With strong evidence that schools close to highways are setting off asthma attacks in kids, this 2011

Does the air around your child’s school trigger asthma attacks? George Thurston, an environmental health science professor at New York University, wanted to know, so a few years ago he enlisted a bunch of 5th grade students in the South Bronx to help. The kids lived in a neighborhood where 13 percent of children suffer from asthma and where the hospitalization rate for asthma was dramatically higher than in other areas of the city.

In some of the schools, the children and their teachers could see diesel trucks and buses rumble by all day long, spewing out dark, sooty vapors on their way to massive garbage dumps. Was there a connection between all that pollution and the kids’ frequent breathing troubles?

To answer the question, Thurston found 40 children with asthma in four schools in the South Bronx. He gave each child a rolling backpack with air-monitoring equipment. Thurston’s team carefully tracked their symptoms, and later, a local TV crew spoke to participants.

“It feels like somebody’s not letting me breathe,” ponytailed Aldores Lopez said shyly on camera. “My mum gets nervous. I don’t like it when my mum gets nervous.”

The results were striking. All the children’s asthma symptoms – wheezing, coughing and shortness of breath – increased on high traffic days. What’s more, the kids’ breathing troubles were exacerbated by a key pollution ingredient – soot, the carbon particles that look like black smoke spewing out of diesel trucks and buses. They become part of the tiny particulates that get trapped deep in the lungs.

Thurston’s study bolsters a body of research which makes a powerful case that highway-related pollution is a key trigger of asthma attacks in kids. A 2007 review of the research put it this way: “The health studies show elevated risk for development of asthma and reduced lung function in children who live near major highways.” That’s a serious warning when you consider that, according to the same research review, 11 percent of U.S. households are located within 325 feet of a four-lane freeway.

A 2011 study in the shantytowns near Lima, Peru, drives home the point: Teenagers who lived within 800 feet of a congested roadway were twice as likely to wheeze or to use medications for asthma as those who lived four blocks away. Pulmonologist William Checkley, the senior researcher from Johns Hopkins University, sums it up: “The closer to the road, the more disease.”

Many of the studies of the effects of vehicle exhaust have focused on where children live. But a new wave of research, like the South Bronx study, is targeting the air near and at school, where kids spend one-third of their waking hours.

At the University of Southern California, researchers looked at the highway effect both at school and at home by following nearly 2,500 kindergarten and Grade 1 students, none of whom had asthma at the outset. After three years, 120 of the children had developed the lung disease. “Children exposed to higher levels of traffic-related air pollution at school and at home are at increased risk of developing asthma,” the researchers concluded.

Yet it’s still not clear whether exposure to high volumes of traffic-related pollution causes asthma, says Jim Gauderman, an associate professor of preventive medicine at USC and the study’s lead author. It may instead trigger the symptoms of a disease that’s already there. Or, if it does cause the disease, it may be doing so at an earlier age, says Michael Brauer, a professor at the University of British Columbia’s school of environmental health. His research for Canada’s AllerGen research network suggests that children born to mothers who lived beside busy highways during pregnancy are more likely to develop asthma by age 4.

What’s not in dispute among the researchers is this: kids who live or learn near a highway are more likely to cough and wheeze. When you consider that asthma is the most common chronic disease in childhood, this is a major public health issue. Over seven million children in the United States live with asthma. Across North America, it’s the No. 1 cause of missed school days. Now consider this: one-third of U.S. schools sit within 1,300 feet of a major highway, in what the media has dubbed the “air pollution danger zone.”

Little Amarria was the wakeup call. We have the tool, the auto-injector, to stop the senseless allergy deaths like hers. Now we have to use it.

On the first day of school after Christmas of 2011, 7-year-old Amarria Johnson and her Grade 1 classmates in Richmond, Virginia bounced outside of Hopkins Road Elementary after lunch to play. You could usually hear Amarria before you saw her: she loved to sing, in church, for the video camera, in the car, at school. She would sing for anyone, and she had big plans to be a star on the Disney Channel.

For this first day back to school, Amarria’s mother had carefully rolled her daughter’s long hair in a bun. The girl was excited to be going back. “She loved everything,” her mother Laura Pendleton told Allergic Living. “The world was an awesome, innocent place.”

