Yesterday, I was privileged to speak to White House officials in the Office of Management and Budget (OMB) and representatives from the Environmental Protection Agency (EPA) about the EPA’s proposal to improve the standard for ground-level ozone. The invitation for this opportunity to provide public comments came from the group Physicians for Social Responsibility, who are aware of my interests in environmental health, as well as my writings on The PediaBlog. I’ve posted a transcript of my remarks below.

One speaker on the mid-afternoon conference call — the mother of children who have asthma — described how frightening it is when a child has an asthma attack, for both the parents and the child. She said she follows the air quality reports and forecasts for her region closely in order to better predict when her children may be at risk for exacerbations. It occurred to me once again that many parents, and their physicians, may not appreciate just how sensitive children’s airways can be to air pollution, especially if they have asthma. As we discovered on yesterday’s blog post, air quality is, in fact, a huge variable in the development and severity of asthma.

Everyone can now sign up and receive real-time air quality conditions and forecasts at I would encourage anyone who has asthma, or other chronic lung or heart conditions, to sign up here. I would also urge physicians and other providers to sign up and follow your local air quality index where, in the summer especially, the number of asthma exacerbations you treat may mirror local air quality index alerts.


Transcript from White House call — 9/24/15

“Thank you for giving me the opportunity to speak this afternoon regarding the EPA’s proposal to update the air quality standards for ground-level ozone.

My name is Dr. Edward Ketyer and I am a pediatrician from Pittsburgh, Pennsylvania. My practice is Pediatric Alliance, the largest independent primary care pediatrics group in Western Pennsylvania. I am a Clinical Assistant Professor of Pediatrics at the University of Pittsburgh School of Medicine. I am also the editor of The PediaBlog (which I hope you all will read!). I am a member of the American Academy of Pediatrics Council on Environmental Health. I also do consulting work for the Southwestern Pennsylvania – Environmental Health Project.

I have worked as a pediatrician in Pittsburgh for over 25 years. Pittsburgh has a legacy of dirty air since its glory days of steel-making. The air quality remains poor in this region, but for different reasons. The Mon Valley is downwind from some of the nation’s largest coal-fired power plants, which results in an almost constant layer of smog that’s readily visible from most elevated vantage points. Also, this is ground zero for the Marcellus Shale natural gas industry, and as you may know, the process of unconventional natural gas drilling, or “fracking,” is very bad for regional air quality. In 2012, Pittsburgh experienced 280 days without “good” air quality on the Air Quality Index. On 35 of those days (or 10% of the year), the air quality was “unhealthy.”

There is now an overwhelming scientific and medical consensus that air pollution — specifically from ground-level ozone and particulate matter — is dangerous to health, even in otherwise healthy people.

In adults, chronic exposure to air pollution leads to increases in heart disease, strokes, cancer, and early death. A number of studies have also linked chronic exposure during pregnancy to premature births, poor birth outcomes, autism, and infant mortality. In children, chronic exposure to air pollution has been associated with ADHD and obesity.

But ground-level ozone pollution is especially dangerous to children who have asthma (or about 10% of the pediatric population in this country). More frequent and severe asthma exacerbations in asthmatic children lead to higher utilization of health care services with doctors visits, medications, emergency room visits, and hospital admissions. And there are other children, with other health problems, in other parts of the country, who are vulnerable.

Every child needs and deserves a safe environment in which to live, to learn, to breathe, to play. Children — whether digging in the dirt, climbing over rocks in a small stream, building a snowman, or playing sports — spend more time outside than adults and, thus, are more likely to be exposed to environmental health hazards like ozone and other components of air pollution. Ozone pollution has specific mechanisms of action that lead to both obstructive and restrictive lung function abnormalities, which have been shown to be dangerous to all children and even life-threatening to children with asthma, chronic lung disease of prematurity, cystic fibrosis, other chronic lung diseases, and congenital heart disease. Enacting rules that decrease ozone in the air we breathe is the least that we, as responsible adults, can do to protect our children’s health — in real and measurable ways.

I have read the EPA’s proposal to lower the ozone standard. I understand that the lower we go, the more costly the proposal becomes. But I also see that the lower we go — even down to 60 PPB — the greater the health benefits AND economic benefits become.

Going low also sends the message that finally, Americans are being serious about addressing a critical topic you don’t need to be a scientist to understand: the real and present danger of climate change.

Because of all of this, I endorse a new ground-level ozone standard of 60 PPB — the lower the better — in order to do what’s right for children and protect their health today, and tomorrow.”