Hospital Teaches Lung Patients How to Survive in Smog Zone

Times Staff Writer

When you want to know how bad the smog is in the San Gabriel Valley, you look at the mountains. Big, muscular presences that can fill the windshield of your car in January or February, the San Gabriel Mountains just sort of fade in the haze of summer.

On bad days, like a recent Wednesday, they disappear altogether.

A smoggy day in Pomona-town. By 9 a.m., the San Gabriels are just a faint silhouette in the sky, and the foothills, a mile or so north of the 210 Freeway, are detectable only as a slight variation in texture and color out there in the miasmic gray. Auto emissions and tiny particulates start their photochemical fizz in the sunlight, like an Alka-Seltzer tablet in a glass of water, and the ozone level is climbing rapidly.

At Casa Colina in Pomona, one of Dr. Brian Tiep's patients, attached to a little oxygen tank on wheels, glances out the window. It is the apprehensive look of someone who has spotted a lion circling the house. "On days like today, you feel, uh, sweaty," Lillian McNamara said. "It makes it harder to breathe. Like it's"--groping for the unpleasant word--"close."

McNamara has emphysema. A veteran cigarette smoker, she found recently that she was having serious difficulty breathing. "They brought me to the emergency room," said McNamara, 72, a retired production line inspector. "I don't remember anything between Thursday and Saturday. When I came to, I had all these tubes in me."

Health Neglected

McNamara had been neglecting her health ("Every morning, I had to have my nicotine and my caffeine"), she was out of shape and she lived in Glendora, one of the foothill communities where those great waves of poisonous air from the west come to rest.

By the time Tiep, a rehabilitation specialist who directs the Casa Colina pulmonary rehabilitation program, saw McNamara, she had lost a major part of her lung capacity. "Most of our emphysema patients have probably lost about 75%," said Tiep, a slim, tweedy man with a close-cropped beard.

Nobody is certain what the long-term effects of air pollution are for those who breathe it regularly, but Tiep suspects that it's a major contributor to disease. "About the only statement that you can make right now is that people who are at a high risk for developing lung disease in the first place are more likely to get into trouble in smog," he said.

But the San Gabriel Valley has smog--often in greater quantities than elsewhere--and it has lung disease patients. After 20 years of treating people with emphysema, asthma, pulmonary fibrosis, chronic bronchitis and other lung diseases, Tiep thinks that the link is clearly there. "I believe that some causes of lung scarring may be traced to smog," he said.

Scar tissue, a prime reason that lung patients have breathing difficulties, obstructs the flow of oxygen into the blood.

The pollutants arrive mostly via a quirk of geography and meteorology, said John H. Seinfeld, a Caltech engineering professor who has mapped smog patterns in the Los Angeles Basin.

There is a kind of puddling effect in the region, with offshore summer breezes delivering the smog, which is then trapped by the mountains, Seinfeld said.

"Air comes off the ocean and flows over the basin, picking up emissions from downtown and the western part of the basin and carrying them out to the San Gabriel Valley," he said. "With sunlight acting on them, they react. Ozone builds up as the air moves along, reaching a peak somewhere over the San Gabriel Valley."

Usually catching the brunt of this deleterious wafting action are the foothill communities. The county air-quality measuring station in Glendora, McNamara's hometown, has consistently ranked highest in total days in which federal standards for ozone--a kind of corrosive form of oxygen that causes temporary loss of lung capacity--have been exceeded.

Ozone forms when sunlight reacts with auto and industrial emissions. "It's the worst and the most studied component of smog," Tiep said. "It's an irritant. Its presence will decrease your pulmonary function, causing the airways to tighten down, constrict."

Standard Exceeded

Last year, the Glendora station exceeded the federal ozone standard on 148 days. (The closest competitor in Southern California was Redlands in San Bernardino County, with 130 days above the federal standard.) On 49 days last year, the eastern San Gabriel Valley experienced Stage 1 episodes, meaning that, because of the concentration of ozone, the air quality was declared "very unhealthful."

