“Poor air quality affects everyone” — How to protect yourself and clean the air

I remember when you could ride BART for free on a “Spare the Air” day, when smog was expected to reach unhealthy levels based on standards set by the Environmental Protection Agency. Now, there are too many of these days — 26 in the Bay Area last year — to enjoy that perk.

This bad air is making us sick, according to Stanford allergy specialist and clinical associate professor Sharon Chinthrajah, MD. In a recent episode of the Sirius radio show “The Future of Everything,” she spoke with Stanford professor and radio host Russ Altman, MD, PhD, about how we can combat the negative health impacts of air pollution.

“Poor air quality affects everybody: healthy people and people with chronic heart and lung conditions,” said Chinthrajah. “And you know, in my lung clinic I see people coming in with exacerbations of their underlying lung diseases like asthma or COPD.”

On Spare the Air days, Chinthrajah said even healthy people can suffer from eye, nose, throat and skin irritations caused by air pollution. And the health impacts can be far more serious for her patients. So she tells them to prepare for bad air quality days and to monitor the air quality index (AQI) in their area, she said.

The AQI measures the levels of ozone and other tiny pollutants in the air. The air is considered unhealthy when the AQI is above 100 for sensitive groups — like people with chronic illnesses, older adults and children. It’s unhealthy for everyone when the AQI is above 150.

On these unhealthy air days, Chinthrajah recommends taking precautions:

  • Limit the time you spend outdoors.
  • When outside, use a well-fitted air mask that filters out pollutants larger than 2.5 microns (which is about 20 times smaller than the thickness of an average human hair).
  • When driving, recirculate the air in your car and keep your windows closed.
  • Stay hydrated.
  • Once inside, change your clothes and take a quick shower before you go to bed, removing any air particulates that collected on you during the day.

In the radio show, Chinthrajah explained that published studies by the World Health organization and others demonstrate that people who live in developing countries like India and Asia — where they suffer poor air quality many days of the year — have a shortened life span.

“You know, there’s premature deaths. There’s exacerbation of underlying lung issues and cardiovascular issues. There’s more deaths from heart attacks and strokes in countries where there is poor air quality,” she said.

She admitted that it is difficult to definitively say these health problems are due to poor air quality — given the other problems in the developing country

es like limited access to clean water, food and health care — but she thinks poor air quality is a major contributor.

Chinthrajah said she believes we need to address the problem of air pollution at a societal level. And that means we need to target cars that burn fossil fuel, which account for much of the air pollution in California, she said. Instead, we need to move towards using public transportation and electric vehicles, as well as generating electricity from clean energy sources like solar, wind and water.

She noted that California is now offering a $9,5000 subsidy to qualifying low-income families to purchase low emission vehicles like all-electric cars or plug-in hybrids, on top of the standard federal and state rebates.

“So it seems like an overwhelming, daunting task, right? But I think we each have to take ownership of what we can do to reduce our carbon footprint. And then lobby within our local organizations to create practices that are sustainable,” she said.

Chinthrajah hopes that addressing air pollution and energy consumption at a societal level will lead to less asthma and other health problems, she said.

Image by U.S. Environmental Protection Agency 

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

X-rays shed light on how anti-asthmatic drugs work

A new study uncovers how a critical protein binds to drugs used to treat asthma and other inflammatory diseases.

By studying the crystal structure of an important protein when it was bound to two drugs widely prescribed to treat asthma, an international team of scientists has discovered unique binding and signaling mechanisms that could lead to the development of more effective treatments for asthma and other inflammatory diseases.

The protein, called cysteinyl leukotriene receptor type 1 (CysLT1R), controls the dilation and inflammation of bronchial tubes in the lungs. It is therefore one of the primary targets for anti-asthma drugs, including the two drugs studied: zafirlukast, which acts on inflammatory cells in the lungs, and pranlukast, which reduces bronchospasms due to allergic reactions.

Using the Linac Coherent Light Source (LCLS) X-ray free-electron laser at the Department of Energy’s SLAC National Accelerator Laboratory, the team bombarded tiny crystals of CysLT1R-zafirlukast with X-ray pulses and measured its structure. They also used X-rays from the European Synchrotron Radiation Facility in Grenoble, France to collect data about CysLT1R-pran crystals. They published their findings in October in Science Advances.

The researchers gained a new understanding of how CysLT1R interacts with these anti-asthma drugs, observing surprising structural features and a new activation mechanism. For example, the study revealed major differences between how the two drugs attached to the binding site of the protein. In comparison to pranlukast, the zafirlukast molecule jammed open the entrance gate of CysLT1R’s binding site into a much wider configuration. This improved understanding of the protein suggests a new rationale for designing more effective anti-asthma drugs.

