AMERiCAN 

LUNG 

ASSOCIATION, 

Fighting for Air 

February 19, 2014 

President Barack Obama 

The White House 

1600 Pennsylvania Avenue Northwest 

Washington DC 20500 

Dear Mr. President: 

As medical and health professionals who care deeply about people with lung disease, including many 

who are involved in the science of air pollution effects, we are writing to urge you to direct the U.S. 

Environmental Protection Agency (EPA) to adopt lower sulfur gasoline and cleaner vehicle emissions 

standards and to implement the standards as soon as possible. Cars, light trucks, and SUVs remain a 

major source of nitrogen oxides, carbon monoxide, and volatile organic compounds that directly harm 

health and also lead to the formation of ground-level ozone and particle pollution. Unhealthy air 

imposes the risk of serious health impacts on millions of Americans. We see those impacts on our 

patients' health, in public health, and in our research. 

The EPA's proposed Tier 3 Vehicle Emissions and Fuel Standards will significantly reduce ozone and 

particulate matter that harms cardiovascular and respiratory health and can even lead to early death. 

Ozone acts as a powerful respiratory irritant, causing premature death, asthma attacks, inflammation of 

lung tissue, shortness of breath, wheezing, increased susceptibility to respiratory infections, risk of 

cardiovascular harm and lower birth weight. Exposure to particle pollution causes premature death, 

cardiovascular harm, diminished lung function, asthma attacks, increased risk of lung cancer, and 

increased risk of lower birth weight and infant mortality. 

We know the burden of air pollution is not equal. For people with existing diseases such as asthma, 

heart disease, chronic obstructive pulmonary disease (COPD) and diabetes, air pollution can increase the 

burden they face every day. Children, whose lungs continue to grow into adolescence, face a higher risk 

from the effects of air pollution. Adults 65 and older, whose bodies are less able to defend against the 

effects of air pollution, are placed under greater strain. People with low incomes also face higher risks 

from air pollution. 

Traffic-related air pollution causes asthma attacks, may cause the onset of childhood asthma and is 

linked to premature death (NEI 2010). Nearly 1 in 5 U.S. residents live near a major roadway, elevating 

their risk from traffic pollution. People who belong to a racial or ethnic minority or who have lower 

incomes are more likelyto live near busy roadways (ilawan^ould 2013).
Cleaner gasoline alone will immediately benefit public health. Lower sulfur gasoline enables current 

emissions reduction technologies to function more efficiently, reducing nitrogen oxide emissions from 

the existing fleet. Cleaner gasoline will reduce emissions equal to removing the emissions from 33 

million cars off the road, or about as many cars as there are in Maryland, New York, Ohio, Pennsylvania, 

Texas and Washington. Combined with tailpipe emissions standards, the proposed program will save 

thousands of lives each year, prevent tens of thousands of asthma attacks, and reduce the number of 

emergency room visits and hospitalizations. 

Cleaner gasoline and vehicle standards are urgently needed. Mr. President, we request that you direct 

the EPA to adopt new standards that will protect the health of our patients and the public and 

implement the lifesaving program on schedule. 

