Among the authors for this work were researchers from the , Louisville Metro Department of Public Health and Wellness, Louisville Metro Office of Civic Innovation and Technology, Family Allergy & Asthma, Columbia University Mailman School of Public Health, Propeller Health, University of California Berkeley, Harvard TH Chan School of Public Health, University of Texas at Austin and Colorado State University.

Coal-fired power plants are known to emit pollutants associated with adverse health effects, including increased asthma attacks, asthma-related ED visits and hospitalizations. In 2014, coal-fired power plants accounted for 63 percent of economy-wide emissions of sulfur dioxide (SO₂) in the United States. Historically, Kentucky has ranked among the top five states in the U.S. for emissions from power generation.

Starting with a pilot in 2012, the city of Louisville embarked on a project called , which aimed to use data from digital inhaler sensors to gain insights into the impact of local air quality on the burden of respiratory disease in the community. More than 1,200 Louisville residents with asthma and COPD were equipped with sensors produced by , which attach to patients’ existing inhalers and deliver insights on medication use, symptoms and environmental factors to an app on their smartphone.

Between 2013 and 2016, one coal-fired power plant in the Louisville area retired coal as an energy source and three others installed stricter emission controls to comply with regulations from the U.S. Environmental Protection Agency. Researchers took advantage of these circumstances to analyze the impact of the coal-fired power plant energy transitions on residents’ respiratory health, using data from Propeller and local hospitals to assess how asthma-related symptoms, ED visits and hospitalizations changed over time.

The study looked at the frequency of the total number of asthma-related ED visits and hospitalizations per ZIP code in Jefferson County, where Louisville is located, as well as the frequency of asthma rescue medication use among 207 people. Data on rescue medication use for asthma was used as a proxy for patients’ symptoms, as patients use their rescue medication for acute relief from symptoms such as coughing and shortness of breath.

Ted Smith, PhD, director of the Center for Healthy Air, Water and Soil in the UofL Envirome Institute and co-author of the study, said the work confirms important connections between environment and health.

“At the Envirome Institute and the , we are pioneering an approach that puts a focus on place in medicine – the places where people live and how their location affects clinical outcomes,” Smith said. “This research is a great example of the impact of environmental factors on people’s health. Air pollution first affects the lungs, but we know that when people breathe pollutants, it also affects other organs, including the heart.”

The study spanned 2012 to 2017, when four coal-fired power plants in Jefferson County either retired coal or installed stricter SO₂ controls. The researchers found that energy transitions in the spring of 2015 resulted in three fewer hospitalizations and ED visits per ZIP code per quarter in the following year, when comparing areas that had high coal-fired power plant emission exposure prior to the transition to those with lower levels. This translates into nearly 400 avoided hospitalizations and ED visits each year across Jefferson County.

At the individual level, the Mill Creek SO₂ scrubber installed in June 2016 was associated with a 17-percent immediate reduction in rescue medication use, which was maintained thereafter. The study also found the odds of having high rescue use throughout a month (on average more than four puffs per day) was reduced by 32 percent following the June 2016 energy transition.

“AIR Louisville brought together local government, public and private partners and residents for a common mission: To leverage local data to help push for safer and healthier air,” said Louisville Mayor Greg Fischer. “This study demonstrates the public health impact of retiring coal as an energy source or further controlling coal-fired emissions.”

“This study was unique in its ability to measure asthma morbidity based on both hospitalizations and daily symptoms, and to leverage an abrupt change in environmental exposure to more directly attribute changes in asthma exacerbation to changes in coal-fired power plant emissions,” said Joan Casey, PhD, lead author of the paper and assistant professor of environmental health sciences at Columbia University Mailman School of Public Health.

The main funding for the project was provided by the Robert Wood Johnson Foundation. Support also was provided by the Foundation for a Healthy Kentucky, Norton Healthcare Foundation, Owsley Brown Charitable Foundation, the American Lung Association, the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency. The contents of the research and related materials are solely the responsibility of the grantee and do not necessarily represent the official views of the USEPA or the Robert Wood Johnson Foundation.

Led by  Professor Barbara Polivka, PhD, RN, FAAN, the researchers are taking in-home measurements of 85 volatile organic compounds (VOCs), chemicals that easily become gases at room temperature and are emitted from common household items, including paint, aerosol sprays and cleansers. Researchers also are measuring levels of fine particulates, carbon monoxide, carbon dioxide, nitrogen dioxide, temperature, humidity and environmental asthma triggers, including mold and secondhand smoke.

