Podcast: Why is Air Quality Worse in the Summer?

Dr. Tsirilakis: When you have all of the carbon emissions, when you have the exhaust fumes from all the cars, and the airplanes, combined with that heat. You start to see, the increases in the ozone levels, and so when those ozone levels are very high in the summertime and also as the day heats up, people can have more problems with their breathing.

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from New York Presbyterian. I’m Courtney Allison. Temperatures aren’t the only thing rising in the summertime. As we step outside to enjoy the sunshine, it’s also important to pay attention to elevated levels of pollutants and irritants. This week, we talk to Dr. Kalliope Tsirilakis – a pediatric pulmonologist at NewYork-Presbyterian and Weill Cornell Medicine – about how to take care of our lung health, especially with the increase in wild fires and through these hot summer months.

Hi, Dr. Tsirilakis. Welcome to the show. Thank you for being here.

Dr. Tsirilakis: Thank you, Courtney. I really appreciate the opportunity to talk with you today.

Courtney: So I’m sure you see a lot of respiratory conditions in your practice. What kind of concerns do you hear most about respiratory health during the summer months?

Dr. Tsirilakis: So there are a lot of conversations about triggers for potential asthma exacerbations in particular, and then other respiratory conditions. In the summertime, we really worry a lot about air quality with a lot of the wildfires that we’ve been seeing over the last few years, as well as other heat indexes, rising temperatures, and a lot of the viruses which we are still seeing even into the spring and summer months.

Courtney: And what is it about the heat that affects the air quality?

Dr. Tsirilakis: So if you have the high temperatures which can end up causing some of the wildfires that we do see in the area, that can release a lot of particulate matter into the air. That combination of heat really increases the ozone that is released into the air and can increase a lot of the smog. So the summertime high temperatures really make that air quality much worse and can actually increase a lot of the effects of pollution on people’s respiratory systems. 

Courtney: So let’s talk more about pollution. You’re touching on this already, but can you walk us through some of the different types of pollutants we see?

Dr. Tsirilakis: So the two major ones that we talk about, one is particulate matter, which is gonna be things like, soot, ash. Particulate matter can be very, very small and can actually get very far down into patients’ airways, which is why that can cause actual irritation in people’s airways and cause breathing problems and respiratory problems even in people who don’t have underlying respiratory disease.

And then the other pollutant that we really talk about is ozone levels. So when you have all of the carbon emissions, when you have the exhaust fumes from all the cars, and the airplanes, combined with that heat, you start to see the increases in the ozone levels. And so when those ozone levels are very high in the summertime and also later in the day, as the day heats up, people can have more problems with their breathing. 

Courtney: Are any of these pollutants more concerning than the others?

Dr. Tsirilakis:  All pollutants are concerning, because they can all cause irritation in the airways and can really have people experience respiratory symptoms at high levels. The key is how high are the levels of those pollutants in the air. And so that’s where it can come in handy to monitor something like the air quality index, so that you can see when we have those days where the air quality index is much higher.

Courtney: Can you talk more about the basics of tracking air quality or the AQI?

Dr. Tsirilakis: So the AQI is a combination of measures where they look at all of those different pollutants in the air and how those add up to potentially causing respiratory symptoms. So in general, an AQI—air quality index—below a hundred is considered to be safe for most people. If the air quality index rises above a hundred, then people with respiratory conditions such as asthma, COPD, or other problems with their breathing can have more respiratory symptoms when they are exposed to the higher concentration of pollutants in the air.

If the air quality index goes over 150 and especially so if it goes over 200, then you start to see symptoms even in people who do not have respiratory conditions. So anybody walking outdoors, can feel the effects of that poor air quality.

And the air quality index is definitely higher in the summer months. With the heat and the humidity incorporated into the additional pollutants, you can have a lot more aerosolization and you can have a lot more of those pollutants in the air in the summertime in particular.

Courtney: I think we all remember the orange sky from a couple of years ago where it just looked apocalyptic outside. And so on that day, the AQI was 484 and we could see that it was dangerous to go outside. We could feel it. But why is it important to also consider the pollutants that don’t appear to the naked eye?

Dr. Tsirilakis: So those are the pollutants that are actually sometimes the scariest, particularly for people who have respiratory conditions because those are the really tiny particles for instance, ozone, you cannot see it. And those are pollutants that can make their way much farther down into the airways, and can cause coughing and wheezing and chest tightness even in people who don’t have respiratory issues. So when you can see the orange sky and you can see ash in the air, that is actually much less likely to make its way down into your lower airways and to cause those symptoms.

Courtney: Are different age groups more susceptible to poor air quality?

Dr. Tsirilakis: We know that children’s lungs are definitely more sensitive, and they can be more reactive. And so, because children’s airways are smaller to begin with, if you make their airways react because of an irritant or pollutant in the air. Then their airways are gonna tighten up and they’re gonna get much smaller very quickly. And so that’s why children sometimes will appear more sensitive to what wouldn’t affect an adult as much, just because their airways are also smaller, so they have less room to really shrink and to get tighter.

Courtney: Are older people more susceptible?