Then a child in the playground gave her a peanut. Amarria had always avoided the peanut butter and jam sandwiches that the school offered for lunch every day because she had an allergy to peanuts. But this time, for reasons no one knows, she popped the peanut into her mouth.

Amarria knew right away she was in trouble. She asked the teacher outside to help. That was exactly what she was supposed to do. But then the system failed her.

The teacher walked Amarria to the school’s health clinic, where an aide searched for an epinephrine auto-injector with Amarria’s name on it. An auto-injector shoots epinephrine, also known as adrenaline, into the body. The drug can stop a severe allergic reaction outright or buy enough time for paramedics to arrive. Amarria desperately needed that shot of life; in the minutes after she arrived at the clinic, she was struggling to breathe. But the clinic did not have an auto-injector prescribed for Amarria.

A Child Runs Out of Breath

Over the next few minutes, the girl ran out of breath, right there in the clinic. Just before 2:30 p.m., the school called 911, but by the time firefighters and police arrived, Amarria’s heart was failing. The rescuers tried CPR; they tried to restart her heart with a defibrillator. They rushed her to Chippenham Hospital, but it was too late. Amarria was pronounced dead shortly after she arrived. The cause of death: anaphylaxis and cardiac arrest.

It is such a senseless, heartbreaking loss of a little girl so full of life. But beyond the tragedy, this disturbing issue has emerged: there were likely auto-injectors prescribed to other students in the Hopkins Road Elementary clinic. (Allergic Living has learned this was likely the case, though the school board declines to comment on specifics.) If an auto-injector was there, however, the aide was not allowed to use it. Why?

“Many of our students [in Chesterfied County] have EpiPens at school,” acknowledged Shawn Smith, the board’s spokesman. “It’s illegal to give a prescription drug to someone else,” he said.

The staff at the county’s public schools are instructed that they are only allowed to use an epinephrine auto-injector if it is specifically prescribed by a doctor for the child in question and if the school has the child’s written action plan for allergy emergencies. “Absent those two,” Smith said, “we’re unable to carry out the doctor’s [verbal] orders.”

Next page: Why we can stop the tragedies – now

Autos

Let’s start with your vehicle. If you’re driving an SUV, it burns one-half to two-thirds more fuel than a regular car. As for cars, newer models can vary con­siderably on environmental and energy efficiency, so compare both fuel effi­ciency and emission controls before buying or leasing.

Technology can only help so much, though. We need to reduce the number of vehicles and the time they spend on the road. One way is to hike the price of gas. As the David Suzuki Foundation points out, in Europe, fuel costs two to three times more than it does here, and European consumption is one-third less.

This is also an urban planning issue, since the growth of suburbs has extend­ed commuting times. So we need to halt sprawl and encourage people to live downtown or close to where they work. This means greater density, with more condo high-rises along subway and bus routes. To get people out of cars, you also need better public transit, as well as more bike lanes. Businesses need to be encouraged to provide secure bicycle racks, plus showering areas.

But in the shorter term, what can you do this summer?

- Carpool, use public transportation, walk or bike (if it’s not a smoggy day). One car commuter uses as much energy as a transit rider uses in 10 years. Viewed another way, if you take public transit instead of a vehicle for a year, you can save nearly a tonne of pollutants, including carbon dioxide.

- Avoid idling. Ontario stats show 3 per cent of fuel is wasted by idling.

- Tune up your car. If we all did it on a regular basis, we could reduce Nitrogen oxides by 12 per cent and volatile organic compounds (VOCs), a key part of smog, by 30 per cent.

- Keep tires properly inflated. Each 5 per cent of under inflation in a tire translates into a 1 per cent increase in fuel consumption.

- Fill your gas tank in the evening, as this a major source of VOCs. If they combine with other gases in the sun, they create smog.

- Consider fuel efficiency when you buy a car. See www.fueleconomy.gov to check gas consumption and emissions.

- Buy a hybrid. Enjoy the sound of silence as you push the button that starts the electric-powered motor. You might qualify for Ottawa’s new rebate for hybrids – up to $2,000. They’re expensive, but what’s the price for breathable air?

- Retire the energy-guzzling clunker. A program called Car Heaven offers a free car tow and eco-friendly recycling.

Next Page: At Home

But the tenth name on the list may surprise: sulphites. These are the chemical additives used to stop food from browning or spoiling. In 1 per cent of the population, mostly those with asthma, even tiny amounts of sulphites can cause reactions. An estimated 4 per cent of asthmatics are sensitive to them.