An average of 30 chemicals have been detected in each home and indoor concentrations have been about 7.5 times that of outdoor concentrations.

“One of the things we’re looking at is whether VOCs trigger asthma or make it worse,” Polivka said. “A number of these chemicals have been shown to impact our cardiovascular and respiratory health.”

Average indoor concentrations of several chemicals have exceeded health standards. These include benzene, a known carcinogen found in gasoline, scented candles and carpet glue, and chloroform, which can cause depression and asthma and is found in chlorinated tap water and bleach.

Louisville-area residents may qualify to participate in the study if they meet these requirements:

• Have asthma
• Are 60 or older
• Not a current smoker
• Do not have other major lung disease

Participants will receive a total of $200 in gift cards, asthma trigger control supplies and results of their home environmental assessment.

To see if you qualify to participate, contact asthma@louisville.edu or 502-852-2273.

Thanks to a pledge of $1.05 million throughout five years from the GSG III Foundation Inc., the UofL School of Medicine will create the Gibbs Lung Research Program at the Cardiovascular Innovation Institute (CII). The program will use established research and existing partnerships at CII to develop improved methods for studying diseased lungs and to explore new treatments for inflammatory lung disease.

“Given the number of people in Louisville and Kentucky who suffer from lung diseases, from COPD to cystic fibrosis to asthma, we are happy to support the community by creating a program that can ultimately lead to life-changing therapies for the people of Louisville and across the United States,” said George Gibbs, chair of the GSG III Foundation, which is based in Louisville.

Lung disease is the third leading cause of death in the United States, with chronic obstructive pulmonary disease (COPD) alone affecting 13.5 million people. Inflammation of the lungs is often the first sign of more serious lung disease. However, scientists have limited methods for studying inflammation in lungs to better understand how and why it occurs and to develop treatments.

“Other than lung cancer, most people do not understand the extent of the problem of lung disease,” said Laman Gray Jr., MD, executive and medical director of the CII. “Inflammatory lung diseases are debilitating and affect millions of individuals. What is worse is the scientific world has limited capabilities for studying these diseases. This gift from the GSG III Foundation will allow us to develop expanded modeling opportunities with the goal of reducing human suffering from lung disease.”

More than 70 percent of donor lungs are unusable for transplant. Support from University of Louisville Hospital and Jewish Hospital, both part of KentuckyOne Health, will enable the program’s investigators to obtain donated human lungs that cannot be used for transplant. Researchers in the new program plan to develop techniques to sustain these donor lungs over a longer period of time, allowing them to study the causes of inflammation as well as test potential therapies.

The goals for the program are three-part:

1. Establish an ex vivo human lung model allowing lungs that are unsuitable for transplant to be brought to CII for research. The donated lungs will be enclosed in a sterile plastic dome, attached to a ventilator, pump and filters. The lungs will be maintained at normal body temperature and treated with a bloodless solution containing nutrients, proteins and oxygen.
2. Develop methods for long-term support of the ex vivo lungs. Current processes enable the lungs to be supported for up to 12 hours, which is long enough to transport them for transplant, but not long enough for meaningful study.
3. Once these techniques are in place, researchers in the program intend to use the research models explore areas of potential benefit, including:

• Cell therapy – Explore the use of stem and regenerative cells isolated from a patient’s own fat tissue to treat lung inflammation.
• Mechanics – Develop improved methods of respiratory support by studying the biomechanics of diseased lungs and the benefits of ex-vivo lung perfusion, a method of strengthening lungs outside the body.
• Gene expression – Understand the course of dysfunction and dysregulation among the more than 40 different cell types within the lung and profile the functional changes that occur in diseased lungs and compare the gene expression to healthy lungs.

The program’s investigators will include Gray, James B. Hoying, PhD, division chief, cardiovascular therapeutics, Stuart K. Williams, PhD, division chief, bioficial organs, George Pantalos, PhD, professor of surgery and bioengineering, Victor van Berkel, MD, cardiovascular and thoracic surgeon, and Shizuka Uchida, PhD, associate professor of medicine, all of UofL.

UofL researchers hope the Gibbs Lung Research Program ultimately will become a comprehensive lung research program, leading to valuable treatments that will slow or reverse the course of lung disease, improving quality of life for millions of people.