Wildfire Smoke is Sending More People to the Hospital. Here's How to Stay Safe.

Wildfires are increasingly becoming a fact of life during the warmer months, destroying forests, homes, and anything in their path. But you may not realize that they also pose a different kind of public health threat. Wildfire smoke contains acids, chemicals, metals, and other harmful substances, collectively known as particulate matter, or particulate pollution.

Particulate matter is microscopic. It’s inhaled when you breathe and gets into your lungs or even the bloodstream. It causes cough, headaches, shortness of breath, increased heart rate, and more. And it’s ten times worse for your respiratory health than anything else you ever inhale.

Because particulate matter aggravates preexisting conditions, the risk of adverse reactions is greater if you have asthma, Chronic Obstructive Pulmonary Disease (COPD), heart disease, and other chronic health issues. It’s also worse for people who are pregnant, children, and older adults. But wildfire smoke does not discriminate. Inhaling it may increase the risk of heart attack, stroke, and damage to vital organs, even if you’re otherwise healthy. The Canadian wildfires of spring 2023 led to a 17% spike in asthma-related hospital visits.

We spoke with pulmonologist Aliva De, MD, to find out more about what we saw during last year’s wildfires, what to expect going forward, and how to prepare for wildfire smoke polluting the air.

What did you see in New York City in June 2023? Have you ever seen anything like this before?

There was an increase in the number of children experiencing cough and respiratory symptoms during a time of the year when the usual seasonal allergy-related exacerbations start to wane.

The unexpected and quick deterioration of the air quality was a surprise for both patients and providers. It invoked panic and uncertainty. There were several phone calls from concerned parents seeking advice on how to protect their children. Little information was available as this was unprecedented in our region.

Further, inadequate ventilation systems for some New York City homes and schools exposed how unprepared we were to tackle a catastrophe of this kind.

What are the risks of breathing in wildfire smoke if you are healthy?

For otherwise healthy people, exposure to wildfire smoke can lead to stinging eyes, congested sinuses, shortness of breath, headaches, coughing, and more.

We need more studies to determine the long-term effects of wildfire smoke exposure in healthy people.

If you are sick or have a chronic health condition, what are the risks of breathing in wildfire smoke?

Wildfire smoke inhalation is particularly dangerous for children, young adults, elderly people, pregnant women, and anyone with pre-existing respiratory and cardiac diseases, particularly, asthma and chronic obstructive pulmonary disease. Smoke and particle pollution can trigger asthma attacks and cause heart attacks or strokes in vulnerable populations.

Why are children more susceptible to smoke and bad air quality?

Children have smaller-sized airways and respiratory tracts that can more easily constrict in response to smoke and lead to coughing and wheezing.

Will wildfires cause more asthma in the future?

Yes. More wildfires can definitely cause increased asthma.

A major component of wildlife smoke is particulate matter. Studies have connected particulate matter with an increased incidence of asthma. The effects are particularly worse for people living in densely populated urban areas.

Why is particulate matter dangerous to the lungs (and overall health)?

Particulate matter comprises ultrafine-sized particles containing a mixture of solid and liquid droplets suspended in the air. They are often produced by combustion-related activities such as wildfires.

Given their minute size, particulate matter can:

• evade the normal respiratory system barriers
• penetrate very deep into the lung
• damage the alveolar cells in the lungs
• trigger toxic reactions
• trigger inflammatory processes, including DNA breaks and damage

These reactions lead to an increase in respiratory illnesses such as asthma, bronchitis, and colds, as well as reduced lung function. They also increase other cardiopulmonary diseases, promote carcinogenesis (when normal cells turn into cancerous ones), and increase the number of deaths.

What should you do if you or your loved ones inhale wildfire smoke?

We generally recommend a few things:

• Stay indoors as much as possible during bad air quality days
• Use an air cleaner with a filter to keep the indoor air clean
• Use tested and approved respirator masks when outdoors to minimize smoke inhalation
• After smoke exposure, wash off all exposed surfaces with clean water
• If there is nasal congestion or sinus irritation, using saline nasal irrigation can clean the nasal passages of smoke particles
• If you have asthma, rescue inhalers can be used pre-emptively.

When should someone seek medical help when wildfire smoke is in the air?

There are a couple of really important things to remember in a situation with a lot of wildfire smoke.

• If you have asthma, be prepared to increase your rescue inhalers during times of bad air quality. Call your doctor or other healthcare provider for advice if symptoms persist or worsen.
• If you or someone else is in respiratory distress—shortness of breath; wheezing—call 9-1-1. Urgent care is necessary.