Kids with asthma head indoors during smog season

Eight-year-old Adrian Dukes loves to swim and go horseback riding, but enjoying summer outdoors is far from a given.

Adrian has asthma, and with the rising heat, an ominous threat prevents him from even leaving the house many days: smog season.

During the summer months, healthy Code Green air days sometimes give way to a rainbow of rising smog, or ozone, alerts: Codes Yellow, Orange, Red and, in the worst-case scenario, Purple.

On Code Orange days, when the air is considered unhealthy for those at risk, many people seek cover to avoid sucking in bad air. But for children and adults suffering from respiratory problems, smoggy days can pose serious health threats, triggering shortness of breath, wheezing, even life-threatening asthma attacks.

On such high ozone days, the Dukes family takes no chances. Adrian, who was diagnosed with asthma during a bad cold last winter and now uses a Flovent corticosteroid inhaler twice a day as a preventative measure, often hibernates in the family’s air-conditioned south Fulton home.

“We have a strict plan of action,” said his mom, Melanie Dukes. “He will be indoors all day during peak hours. He might go out on our deck for a few minutes early in the morning or at night when the sun is not as intense, but that’s it.”

Melanie and her husband check for daily air-quality updates on their BlackBerrys. They have enrolled Adrian in mostly indoor camps — gymnastics, Taekwondo and chess. And they’ve connected with Mothers & Others for Clean Air, a local advocacy group that sends regular updates on air quality and encourages carpooling, turning up the thermostat one degree during the summer months and other measures to reduce air pollution.

In Georgia, 8 percent of adults and 10 percent of children suffer from asthma, according to the Georgia Division of Public Health. One in five children with asthma visits an emergency room or an urgent care center at least once a year.

Atlanta is rated the 19th worst city in the nation for ozone, and the 16th worst for particle pollution, according to the American Lung Association’s “State of the Air 2010 Report.”

Ozone the issue

From May through September, polluted air masses hover in relentless heat and stagnant winds. During the hottest days of the year, emissions from tailpipes and factories cook in the sky. So far this summer, there have been six Code Orange days, putting us slightly behind last year’s pace, which ended with 16 Code Orange days.

When the ozone is predicted to exceed 75 parts per billion (ppb) and violate federal standards for air quality, an Orange smog alert goes into effect. (Parts per billion is a measure of concentration: 75 parts per billion of ozone means that for every billion units of volume of air, 75 of those units would be ozone).

Some people might not be able to distinguish a difference in the air. But for others, the air seems as heavy as a San Francisco fog, so thick you can almost taste it.

In recent years, the number of ozone days has declined. Metro Atlanta has not seen a Code Purple declared since 2002. Experts say cooler, wetter weather in the area may be the biggest factor in that, and say it remains to be seen whether the trend will continue. Mary Stoops of Decatur considers smog alert days a health threat to her whole family. No one in her family suffers from asthma. But on bad air days, she takes steps to limit her family’s exposure.

Last summer, Stoops was pleased when her daughter’s outdoor camps moved inside after lunch on bad air days. This year, her daughter is attending mostly indoor camps.

Stoops, who moved here from rural Nebraska about two years ago, said her attention to air quality is part of a larger commitment to having a green and healthy lifestyle.

She is happy to see more emphasis on healthy eating and supports new farm-to-school programs designed to get more locally produced fruits and vegetables in school cafeterias, but she believes there should be more emphasis on the issue of healthy air.

“There is a lot more awareness today about what we put in our bodies and I think that is great,” she said. “But what about healthy breathing?”

Limiting exposure key

Dr. Ann-Marie Brooks, a pediatric pulmonologist and medical director of the Children’s Asthma Center at Hughes Spalding Hospital, said a high ozone level is the most common cause of asthma attacks during the summer months.

Brooks said exposure to high ozone levels can trigger an asthma attack in some people. But, she added, damage to lungs is often the result of more continuous exposure to air pollution over time. Even healthy children can experience shortness of breath from playing outside during a Code Orange alert day, she said.

