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Increased environmental controls over outdoor and indoor air pollution will also improve quality of life of the patient with bronchial asthma as well as the entire population. Federal guidelines for outdoor pollution have been established under the Clean Air Act amended in 1990. It covers automobiles and industry and sets air quality standards. Regional compliance with these standards has yet to be achieved, although progress has been made recently. Some states have passed laws with stricter standards that continue to tighten controls over automobile exhaust and the industrial combustion of fuels. Gasoline-engine manufacturers have reduced harmful emissions in their new vehicles by nearly 90 percent over the past twenty-five years, but makers of diesel engines have reduced noxious exhaust fumes by only half that percentage. New EPA guidelines, drafted in 1995 aim to reduce diesel emissions by another 50 percent by 2004. Increased attention has also been directed at control of chlorofluorocarbon propellants that destroy the ozone layer. Although some progress has been made toward cleaner air, air pollution will continue to be a major source of lung disease well into the next century. Greater attention must also be paid to "indoor pollution." This problem is now largely unregulated. Standards developed for outdoor pollution cannot be applied equally indoors. Fortunately, great strides have been made to restrict cigarette smoking. Further restrictions and ultimately a total ban on public smoking would be an important step toward reducing indoor and outdoor pollution as well as improving the general health of the entire population. Every patient can be an active voice for improving the environment. Forming a Partnership against Asthma with Your Physician Although medications are likely to be better in the future, patients must maintain an active role in preventing asthma attacks, particularly by avoiding and reducing irritants and allergens in their home and work environments. If you have asthma, it is vital to acknowledge that you have a problem, then to deal with it by working with your physician. Tho often, denying the problem only leads to unnecessary illness. This first step may be the most important in a series of measures you can take to avoid asthma attacks. Other measures include an "early warning system" that relies on home peak flow measurements and close communication between patients and their physicians to prevent serious and even potentially fatal attacks. Patient education should be given a high priority by physicians and their staffs. Self-education should always be encouraged. Through dialogue and education patients can recognize when they must call for assistance, thereby avoiding the life-threatening tendency to "push through" a serious asthma attack on their own. This partnership between patients and physicians, both working toward reducing the frequency and severity of attacks, can succeed in improving the quality of life for those who have asthma. Cooperation can also reduce the number of fatal asthma attacks that often could have been prevented by earlier recognition and treatment of this largely reversible disease.
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