Dr. Tsirilakis: Yes, definitely as well, not so much for anatomic reasons, but simply because their lungs are not necessarily as strong and they have definitely experienced more exposures over their lifetime that has sensitized their airways more to those pollutants.

Courtney: Can you talk about the risks of exercising outdoors when air quality is poor?

Dr. Tsirilakis: In order to exercise, you need to be able to increase your lung volumes and your lung capacity, and you need to be taking in those big, deep breaths. You can imagine trying to exercise with a cigarette in your mouth, it’s not gonna work. 

You know, when you’re inhaling the particulate matter, the smoke, the ozone, all of those pollutants going into your lungs, there’s less room for oxygen to make its way into your lungs. So the problem is that you’re not able to exercise as much, and so you significantly increase your chances of having respiratory symptoms as well as fatiguing much earlier as well as having significant problems with exercising itself.

Courtney: So maybe try to stay inside for whatever you hope to do?

Dr. Tsirilakis: Oh definitely, if you need to exercise, which we all should be doing, it’s a great idea to do it indoors. Especially on those days when the air quality is very poor. Definitely over 150, and for people with respiratory conditions, they should be staying indoors even over a hundred.

Courtney: So staying indoors and what are some other ways that people can protect themselves from pollution?

Dr. Tsirilakis: Running air conditioners. Fresh air is not always fresh air, so sometimes it’s not a great idea to open up your windows. And what you really wanna do is turn on the air conditioner, which has that filter. Make sure that your air conditioner filter has been cleaned or changed recently.

And then that will help to filter out the air. You can use things like air purifiers within the home as well. But they will not replace an air conditioner. And they will not remove a lot of the irritants that can actually settle on the ground. So things like dust mites and other allergens that are not so much in the air, but they can help definitely with pollutants and with smoke.

Another thing that a lot of people can do, particularly those with respiratory conditions, if you have to go outside, because sometimes we do have to go outside, it’s a good idea to wear a mask. You can wear a surgical mask or some sort of a face covering that covers both your nose and your mouth so that it can act as a filter so that you are not breathing in as much of the pollutants and as much of even the allergens and other triggers that are in the air.

Courtney: So moving to allergies—I think we usually associate allergies with springtime, but is it something to worry about in the summer as well?

Dr. Tsirilakis: So allergies in general can occur year round. So a lot of us have springtime allergies. Some folks have more significant fall allergies, so particularly the fall weeds which usually that season actually starts mid-August, which is still summertime in a lot of people’s books. And that can last until October. 

Earlier in the spring, most people suffer from the tree pollen allergies, and that usually ranges from about March to June, and then after the tree pollen settles down, the middle of the summer is more grass pollens, and then your wintertime, that’s when you’re gonna be more worried about your indoor allergens. Which obviously are still there in the summertime when we’re talking about things like dust mites, cockroaches, mouse allergens, as well as molds.

Courtney: So I think another thing people don’t always associate with summer are respiratory illnesses. I think we often think about them in winter… 

Dr. Tsirilakis:  So unfortunately, post pandemic, we have seen that respiratory season seems to be year round, which is very difficult and very challenging for a lot of people. Wintertime is definitely worse. There’s no question about that. We’ve seen multiple, multiple viruses at the same time that have really been affecting a lot of folks with respiratory illnesses.

However, even in the summertime, it is not unusual for us to see spikes in certain strains of certain viruses. This past spring we’ve had a really, really rough season with some of the viruses that have been making a lot of people very sick, landing some folks into the hospital, making some people wheeze that have never wheezed in their lives before. And a lot of folks act like they have asthma when they get these respiratory illnesses. So if your physician is telling you that you sound like you have asthma, it might be time to go see a specialist to see if there is something more that you need to take care of.

Courtney: So you’ve given us so many practical tips and everyday tips. Are there any long term  implications you could discuss when it comes to exposure to pollutants and lung health?

Dr. Tsirilakis: So the concern is that with long-term exposure to pollutants, particularly for those of us who live in the inner cities, who are exposed to much higher pollution levels than folks who live out in the country, there is a concern that you can have significantly increased rates of asthma. Which is why we see such hotspots for asthma specifically, co-located or very close to highways, very close to airports, think of any place where there is high traffic areas. The Cross Bronx Expressway is notorious for being one of the highest areas or regions with asthma prevalence in the entire country. And we have similar types of hotspots throughout New York City.

And so it is really, really important to be mindful of where you are and to try to protect yourself and your family from those high pollutant areas, utilizing tools such as the air conditioners, the air purifiers, monitoring the air quality index in your specific regions so that you are aware of when you need to take extra precautions for yourself.

Courtney: Dr. Tsirilakis, thank you so much for all these helpful tips. I learned so much talking with you, and I really appreciate all these practical things you walked us through.

Dr. Tsirilakis: Thank you for inviting me today. This was a lot of fun.

Courtney: Our many thanks to Dr. Kalliope Tsirilakis. I’m Courtney Allison.

Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Tsirilakis’s work with patients, check out the show notes. NewYork-Presbyterian is here to help you stay amazing at every stage of your life. To get the latest episodes of Health Matters, be sure to follow and subscribe on Amazon Music.