Most people know that air pollution is bad for human health. Scenes of smokestacks and hazy horizons conjure up mental images of coughing and wheezing. But not everyone realizes what it takes to stay safe in an area with consistently harmful levels of air pollution, especially for people with a chronic lung disease.

Dr. Karen Jakpor is a physician who suffers from severe asthma and lives in Riverside, California, which has some of the highest air pollution levels in the country. For Dr. Jakpor, air pollution levels dictate how she can spend her days.
Yet air pollution doesn't prevent Dr. Jakpor from living her life and making a difference for everyone in her community. She is a long-time American Lung Association volunteer and was awarded a Clean Air Award last month by the South Coast Air Quality Management District for her advocacy to protect health from transportation-related air pollution. She has also opposed projects that bring increased diesel pollution to the Inland Empire region in California, where her family lives.

What is life like when you suffer from severe asthma and live in a polluted city like Riverside? We spoke with Dr. Karen Jakpor about her experiences.

Q: How has the air pollution in your area been recently?

Dr. Jakpor: This summer the air quality in Riverside and the area around it was terrible – the worst I've seen in recent years. We had so many unhealthful air days. My family makes sure to check the Air Quality Index every morning, and during the summer it was hitting the "red flag" or "code red" air pollution levels very frequently. Days with air pollution levels that are high enough to be unhealthful for everyone are labeled "code red days," whereas days with air pollution levels that are unhealthful for sensitive groups, which include children, the elderly and anyone with heart, lung disease or diabetes – are labeled "orange flag" or "code orange days." Summer 2016 gave us many code orange days as well.

For example, in June 2016 there were only four days that did not exceed the federal standards for ozone in the South Coast Air Basin, which includes Riverside County and the greater Los Angeles area. In other words, the ozone pollution levels in that area were unhealthy every day that month with the exception of four days. In July, every day exceeded those standards except for July 31.

The hotter it gets, the more easily ozone pollution forms and the worse the air quality gets. This is one way that climate change affects our air quality. Another way is through increasingly long and worsened allergy seasons. The Santa Ana Winds further exacerbate the allergen issue because they blow around pollen, which is bad for people with asthma, even aside from air pollution.

Q: Can you tell me about your respiratory illness? How long you have had it? How does it affect you?

I developed severe asthma in 1996. My asthma was caused by my severe latex allergy, which developed at work since I was exposed to latex gloves as a practicing physician. I am no longer able to work in the medical field because of this severe allergy. Unfortunately, the steroid medication I took to control my asthma caused a complication called steroid myopathy, which weakened my muscles, including my breathing muscles. 

Once a person has asthma, there can be multiple triggers. Beyond my latex allergy trigger, I have to deal with many other triggers including: unhealthful air days when ozone pollution and/or particle pollution levels are high, upper respiratory infections (common colds) and cold weather.

Q: How does the air pollution in your area affect you personally?

This summer is a good example: during June and July, there were so many unhealthful air days that I experienced a bad asthma flare-up and was hospitalized for three days. Even after I got out of the hospital I required large doses of steroids to get the asthma under control. The asthma symptoms I experienced this past summer were the worst I have had in a decade, and it was probably associated with some of the worst air pollution we have had in a decade. My friends at the American Lung Association call me the canary in the coal mine, because I'm very sensitive to air pollution.

Q: What steps do you need to take every day to avoid the worst impacts of air pollution?

I check the air quality each day, and I subscribe to air alerts because sometimes the air quality changes during the day. If it's a code orange or red day, then I plan on staying indoors as much as possible. What that means for my daughter is that she can't go outside as much to play, because I can't leave her unsupervised. I was just looking at the "State of the Air 2016" report, and it found that Riverside County is the second most polluted county for ozone pollution in the country. Nearby San Bernardino County is number one. The pollution in my home county poses a very real, very frequent health issue for me and my family.  

On those days I stay indoors, I keep the windows closed. We have a whole-house air filter and I run the air conditioning. If using an air filter, make sure to only use types that don't produce ozone pollution, and if using air conditioning, make sure to keep the fresh air intake closed. If it's a hazardous air day and you fall into one of the air pollution "sensitive" categories of the population, it's not enough to just be inside, you need to decrease your activity too, such as quietly reading rather than hitting the treadmill. Having said that, exercise is important, but on code red days (as opposed to code orange days), sensitive populations should reduce their overall inside activity.

The air pollution in this area affects my family in other ways too. I told my daughter that I didn't want her to run cross country, because it's unhealthy to breathe air pollution, even though neither of my daughters have asthma.

Major highways have high levels of pollution and people need to be aware of that when they buy a house and send their child to school. My younger daughter was going to an elementary school with a major freeway behind the playground, and I started having asthma attacks every time I picked up my daughter from school, triggered by the highway pollution. It was so bad that I moved my daughter to another school.

Q: Have you noticed air pollution-related health impacts in your community?

My older daughter did a science fair project where she checked lung function on her test subjects, and she actually discovered several people that had undiagnosed asthma. That's how common asthma is in Riverside – particularly among high school athletes.

In fact, the ongoing Children's Health Study conducted by the University of Southern California studies a large number of communities in Southern California and follows children over time. They found an increase in stunted lung development in teens in the Inland Empire area, where Riverside is located. I think the high rates of asthma are related to the amount of pollution in this area. A recent study showed that at least eight percent of the cases of childhood asthma in Los Angeles County can be at least partly related to traffic related pollution within 75 meters of a roadway. Yet people continue to build right up to the freeway with schools, homes, offices, even hospitals.

Q: What advice do you give to your community members on how to stay safe and healthy on bad air pollution days?

Check the air quality; stay indoors; avoid wood smoke; keep windows closed; use air filters that don't produce ozone; decrease activity on hazardous air days; when it's hazardous but still unhealthy exercise indoors; don't attend school/buy house/join gym near major roads; and use the recirculate air option when driving.

And last but certainly not least, speak up for clean air because it really does make a difference! For example, there is always a lot of development going on in Riverside County, and developers always want to build more warehouses. Goods come in from ports on large trucks and trains, and there are increased levels of air pollution because of this. People need to be aware of what is happening in their communities, and they need to speak up, especially to make sure that new schools are not built by roadways.

Although air quality in Riverside has lots of room for improvement, it has improved over the past decades thanks to the Clean Air Act and the advocacy of those who care. That same Children's Health Study found that children's lungs have improved over the past 20 years as pollution levels in the Los Angeles Basin has declined. Healthy change is possible and critical to protect the lungs of all communities.

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