Sincerely,

Alaska Robert Chang, MD 

Linda Van Houten, MPH, CPH Ralph Dilibero, MD 

David Erle, MD 

Alabama Robert Gould, MD 

Veena Antony, MD Karen Hardy, MD 

Michae) Lyerly, MD Fred Herskowitz, MD 

Wesley Granger, PhD, RRT, FAARC Michael Kelly, MD 

Cathleen Shepard, RRT, AE-C Thomas Larwood, MD 

Myron Liebhaber, MD 

Arizona Mohsen Mabudian, MD 

lack Tuber, DO Robert Meagher, MD 

Jean-Paul Bierny, MD Richard Moss, MD 

David Sanderson, MD John F. Murray, MD 

Eve Shapiro, MD Helen Rockas, MD 

Schuyler Hilts, MD, FACP, FACNM Maher Roman, MD 

Barbara Warren, MD, MPH Cindy Russell, MD 

Rolf Halden, PhD, PE Sunil Saini, MD 

Tina Tharp, RRT Nirupam Singh, MD 

Roger Spragg, MD 

California Harry Wang, MD 

Victoria Bermudez, RN Robert Watson III, MD 

Leslie Hata, DDS Kari Nadeau, MD, PhD 

AI Landucci, DDS Richard J Jackson, MD, MPH 

Joseph Schuchter, DrPH, MCP Karen Jakpor, MD, MPH 

Elena Lingas, DrPH, MPH Wendy Ring, MD, MPH 

Janet Abshire, MD Linda Rudolph, MD, MPH 

Samuel Applebaum, MD Steven Chang, MD, PhD Laura Applebaum, MD 

Carlos Bello, MPH lose Arrezola, MPH 

Donna Carr, MD Maria Elena Avila-Toledo, MPH

2 
Carlos Bello, MPH Tee Guidotti, MD, MPH, DABT 

Megan Gaydos, MPH Todd Bixby, MPH 

Tamanna Rahman, MPH Jane Ward, OD, MD, MPH 

Colleen Reid, MPH 

Susie Rico-Vasquez, MPH Delaware 

Melissa Ta, MPH Albert A. Rizzo, MD, FACP, FCCP 

Catherine Thomsen, MPH Sandra Glenn-Vernon, RN, BSN 

Rachel Bennett, MPH, MURP 

lames Howard, MS Florida 

Torey Ivanic, MS, PA-C Roslyn Whitley, BSc 

Joan Edelstein, MSN, DrPH, RN Jenny Batalla, CCRP 

Elsa Estrada, MSN,FNP,RN,PHN Tad Fisher, CEO 

Luella Engelhart, PhD J. Brent Kooistra, MD 

Fred Lurmann, PhD Juan C. Martinez, MD 

Jennifer Miller, PhD Richard Thurer, MD 

Mel Hovell, PhD, MPH Lynn Ringenberg, MD, FAAP 

Ellen Levine, PhD., MPH Robert DeMarco, MD, FCCP, FACP 

Rebecca Gilbert, PT lason Lang, MD, MPH 

Valerie Naegele, RCP, RRT Faisal Fakih, MD 

Renee Bryant, RN Kathryn Blake, PharmD 

Lucy Pastrana, RN, BSN John Lima, PharmD 

Diane Reeves, RN, MPA/HSA Blanca Camoretti-Mercado, PhD 

Kelley Jones, RRT Brenda Olsen, RN 

Marco Soto, RRT Nancy Archer, RN, BSN 

Shirley Windsor, RRT, RCP, BS, GS Deanna Seymour, RN, BSN 

Colorado	 Geor ia 

Timothy Kennedy, MD	 Alan Plummer, MD 

Peter Mourani, MD	 Paul Weinb, MD 

Christopher Stanley, MD, MBA	 Anne Mellinger-Birdsong, MD, MPH, FAAP 

Dale Varner, MD, MBA, FACS	 Michelle Griffith, MPH, CHES 

Lisa Maier, MD, MSPH	 Ginger Tuminello, MS, CCLS, AE-C 

Brie Hawley, MS	

Jodie Rodriguez, RN, MS, CPNP, AE-C 

Edna Fiore, MT	

Ateya Wilson, MS

Connecticut Hawaii 

Naftali Kaminski, MD Chris Fukui, MD 

David Hill, MD, FCCP Dian Kiser, PhD 

lonathon Rosen, MD, FAAFP

lowa 

District of Columbia Alison Beer, MD 

Stephen Waller, MD Jill Welch, MPH 

Rosemary Sokas, MD, MOH

3 
Maine 

Martine Eon, BS, RRT, NPS, RPSGT 

D. Lee Berry, BSN 

Ingrid Scott, BSN, RN, PNP, EMT-B 

Ann Harrison-Billiat, BSN, SCM 

Trish Riley, MPH 

Alan Leo, EMT 

Emma McFarland, Health Officer 

Jill Delaney, Health Officer, 

Charles Norburg, LHO, LSE, CEO 

Mary Frances Bartlett, Local Health Officer 

Emily Jacobs, Local Health Officer 

Patricia Nash, LPN 

David Bachman, MD 

Douglas Couper, MD 

Paul Dumdey, MD 

Donald Endrizzi, MD 

David Kern, MD 

James Melloh, MD 

Paul Shapero, MD 

Thomas Van der Kloot, MD 

Bruce Taylor, MD, FAAP 

Ronald Blum, MD, FACOEM, FAAFP 

Effie Craven, MPH 

Tina Pettingill, MPH 

Steven Trockman, MPH 

Anne Hill, MS 

Julie Osgood, MS 

Shane Gallagher, MS, CHES 

Lee Beth Gilman, MS, CHES 

Brenda Hamilton, MSW 

Gildace Arsenault, Municipal Health Officer 

Peter poran, PhD 

Cece Ohmart, RD 

Joyce Alcorn, RN 

Mary Heroux, RN 

Joan Miller, RN 

Diane Haskell, RRT 

Stacey Schmidt, RRT, AE-C 

Rhonda Vosmus, RRT, NPS, AE-C 

Craig Donovan, RRT, RN

Illinois 

Rebecca Shilling, MD 

Kevin Kovitz, MD, MBA 

Stephen Joyce, MD, MPH 

Matthew Schmitz, MS 

Massachusetts 

Francis Veale III, BS, MPH 

Lisa Waterman, BSN 

Llnda Kovitch, CRNA, RRT, MSN 

Philip O'Donnell, CRT 

Michael Ginieres, IH, REHS 

Peter Hou, MD 

Denis Lin, MD 

James Recht, MD 

Leonard Sicilian, MD 

Lewis Pepper, MD, MPH 

Debra Saryan, MLS 

Katie Mowatt, MPH 

lamie Klingensmith, MPH, MPPA, RD 

Erica Streit-Kaplan, MPH, MSW 

Christine Gadbois, MSN, RN-BC, CDDN, PHCNS-BC 

Sarita Hudson, MTS 

Julia Brody, PhD 

Sharon Casey, PT, DPT 

Sam Lipson, REHS 

Mary Lord, RN 

Marijane Barrett, RN, BSN, MS 

Nancy Jenks, RN, BSN, NCSN 

Susan Sommer, RN, NP, AE-C 

Mark Waksmonski, RN-BSN, MPA 

Patrice Benjamin, RRT 

Marvland 

Elizabeth Agbetsiafa-Awuah, BSN, RN-BC 

Michae) Lansing, MD 

Karen Lewis, MD 

Gary Kreps, PhD 

Lisa Jordan, PhD, RN 

Melinda Power, ScD

Cl
Christine Stanish, RRT 

Michiean	 Dora Cardillo, RRT-NPS, BS, CPFT, AE-C 

Kenneth Rosenman, MD	

Lora Weir, RN

Eric White, MD 

Jiayi Wan, RN North Carolina 

Terry Noah, MD 

Minnesota Adrienne Ferriss, MD, MPH 

Rachele Gibson, MD Lisa Johnson, RRT, RCP, BAS, AE-C 

Robert Hyatt, MD 

Andrew McKibben, MD Nebraska 

Angela Fabbrini, MPH Debra Romberger, MD 

Michael Chappell, PhD Ketki Patel, MD MPH 

Jean Regal, PhD David Corbin, PhD 

Marlene Wilken, RN, MN, PhD 

Missouri 

Mario Castro, MD, MPH New Hampshire 

Ajay Sheshadri, MD Astrid Wielens, EMT 

Oscar Sierra, MD Karen Johnston, RRT 

Thomas Siler, MD 

Jaime Tarsi, RN, MPH New Jersev 

Susan Landick, BS, RRT 

Mississippi Derek Shendell, D Env, MPH 

Jennifer Cofer, MPH, CHES, AE-C Oscar Mayer, MD 

Maximo Romen, MD 

Montana Ramya Lotano, MD, FCCP 

Diane Dean, MS, CTR Olga Autote, MPH 

Jennifer Sofie, DNP, FNP, ANP Stephen Crane, PhD, MPH 

Paul Smith, DO John Rutkowski, RRT 

Paul Loehnen, MD 

David Mark, MD New Mexico 

Kathleen Masis, MD Rogene Henderson, PhD 

Robert Merchant, MD Benjamin Schulte, PhD, MPH 

Michael Zacharisen, MD 

Lori Byron, MD, FAAP Nevada 

Robert Byron, MD, MPH Charles McPherson, MD 

Carolyn Goren, MD, PhD 

Diana Hammer, MPH New York 

Tony Ward, PhD Margaret Collins, MS 

Elizabeth Schenk, PhD, RN Erin Streiff, BSN, RN 

Cynthia Smith, RN Lawrence Kurlandsky, MD 

Josy Jahnke, RN, BSN Colleen Lynch, MD 

Stanley Alkire, RRT Charles Powell, MD 

Colleeh Holmquist, RRT Joerel Ramos, MD

5 
William Scheider, PhD 

Liz D'Imperio, RRT 

Ohio 

Robert L. Hunter, DO, FACOEP, FACOFP 

John Carl, MD 

Amy Chuang, MD 

William Hardie, MD 

Benjamin Kopp, MD 

Richard Lavi, MD 

Maia Ray, MD 

Pojchawan Yampikulsakul, MD 

Jeffrey Hammersley, MD 

Dorr G. Dearborn, MD, PhD 

Pamela Jacques, MS, CPW, CHES 

Kathleen Morris, MSA, BSN, RN 

Chris Rea, PhD, MPH 

Richard Pellegrini, RCP,RRT 

Kimberly Stanislo, RN, MSN, ARNP 

Cheryl Laubacher, RPh, PharmD 

Shawn Chapman, RRT 

Barbara Rushley, RRT, AE-C 

Amy Pellegrini, RRT-NPS, CPFT 

Oregon 

W. Andrew Harris, MD 

Thomas Jeanne, MD 

Theodore Shultz, MD 

Thomas Stibolt, MD 

Bonnie New, MD, MPH 

Sarah Present, MD, MPH 

Kathy Blaustein, MPH, CPH 

Annee von Borg, MSW, MPH 

Theodora Tsongas, PhD, MS 

Pennsvlvania 

Jeff Campbell, RRT 

1an Eckstein-Makar, RRT, NRP 

Charlotte Galuska, BS, RRT 

Lewis Murray, BS, RRT 

Kenneth Kraut, BS, RRT-NPS 

Jen Mahone, BS, RRT-NPS 

Mariellen McDonald, BSHA, RRT

Kristin Jaros, CPFT 

William Adamson, CRT 

Adrienne Bukovsky, CRT 

Lyubov Gayevaya, CRT 

Charles Hartzell, CRT 

Lindsay Kumiega, CRT 

Nancy Martin, CRT 

Karen Polcino, CRT 

Robert Shellenberger, CRT 

Linda Hughes-Vose, CRT, RPSGT 

Robert Jordan, CRT, RRT 

Susan Wise, CRT, RRT 

Timothy Craig, DO 

Jim Oberdorf, LPN, CRT, RRT, RPFT 

Jennifer Bamford, MD 

Deborah Gentile, MD 

Eric Gibson, MD 

Susan Gregory, MD 

Sukhdev Grover, MD 

Brian Jenssen, MD 

Alisa LoSasso, MD 

Gabriela Marein-Efron, MD 

William McCauley, MD 

Alan Peterson, MD 

Levon Utidjian, MD 

Margaret Wojnar, MD 

Mona Sarfaty, MD MPH 

Leslie Scheunemann, MD, MPH 

Esther Chung, MD, MPH 

Poune Saberi, MD, MPH 

Carla Campbell, MD, MS 

Chen Kenyon, MD, MSHP 

Yasmine Wasfi, MD, PhD 

Natalie Napolitano, MPH, RRT-NPS 

Ada Matthews, MSM, BS, RRT 

Marie Engberg, MSN, CRNP 

Susan Schrand, MSN, CRNP, NP-C 

Dora Martinez-Armstrong, MSN, MPH 

Enelida Gomez, RN 

Erin Johnson, RN, MSN, MPH 

Nancy Berry, RN, MSN 

Ethel Appenzeller, RRT 

Matthew Basile, RRT

6
Tracy Benenson, RRT

Joan Brandts, RRT Rhode Island 

Elaine Chrissos, RRT Michael Fine, MD 

Wayne Codner, RRT Polly Barey, RN 

John Conrad, RRT 

Heather DiMatteo, RRT South Carolina 

Doreen Fura, RRT William Cook, MD 

Caryl Gallo-Barnett, RRT Aimee Tiller, RN, AE-C 

Mark Harter, RRT Kristal Bagwell, RRT 

Amy Heberling, RRT Robin Sullivan, RRT 

Regena Hengst, RRT Tennessee 

Carol Ingenito, RRT Bruce Henschen, MD 

Donna Knitter, RRT Jatin Kadakia, MD 

Lisa Lauritsen, RRT Lacey Snell, RRT-NPS 

Kari Magill, RRT 

Dawn Patterson, RRT Texas 

Gregory Pepe, RRT Lung-Chang Chien, DrPH 

Lauren Reichbaum, RRT Celeste Monforton, DrPH, MPH 

Maureen Romano, RRT Lewis Brown, MD 

Steven Schickman, RRT Harold Farber, MD, MSPH 

Katrina Schlichtkrull, RRT Adele Houghton, MPH 

Ameenah Shaheed, RRT 

Susan Telmanik-Schwartz, RRT Utah 

Melissa Thornborough, RRT Fadi Asfour, MD 

Jamie Vaccaro-Glanfield, RRT Richard Kanner, MD 

Larry Vosburgh, RRT Cheryl Pirozzi, MD 

Robin Walker, RRT Laura Nary, RRT 

Nick Whalen, RRT 

Charles Wielobob, RRT Vireinia 

Azael Hernandez, RRT, RPFT Laura Anderko, RN, PhD 

Cheryl Garner, RRT, AE-C Paula Davidson, RN 

Robert Levin, RRT, RN. CRT, BSN Laure) West, BSN 

Mary Bryner, RRT, RPFT Deborah Mercer, BSN, Patient Educator 

Elizabeth Carr, RRT, RPFT Greg Gelburd, DO 

Eileen Higgins, RRT, RPFT-NPS Deborah Hartz, MA, RN, CDE, CCM 

John W Stoltzfus, RRT, RPSGT Larry Borish, MD 

Cheryl Zearfoss, RRT, RPSGT Zachary Bush, MD 

loan Richards, RRT, NPS, AE-C Kevin Cooper, MD 

Tony Ruppert, RRT-ACCS, CPFT Thomas Daniel's, MD 

Saralyn Foley, RRT-AE-C Janet Eddy, MD 

Bradley Lavan, RRT-NPS Alpha Fowler, MD 

Danielle Mertz, RRT-NPS Dan Grinnan, MD 

Vicki South, RT Catherine Grossman, MD

7 
Stephen Shield, MD 

Andrew Woods, MD 

Christopher Lillis, MD, FACP 

Nauman Chaudary, MD, FACP, CFFP 

Robert Leek, MHA 

Amy Paulson, MPH, AE-C 

Teresa Polk, MSA, RN 

Daniel Rowley, MSc, RRT-ACCS, NPS, RPFT 

Sarah Southard, MSN, PPCNP-BC, AE-C 

Gayle Slifka, PharmD 

Sarah Parnapy Jawaid, Pharmacist 

Scott Ickes, PhD 

Mary O'Laughlen, PhD 

Alison Scott, PhD 

leanne Erickson, PhD, RN 

Chase Poulsen, PhD, RRT-NPS; ACCS 

Kendra Fink, RD 

Linda Hudgens, RN 

Rebecca Geary, RN, BSN 

Cheryl Burnette, RRT, CTTS 

Gail Bush, RRT-NPS, AE-C 

Linda Cochran, RRT-NPS, AE-C, CPFT 

Vermont 

Laurie Leclair, MD 

David Kaminsky, MD 

J S Weisfeld, MD, MPH 

Karen Stewart, MPH, LMT 

Daniel Weiss, MD, PhD 

Washineton 

David Park, MD 

Randall Curtis, MD, MPH 

Nicole Lucero, MPH 

Kathleen McGovern, OMS I 

Steven Gilbert, PhD 

Wisconsin 

lanet Anderson, BA, CPFT, RRT 

Richard Gaeta, BS 

Virginia Sheppard, BSN, AE-C 

Dawn Alberts, BSN, RN-BC 

Ingrid Andersson, CNM, RN, MSN

Rachel Tybor, CPM, LM 

Anja Freudenreich, CRT 

Dorian James, CRT 

Scott Karstenson, CRT, RCP 

Kathleen Roebber, MA, BSN 

Kristen Grimes, MAOM, MCHES 

Ann Behrmann, MD 

Joel Carroll, MD 

Claire Gervais, MD 

Elizabeth Gore, MD 

Mitchell Grayson, MD 

Ted Gronski, MD 

Todd Mahr, MD 

Juan P. Ruiz, MD 

Monica Vohmann, MD 

Pamela A. Wilson, MD 

Heidi Zafra, MD 

Terrell Brock, MPH, RD 

Kathleen Shanovich, MS, RN, CPNP 

Sara Lowe, MSN, APNP, CPNP, AE-C 

Elly Fatehi, PharmD 

Erika Horstmann, PharmD, RPh 

Traci Kouhel, RN 

Sara Motisi-Olah, RN 

Jane Shabtaie, RN 

Lisa Turner, RN 

Debbie Yohn, RN 

Laurie Smrz, RN, AE-C 

Ann Schlimgen, RN, BSN, AE-C 

Deborah Grayson, RN, MSN, MPH 

Mary Koller, RN, BSN 

Kimberly Granger, RN, MSN, FNP-C, AE-C 

Rhonda Duerst, RRT-NPS 

West Vireinia 

Anne Berry, MD

8