Years ago, when I was the only otolaryngologist in Columbia County, Pennsylvania, I treated a young boy with allergies. We had tested him, confirmed his sensitivities, and gotten him stable: a daily antihistamine, a nasal steroid spray, and allergy shots he received in my office. He was doing well. Then, at the end of one summer, he went back to school and fell apart. His controlled allergies flared. His asthma turned unstable. I escalated everything I had, a steroid inhaler, a leukotriene inhibitor, a rescue inhaler kept at school for emergencies, and still could not hold him. He ended up needing a pediatric pulmonologist in the next county.
What stopped me was the timing. He had been symptom-free all summer. The crash came the week he walked back into the building.
So his mother and I put a request to the school administration in writing: Test the air. They did. The air samples came back loaded with mold spores, because the school was in the middle of a renovation. We retested the boy, and he was sensitive to that exact allergen. No combination of inhalers was ever going to win that fight, because the problem was not in his chest. It was in the building. The district moved him to a different school and paid for his transportation. He settled in, and his airway inflammation improved.
I have never forgotten the lesson: Sometimes the most powerful prescription is changing the air a patient breathes.
Now I practice in metro Phoenix, where the air tells a different version of the same story. We have a lot of bad-air days here, with ozone and particulates. On those days the local news runs the same advice: Carpool, do not let your engine idle, fuel up after dark, skip the outdoor workout. That advice exists for a reason. What we breathe reaches the airway, and the airway reacts.
Here is what I see in my office, and why it worries me. In my practice, a meaningful share of patients with chronic airway inflammation, roughly a quarter, test negative for any allergy at all. I cannot find anything they are allergic to. And yet their mucosa is inflamed. They spend time outdoors, and when you irritate that lining, with ozone, with particulates, it sends signals through the immune system, and the person feels those signals as the beginning of an infection. Pressure, drainage, congestion, that unmistakable “I’m getting sick” feeling. But many of them never had a bacterial infection. Not once. What they had was a virus, or an immune response to mucosal irritation from the air.
The trouble is what happens next. They go to urgent care or their primary doctor, and they leave with an antibiotic. A few days later they feel better, and now we have a problem, because they have drawn the wrong conclusion. Some antibiotics, the macrolides like the Z-Pak, have real anti-inflammatory effects that are entirely separate from killing bacteria. So the improvement may have come from a virus simply running its course, or from the anti-inflammatory effect of the drug, not from wiping out an infection that was never there.
The patient’s logic, though, is clean and completely understandable: I was sick, I took the antibiotic, I got better, so the antibiotic must have killed the bug. The next time they feel that same irritation, the request to the doctor is, “Can I have what worked last time?” And what worked last time was the Z-Pak.
That is how resistance gets built, one reasonable-sounding refill at a time. Each unnecessary course kills off the healthy, protective bacteria that live in the nose and sinuses. Resistant organisms can move into the empty space, set up biofilms, and dig in. Eventually that patient lands in my office with disease that is genuinely hard to treat.
Now layer the air back on top. Here is the cycle I see play out. If that same patient also has airway inflammation driven by pollution, they are sicker to begin with and slower to recover. As the resistant bacteria take hold, the mucosal immune system calls in reinforcements, more antibodies, killer T cells, and the patient feels that immune activity as yet another infection. Back to urgent care, back to the antibiotic, back to the brief anti-inflammatory relief that confirms the false belief. Round and round. It is a vicious cycle, and dirtier air turns the wheel faster.
This is the part that stays with me when I read about proposals to weaken the rules that limit tailpipe pollution. I am not writing as a policymaker; I am writing as the physician these patients eventually reach. From where I sit, cleaner air is not an abstraction. It is fewer inflamed airways, fewer mistaken infections, and fewer unnecessary antibiotics priming the next wave of resistance. Loosen those protections, and the bill comes due in my exam room.
But you do not have to wait on anyone in Washington to protect your own airway. Own your air.
Clean the air you can control. Change the filters in your home. Pay attention to your local air quality the way you would check the weather, and on bad days take the same advice we give here: Limit the outdoor exposure you do not need. After you have been outside on a high-pollution day, rinse your nose with saline; it physically washes the pollutants off the mucosa before they can do their work. Saline irrigation is not folk advice. It carries a strong recommendation in the current national sinusitis guidelines.
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And when you do feel that “getting sick” feeling, pause before you reach for an antibiotic. Try the over-the-counter measures first, and give it time. Most of these episodes are viral or inflammatory and resolve on their own within a week to ten days. If you are getting worse, or you are still sick after ten days, that is when to be seen.
The boy in Pennsylvania did not get better because we found the perfect inhaler. He got better when we changed his air. Most of my patients can’t simply leave the building making them sick, the way that boy did, but they can own the air they breathe, and they can stop feeding a cycle that was never going to cure them. That is a prescription anyone can fill.
Franklyn R. Gergits is a board-certified otolaryngologist and fellowship-trained otolaryngic allergist with a clinical focus in rhinology and airway disorders and more than 30 years of clinical experience. He is affiliated with HonorHealth Scottsdale Shea Medical Center and is the founder of Sinus & Allergy Wellness Center of North Scottsdale.
Dr. Gergits performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK posterior nasal nerve ablation, and Eustachian tube dilation under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania and holds dual Entellus Centers of Excellence certifications.
His recent scholarly work includes “Posterior Sinonasal Syndrome: A Pepsin-Mediated Hypothesis for Chronic Rhinosinusitis” and “The Continuous Mucosal Liquid Layer: A Unified Hypothesis for Airway-Digestive Immune Surveillance, Mucociliary Transport, and Disease Susceptibility.” His ORCID profile is available at ORCID. He also publishes patient education and clinical commentary through the Airway & Sinus Wellness Review and shares updates through Facebook, Instagram, LinkedIn, X, YouTube, and TikTok.
