Ozone and childhood respiratory health: A primer for US pediatric providers and a call for a more protective standard

Abstract

Ground level ozone is a potent respiratory toxicant with decades of accumulated data demonstrating respiratory harms to children. Despite the ubiquity of ozone in the United States, impacting both urban and rural communities, the associated harms of exposure to this important air pollutant are often infrequently or inadequately covered during medical training including pulmonary specialization. Thus, many providers caring for children's respiratory health may have limited knowledge of the harms which may result in reduced discussion of ozone pollution during clinical encounters. Further, the current US air quality standard for ozone does not adequately protect children. In this nonsystematic review, we present basic background information for healthcare providers caring for children's respiratory health, review the US process for setting air quality standards, discuss the respiratory harms of ozone for healthy children and those with underlying respiratory disease, highlight the urgent need for a more protective ozone standard to adequately protect children's respiratory health, review impacts of climate change on ozone levels, and provide information for discussion in clinical encounters.

Keywords: air pollution; childhood asthma; ozone.

Figure 1:

Ozone design values (3-year average of annual 4^th highest maximum daily 8-hour average ozone concentration) for individual monitors for 2015–2017. ppb= parts per billion. Source: Figure 1–8 from ISA