Home CHEST Thought Leaders Clean Air

Clean Air

By: Douglas E. Masini, RRT, EdD, FCCP

…After heating the mercuric oxide powder, he (Joseph Priestly) took a few puffs of the air and declared “The feeling of it to my lungs was not sensibly different from that of common air; but I fancied that my breast felt peculiarly light and easy for some time afterwards.”1

Very early in life, you acquired the sense and feeling of a breath of fresh, clean air. When you travel to the beach and take that first deep breath of salty sea air, or travel to a cold climate with invigorating brisk, frigid air, you know that quality air is important to your sense of well-being.  When discussing clean air, how many people consider the composition of quality air, what is in the air that we breathe today, and the healthful (or hurtful) components of the air? In this piece, let’s consider what happens when air quality declines due to smoke or pollution and the quality of the air you breathe becomes THE problem.

Grainge and associates1 reflected on a time before physicians added intermittent oxygen to a patient’s inhaled environment as a medical therapy and a common “cure” for tuberculosis was lots of fresh air and sunshine, preferably at a sanitarium. Cascio’s team researched people who lived in communities impacted by smoke from wildfires and reported poor health outcomes frequently arise in communities with high exposure to air pollutants.

“The most common difficulty encountered in evaluating community risk to air pollutants is that many health factors associated with poor health outcomes occur in communities where exposure to air pollutants is high.”2

Billings’ team looked at the quality of air on multiethnic groups and found that  “individuals with higher annual nitrogen dioxide or NO2 and small particulates ( <2.5 or PM2.5 ) exposure levels had greater odds of sleep apnea.”3  Similarly, Rappold’s research found that “increases in emergency department (ED) visits for congestive heart failure (CHF), asthma, chronic obstructive pulmonary disease, pneumonia, and acute bronchitis”4 (in the affected population) seemed to worsen the health of economically disadvantaged people living in rural areas, especially if they lived in regions “with high prevalence of hypertension, diabetes, obesity, high blood pressure and other health conditions in comparison to the remainder of the state.”4  We need to be sure that we keep Priestly in mind as we see the precious air we breathe rapidly becoming an independent variable to be considered along with economics, health disparity, and disease.


  1. Grainge C Breath of life: the evolution of oxygen therapy. JRSocMed. 2004;97:489-493. https://journals.sagepub.com/doi/pdf/10.1177/0141076809701011. Accessed April 11, 2019.
  2. Billings ME, Gold D, Szpiro A, et al. The association of ambient air pollution with sleep apnea: The multi-ethnic study of atherosclerosis. Ann Am Thorac Soc. 2019;16(3):363-370.             
  3. Rappold AG, Cascio WE, Kilaru VJ, et al. Cardio-respiratory outcomes associated with exposure to wildfire smoke are modified by measures of community health. Environmental Health 2012 11:71. https://doi.org/10.1186/1476-069X-11-71. Accessed April 11, 2019.
  4. Cascio WE, Long TC.  Ambient air quality and cardiovascular health: translation of environmental research for public health and clinical care.  North Carolina Medical Journal. 2018;79(5):306-312. http://www.ncmedicaljournal.com/content/79/5/306.full.pdf+html. Accessed April 11, 2019.
Read our other Air Quality Awareness Week 2019 blog.

Doug MasiniDr. Douglas Masini is a member of the CHEST Respiratory Care NetWork with interests in pulmonary disease and respirology.