TheBakersfieldCalifornian.com

Children's asthma-related emergency room visits rise in the San Joaquin Valley at a similar rate as fine particulate levels do -- even on days where air quality is considered in the moderate range.

That's a key finding of a yearlong study by the Central Valley Health Policy Institute at Fresno State, which examined the short-term impacts of air quality changes in Bakersfield, Fresno and Modesto.

Although nationwide studies have found similar connections between heightened pollution and hospital visits, the report is the first of its kind using valley-specific data.

The results are also compelling for the proportional findings, meaning that asthma-related visits climb in lockstep with increased pollution, even on days considered "yellow" or moderate.

"The study really validates the difficult things we ask of businesses and households," said David Lighthall, the health science adviser for the San Joaquin Valley Air Pollution Control District, which funded the $125,000 study. "It gives our board and staff reassurance to continue making tough regulations to reduce the exposure, particularly for fine particulates."

The study calculated that children with asthma in the three regions surveyed make an extra 1,596 hospital visits a year as a result of elevated fine particulate matter (PM 2.5), and 217 because of high ozone levels, according to Tim Tyner, the co-author of the report and the associate director of the Center for Clinical and Translational Research at the University of California at San Francisco-Fresno, a partner in the study.

Each of those ER visits costs an average of about $1,500, and hospitalizations can cost 10 times that, Tyner said.

While exacerbated childhood asthma as a result of the fine particulate matter was the most significant correlation found, the study also discovered other health connections, such as increased emergency visits for children with pneumonia and adults with asthma and cardiovascular problems.

It was also troublesome to see the correlation even on days when air pollution is at levels parents might consider healthy for their asthmatic children. The correlation began at a level of 20 to 30 micrograms per cubic meter, which is below the national fine particulate standard of 35.

Particulate pollution tends to burden the valley more heavily from October to March. Summertime ozone pollution didn't pose as serious a short-term health threat, though experts cautioned there are numerous national reports linking that pollutant to longer-term health consequences such as respiratory and heart problems.

This study's findings could be used with ongoing research that examines particulates' distinct parts such as metals or ammonium nitrate. If a component is found to be more closely tied to the days with high emergency room visits, the district could focus its efforts on that element.

Historically, the district had treated all particulates the same, according to federal law, said Seyed Sadredin, the air district's executive director. Pinpointing the most unhealthy particulates potentially could convince the federal government to adopt a more targeted pollution-reducing policy.

"It gives us the biggest bang for our buck since we can find which pollutants are causing the most problems," he said. "We may find ammonium nitrate is different than the particulates you get from a leaf blower or diesel combustion."

The study also demonstrates that the job of cleaning the air is far from complete, said Kevin Hamilton, the deputy chief of programs at Clinica Sierra Vista.

"We're far, far, away from protecting families and children from the impact of air pollution," he said. "The so-called protective levels are indeed not as protective as we've been led to think."

Hamilton also emphasized the financial burden on the healthcare system from pollution-tied ER visits.

Sarah Sharpe, community health director at Fresno Metro Ministry, said the results are a wake-up call to decision-makers as well as residents, many of whom "are in denial about how serious the health impacts are."

From the public health perspective, more research -- especially valley-based reports -- can help the department alert and educate more people, said Kirt Emery, the health assessment and epidemiology program manager for the Kern County Department of Public Health.

While Emery said he's aware of the reported link between air pollution and hospital visits, studies are more relevant if done in one's own region, he said. That could translate into public health efforts to prevent exposure, thereby limiting expensive emergency room visits, he said.

Emergency room doctors say the study isn't surprising, though it is significant.

Anecdotally, Dr. Manish Amin, an emergency room physician at the Bakersfield Heart Hospital, said he notices increased asthma visits when the air is particularly dusty.

At Kern Medical Center, emergency medicine chairman Dr. Rick McPheeters said the additional patients might not be enough to notice at one hospital. He said the link between inhaling irritants and exacerbating health conditions isn't surprising, though he pointed out that this study does not demonstrate that air pollution causes asthma.

When children are taken to the emergency room for asthma complications, they typically receive breathing treatment and oral medications, emergency room doctors say. Sicker kids have to stay longer in the emergency room and receive medications intravenously.

Bad cases could require a hospital stay of several days and, very rarely, patients can die despite medical treatment.