Episode #33: Poor Air Quality Across the U.S.: What You Need to Know

Kevin Kunzman: Welcome to Lungcast, the monthly respiratory health podcast series from the American Lung Association and medical news site HCP Live. I’m not your host, Dr. Al Rizzo, chief medical officer of the ALA, but I am joined by him today. I am show producer Kevin Kunzman, associate editorial director of HCP Live.

Dr. Rizzo and I are recording an out-of-schedule episode today to address the climate crisis driven by wildfire smoke that has traveled from Canada to regions of the United States—Northeast, Midwest, and South—over the last few days. The Air Quality Index, which we will discuss at length in this episode, has reached historically poor levels in major U.S. cities, including New York.

In fact, Dr. Rizzo, as you and I record this discussion at around 10 a.m. Eastern time on Thursday morning, we are both in an approximately 200-mile area that constitutes the most air-polluted region in the country, and possibly the world. I wasn’t able to check the map, but with that in mind, how are you today?

Dr. Al Rizzo: I’m doing fine, Kevin, and thank you for this opportunity to talk about such a timely issue.

Kevin Kunzman: Unfortunately.

Dr. Al Rizzo: Unfortunately, yes. I wish we had a more fortunate circumstance to be recording a special episode today, but here we are.

So, let’s start first and foremost. I think this is the most pertinent subject—identifying this metric that everyone is now coming to better appreciate in the Northeast region with regard to wildfire smoke exposure. What exactly is the Air Quality Index, and what is it measuring?

Dr. Al Rizzo: Sure. The Air Quality Index, or AQI, is something that the Environmental Protection Agency developed to let individuals know about the quality of air in their particular county or area. It’s made up of several pollutants: ozone, particulate matter, carbon monoxide, sulfur dioxide, and nitrogen dioxide—basically the six criteria pollutants. By far and away, the most important two are ozone and particle pollution.

Right now, particle pollution is the main one we’re seeing make these levels so unhealthy. Particle pollution itself is really fine particles—2.5 microns in size—which represents about 1/30 the diameter of a hair. The importance of this size is that it can be respired deep into the airways. Even smaller particles, called ultrafine particles at 0.1 micron in size, can cross the membrane in the airways and enter the vascular system, potentially causing non-respiratory issues like cardiac events, which we know occur at higher rates when particle pollution is this high.

Kevin Kunzman: That segues perfectly into what we wanted to talk about next: the value of understanding this metric. Most people’s interpretation is likely coming from their weather apps or other services, and it’s a 0–500 metric. The higher the number, the poorer the air quality.

With regard to people’s awareness—why they’re tracking it, discussing it, possibly for the very first time—what exactly are the risks? Is there a risk of people dying from poor air quality, for example?

Dr. Al Rizzo: Oh, there’s no question that mortality is increased with poor air quality. Worldwide, probably seven million people die each year due to poor air quality, according to the World Health Organization. In this country, it’s in the hundreds of thousands. The reason it’s important to know about this is that at fairly good air quality (green or yellow on the AQI), most individuals are not affected outdoors. Once you get into the orange level, at-risk individuals may notice symptoms like cough, chest tightness, or wheezing.

This includes people with chronic lung conditions, like asthma or COPD, young children who breathe faster outdoors, the elderly, and pregnant individuals. These groups are more sensitive to immediate signs and symptoms of poor air quality.

Kevin Kunzman: What exactly should clinicians be advising patients to watch for in terms of acute signs and symptoms?

Dr. Al Rizzo: Even aside from a crisis like this, it’s good practice for patients with chronic lung disease—or those at risk—to check the air quality regularly via phone apps, newspapers, or radio stations. This can help shape daily activity. On hazardous days like today, limit outdoor exposure and avoid heavy exertion—mowing the lawn, playing sports, anything physically demanding. Stay indoors as much as possible, run your air conditioner on recirculate, and use HEPA filters if available.

If you must go out, minimize your time and wear an N95 mask, which is most effective for this type of air quality issue.

Kevin Kunzman: That’s a great point. I’ve seen people instinctively seek fresh air, but that’s actually harmful right now. Fresh air doesn’t exist in the impacted regions. So all outdoor activity—even walks, runs, or trips to the shore—should be paused. The safest air is filtered indoor air.

Dr. Al Rizzo: Exactly. Beyond general precautions, patients with pre-existing conditions—including asthma or cardiovascular disease—should maintain an adequate supply of medications, especially rescue inhalers. Asthma patients should have an up-to-date asthma action plan. If symptoms aren’t controlled, they should contact their clinician or seek urgent care.

Kevin Kunzman: Some patients with milder asthma may not have an inhaler and could face exacerbations. Any advice for them?

Dr. Al Rizzo: Avoid exposure, have medications on hand, and minimize outdoor activity. The current situation stems from approximately 200 wildfires in Canada, which are impacting air quality across North America. Weather conditions may prolong the effect in some regions.

Kevin Kunzman: How long do we anticipate living in this circumstance?

Dr. Al Rizzo: Short-term, it depends on prevailing winds. Some reports suggest the Northeast may be spared by this weekend. Long-term, climate change contributes to more wildfires through hotter, drier conditions and increased lightning. We’re already seeing historic wildfire levels in Canada this year, early in the season.

Kevin Kunzman: Absolutely. This domino effect reminds people of West Coast wildfires in 2020. The resolution isn’t immediate, and interim public health responses include flight and school closures.

Dr. Al Rizzo: Correct. Beyond AQI, asthma patients can use peak flow meters to monitor their personal best. Symptoms or drops in peak flow indicate when to use medications or contact a clinician.

Kevin Kunzman: Long-term clinical effects—what might they look like?

Dr. Al Rizzo: People may experience eye irritation, nasal congestion, cough, chest discomfort, and wheezing. Masks like properly fitted N95s are recommended. If new symptoms arise, notify your healthcare provider—they may reveal predisposition to airway disease. Avoid smoking, which compounds the issue. In the long run, reducing fossil fuel use—electric vehicles, electric lawn mowers—helps lower particle pollution.

Kevin Kunzman: Absolutely. We all need advocacy and systemic solutions. Lung.org is a great resource to learn more and take action.

Dr. Al Rizzo: I think that covers it. Thank you for the opportunity to discuss this.

Kevin Kunzman: Absolutely. I was just along for the ride, but it’s immediately affecting me and my family—we’re seeing the smog outside. Thank you again, Dr. Rizzo, for talking through this.

Thanks to all of you for listening to Lungcast. We hope to return to regular programming later this month with an episode on pulmonary hypertension. In the meantime, you can learn more about air quality and climate-related health from Dr. Rizzo’s interviews with Drs. Alan Green and Pune Severy in our May 2021 episode. Subscribe to Lungcast on your preferred platform and visit Lung.org or HCP Live for more resources.

Dr. Rizzo always says: “If you can’t breathe, nothing else matters.” Stay safe, everyone.