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ALA State of the Air 2026: Clinician Action
Drs. Vin Gupta and Juanita Mora discuss the recent report and how it should inform clinician actions.
The American Lung Association (ALA)'s 2026 State of the Air report documents a continued and in some measures worsening picture of air quality across the United States. The 27th edition of the annual assessment finds that 44% of Americans — 152.3 million people — live in counties that received failing grades for unhealthy ozone or fine particulate matter (PM2.5) levels, with nearly 4 million more people breathing unhealthy ozone compared with the prior year's report.¹ Failing ozone grades now cover 219 counties across 36 states, the broadest distribution since 2016.¹ The report attributes the trend in part to the compounding influence of climate change on ozone formation conditions, as well as to wildfire smoke events with expanding geographic footprints.¹
Children represent both the most exposed and the most physiologically vulnerable population in these findings. Some 33.5 million children — 46% of those under 18 — live in counties that failed at least one air quality measure, and 7.3 million live in communities failing all 3.¹ Developing lungs are uniquely susceptible to the effects of chronic pollution: children breathe proportionally more air for their body size than adults, spend more time outdoors, and face cumulative developmental consequences from exposure during periods of active lung growth. Hispanic and Latino children bear a disproportionate share of this burden, with the report finding they are approximately 3 times more likely than white children to live in a community that fails all three pollutant grades.¹ Bakersfield, California — which carries both chronic ozone and particle pollution burdens — ranked as the metropolitan area with the worst year-round particle pollution for the seventh consecutive year.¹
HCPLive spoke with Juanita Mora, MD, allergist-immunologist at Chicago Allergy Center and attending physician at Advocate Illinois Masonic Medical Center, and Vin Gupta, MD, MPA, pulmonologist and Managing Director of Health Innovation at Manatt, also of Virginia Mason Medical Center and MS NOW news, about what the 2026 findings mean for patients and for the field. Mora, a medical expert for the ALA, focused on the clinical stakes for children with developing lungs and called on clinicians to engage legislators on maintaining EPA funding and clean air protections. Gupta, an ALA board member, framed the report's value primarily as a public education opportunity, while expressing skepticism that the current administration's regulatory posture will shift in response to it — and arguing that the more effective path forward lies in communicating about air quality in non-divisive, fact-centered terms capable of reaching a broader public over time.
“How do we smartly animate people? I think a lot less of it is stoking division and creating conflict, and it's more about persuasion through just informing… I do think there's a majority of this country, when given facts in a calm, rational, apolitical way, will be able to at least receive that message,” Gupta said.
The full 2026 State of the Air report is available at lung.org/SOTA.