In Canada, there have been reports of more than 100 sulphite-related reactions, ranging from nausea and abdominal pain to anaphylactic attacks. At least one Canadian has died.

Although sulphites are known to trigger symptoms in susceptible individuals that appear to be allergic reactions, including anaphylaxis, scientists still don’t know how they do this. Unlike the other food groups on the list, sulphites are chemicals, not proteins.

Researchers don’t yet know whether sulphites cause the immune systems of some people to respond abnormally or whether they set off some other mechanism that causes allergic-like reactions. The researchers also haven’t figured out why sulphites pose a threat to some people and not to others.

One theory is that people sensitive to sulphites have a genetic abnormality that hinders the body’s breakdown of these chemicals. However, Dr. Susan Tarlo, a respiratory physician at Toronto’s University Health Network and a specialist in lung disease and allergic response, says her extensive research does not confirm that theory. Another theory links sulphite sensitivity to a lack of B12 vitamins, but that research is still riot conclusive.

If you develop hives or have trouble breathing after a restaurant dinner and a glass of wine and suspect you may have this sensitivity, the first step is to see an allergist and confirm what is causing your reaction.

The only way to be sure that it is a sulphite sensitivity is to undergo an oral challenge in a hospital setting. In such a test, doctors will give you a glass of juice with sulphites to see whether you respond. (For sulphites, Tarlo says a skin test is riot reliable enough.)

The food inspection agency has added sulphites to its top 10 allergens list because they cause allergic-like reactions in such a significant number of people. (One per cent of the Canadian population equates to about 320,000 individuals.) But there is no scientific evidence that the prevalence of sulphite sensitivity has actually increased over the past years.

Consider the Canadian Food Inspection Agency’s list of the top 10 food groups that cause the most frequent and severe allergic reactions. Nine of the names will be familiar to most Canadians: peanuts, tree nuts, milk, eggs, fish and shellfish, soy, wheat and sesame seeds.

But the tenth name on the list may surprise: sulphites. These are the chemical additives used to stop food from browning or spoiling. In 1 per cent of the population, mostly those with asthma, even tiny amounts of sulphites can cause reactions. An estimated 4 per cent of asthmatics are sensitive to them. In Canada , there have been reports of more than 100 sulphite-related reactions, ranging from nausea and abdominal pain to anaphylactic attacks. At least one Canadian has died.

Although sulphites are known to trigger symptoms in susceptible individuals that appear to be allergic reactions, including anaphylaxis, scientists still don’t know how they do this. Unlike the other food groups on the list, sulphites are chemicals, not proteins. Researchers don’t yet know whether sulphites cause the immune systems of some people to respond abnormally or whether they set off some other mechanism that causes allergic-like reactions. The researchers also haven’t figured out why sulphites pose a threat to some people and not to others.

One theory is that people sensitive to sulphites have a genetic abnormality that hinders the body’s breakdown of these chemicals. However, Dr. Susan Tarlo, a respiratory physician at Toronto’s University Health Network and a specialist in lung disease and allergic response, says her extensive research does not confirm that theory. Another theory links sulphite sensitivity to a lack of B12 vitamins, but that research is still not conclusive.

If you develop hives or have trouble breathing after a restaurant dinner and a glass of wine and suspect you may have this sensitivity, the first step is to see an allergist and confirm what is causing your reaction. The only way to be sure that it is a sulphite sensitivity is to undergo an oral challenge in a hospital setting. In such a test, doctors will give you a glass of juice with sulphites to see whether you respond. (For sulphites, Tarlo says a skin test is not reliable enough.)

The food inspection agency has added sulphites to its top 10 allergens list because they cause allergic-like reactions in such a significant number of people. (One per cent of the Canadian population equates to about 320,000 individuals.) But there is no scientific evidence that the prevalence of sulphite sensitivity has actually increased over the past years. According to Tarlo, the incidence may simply be the result of better diagnosis and awareness. In fact, in the United States, studies show that the number of sulphite reactions has actually declined with improved food labelling and a ban on spraying sulphites on raw fruits and vegetables.

