It may be hard to imagine that pollution could be invisible, but ozone begins that way. As ozone concentrates and mixes with other pollutants, we often call it by its older, more common name—smog. It is currently one of the least well-controlled pollutants in the United States.1 And it is also one of the most dangerous.
Scientists have studied the effects of ozone on health for decades. Hundreds of studies have confirmed that ozone harms people at levels currently found in the United States. In the last decade, we have learned that it can also be deadly.
What Is Ozone?
Ozone (O3) is a gas molecule composed of three oxygen atoms. Often called "smog," ozone is harmful to breathe. Ozone aggressively attacks lung tissue by reacting chemically with it. When ozone is present, there are other harmful pollutants created by the same processes that make ozone.
The ozone layer found high in the upper atmosphere (the stratosphere) shields us from much of the sun's ultraviolet radiation. However, ozone air pollution at ground level where we can breathe it (in the troposphere) causes serious health problems.
Ozone develops in the atmosphere from gases that come out of tailpipes, smokestacks and many other sources. When these gases come in contact with sunlight, they react and form ozone smog.
The essential raw ingredients for ozone are nitrogen oxides (NOx) and volatile organic compounds (VOCs). They are produced primarily when fossil fuels like gasoline, oil or coal are burned or when some chemicals, like solvents, evaporate. NOx is emitted from power plants, motor vehicles and other sources of high-heat combustion. VOCs are emitted from motor vehicles, chemical plants, refineries, factories, gas stations, paint and other sources.2
If the ingredients are present under the right conditions, they react to form ozone. Sunlight is key. And because the reaction takes place in the atmosphere, the ozone often shows up downwind of the sources of the original gases. In addition, winds can carry ozone far from where it formed, even internationally across borders and across the oceans.
You may have wondered why "ozone action day" warnings are sometimes followed by recommendations to avoid activities such as mowing your lawn or driving your car. Lawn mower exhaust and gasoline vapors contain nitrogen oxides (NOx) and volatile organic compounds (VOCs) that are key to the formation of ozone in the presence of heat and sunlight.
Anyone who spends time outdoors where ozone pollution levels are high may be at risk. Four groups of people are especially vulnerable to the effects of breathing ozone:
- children and teens;3
- anyone 65 and older;4
- people with existing lung diseases, such as asthma and chronic obstructive pulmonary disease (also known as COPD, which includes emphysema and chronic bronchitis5; and
- people who work or exercise outdoors.6
In addition, some evidence suggests that other groups—including women, people who suffer from obesity and people with low incomes—may also face higher risk from ozone.7 More research is needed to confirm these findings.
The impact on your health can depend on many factors, however. For example, the risks are greater if ozone levels are higher, if you are breathing faster because you're working or exercising outdoors or if you spend more time outdoors.
Again, the impact of even short-term exposure to ozone pollution on healthy adults was demonstrated in the Galveston lifeguard study. In addition to the harmful effects of particle pollution, lifeguards had greater obstruction of their airways at the end of the day when ozone levels were high.8
Premature death. Breathing ozone can shorten your life. Strong evidence exists of the deadly impact of ozone from large studies conducted in cities across the U.S., in Europe and in Asia. Researchers repeatedly found that the risk of premature death increased with higher levels of ozone.9 Newer research has confirmed that ozone increased the risk of premature death even when other pollutants also are present.10
Immediate breathing problems. Many areas in the United States produce enough ozone during the summer months to cause health problems that can be felt right away. Immediate problems—in addition to increased risk of premature death—include:
- shortness of breath, wheezing and coughing;
- asthma attacks;
- increased risk of respiratory infections;
- increased susceptibility to pulmonary inflammation; and
- increased need for people with lung diseases, like asthma or chronic obstructive pulmonary disease (COPD), to receive medical treatment and to go to the hospital.3,4,5
Long-term exposure risks. New studies warn of serious effects from breathing ozone over longer periods. With more long-term data, scientists are finding that long-term exposure—that is, for periods longer than eight hours, including days, months or years—may increase the risk of early death.
- Examining the records from a long-term national database, researchers found a higher risk of death from respiratory diseases associated with increases in ozone.14
- New York researchers looking at hospital records for children's asthma found that the risk of admission to hospitals for asthma increased with chronic exposure to ozone. Younger children and children from low-income families were more likely than other children to need hospital admissions even during the same time periods.15
- California researchers analyzing data from their long-term Southern California Children's Health Study found that some children with certain genes were more likely to develop asthma as adolescents in response to the variations in ozone levels in their communities.16
- Studies link lower birth weight and decreased lung function in newborns to ozone levels in their community.17 This research provides increasing evidence that ozone may harm newborns.
