Opponents of stricter regulations for air pollution try to minimize the adverse health effects of outdoor air by pointing to the role of indoor pollution in illnesses like asthma. However, research on the significance of indoor hazards does not get outdoor pollution off the hook. Both indoor and outdoor pollutants increase the frequency and severity of breathing problems for asthma sufferers. Therefore, there is a need to control both exposure pathways.

Asthma is the most common chronic disease of childhood. Prevalence has more than doubled in the last two decades. Deaths of children from asthma, now nearly 1,500 a year, increased by 50% in the 1980s. Urban poor children are at greatest risk. The American Lung Association estimates that in the Cleveland area 23,000 children suffer from asthma.

It is not known why asthma rates have increased in the last several years, particularly among children. But we do know that with the greater prevalence of asthma (whatever the cause), many more people are now especially sensitive to both indoor and outdoor pollution.

There is a natural division of responsibility in the control of indoor and outdoor pollutants that trigger asthma attacks. For example, there are things that parents can do to reduce their children's exposures to tobacco smoke, roach dust, dust mites and molds. Landlords have a responsibility to provide housing that is free of roach infestation, water leaks and other defects which give rise to asthma hazards. But neither parents nor landlords control pollution in the outdoor air. That must be done by government and industry.

Lead poisoning is a good example of the division of responsibility for indoor and outdoor pollution. Until the early 1980s, when EPA regulations began to remove lead from gasoline and to reduce industrial lead emissions, an astonishing 88% of children nationally were lead poisoned (by the current definition), as compared to less than 2% today. This is a dramatic public health success, though lead poisoning levels are still unacceptably high, particularly among poor children living in deteriorated housing. Parents and building owners still have a serious responsibility to protect children from lead paint hazards and soil contaminated from past leaded gasoline use. But these measures by themselves, without the dramatic drop in air lead levels, would never have reduced lead poisoning so substantially.

A brochure from the Northeast Ohio Ozone Task Force warns parents of asthmatic children that on high ozone days they should limit their children's time outdoors. Do we really want a public health policy which tells parents of asthmatic children to try to find a safe place in the house where their children must hide when the outside air is too damaging to their lungs?