While Glendora is the latest "hot spot," Seinfeld said, its foothill neighbors, from Azusa to Pomona, are "almost certainly just as high" in smog content.

"I blame smog on my problems," said Emma Furness, 81, another longtime Glendora resident who is going through Tiep's program.

Three years ago, Furness was on her way into a theater with some friends. "That's when I really became aware of the problem," she said. "There was this little ramp you had to go up, and I couldn't keep up." She was diagnosed as having emphysema. A thin, fragile-looking woman, Furness says she never had pulmonary problems until she moved to the "smog belt."

But Tiep, most of whose patients come from the San Gabriel Valley, does not subscribe to the old theory that there are good places and bad places for pulmonary patients. "They've even found some evidence of pollution in Antarctica," he said. The world is catching up with all the ideal places, he added. "What happens is that people move to those places, and along with them come cars and industries." The answer is to clean up existing pollutants, he said.

Not that life is finished for Tiep's patients. Until about 20 years ago, lung patients were told to take it easy. "Essentially they were waiting around to die," Tiep said. But the doctor and his team of amiable rehabilitation specialists put their patients through a stiff three-week regimen of exercise and training to get the patients to use their remaining lung power more efficiently. "We can teach them to cope with lung disease," Tiep said.

Pulmonary Rehab is in a brightly lit wing of the hospital, far from outside smells, such as cigarette smoke or perfume, that might touch off a reaction in already irritated lungs. Despite the agonizing effort of the patients, who arduously pedal "arm bicycles," pace on treadmills or hike the hospital's long hallways, it's an upbeat place, with a high value placed on jokes and laughter.

Plays Violin

Tiep, who on special occasions plays bluegrass or chamber music on his violin in the ward, likes to greet his patients every morning with hugs. "They have a lot of fun here," said Nikki Gramatikos, the hospital's public relations coordinator. "And he's the prime trouble-maker."

The doctor watches as his patients go through their paces, murmuring encouragement here and there. A thin elderly man, guided by a therapist with a small oxygen tank, paces up and down a corridor in short, hesitant steps. A plastic nosepiece--one of Tiep's inventions--keeps a supply of oxygen near his nostrils, but he groans painfully with each step.

"His breathing method is not exactly where we want it to be yet," Tiep said. "In another week, he won't be groaning."

'Wrong Thing to Do'

Tiep says that lung disease causes its victims to neglect physical conditioning. "The body responds by becoming less active," he said. "You learn subconsciously to avoid those stairs and take the elevator. You learn that walking in from the parking lot should be avoided, so you get to work early so you can park close to the door. That's exactly the wrong thing to do."

There are two reasons for his patients' shortness of breath. "They've got their lung disease, and they're physically unfit," he said. "It's as if you went to bed for six months. Try doing something active when you get up."

The rehabilitation program gets them active again. "We've got to convince them that it's OK to be short of breath, that it's just a step they go through on the way to feeling better," Tiep said.

Tiep and his team also teach them what to do on a day with all the debilitating pollutants floating around. Avoid heavy breathing, try to breathe through your nose (which actually serves as a kind of air filter, warming and humidifying the air) and stay inside.

20-Year Plan

"Ozone is very unstable," the doctor said. "It breaks down in contact with walls and screens. Inside, you're protected from it."

But without drastic measures--such as the Air Quality Management District's 20-year plan to place restrictions on everything from single-passenger cars to barbecue lighter fluid--the program's efforts may be ultimately a losing battle, Tiep said.

The photochemical simmering continues outside. By late afternoon, the ozone level will veer close to the second-stage, or "hazardous," level. But in Pulmonary Rehab, the treatment continues.

Carl Glenn, a retired truck driver from Azusa, is about to go for a personal best. When he was first examined by Tiep two months ago, Glenn was bedridden, on bottled oxygen 24 hours a day. But today he is going to take an hourlong hike through Casa Colina's hallways.

Glenn nods toward the window. "Out there, I wouldn't last 15 minutes," he said.

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