A new Emory University study looking at air quality and emergency room visits from 1993 to 2004 suggests even moderate increases in air pollution can cause problems for children with asthma.

The study, analyzing 91,386 emergency room visits in metro Atlanta among children between the ages of 5 and 17 with asthma, found that during the summer months, children with asthma were 8 percent more likely to go to the emergency room when the ozone levels rose even moderately.

“When you get into the maroons and reds [ozone alerts], we know it’s bad for children with asthma, but this suggests there are effects even on yellow days,” said Matthew Strickland, lead author of the study, and assistant professor in Emory University’s Department of Environmental Health. “But what should we do? Should we stay inside? There are obvious trade-offs and it’s challenging.”

Brooks said most parents are aware that it’s not a good idea to spend a lot of time outdoors on bad air quality days but don’t always do what’s necessary to limit their children’s exposure. Because the damage done to the body from air pollution often happens over time, Brooks said, many people lack a sense of urgency in dealing with the problem.

“People don’t like to make sacrifices. They want to do what’s convenient,” Brooks said. “But sometimes you need to make some sacrifice and it may mean doing something that’s not convenient. And you know what? Going to the hospital is not convenient.”

Seeking alternatives

Two years ago, Mothers & Others for Clean Air sent recommendations to schools and day care centers across metro Atlanta with guidelines for limiting outdoor activities during smog alert days. The group urges children to stay indoors between the hours of 2 and 7 p.m., when ozone concentrations are typically highest.

Rebecca Watts Hull, executive director of Mothers & Others, suggests day cares and camps get into a habit of routinely scheduling outdoor activities for the early morning hours.

She said the group doesn’t want to discourage exercise. It recommends activities like yoga as a way for kids to work up a sweat even if they can’t go outdoors or don’t have a large space to run around.

She estimates about half of schools and day care centers in metro Atlanta are following the suggested guidelines, according to early results of a survey her group has done. She said she understands it’s not always easy to stay indoors.

“One of the biggest reasons they don’t follow it is because they say our only alternative is a non-air-conditioned gym,” she said.

She said the goal is to make sure children have alternatives, such as a cool space to play indoors. She is working with the Georgia High School Association, for instance, to make it a requirement for all children — including athletes —to avoid outdoor exercise on smog alert days. That can be a tough sell to football coaches reluctant to skip outdoor practice when a big game is on the line.

‘Better stay indoors’

At the Dukes home, they have Wii fitness games ready to roll on smog alert days. Adrian loves the basketball and bowling. He and his parents might spend a few minutes on their deck to check on their potted tomatoes, but otherwise the day is spent inside.

Recently, on a high ozone day, Adrian opened the door, took one breath and turned around.

“The air is so heavy, Mom,” he said. “Better stay indoors.”

Tips for high-alert days

- Avoid strenuous outdoor activities, particularly between the hours of 2 and 7 p.m. when ozone concentrations tend to be most concentrated. Better to run in the early morning hours before it gets too hot.

- Try to find an air-conditioned place inside for you and your kids to be active.

- Consider taking MARTA or a carpool. With about half of smog-forming emissions coming from tailpipes, smoggy days are good days to find alternatives to driving solo.

- Know your triggers. Whether or not you have asthma, heavy smog days can cause breathing problems for some people. If this is one for you, take extra precautions.

- Sign up with the Clean Air Campaign ( to get smog alerts sent to your inbox.

- Check the AJC in print or online; it lists air quality every day.

Sources: Clean Air Campaign; Children’s Healthcare of Atlanta; Mothers & Others for Clean Air.

About Mothers & Others for Clean Air

Founded in 2004 by Laura Turner Seydel and Stephanie Blank . The local advocacy group sends regular updates on air quality and encourages carpooling, turning up the thermostat during the summer months and other measures to reduce air pollution. For more information: