NUMBER NECESSARY TO TREAT (NNT) Per Day to Prevent One EVENT CALCULATOR

[Brook et al., Air Quality Index Guidance]

STEP 1. Select A) 10-year ASCVD risk1
or B) Estimated number of COPD or
Asthma events per year 0
STEP 2. Select PM2.5 concentration
converted from the daily AQI for PM2.52

13
STEP 3. Select effectiveness
of intervention to reduce exposure3

15
NNT1 (day)4:
A) ASCVD Estimated Range
(1-20%)
10-500(µg/m3)
15-50 (%) 15
NNT1 (day)4:
1
13
15
B) COPD or Estimated Asthma Events Per Year
(Estimated Range 0.5-4) 0
10-500(µg/m3) 13
15-50 (%) 15
1
13
15

Notes: ASCVD: Atherosclerotic Cardiovascular Disease, a condition caused by plaque buildup in arterial walls that includes:

COPD: Chronic Obstructive Pulmonary Disease.

1. To calculate 10-year ASCVD risk visit ACC website:

*People with pre-existing ASCVD should select '20%'

2. To convert AQI for PM2.5 to PM2.5 concentration visit EPA airnow website (must be >9 µg/m3)

3. AQI activity guidelines Gen pub RecommendationGen pub exposure reduction (range)ASCVD/pulm pt Recommendation ASCVD/pulm dz exposure reduction(range)

Unhealthy for sensitive groups (patients with ASCVD or pulm dz)NANA↓ Prolonged/heavy exertion outdoors15% (10-20%)

Unhealthy (AQI 151-200; PM2.5: 55.5 – 125.4 µg/m3)↓ Prolonged/heavy exertion outdoors15% (10-20%)Avoid prolonged/heavy exertion outdoors25% (20-30%)

Very unhealthy (AQI 201-300; PM2.5: 125.5 – 225.4 µg/m3)Avoid prolonged/heavy exertion outdoors25% (20-30%)Avoid all physical activities outdoors35% (30-40%)

Hazardous (AQI 301-500; PM2.5: 225.5+ µg/m3)Avoid all physical activities outdoors35% (30-40%)Remain indoors/keep activities low50% (40-60%)

Wildfires and severe events (e.g., "hazardous" AQI levels)Remain indoors/keep activities low50% (40-60%)Remain indoors/use PAC50% - 75%

4. Number needed to treat per day to prevent 1 event (ASCVD [fatal or nonfatal MI or stroke]; COPD or Asthma)

5. Note: On February 7, 2024, the U.S. Environmental Protection Agency (EPA) announced a final rule to strengthen the nation’s National Ambient Air Quality Standards (NAAQS) for fine particle pollution, also known as fine particulate matter (PM2.5) or soot.

EPA is setting the level of the primary (health-based) annual PM2.5 standard at 9.0 micrograms per cubic meter (µg/m3) to provide increased public health protection, consistent with the available health science.