Breathing other pollutants in the air may make your lungs more responsive to ozone—and breathing ozone may increase your body's response to other pollutants. For example, research warns that breathing sulfur dioxide and nitrogen oxide—two pollutants common in the eastern U.S.—can make the lungs react more strongly than just breathing ozone alone. Breathing ozone may also increase the response to allergens in people with allergies. A large study published in 2009 found that children were more likely to suffer from hay fever and respiratory allergies when ozone and PM2.5 levels were high.18
Research shows lower levels of ozone cause harm. EPA released their latest complete review of the current research on ozone pollution in February 2013.19 EPA had engaged a panel of expert scientists, the Clean Air Scientific Advisory Committee, to help them assess the evidence that was brought together by EPA; in particular, they examined research published between 2006 and 2012. The experts on the committee and EPA concluded that ozone pollution posed multiple, serious threats to health. Their findings are highlighted in the box below. Based on that review, EPA strengthened the official limit on ozone, called the National Ambient Air Quality Standard, in 2015.
However, new research provides evidence that ozone can cause serious harm even at much lower levels. In a 2017 scientific paper, researchers provided further evidence in a nationwide study that older adults faced a higher risk of premature death even when levels of ozone pollution remained well below the current national standard.20
EPA Concludes Ozone Pollution Poses Serious Health Threats (2013)
- Causes respiratory harm (e.g., worsened asthma, worsened COPD, inflammation)
- Likely to cause early death (both short-term and long-term exposure)
- Likely to cause cardiovascular harm (e.g., heart attacks, strokes, heart disease, congestive heart failure)
- May cause harm to the central nervous system
- May cause reproductive and developmental harm
—U.S. Environmental Protection Agency, Integrated Science Assessment for Ozone and Related Photochemical Oxidants, 2013. EPA/600/R-10/076F.
U.S. EPA. 2017. Nonattainment Areas for Criteria Pollutants (Green Book). Accessed at https://www.epa.gov/green-book. Data updated as of January 31, 2018.
U.S. Environmental Protection Agency. Integrated Science Assessment of Ozone and Related Photochemical Oxidants (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-10/076F, 2013.
U.S. EPA, 2013, Section 184.108.40.206.;
U.S. EPA, 2013, Section 220.127.116.11.Medina-Ramón M, Schwartz J. Who is more vulnerable to die from ozone air pollution? Epidemiology. 2008; 19: 672-679.
U.S. EPA, 2013. Section 8.2.2 and 8.2.3.
U.S. EPA, 2013. Section 8.4.4.
U.S. EPA. 2013, Section 8.3.2, 8.3.3,and 8.4.2.
Thaller, et al., 2008.
U.S. EPA, 2013, Section 6.2.
Di Q, Wang Y, Zanobetti A, et al. Air Pollution and Mortality in the Medicare Population. N Engl J Med. 2017; 376:2513-2522.
Mar TF, Koenig JQ. Relationship between visits to emergency departments for asthma and ozone exposure in greater Seattle, Washington. Ann Allergy Asthma Immunol. 2009; 103: 474-479 Strickland MJ, Darrow LA, et al. Short-term associations between ambient air pollutants and pediatric asthma emergency department visits. A J Respir Critical Care Med, 2010, 182:307-316.
Desqueyroux H, Pujet JC, Prosper M, Squinazi F, Momas I. Short-Term Effects of Low-Level Air Pollution on Respiratory Health of Adults Suffering from Moderate to Severe Asthma. Environ Res. 2002; 89:29-37.
Lin S, Liu X, Le LH, Hwang SA. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008; 116: 1725-1730.Medina-Ramón, et al., 2006
Jerrett M, Burnett RT, et al. Long-term ozone exposure and mortality. N Engl J Med. 2009: 1085-1095.
Lin S, Liu X, Le LH, and Hwang S-A. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008; 116:1725-1730.
Islam T, McConnell R, Gauderman WJ, Avol E, Peters JM, and Gilliland F. Ozone, oxidant defense genes, and risk of asthma during adolescence. Am J Respir Crit Care Med. 2009; 177(4):388-395.
Salam MT, Millstein J, Li YF, Lurmann FW, Margolis HG, Gilliland FD. Birth outcomes and prenatal exposure to ozone, carbon monoxide, and particulate matter: Results from the Children's Health Study. Environ Health Perspect. 2005; 113: 1638-1644; Morello-Frosch R, Jesdale BM, Sadd JL, Pastor M. Ambient air pollution exposure and full-term birth weight in California. Environ Health. 2010; 9: 44.
Parker JD, Akinbami LJ, Woodruff TJ. Air Pollution and Childhood Respiratory Allergies in the United States. Environ Health Perspect. 2009; 117:140-147.
U.S. EPA, 2013.
Di Q, Dai L, Wang Y, Zanobetti A, Choirat C, Schwartz JD, Dominici F. Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults. JAMA. 2017; 318: 2446-2456.
Page last updated: April 20, 2020