Sulphite sensitivity is sometimes discovered in children but is most often identified in adults, perhaps because it is as adults that we begin to drink wine and beer. As most wines ferment, sulphites occur naturally, and winemakers usually add more of the chemicals to prevent spoiling. Some organic wineries carefully avoid these additional sulphites, and in the United States, several organic wines have been deemed to fall within safe guidelines of under 10 parts per million of the chemicals. (There are a few organic wineries in British Columbia as well.)

But not everyone with the sensitivity has summoned the nerve to try these new vintages. The reactions that Glynnis Brassil gets to sulphites might be clincially described as “mild” when compared to life-threatening food allergies. But don’t tell her that: if she drinks regular wine or eats a food containing sulphites, Brassil develops a migraine so painful that “my hair hurts.” She does not drink wine at all any more and, to avoid headaches that can last a number of days, the Vancouver computer consultant strives to “eat fresh, fresh food, not preserved, prepared or processed.”

Canadian regulations prohibit sulphites from being added or sprayed on fruit and vegetables that are intended to be consumed raw, with a key exception – grapes. But sulphites can be legally added to a wide range of packaged foods, including dried fruit and vegetables, which can have very high levels of sulphites, as well as baked goods, canned vegetables, soup mixes, jams, pickled foods, potato chips, trail mix, molasses, shrimp, guacamole, and maraschino cherries.

In the United States, packaged food with more than 10 parts per million of sulphites must disclose the presence of sulphites on the label. In Canada the rules are a little different: If sulphites are added to food that is sold in packages, the label must say so. If you don’t see sulphites on the label, however, that’s no guarantee because there are many exceptions to the rule. For example, the labelling rule does not apply to the ingredients used in a food, such as glucose, which may include sulphites. It does not apply to food prepared locally and sold in vending machines, or to food cooked and sold in a grocery store.

Sulphites that occur naturally don’t have to be listed. In Canada, wine labels do not have to disclose the presence of sulphites (real or added), although proposed federal rules may change that in the coming years.

Consumers can also be fooled by the names on a food label. The word “sulphites” is not always used. Sometimes the chemical compound is listed instead. Here are the names to watch out for: potassium bisulphite, potassium metabisulphite, sodium bisulphite, sodium metabisulphite, sodium sulphite, sodium dithionite, and sulphurous acid. All are sulphites.

There is another mysterious aspect to sulphite sensitivity: It is highly individualistic. Some people can drink a glass of wine. Others will react after a spoonful of sauce that contains a dash of red wine. This means that each person with a sulphite sensitivity will have to tailor his or her plan of action for dealing with food. If you are sensitive to sulphites, you’ll want to get advice from your allergist and perhaps a dietitian about foods that are safe to eat. There are many exceptions to the labelling rules and you need to be aware of foods that may contain this allergen.

Despite shortcomings though, current labels have proved “a huge help,” notes Brassil. “I have to go shopping with my glasses on; I have to read every ingredient on everything.” One of her personal strategies – avoid imported foods where possible, because the ingredients of the listed ingredients are not at all clear.

Staying Safe

1. If you’re sensitive to sulphites, avoid dried fruit and vegetables.
2. Most wines produce natural sulphites in the fermentation process, and sulphites are also added as a preservative. But some organic wineries are creating wines with no added sulphites. Some, such as LaRocca Vineyards in California, say their wines also have no natural sulphites or only traces of it. LaRocca’s red wine contains no sulphites, while its white contains only 1 part per million of the chemical.
3. Check wine labels. Under U.S. rules, wine with less than 10 parts per million of sulphites is considered safe for most who are sensitive, and winemakers are required to list the sulphite content when it is greater than that. If the the wine contains only 8 ppm, the winemaker is allowed to label it: “sulphite-free”. Canada does not require winemakers to disclose the level of sulphites on labels, but the government has proposed legislative changes that would require this. In the meantime, if it’s a North American wine, check with the winery or distributor regarding questions on sulphite content. And don’t leave “sulphite-free” bottles of wine on the shelf for long; they may spoil.
4. Always read package labels, but be cautious. Even if you don’t see sulphites on the label, they may still be hidden in the food, in one of the ingredients like glucose. Also, remember that some foods prepared in grocery stores or sold in vending machines don’t have to be labelled.

