Physicians encouraged to be proactive with patients with asthma during wildfire season
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Key takeaways:
- PM2.5 from wildfire smoke is small enough to penetrate deep into the lungs and trigger inflammation and exacerbations.
- Physicians should provide patients with preventive information.
Wildfires such as the current blazes in Canada affecting air quality on the East Coast and in the Midwest are dangerous for patients with asthma and other respiratory diseases.
The smoke from these fires includes particulate matter at diameters of 2.5 µm (PM2.5) and smaller, which can be especially toxic for patients with asthma.
“PM2.5 can penetrate well into the lungs and cause increased inflammation and exacerbate anybody’s asthma,” Paul V. Williams, MD, president-elect of the American Academy of Allergy, Asthma & Immunology, told Healio.
These materials particularly affect patients with more severe asthma or whose asthma is poorly controlled, Williams continued.
Smoke from these fires also includes carbon dioxide, nitrogen dioxide and sulfur dioxide in addition to other chemicals, Tania Elliott, MD, FAAAAI, FACAAI, spokesperson for the American College of Allergy, Asthma and Immunology, told Healio.
“It can trigger asthma attacks, sneezing, congestion and cough,” Elliott said. “It can cause the airways to spasm, a mechanism the body is using to try to get rid of harmful particles that are breathed in.”
Williams noted the presence of hydrocarbons and further substances that may be in this smoke as well.
“There are all sorts of toxins like benzene and other things that are attached to those particles that potentially are carcinogenic in the long term,” he said.
“We know that wildfires release a variety of pollutants into the air,” Brandon J. Hooks, DO, pulmonologist with University of Michigan Health-West, agreed. “These pollutants can have detrimental effects on respiratory health and affect those with underlying lung disease, in particular asthma and COPD.”
In addition to increases in coughing, wheezing and shortness of breath, individuals with pre-existing respiratory conditions are at higher risk for increased exacerbations during wildfire seasons, Hooks continued.
These risks extend beyond asthma and respiratory health and into cardiovascular health as inflammation impacts the heart, with increased risks for cardiac events among people with heart disease, Williams added.
The particles in wildfire smoke can carry pollen too, presenting risks for patients with allergies as pollen grains penetrate deeper into the lungs, Williams said.
“They can cause increased nasal inflammation as well, and the larger particles would do that because they get into the nose,” Williams said. “Larger sizes will get into the nose and cause irritations and sore throats and irritated eyes.”
This inflammation may even make patients who do not have allergies more prone to developing them, Williams said.
“Those who haven’t developed allergies may be at an increased risk for developing allergies and asthma because of that exposure,” he said.
As emeritus physician at Northwest Asthma & Allergy Center in Washington, Williams is familiar with the effects of wildfires.
“We typically will have some issues in the summertime here in the Pacific Northwest, but it’s not as bad as what I saw in New York,” he said.
Williams reported that he and his practice see upticks in patients with increased asthma symptoms when the air quality gets poor.
“It usually doesn’t get bad enough to end up in the emergency room, but there are times when it can be pretty nasty,” he said.
To help patients take preventive action, Williams advises physicians to be proactive.
“If they have a register of their more severe asthmatics, they can get on the phone and remind them about taking precautions or publish something on the practice’s website about these precautions,” Williams said.
Elliott agreed that physicians should work with their patients when wildfires strike.
“Make sure they have adequate medications,” Elliott recommended. “Make sure they have an N95 mask. Have them stay indoors with their windows closed. Avoid the use of gas burning stoves or fireplaces indoors.”
Williams called wildfires a good opportunity to remind patients to take their medications.
“You just want to make sure that they’re taking their inhalers regularly like they’re supposed to be,” Williams said. “And in some patients, you may have to actually increase their dose of inhaled steroids for a short period of time.”
Indoor air filters also may help patients mitigate exposure to wildfire smoke, Williams continued. Further, Williams cautioned physicians about the timing of exacerbations.
“Breathing difficulties may lag a couple of days behind the exposure,” he said.
Hooks also agreed that it is important for physicians and medical providers to educate patients, especially those with respiratory conditions, to take precautions such as staying indoors and using air purifiers, as well as following guidelines from public health authorities.
“By monitoring air quality reports and the air quality index in your region, you can better determine when air pollution from wildfires may be at its worse,” Hooks said.
Hooks also said that it is crucial for patients who are experiencing persistent or worsening breathing symptoms to seek medical attention and to leave areas that are impacted if necessary.
“A general rule of thumb regarding air pollution from wildfires is that the highest levels of pollution are typically experienced in the immediate vicinity and downward of the affected area,” he said.
“If you are in the immediate vicinity of a wildfire, leave the area and seek a safe area away from the region,” Brooks said. “As the distance from the fire increases, the concentration of pollutants gradually decreases.”
As national agencies and other stakeholders expect the size and frequency of wildfires to increase, Williams said that research into their effect on respiratory and cardiovascular disease will grow as well.
In fact, he said, physicians have had epidemiological evidence of the negative effects of wildfires on health for many years. But as the impacts of wildfires spread, as they have with the current fires in Canada, more people with asthma will be affected as well.
“It’s interesting this year. In the past, it has always been, ‘It’s a problem for you guys on the West Coast,’ so the rest of us don’t see it,” Williams said. “But now it’s different.”
For more information:
Paul V. Williams, MD, can be reached at pvwilliams@earthlink.net. Tania Elliott, MD, FAAAAI, FACAAI, can be reached at tania.elliott@nyulangone.org.