The Asthma Conundrum: Cleaner air, but more coughing and wheezing

[October 26, 2015]  By Rob Nikolewski / October 21, 2015 / 6 Comments
 
One of the biggest cities in the country, Houston has seen its air quality become cleaner in recent decades.

But at the same time, an estimated 96,000 children and 186,000 adults in Harris County have been diagnosed with asthma and Houston is one of six Texas cities where doctors have seen an increase in asthma-related claims.

It’s a conundrum that has confused and even divided air quality experts and policymakers in Texas and across the country.

“People are spending a huge amount of money to get to the root of this thing, but they really haven’t discovered what it is,” said Dan Kish, senior energy and regulatory policy expert at Institute for Energy Research.

“There are some studies that have found an increased risk of developing asthma, but asthma is a really complicated disease,” said Janice Nolen, assistant vice president of national policy for the American Lung Association.

Earlier this month, the U.S. Environmental Protection Agency announced it is lowering the national standard for ground-level ozone — what’s commonly known as smog, which comes from sources such as tailpipes and smokestacks — from 75 parts per billion to 70 parts per billion.'

A big reason for the stricter standard, EPA said, is to reduce the ozone in the air, saying it “can cause a number of harmful effects on the respiratory system, including difficulty breathing and inflammation of the airways.”

But making the air cleaner does not necessarily mean the number of asthma cases is going down.

In fact, statistics show that even as the country’s air has become much more healthy since the adoption of the Clean Air Act in 1970, the number of Americans suffering from asthma has gone up.

That has made critics like Kish question why EPA and clean-air advocates tout the benefits of ozone mitigation.

“The question for me as a simple country boy is, how is it that you can claim that (a tougher ozone rule) is going to somehow help asthma sufferers when asthma is going up, even as we’ve had a precipitous drop in the amount of ozone in the air?” said Kish, whose organization looks to solve energy and environmental issues with free-market solutions and opposed the recent ozone ruling.

Earlier this year in an interview with Watchdog.org, Michael Honeycutt, director of the toxicology division at the Texas Commission on Environmental Quality, questioned some EPA data.

Honeycutt pointed to a chart tucked in the appendix of a 597-page 2014 EPA policy analysis showing that 48 more people in Houston would suffer premature deaths with ozone levels toughened at 70 ppb, but one fewer person would die if ozone levels were worse — at 75 ppb:

“In Texas, our asthmatic hospital admissions increase in the wintertime when we have our lower ozone as opposed to during the ozone season,” TCEQ chairman Bryan W. Shaw told a committee in the Texas House of Representatives in February.

Shaw said the EPA “is chasing the wrong rabbit.”

But EPA has defended its studies, telling Watchdog.org earlier this year, “Proposing, and then finalizing, an air quality standard involves evaluating the latest available science, and we have more than 1,000 new studies since the last review that we’ve taken into account.”

Nolen said there’s been confusion about the relationship between asthma and ozone, specifically between new cases and asthma attacks.

“We have seen a great increase in the number of people with asthma since the 1970s,” Nolen said in a telephone interview. “We are not saying, and the research is not clear, what impact ozone has on the development of the disease, on new people having it.

“What is very clear, what is absolutely shown in study after study, is that people with asthma have more asthma attacks and have other problems associated with their lungs that linger, that contribute to hospitalization, emergency room visits, as well as just coughing and wheezing as part of their attacks when ozone is higher.”

Nolen said higher levels of ozone makes asthma worse. But that doesn’t mean ozone causes asthma.

“Right,” Nolen said, adding. “Ozone may play a part in that, but it’s probably not the only thing.”

What about the EPA numbers showing one fewer death in Houston even though the ozone standard is 5 ppb higher?

Nolen said Houston, like a number of cities, did not meet the “cookie-cutter model” when the tests were conducted and that a more sophisticated measure will be performed.

Kish isn’t so sure.

“There are a lot of theories about this,” Kish said. “Part of it has to do with people being indoors much more. There appears to be a link between poverty and and urban areas and asthma” and even insects, such as cockroaches.

So what’s going on?

“We don’t know,” Kish said. “But the EPA doesn’t know either.”

The American Lung Association and IER do have one thing in common: Each criticized EPA’s new ozone rule when it was announced Oct. 1 — Kish for being too strict and Nolen for not being tough enough.

ALA’s leadership has compared asthma to getting a sunburn in your lungs.

“The evidence is growing that ozone doesn’t just do that sunburn effect, but it can have much more broader effects on the body,” said Nolen, who said her group will push EPA to reduce ozone levels to 60 ppb when the standard comes up for review in five years.

“It’s clear that ozone (levels have) been going down significantly, but asthma rates have been going up,” Kish said. “There’s apparently no corollary, looking at the objective information in (EPA’s) own numbers. Yet they continue to repeat it because this is an emotional thing.”