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These are prime dating years for 16-year-old Lisa Gordon, an outgoing Grade 11 student from a northern suburb of Toronto. But long before Lisa gets to the first kiss, she has to ask a few questions that are not likely to be written into any romantic plot: Did you eat any peanuts today? Or shellfish? Or coconuts? What about pecans or walnuts? “If we haven’t talked about it, there’s no kiss,” says Lisa. “I wouldn’t want him not to know, and then something terrible happens.”

No longer can those first few fumbled kisses just happen by chance or circumstance. It is a new world for Lisa and other teenagers with food allergies who are entering the dating arena, and that world can be dangerous. A kiss, even a careful peck on the cheek, can cause an allergic reaction or even a potentially fatal anaphylactic attack.

It was long believed that allergic reactions from kissing were exceedingly rare. But then, in 2002, Dr. Rosemary Hallett and her colleagues at the University of California at Davis discovered that kissing was far more hazardous for people allergic to nuts and seeds than doctors had thought.

Hallett and her fellow researchers sent out a general questionnaire to 379 individuals with allergies to nuts and seeds, or parents of children with those allergies. Twenty people who completed the survey, or 5.3 per cent, volunteered reports of reactions after kissing. When Hallett tracked down 17 of them, she found they all had symptoms of itching and swelling in the area kissed within a minute after the contact. Four of them had also started wheezing.

There was one child who nearly died. He was, Hallett wrote, “kissed on the cheek by his mother right after she tasted pea soup on the stove, and a large wheal immediately developed at the exact site of the kiss.” The child then flushed and started wheezing, and he was whisked to a hospital emergency department, where he was given a shot of epinephrine.

In the findings, published in The New England Journal of Medicine, the researchers noted that four people suffered reactions even though their partners had brushed their teeth. What’s more, Hallett suspected the percentage of people suffering post-kiss reactions might be far higher than 5 per cent, because the 20 people in the survey volunteered their information as opposed to being asked directly.

Her conclusion: “Since one-third of our subjects had reactions while dating, teenagers and young adults in particular need to be informed about this mode of exposure to allergens; patients of dating age who have severe food allergies may need extra encouragement to tell friends about it.”

For Lisa, this is easy. “I tell people whenever I make new friends,” says the extroverted teenager. “I just put it out there.” In Grade 9, for instance, Lisa met a boy from Barrie, Ontario, during a choir exchange. On the first day they were sitting with friends in the school cafeteria and Lisa was eating a rhubarb pie. “We were joking about it and it just came up. I said there aren’t many desserts that I can eat and I launched into my spiel.”

Then Lisa grew closer to Michael. One day he asked Lisa a question: If you smell nuts, would you have a reaction? Lisa leapt at the opportunity: “The allergen has to get into my body, either through food or by kissing someone.” Not long after, Michael asked Lisa out. She asked if he remembered what she had said about her allergies. “No kissing if I’ve eaten bad stuff, so I won’t,” he replied.

They kissed that night, and again over the next couple of months. Michael wouldn’t eat nuts either the day he was to see Lisa or the day before. He didn’t take any chances. “He’d brush his teeth five times a day, and five times the day before,” she says. The relationship ended after a couple of months, but Lisa feels optimistic about her dating life: “I can talk to anybody,” she says. “If I don’t feel comfortable, I won’t do anything, and I have the will power to pull it off.”

For the parent, dealing with an allergic teenager entering the dating world can be nerve-racking. Most deaths caused by reactions to food happen to people between 10 and 19 – a coming of age period when kids fear an allergy will prevent them from fitting in, according to a survey conducted by the Food Allergy & Anaphylaxis Network. Communication is key: “You have to know your teen,” says Beth Goldstein, a social worker whose 17-year-old son is allergic to peanuts.

Beth’s son, Ben, is so exquisitely sensitive to peanuts that she believes he once had a reaction from bits of peanut shell stuck to his shoes after a Toronto Blue Jays baseball game. A couple of days after the game, Ben put on his shoes just before popping an allergy pill. He promptly threw up, his usual reaction to small amounts of the allergen. Beth thinks his fingers touched the soles of his shoes and then the pill he put in his mouth. “I’m pretty sure thats what caused it,” she says.

