.

John Horton:

I love that. You're looking out for everybody, people, pets, the whole shebang. So, as we move through those kinds of things, I know that the next level is just unhealthy, where the air is classified in that unhealthy range. And when it's at that point, I take it even if you're just a healthy person — you go out, you exercise, you do all that — that's where you could start seeing some adverse effects if you're outside and you're breathing this air in while working out, really exerting yourself.

Dr. Neha Solanki:

Exactly. When the AQI is in that range, if a person who is relatively healthy doesn't have lung problems, goes outside, does work outside, does exercise outside, they will feel the effects of the air quality. And usually, that will include headaches, sinus drainage — some people may experience shortness of breath. Those would be the short-term side effects of air pollution.

John Horton:

And then the next level, I know, is the very unhealthy — and that's at 200 to 300 — is very unhealthy, and then, 300 and up is hazardous. But if you're out in that, I take it odds are you're going to feel that later.

Dr. Neha Solanki:

Definitely. I think that it's everything we discussed but more severe. People will feel sicker. They'll feel like they're coming down with something. They may feel like they've caught some sort of infection — just because you'll feel more rundown due to all of the toxic material that you're breathing in. Some people, it can worsen their underlying health conditions, whatever those are. You will see an increase in emergency department visits, an increase in utilization of urgent care, doctor visits, more prednisone prescriptions being called in for asthma, COPD, that sort of thing. So, it really also makes it difficult for healthcare providers to take care of everybody because everybody's getting sick at the same time.

John Horton:

It's one of those things when the AQI gets that high and you look outside and you go, "Ah, it doesn't seem that bad." Because it's not like a danger you can see. But I know, as we were talking about before, there's been a lot of these fires lately and we had some obviously really bad days near us. And I know one of those days, I went out in the morning and went for a run. And I got to tell you, I felt it the rest of the day, which surprised me, but it's amazing what it does, and I don't think a lot of people really think it's going to affect you that much.

Dr. Neha Solanki:

Yeah. My neighbors actually were talking about how when the AQI is very high, when that number is higher than 200, higher than 300, they start feeling these vague symptoms such as headaches, sore throat, they just feel generally unwell. And that's because the air you breathe in supplies your blood, which supplies all of your organs, including your brain and your heart. And if that air you breathe in is unhealthy, then your organs are getting unhealthy toxic particles exposed to them. So, it makes sense that you feel unwell on these days. So, trying to stay indoors is the takeaway.

John Horton:

Dr. Solanki, that was such a great way to explain it, because I don't think a lot of us connect that you breathe something in and then it scatters throughout your body and touches everything inside you. So, it's a wonderful explanation. And actually, that's right where we're going now with what impact this poor air quality can have on your health. Obviously, I take it, breathing issues are the big thing and the first thing that comes to mind. So, can we run through a little bit as to what it can set off or do?

Dr. Neha Solanki:

Particulate matter and these gases that are in air pollution that you breathe in cause inflammation in the airway, this inflammation can then trigger asthma, can trigger COPD in people that already have these underlying conditions — but even if you don't have asthma or COPD, these particles and these gases can still cause shortness of breath because people can still have something called reactive airways. It's where your airways are just reacting to all that toxic fumes that you're breathing in and your airways get angry and they get inflamed and they start spasming — they can create mucus, and this causes shortness of breath and coughing that people often experience.

John Horton:

How long can that last? If you are out in that, and like you said, you're not somebody who has asthma or some of these other issues, but you kind of get that gunk in there. How long will that hang around?

Dr. Neha Solanki:

Usually, what we see is that this will be related to the amount of time you were exposed to the pollution. So, if you have a short exposure, your symptoms should not last that long. If you had a long exposure to it, your symptoms would last a fair bit longer. And some people, though — and we still don't know why these people are different than other people — pollution can trigger a chronic condition. This can be said for a lot of different things we breathe in and not just air pollution, but anything we breathe in has the potential of setting off an immune reaction in our body, which can cause a chronic illness.

So, there is a chance, not for everybody, but for some people who have a genetic predisposition to developing certain chronic autoimmune diseases or something like asthma, if that person has a good amount of exposure, it may not take that much time to develop a chronic condition. But again, that's not most people. Most people, it's going to be related to how much time you're actually out there, how much time you're exposed. So, they would only experience a short-term effect of the pollution.

