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By Nila Rafiq

Rafiq is an internist in Falls Church and an assistant professor at George Washington University and Georgetown University and a member of Virginia Clinicians for Climate Action.

Air pollution may be about politics and money in Washington, but as an internist caring for adults with chronic lung disease in an intensive care unit, air quality directly affects my patients’ lives.



Sarah is a 63-year-old woman who is hospitalized three or four times per year for exacerbations of her chronic obstructive pulmonary disease (COPD). In July 2016, poor air quality tipped her into a severe attack. She was admitted to the ICU and placed on a ventilator for several days. Sarah later shared that she had been having difficulty breathing for many weeks; she felt she could not continue to work and planned to retire.

For people with chronic respiratory disease like Sarah, reducing air pollution is not about the environment. It is critical to their ability to breathe, work and stay out of the hospital. This fact makes the recent decision by Environmental Protection Agency (EPA) Administrator Scott Pruitt and the Trump Administration to repeal the Clean Power Plan extremely troubling.

The Clean Power Plan has the potential to set national standards to reduce harmful carbon pollution coming from power plants. In 2015, the EPA estimated that the Clean Power Plan would prevent up to 90,000 asthma attacks in children and 3,600 premature deaths each year. Revoking the Clean Power Plan denies Americans these health benefits. This news also comes on the back of drastic proposed cuts to the EPA’s budget and rolling back of fuel economy standards.

Hazardous air quality because of air pollution from tailpipes and power plants affect our health directly through worsening of chronic heart and lung disease. These conditions are a major public health concern. COPD affects 12-16 million people in the United States and is our third-leading cause of death. Asthma, which affects 25 million Americans, caused 1.8 million ER visits and 439,000 hospitalizations in 2010. Nearly 13 percent of Virginia’s population suffers from either asthma or COPD.

The effects of air pollution on health are also exacerbated by climate change. Rising amounts of greenhouse gases in our atmosphere, emitted through burning of fuels like coal and gas, are causing our planet to warm. This fact is accepted by virtually every scientific academy in the world and should not be a political issue.

As temperatures rise, the life cycles of plants and animals are changing. Higher temperatures are allowing Lyme disease-carrying ticks to live in northern regions like Maine and Canada, where it used to be too cold for them to survive. Plants are blooming earlier and longer, lengthening the allergy season. Allergies are a leading cause of asthma exacerbations.

Toni is a 54 year-old woman with poorly controlled asthma. Every year, her allergies cause her asthma to flare. In May, allergies precipitated an attack that landed Toni in the ICU. I cared for her for seven days as she was treated with high-dose intravenous steroids, inhalers and anti-histamines before she was able to breathe comfortably.

While the health of all people can be affected by climate change, certain groups, including children, pregnant women and the poor, are particularly vulnerable. Health conditions lsuch as heat illness, lung disease and climate sensitive infections are getting worse as our climate changes. That is why 17 of the nation’s leading medical organizations released a statement defending the Clean Power Plan, and calling on the EPA “to heed the clear scientific evidence and protect public health by cleaning up major sources of carbon pollution from power plants and taking steps to avoid the worst health impacts of climate change.”

Americans deserve clean air to breathe and a safe climate in which to raise their families. The rollback of higher fuel economy standards, the repeal of the Clean Power Plan, and the proposed cuts to the EPA’s budget all put American families at increased risk. Sarah, Toni, and every one of my patients deserve an EPA that is fully funded and empowered to do its job protecting our health.

In the fight for a clean and healthy future, physicians are on the frontlines. We are ready to do our part, but Congressional representatives from Virginia need to ensure that Washington does theirs.

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