When Ben was 13, Beth sat him down before dispatching him to summer camp. “You may have a girlfriend,” Beth told her son, “and you’re probably going to want to kiss her.” Then Beth told a story about the babysitter with a severe peanut allergy who kissed a girl at a high school dance and had to rush to the emergency room. It turned out the girl had eaten an Oh Henry candy bar. The moral of the story, Beth told her son, was this: “You’re going to have to feel comfortable enough to ask her whether she’s eaten peanut butter in the last few hours.” He replied: “Oh Mom, I know.”

Today, Ben puts it this way, “Whoever I am dating needs to have a very good understanding of my allergy.” He always asks before kissing, noting: “You have to pull one of the smooth moves.” His technique? Ask her if you can share her Coke and then, before sipping, pop the question: Have you had peanuts today? Or pull out the EpiPen. Ben’s not embarrassed about it any more. “It’s a shy issue but you have got to overcome it. If she isn’t willing to understand, or if you don’t feel comfortable, maybe it’s not worth it.”

Even after you get past those teenage kisses without any side effects that could arrest the romantic moment, dating with allergies continues to be a challenge, says Amy Cameron, the 33-year-old author of a new book on dating, Playing with Matches. Amy’s boyfriend, John, is allergic to milk, eggs and cats. The milk and eggs have never posed a real problem; John does the cooking.

But the dander allergy did cause a hitch. Amy has three cats that she picked up as strays, so John could not stay the night. “It was crazy,” says Amy. “We dated for 2 1/2 years, and he never stayed over.” Amy is allergic to cats as well, but she just puts up with sniffles. Then John moved in. “We were worried,” Amy says. But his tolerance, it turned out, had improved, while “my allergies are getting worse.”

While they were dating, Amy discovered she was allergic to tree nuts when her throat seized up after eating a second helping of a friend’s pecan pie. She saw an allergist, tested postively to nuts and now carries an auto-injector. Ever since that episode, John has helped by reminding her to check the ingredients in her food.

They’re careful about kissing, too. “If John has eaten nuts, he brushes his teeth and drinks lots of water.” In Amy’s case, that works just fine. John, by the way, doesn’t need any encouragement to brush. “Are you kidding?” says Amy. “Guys will give up pretty much anything if they can kiss someone.”

First published in Allergic Living magazine, Spring 2005
(c) Copyright AGW Publishing Inc.

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Related Reading

• Article on Adult Dating with Allergies, Celiac
  
• Food allergy Dating Tips

In June of 2005, the smog hanging over downtown Toronto was so thick you couldn’t see the CN Tower from the mid-town restaurant where Sara La Rocque was waiting tables at an outdoor patio. That was when Sara, a 21-year-old creative writing student, quit her job to go home and strip wallpaper.

One day later, she couldn’t breathe properly. Although she had experienced asthma briefly as a child, this was different. It was like breathing through a straw. For most of the rest of the summer, as Ontario lumbered through a record summer of smog advisories, Sara stayed indoors. She was miserable.

It wasn’t until six weeks later that she could even walk around the block with the family’s golden retriever (she is not allergic to dog dander) or the Burmese mountain dog.

Sara’s pretty sure what triggered her condition, and it wasn’t the wallpaper: “My asthma is smog-induced,” she says. “I think that’s what caused it.” A few years ago, most scientists would have doubted her analysis. The common wisdom was that air pollution could only exacerbate symptoms in people already living with asthma.

But now, a handful of mavericks in the scientific world are building a case to prove Sara’s point – that pollution might not just worsen asthma, but cause it. Not that these asthma researchers can yet say how this might happen. That’s still under study.

When it comes to asthma, theories abound as to why it develops, starting with the hygiene hypothesis. This suggests that our urban society is too germ- and virus-free, causing the underworked immune systems of those who inherit the allergic tendency to react to proteins – such as inhaled pollen or dust mites – that should be harmless. The immune system’s over-reaction results in airway inflammation and allergic asthma attacks.

There are also new indications that antibiotics in early life and obesity may be contributing factors. But some scientists keep coming back to the relationship between asthma and air pollution, particularly to that dense layer of smog that blights our cities all too often in the summer.

Somewhere in that haze of pollution, they believe, lies an answer to the mystery of why asthma gets switched on with such frequency in the urban world.

Over the past decade, scientists have found compelling evidence that air pollution irritates the lungs and triggers attacks in those who already have asthma. Some research indicates it can also worsen asthmatic flare-ups to allergens such as pollen, dust mites or pet dander.

