There is substantial scientific evidence linking many respiratory conditions to chronic and acute exposures to air pollution. Recent publications found an association between ambient air pollution and acute respiratory distress syndrome (ARDS) and the risk of mortality from COVID-19. To open this webinar, Dr. John Balmes discussed how air pollution affects health throughout the life course from in utero exposures through childhood into older adulthood. He provided an overview of the public health impacts of three of the most important pollutants – ozone, nitrogen dioxide (NO2), and fine particulate matter (PM2.5). He presented findings from the first studies that showed an association between exposure to ozone or PM2.5 and ARDS. ARDS is a type of acute lung injury that causes some people with COVID-19 to develop severe hypoxemia (low oxygen tension in the blood), require intensive care, and be placed on mechanical ventilation. Dr. Balmes also reviewed the emerging literature on the association between exposure to air pollution and COVID-19.

Chronic exposures to particulate matter and ozone pollution can affect respiratory function. ARDS is precipitated by conditions such as infection or toxic inhalation and has a high mortality. It is most common among older adults, with the average age of developing ARDS around 62 years and a mortality rate ranging from 69% to 80% among older adult patients compared to 40% to 60% in the general population. However, few epidemiology studies have investigated an association between air pollution and the risk of ARDS. During this webinar, Dr. Jongeun Rhee presented her study examining data from nearly 30 million Medicare beneficiaries (≥ age 65) per year discharged from American hospitals from 2000 through 2012. Dr. Rhee and colleagues found that long-term exposures to PM2.5 and ozone were associated with increased risk of ARDS among older adults in the United States, including exposures below current annual US National Ambient Air Quality Standards. Dr. Rhee closed her talk with a discussion of the current evidence linking air pollution and ARDS.

To conclude, Dr. Xiao Wu presented his recent study, leveraging 16 years of data—68.5 million Medicare enrollees, in which he and co-authors provided strong evidence of the causal link between long-term air pollution exposure and mortality under a set of causal inference assumptions. Assessing whether long-term exposure to air pollution increases the severity of COVID-19 health outcomes, including death, is an important public health objective. However, limitations in COVID-19 data availability and quality remain obstacles to conducting conclusive studies on this topic. At present, publicly available COVID-19 outcomes data for representative populations are available only as area-level counts. During this webinar, Dr. Wu discussed these challenges in the context of one of the first preliminary investigations of the relationship between air pollution and COVID-19 related mortality in the US. Investigators found that higher historical PM2.5 exposures are positively associated with higher county-level COVID-19 mortality rates after accounting for many area-level confounders. Motivated by this study, they lay the groundwork for future research on this important topic, describe the complex challenges, and outline promising directions and opportunities. Research on how modifiable factors may exacerbate COVID-19 symptoms and increase mortality risk is essential to guide policies and behaviors to minimize fatality related to the pandemic. Such research could provide a strong scientific argument for revision of the US national PM2.5 standards and other environmental policies in the midst of a pandemic.

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