Bernadette M. Longo, PhD,RN, Brian Panik, DO, FAAEM, FACOEP, FACEP, Brianne Dacalio.
This information for distribution as a trifold community handout for registered TFH members.
Vog is commonly thought of as a mixture of sulfur gases and particles that appear visible as a fog. However, it can also be an invisible gas consisting primarily of sulfur dioxide. The Ka' *ū community knows vog as the “unwanted thing.”¹ We, the people of Hawaii, are able to identify vog in the air by sight, and occasionally by smell or even taste during high exposure; but there is much more to know. We need to be informed and akamai about this issue so that we can maintain a healthy lifestyle here on our island paradise.
EXPOSURE
Many of us on island feel that we are able to identify times when the sulfur dioxide (SO2) levels are high by looking in the air for a misty haze, occasionally even smelling or tasting the SO2. Although many individuals can be highly accurate with this simple and direct detection, the SO2 levels can still trick us. When the skies seem to be clear of vog, there may still be some low levels of particulate matter (PM) present. There can also be dangerously high levels of SO2 in the air, when the skies are clear, which can cause harm and endanger our people.
Regions exposed to high vog levels may vary due to conditions such as the amount of SO2 and PM that Kilauea has recently emitted, the direction of the winds (Trade winds vs. Kona winds), and the time of day.¹ The prevailing North East Pacific Trade winds carry volcanic air pollution “downwind” from sites of emission during daylight hours. This is responsible on the Big Island for the Ka‘ū district’s daily pattern of vog.² Studies have shown that the Ka‘ū district receives the highest vog exposure from 7:00 PM to 10:00 AM daily (evening to midmorning hours when the Trade wind effect subsides).³ When the Trade wind patterns reverse for an extended time period, and the Kona winds come in from the South; they tend to bring the vog towards the less frequently affected Eastern parts of the Big Island (Hilo, Hamakua, North Kohala).
AVOIDANCE
One simple way to avoid vog exposure when the SO2 levels are high would be to simply close your windows. This is an especially good method to implement at night while sleeping. However indoor SO2 levels can still be 59-69% of the outdoor level, so another suggestion would be to seek spaces with air conditioning (A/C).² Its use has been shown to reduce indoor air pollution, including that from vog. When in your car close the windows and, if possible, turn the A/C on with the mode set to recirculation to prevent new particulate matter and SO2 from entering your vehicle. While the costs of A/C can be expensive, there are public places including libraries, which can provide a place of refuge. In Pahala, the public library is one of the largest buildings in town and it provides A/C to its patrons. Studies have shown that this facility was one of the best places to be during times of high vog exposure.³
SPECIAL (SPECIFIC) GROUPS
KEIKI (CHILDREN), SMOKERS, ASTHMATICS, COPD (EMPHYSEMA)
All of these specific groups hold a high priority in community health and should visit their Physician or Emergency Department (ED) as soon as they are experiencing any general symptoms, which include:
• Eye Irritation
• Sore or Dry Throat
• Daily Cough
• Sinus Congestion
• Wheezing
• Rash, Vog can be a dermal Irritant (for those with sensitive skin)²
KEIKI (CHILDREN)
Vog is more harmful and dangerous to children and adolescents 14 years old and younger. Children have several known reasons for an increased susceptibility to vog: (1) higher ventilation rates, (2) increased mouth breathing, (3) enhanced physical activity with higher oxygen demands, (4) a larger lung surface area per unit of body weight, (5) the ongoing development of respiratory organs. Increased breathing through the mouth as opposed to the nose, results in less nasal filtering by the nasal passages. This can lead to an increased respiratory rate, which further leads to less efficient filtering of vog. As you can see this cycle leads to an increasing severity of symptoms. It is important for parents to notice any symptoms that their child may be experiencing so that immediate care, from their Physician or The Emergency Department, can be provided.
SMOKERS
Smokers, having a damaged respiratory system, are more susceptible to air pollution. They have been categorized as “being the most affected by the vog since they experience more daily phlegm (thick mucus).³ Smokers should start by taking the first steps to quit, including consulting their physician for help and seeking the support of their family and friends, with the long-term goal of quitting permanently.
ASTHMATICS
Asthmatic in the communities exposed to vog described having “difficulty controlling their disease.”³ When exposed to vog, asthmatics experience more frequent and intense wheezing and shortness of breath. Inhaler care is one of the most important factors for those with asthma.
INHALER CARE
Here are some guidelines for inhaler care:
1. Check the expiration date
2. Have one on you at all times
3. Make sure it is properly working in case of an emergency
4. “New” environmentally friendly inhalers can clog more frequently, and thus require more frequent care
5. Clean inhaler by separating it and running plastic portion under warm water
6. Verify spray by direct visualization
COPD (EMPHYSEMA)
Chronic Obstructive Pulmonary Disease (COPD) includes emphysema, chronic bronchitis, and asthma. This condition can cause difficulty with breathing and can become a progressive condition.⁴ Avoiding vog, taking your medications daily as prescribed, and, in a worst case scenario, being placed on ventilator is necessary to help regulate and control this condition.
EVERYONE ELSE IN THE COMMUNITY
Individuals not in the “special groups” can still be affected by exposure to vog with a condition called Chemical Pneumonitis. This condition is an inflammation of the lungs or difficulty in breathing due to the inhalation of chemical fumes.⁵ It is frequently misidentified as “bronchitis” or “pneumonia” by the community.
MAINTAINING A HEALTHY LIFESTYLE
• Act early and quickly if you experience trouble breathing, coughing, or tightness in your chest
• Take prescribed medications daily as prescribed and have them nearby in case of an emergency
• Drink water (except if on a fluid restriction) to help proper hydration
• Check your blood pressure (it is reported that exposed individuals have shown an increased BP)
• Make an effort to quit smoking or limit daily smoking
• Increase your knowledge of vog and its effects on the community
BE ALERT WHEN LEVELS ARE HIGH
• Stay indoors and keep windows closed
• Use A/C if available
• If you have breathing problems (asthma, bronchitis, emphysema, heart disease) limit physical activity
• Open windows after the levels of SO2 have dropped
• Monitor current air conditions
o Call 1-866-767-5044 for the daily Vog Index Report
o Go online at http://www.hiso2index.info/ for the Hawai‘i Short Term SO2Alert Index
Join the community discussions online
o ToFindHealth.com
http://www.tofindhealth.com/forums/register.php
o Respiratory and Vog Forums
http://www.tofindhealth.com/forums/forumdisplay.php/98
¹ Longo, Bernadette M. "The Kilauea Volcano Adult Health Study." Nursing Research (January/ February 2009): 23-31.
² Longo, Bernadette M and Wei Yang. "Acute Bronchitis and Volcanic Air Pollution." Journal of Toxicology and Environmental Health (2008).
³ Longo, B., et al. "An Indoor Air Quality Assessment For Vulnerable Populations Exposed To Volcanic Vog From Kilauea Volcano." Wolters Kluiwer Health (2010).
⁴ Barkin, Roger and Peter Rosen. Rosen and Barkin's 5-Min Emergency Medicine Consult (2nd Edition). Philadelphia, PA: Lippincott Williams/ Wilkins, 2003.
⁵ "Chemical pneumonitis: MedlinePlus Medical Encyclopedia." 25 June2010.MedlinePlus.June2010
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