“Air pollution remains one of the most under-appreciated contributors to asthma exacerbation,” wrote George Thurston, an associate professor of environmental medicine at New York University School of Medicine, in a 2005 article in the Journal of Allergy and Clinical Immunology.

A classic instance: When a strike closed a steel mill in the Utah Valley for the winter during the mid-1980s, researchers found that admissions of children to hospital for asthma and pneumonia were cut in half – and they climbed right back up the following winter after the steel mill had reopened. That’s a vivid example of pollution’s effect on asthma, and there are plenty more.

Next Page: Proof from California

Even Canadian Prime Minister Stephen Harper, our most prominent person with asthma, has switched gears to appeal to the green vote. But what about a green revolution on the ground level? What will it take to make our cities tolerable for those with asthma who are advised to stay indoors every time there’s a smog warning?

You might wonder. Despite all the clamour about climate change, we still shrug off the monumental human toll that dirty air is exacting on our communities right now. Health Canada estimates that air pollution, mainly from burning fossil fuels to power industry, homes and cars, kills about 5,900 Canadians a year in eight cities: Quebec City, Montreal, Ottawa, Toronto, Hamilton, Windsor, Calgary and Vancouver.

That’s nine times the annual number of homicides. And for the three million Canadians with asthma, which includes 12 per cent of all Canadian children, the dirty air is particularly dangerous. In Ontario alone, asthmatics last year made more than 73,000 visits to the emergency room, according to hospital statistics.

Think of what that means: on 73,000 occasions, an adult or a child was wheezing or coughing or gasping so badly that he or she had to rush to emergency just to breathe. Although there are many asthma triggers, smog is a significant one; it’s associated with a quarter of respiratory admissions to Toronto hospitals – and half of the admissions on peak air pollution days.

And yet, we tolerate the situation. In the Windsor-Quebec corridor, which has Canada’s worst smog problem, a summer smog advisory has become commonplace. In 2005, a record year, there were 53 smog advisory days in Ontario, 24 in Quebec and three in Atlantic Canada (where most of the pollution blows in from the United States.) Last year was a little better: Ontario and Quebec each had 17 smog advisory days.

But that’s little consolation when many asthmatics have trouble breathing outdoors even on days that are considered to be “safe”. They have every right to demand change. Smog, for the person with asthma, means denial of the most basic right: to step outside, breathe a lungful of air and not choke.

The battle against smog and its components – ground-level ozone, nitrogen oxides, sulphur dioxide, volatile organic compounds (VOCs), carbon monoxide and fine particulate matter – has a lot in common with the worldwide campaign to save the upper ozone layer by cutting greenhouse gases, mainly carbon dioxide.

The man-made emissions that cause both are produced from burning fossil fuels, which power industry, heat and light homes, and run cars and trucks. Burn less fossil fuel, and you can reduce greenhouse gases and smog at the same time.

The biggest single human source of the smog is transportation. According to a 2005 air quality report from the Ontario government, vehicles create 17 per cent of VOCs and 29 per cent of nitrogen oxides. These combine in the sun and heat to create the ground-level ozone part of smog.

Vehicles also cause 56 per cent of carbon monoxide, while all forms of transportation, including cars, trucks, boats and trains, are responsible for 18 per cent of fine particulates or soot, another key part of the dirty haze. Ontario, the province with the worst smog problem, is taking action on the road.

It has cracked down on clunkers, and issues rebates to those who buy hybrids. The Harper government (which announced its own hybrid rebates), meanwhile, promises stricter fuel efficiency standards by 2010, but hasn’t specified a standard.

Industry, especially coal-fired power plants, also plays a big role in creating smog, and is a big target for regulators. Ontario has ordered smelters and cement plants to reduce their emissions of nitrogen oxides and sulphur dioxides to a new standard by 2015. Each of seven industrial sectors affected will have its own limit, so if new plants are built, they will only be permitted a small percentage increase in emissions. If industry also curtails energy use, it will help both the smog and the climate change issues.

But in the end, the biggest target is the hardest to hit. That’s the way we live our lives. We are the ones driving the gas-guzzling SUVs from monster homes in the suburbs to work and soccer practice. We supply the coal-fired power plants with their raison d’être by thoroughly chilling our houses in summer. Consider that Ontarians, per capita, consume 55 per cent more electricity than people living in the state of New York.

Next Page: The Green Prescription