Living in the city ? Or living in the country ? Or in between ?

Question

Are certain air-conditions better than others for patients with CF? Dry air, the sea, the woods, humid air?
We live in the center of the city and wonder if this is appropriate. I think that there is more air pollution than in the rest of the city. Can you say anything about where the air is cleaner and what is best for patients with CF ?

Answer

Air pollution is caused by burning fuel in cars, industry, planes.. whereby nitrogen products, sulphur products, ozone and ‘fine particulate matter’ are produced. Especially these fine particles (diameter less than 10 picometer) penetrate deep in the lungs and cause irritation and inflammation in the smallest airways.
A lot has been published about air pollution. Many studies examined the short and long term effects of air pollution in healthy people. Short term there is a clear correlation between air pollution and coughing, shortness of breath and airway infection. Long term there is an increased risk of chronic bronchitis, cardiovascular problems and lung cancer. In people who already have a chronic lung disease like asthma, chronic bronchitis or CF, the inflammation of the airway is potentially worsened by air pollution. A few studies in patients with CF have demonstrated that living in a polluted area is associated with a somewhat faster decline in lung function and an increased risk of pulmonary exacerbations compared to patients who live in less polluted areas. The difference is attributed to the concentrations of fine particulate matter and ozone.
To decide which parts of the country would be advised and which not, is difficult in densely populated countries like Holland and Belgium, since fine particulate matter spreads quickly. Large cities and areas close to major highways are zones with high concentrations of fine particulate matter. Detailed maps with the concentration of fine particulate matter, ozone and nitrogen products can be found on the website www.vmm.be for Belgium and www.lmI.rivm.nl for Holland.
But off course this problem of air pollution should be evaluated on an individual basis. If as a CF-patient you seem to really suffer from air pollution you might consider to move to another area. When the concentration of fine particulate matter rises above the admitted norm, ‘smog alarm days’ are anounced. On these days outside activities like walking, jogging, biking are to be avoided. The days of the smog alarm are clearly communicated by the media.
As extra info: do not forget that the major pollution occurs inside the house. Cigarette smoke is very toxic and exposure to cigarette smoke is still a major health problem (much more than air pollution): even up to 15% of CF-patients do smoke. Avoiding cigarette smoke is thus a very important message for patients with CF.
Kind regards
Dr. M. Boon

01.12.2011