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NAPLES, Italy — Whether it’s burning trash or too many cars spewing carbon dioxide, one thing is clear: Naples is not a breath of fresh air.

Just how dangerous breathing that air is, however, depends on whom you ask.

Living in Naples is hazardous to one’s health, said Dr. Silverio Martufi, head pulmonologist at the Monaldi hospital in Naples. Martufi — who says he has an ever-growing patient list — maintains exposure not only is making people sick, but that Naples’ air quality is getting worse.

“Naples rates one of the worst cities for air in both Europe and Italy, along with Milan and Rome, and is getting worse and not better,” he said.

According to a 2006 study by the World Health Organization, long-term effects of particulate matter air pollution and ozone annually accounts for more than 8,000 deaths in Italian cities. Thirteen Italian cities — including Naples — were the subject of the study.

The demise of air quality, as Martufi characterized it, is related to the increased traffic, and a higher circulation of older vehicles that aren’t regulated by stricter emission standards.

“It’s the deadly vehicular emissions that provoke bronchitis and tumors,” Martufi said. His patients suffer from acute asthma and bronchitis to more serious and potentially fatal ailments of chronic bronchitis, pulmonary tumors and cardiac complications.

Martufi, who led his own study in 1997, said the biggest problem is in downtown Naples, where between 16 percent and 20 percent of residents suffered from asthma and respiratory ailments like bronchitis. Comparatively, 4 percent of residents in Naples’ suburbs suffer from those ailments, he said.

Despite those studies, U.S. Navy health experts said the air quality in Naples is no worse — and often is better — than several densely populated U.S. cities.

“There is no increase in the number of incidents of respiratory illnesses here, which has historically been the case, when compared to other urbanized areas,” said Navy Dr. (Cmdr.) Walter Dalitsch. “There is nothing here that is extraordinary or unusual compared to any other urban environment.”

Tell that to Chief Petty Officer Glenn Newton, who said his family has suffered from breathing problems since moving to Naples in November 2004.

“My youngest always has a cough, his sinuses are always messed up. He has permanent head congestion that developed only after we got here,” said Newton, the senior enlisted leader for Antisubmarine Warfare Detachment of Combined Task Force 69. “My oldest suffers from severe headaches. … My wife, she coughs a lot and has sinus problems and associated headaches.”

Newton said it’s the Naples’ air that’s to blame.

“You walk around, and it feels like someone has taken sand and threw in your eyes. It’s a constant irritation, scratchy throat, sinus issues. It’s just horrible, and stuff we didn’t show up with. It’s been a product of our time here.”

But Dalitsch said it could simply be a case of people reacting to their environments. One might suffer from allergies in Virginia, for example, and not experience a sniffle in Naples because of a different environment.

“I think what you’re hearing are the people who are more vocal,” said Dalitsch, part of a team of health experts who talk and meet regularly with Italian public health officials such as veterinarians, air quality professionals and epidemiologists. “What you don’t see are the people who get better when they move here.”

There is no unusual “spike” in the number of patients seeking treatment at the Naval Hospital or clinic related to the air quality, said Capt. Dale Molé, commanding officer of U.S. Naval Hospital Naples. Increases in cases are related to the standard seasonal aliments, such as cold and flu, he said.

Even at the height of the garbage crisis that hit the Campania region earlier this summer — in which tons of uncollected garbage billowed from bins and lined the streets, prompting some residents to burn the refuse — the hospital saw no increase in patients seeking treatment for breathing issues, Molé said.

Newton theorized U.S. officials downplay the health risks to avoid ruffling host-nation sensitivities, even after the U.S. embassy in July issued a warning to U.S. citizens because of the trash crisis.

“I’d like to see our government put a little pressure on the local government to try to get a handle on this, to do something for us here having to endure this,” he said. “I don’t know ... maybe reduce our footprint here if they can’t get it fixed.”

Capt. Floyd Hehe, commanding officer of Naval Support Activity Naples, took exception to the thought.

“Anytime there is a suggestion of people at greater risk, that’s a topic of discussion for us. We have a responsibility to the people here, a responsibility we take seriously,” he said. “We could take actions, like making [Naples] an unaccompanied tour if we thought people were at risk. There are items that would trigger a natural trip wire, and we’re nowhere near that.”

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