The study was performed by a collaboration of researchers at SLAC; Moscow Institute of Physics and Technology, Russia; University de Sherbrooke, Canada; University of Southern California; Research Center Juelich, Germany; Universite Grenoble Alpes-CEA-CNRS, France; Czech Academy of Sciences, Czech Republic; and Arizona State University.

Citation: Aleksandra Luginina et al., Science Advances, 09 October 2019 (10.1126/sciadv.aax2518).

For questions or comments, contact the SLAC Office of Communications at communications@slac.stanford.edu.

Image caption: Using X-rays, researchers uncovered details about two drugs widely prescribed to treat asthma: pranlukast (shown up top) and zafirlukast (shown beneath). Their results revealed major differences between how the two drugs attached to the binding site of the receptor protein. In comparison to pranlukast, the zafirlukast molecule jammed open the entrance gate of protein’s binding site into a much wider configuration. (10.1126/sciadv.aax2518)

This is a reposting of my SLAC news story, courtesy of SLAC Linear Accelerator Laboratory.

Superheroes to the rescue: a creative approach to educating patients about asthma

Video by © 2015 Booster Shot Media

Asthma affects over 6 million children and leads to approximately 1.8 million visits to the emergency room annually in the United States, according to the Centers for Disease Control and Prevention.

In order to effectively manage asthma and help eliminate trips to the emergency room, physicians must identify the correct daily control and emergency rescue medications for their patients. However, educating young patients and their families is also critical.

“Patient education needs to be done at every visit,” Richard Moss, MD, professor of pediatrics, emeritus at Lucile Stanford Packard Children’s Hospital Stanford, recently told me. “This includes a review of the asthma symptoms, proper use of medications, written action plan, test results, and educational handouts. The key is continuity of care and reiteration of important information at every visit.”

Last month, NBC News featured the work of an Illinois physician who has taken a non-traditional approach to patient education. Alex Thomas, MD, a cartoonist and pediatric allergist at the Center for Asthma and Allergies, created a multimedia asthma education program called Iggy and the Inhalers, which includes comic books, YouTube videos, posters, trading cards and stickers. I recently spoke with Thomas about this program and Booster Shot Comics, a partnership between Thomas and a health-communication specialist.

What motivated you to create the Iggy and the Inhalers comic book?

I started drawing Iggy characters when I was 11 years old. I grew up with asthma myself, so I drew as a way to understand my medications – turning them into superhero characters. My Mom is an allergist and she had a patient support group for kids with asthma. So I started drawing little comic strips about Iggy in the support group newsletter.

An interest in asthma and asthma education ultimately led me to go to medical school and become a pediatric allergist. When I was working on the pediatric wards, I noticed that a lot of kids were being admitted and readmitted to the hospital for asthma exacerbation due to confusion about their medications. So I eventually revisited my Iggy characters to create educational materials for physicians and patients, with the help of health communication specialist Gary Ashwal.

Can you describe the characters in Iggy and the Inhalers?

Iggy the Inhaler is the main character that teaches kids about the physiology of asthma. He has two teammates. One is Broncho the Bronchodilator, a rescue inhaler for quick relief of symptoms. The other partner is Coltron the Controller, a control inhaler that kids with persistent asthma need to take on a daily basis. There are also asthma trigger villains: Smokey Joe, Moldar, Pollenoid, Dust Mite, Roach and Hairy.

We wanted to create dynamic characters that embodied the mechanism of the medications that they represent, so kids can intuitively understand how the medications actually work. When kids look at a rescue inhaler, they imagine Broncho loosening the muscle bands around the airway because he’s a cowboy with a lasso. Whereas when they look at a control inhaler, they imagine Coltron decreasing inflammation inside the airways using his fire extinguisher arm.

How have families responded to Iggy and the Inhalers?

It has been very effective.

There was one family that really stuck with me. A mother came with a 3-year old son for an initial visit with a bag full of medications prescribed by an emergency room physician and subsequently doctors in urgent care. They were frazzled and overwhelmed, and the child was still coughing. I had them watch the basic Iggy video, while the Mom flipped through the comic book. When we talked afterwards, she said she finally understood the basic differences between the medications. She was very relieved and they went home with the Iggy stickers, comic book and trading cards.

The next week, the family returned for a follow-up. The son specifically asked to watch the Iggy video. He was reciting the words, wanting to play it again and again like an Elmo video. He was responding to the characters and the live actions in the video on how to use an inhaler. Since then, he’s done great. Every time I see him, he asks for more Iggy stickers.

What other projects is Booster Shot Comics working on?

We have plans for future issues of the Iggy comics and animated videos that will cover more specific topics on asthma and allergies, such as how to eliminate allergy triggers from the home. We are also working with physicians at the Children’s Hospital of Wisconsin to turn discharge instructions for a concussion into a comic book, as well as a comic book to teach kids and their parents how to treat pain.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

%d bloggers like this: