## 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

2Carlos 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

3Maine 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 Peterporan, 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

ClChristine 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

5William 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

6Tracy 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

7Stephen 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

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