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First-graders are seen on their second day of school on Thursday, August 12, 2021, at Second Creek Elementary School in Commerce City. (Olivia Sun, The Colorado Sun)

Most of the scorching days this summer on Colorado’s Front Range have come with an air pollution “action alert” from the state government, warning people with sensitive respiratory issues to take extra caution in the presence of elevated ozone or PM2.5 particulate matter drifting in on wildfire smoke. 

What does that mean, exactly, if you’re taking care of kids, or anyone with serious lung or heart problems? 

Radio stations are warning people to stay inside, and not just because of the delta variant. Parents are trying to figure out if letting their kids out into the slightly orange afternoon sun is a good idea. Schools are gearing up for full in-person attendance — some are already back in session — and trying to codify a playground strategy for high-pollution days. 

It’s confusing. 

So we sought the expertise of National Jewish Health, a premier respiratory research and treatment institution, to sort out some of the answers to your air pollution questions. Thank you to Dr. Nathan Rabinovitch, professor of pediatrics in the Division of Allergy and Immunology at National Jewish Health, for squeezing in some responses between patient visits. 

Question: We seem to be alternating high ozone days and high PM2.5 days this summer, are they equally harmful to children? 

Answer: High levels of either one can trigger asthma or other respiratory problems and inflammation in anyone using the outdoors, especially those who are already vulnerable through a preexisting condition. Denver-area health officials do notice spikes in appointments and in the number of children using albuterol inhalers after a recorded day of high pollution. 

PM2.5, which has jumped in Colorado this summer because of wildfire smoke drifting in from California and the Tahoe region, appears to exacerbate asthma in epidemiological studies, Rabinovitch said. PM2.5 refers to the size of the particles — 2.5 microns, too small to be seen by the human eye. 

Q: Can you fend off either high ozone or high PM2.5 pollution with a mask? 

A: Yes to one of those. Ozone is an outdoor gas that permeates masks. The good news is that going indoors lets you avoid ozone. Most of PM2.5 and other particulate matter is stopped by a mask rated N95 or higher, Rabinovitch said. That is not the Bronco-themed cloth mask hanging on your hook since week one of the pandemic. An N95 is a medical-grade mask usually purchased in boxes or bags of three or more, look for an official rating and seal on the packaging. (National Institute for Occupational Safety and Health, NIOSH in marketing circles, is a good bet.) Early in the pandemic, doctors did not emphasize N95s for the general public because they worried about shortages for frontline health workers. Now they are much more plentiful, and are widely available from retail outlets. 

Just throwing one on either yourself or your child is not good enough, though, if you are truly concerned about respiratory issues. The N95 must fit well around the nose and mouth. Medical advisers recommend the masks with two straps, one that fits at the top of the back of your head, and one down lower, to keep the mask sealed tight. 

Remember that unlike ozone, PM2.5 particles can drift indoors. So families who do have air conditioning and are protecting those with health issues can shut windows and doors tight. If you have central air, use quality filters and change them regularly. If you don’t have great air conditioning, experts suggest taking advantage of the central air at a mall, a library or a rec center. 

Q: How should parents read the Air Quality Index in the morning, if they are concerned about their children being at school or otherwise outdoors for the day? 

A: “My feeling is that parents need to take care of susceptible kids, the kids with asthma,” Rabinovitch said. “And the way they will take care of it is not to keep them indoors the whole time, but to actually make sure that there is good asthma control. Make sure they are taking their inhalers, and using their inhalers.”

Medical and air pollution experts emphasize that on high Air Quality Index days, it’s prolonged or intense exertion they are warning against. Rabinovitch said he does not believe this means all parents or school principals need to yank their kids off the playground at the first sign of poor air quality. 

In most cases, for most kids, the benefits of getting off the couch, getting outside and moving around still outweigh the potential dangers of a moderate air pollution day. “I would not keep them in a bubble,” Rabinovitch said. 

Sisters Azul Gonzalez, 12, and Alexa, 14, join Lisa Gonzales, right, use a microphone to thank the supporters of the EcoFiesta in Commerce City in July. Over a dozen organizations and community members gathered near the Suncor oil refinery at Fairfax Park to celebrate an environmental justice project to help transition beyond polluting industries to what they called a safer, healthier and more just environment on July 18, 2021. (Kathryn Scott, Special to the Colorado Sun)

Q: Fall team sports like football, cross country and soccer will be ramping up, too, and are practicing right now. How should parents think about their teenagers playing intensive outdoor sports with PM2.5 or ozone out there? 

A: Take the middle ground in search of air solutions, is the experts’ response. Most students on most days will still benefit more from organized sports and exercise than they will from sitting inside. The key, again, is for those students whose families already know there’s a problem to pre-treat themselves with prescribed respiratory medications, and bring them along for emergencies. 

“If it’s needed, these patients can pretreat with albuterol to allow them to exercise. But if everything else is under control, and they take care, and they pretreat, they should do OK,” Rabinovitch said.

Q: Overall, has metro Denver’s air been getting worse for kids, or better, in the past couple of decades? 

A: Rabinovitch has been practicing medicine in Denver since 1994. “That’s a tough question,” he said. “Compared to the ‘80s, when I was not here, it’s much better,” he said. 

EPA monitors do show Colorado’s worst counties have made some progress over decades in reducing the previous “brown cloud” of air pollution through driving restrictions, woodfire bans and controls on oil and gas production. Colorado still fails EPA limits on ozone, for example, because the agency’s acceptable limit on ozone keeps getting ratcheted down by medical studies. 

“I would say that the wildfires (and their PM2.5) are becoming more of an issue in the last 10 years,” Rabinovitch said. 

Q: What’s the bottom line on what parents should know about recent air pollution problems and how to think about their kids’ health? 

A: Families who have already been dealing with asthma issues and other respiratory problems should keep talking to their doctors, keep using their medications and monitor what happens when children with chronic conditions do exercise on higher pollution days. 

But there’s a difference between chronic conditions and exposure over months and years, and acute dangers, Rabinovitch noted. For other children, he added, “acute exposure I don’t worry about unless they’re just not doing well already.”

Michael Booth is The Sun’s environment writer, and co-author of The Sun’s weekly climate and health newsletter The Temperature. He and John Ingold host the weekly Sun-Up podcast on The Temperature topics every Thursday. He is co-author with...