John Horton:

Now one of the things — and you brought this up a little bit earlier, too, but I still just find it amazing — when you think about the air quality and it's polluted air that you're breathing in or it's not the cleanest air, and you figure it's going to hit your lungs and you might have some issues there, but I was really shocked to see that it leads to increased risk for heart attacks and strokes. That's just all because of the inflammation, right?

Dr. Neha Solanki:

That's right. It's because of the inflammation. And they've done lots of studies that show that people who have chronic exposure to this type of toxic material, they're more likely to have these health conditions such as strokes, heart attacks — and this is all from that chronic inflammation that's caused by these toxic particles.

John Horton:

Wow. Well, given that we all want to avoid all of those issues you just brought up, what should we do when the air quality levels get to those higher numbers, and we want to minimize problems and stay healthy?

Dr. Neha Solanki:

So, we always start with saying stay indoors. But even that is with a caveat because I actually have bought a little indoor air quality monitor device for my house that I put in the kitchen, and just taking my dog out even for a little while into the backyard caused the air pollution in my house to go up because I opened the door to let the dog out and then opened the door back again to come back in. And in that amount of time, I had introduced air pollution.

So, when we say stay indoors, minimize the opening and closing of doors, keep your windows closed. Don't burn candles in the house because that's another thing. If you burn candles that aren't soy-based candles, then you're going to increase your indoor air pollution, which you want to keep as low as possible, especially when the outdoor air is so poor. Don't use gas stoves if you can avoid it. Don't use your wood-burning fireplaces. So that's all indoors.

Have a HEPA filter or some sort of high filtration device for the air in your house to keep the pollution to a minimum indoors. Because some people, their indoor air pollution is just as bad as the outdoor air pollution, so you have to focus on that as well.

Then, if you have to go outdoors, keep your exercise to a minimum. So don't run on days that have poor AQI, don't be very active outdoors basically. Don't take your pets out for a run either. And then for people who have to be outdoors because their job is primarily outdoors, such as construction workers, I'd recommend wearing an N95. A surgical mask isn't enough for the particles and the gases, those will go right through because the surgical mask is pretty porous, so you'd have to wear an N95 to keep the particles out.

John Horton:

When we start getting to those marginal areas are there.

Dr. Neha Solanki:

Oh, one more thing — I was just going to say, the other thing to do is when you're driving in your car, turn the filtration off so that it's only filtering the air inside the car and you're not filtering air from outside to the inside. That's the other thing I would suggest doing.

John Horton:

That's a good bit of advice there. When those levels get to that midpoint or those marginal levels and you're looking to exercise outside or something like that. Are there times of day when those levels naturally drop or even places where you can go, and you might be a little better off?

Dr. Neha Solanki:

The evening is better. Generally, if you want to put gas in your car or you want to go for a walk, air quality tends to improve toward the evening. Green spaces, I think, are also better than walking alongside roads. So, if you have access to a park or access to a place with a lot of trees, that will have better air quality overall.

John Horton:

Well, that, that's some great advice, Dr. Solanki, and kind of a perfect way to wrap up our discussion. But before we say our goodbyes, is there anything else you'd like to add about air quality alerts and what they mean?

Dr. Neha Solanki:

I would like to say that if you think that the air quality is bad by looking outside, it probably is bad. And to try to check the Air Quality Index, or the AQI, which you can just look up on your smartphone and try to follow the guidelines at that point. Whether that is to limit exercise outdoors or to stay indoors or to go outside and enjoy yourself but try to use AQI to be as healthy as possible.

John Horton:

And I think if people are looking to going to look that up, if I remember right, it's airnow.gov, right?

Dr. Neha Solanki:

That's correct. It's just airnow.gov.

John Horton:

All right. Well, I think we all know what we should do when it gets bad and where to go look. And thank you for an enlightening conversation.

Dr. Neha Solanki:

Thank you for having me.

John Horton:

Breathing in pollutants can affect you both immediately and in the long term. So do yourself a favor and pay attention to air quality alerts. Your lungs, your heart, and other parts of your body will thank you. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children’s. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.