Physicians encouraged to be patient, act as policy advocates during wildfire season
Click Here to Manage Email Alerts
Key takeaways:
- Particulate matter presents the greatest dangers to respiratory health.
- Physicians can help patients prepare emergency action kits and clean air rooms.
- Doctors and nurses are among the most trusted voices.
As smoke from wildfires in Canada continues to impact the East Coast, the American Lung Association advises patients and physicians to take steps to prevent asthma exacerbations and other respiratory complications.
Physicians also can speak up in the fight against the climate change driving these blazes, which are increasing in size, frequency and intensity, according to the American Lung Association.
“Living on the East Coast, in my time here, I certainly haven’t experienced anything like the levels of wildfire smoke that we saw a couple of weeks ago and that I’m sure a lot of the country is still experiencing now,” Laura Kate Bender, national assistant vice president of healthy air at the Lung Association, told Healio.
Over the past decade, Canada has averaged 2,068 wildfires including 23 prescribed fires impacting 393,743 hectares each year. So far in 2023, there have been 2,765 wildfires including 1,181 prescribed fires burning 5,958,026 hectares.
“Canada’s wildfire season is off to a huge and early start. It’s creating these smoke events unlike things in recent memory in a lot of states,” Bender said.
Among other pollutants, wildfires generate fine particulate matter, especially particulate matter at the 2.5 µm scale.
“The big danger with particles is that the smaller they are, the more damage they tend to do. The smallest ones can penetrate deep into the lungs and even into the bloodstream,” Bender said. “That’s really what’s driving a lot of the health impacts.”
In the short term, Bender said, exposure to particulate matter in wildfire smoke can trigger coughing, wheezing, shortness of breath, increases in heart rate and irritation.
“If you have asthma or COPD or another lung disease, you can experience these exacerbations,” she said.
In the long term, Bender continued, particulate matter also has been linked to lung cancer and premature deaths with other negative effects on the heart and lungs, in addition to reproductive and developmental health such as low birth weight.
Wildfires also release other toxins into the air, especially as they jump from forests to developed areas.
“You can imagine a home burning and everything inside that home, and then everything inside the garage, all the things that might be released from there into the atmosphere that can certainly pose additional health risks beyond wood smoke,” Bender said.
Patients with asthma are at greater risk for exacerbations due to these pollutants during wildfire season, Bender said.
“As a person with asthma, I have been taking extra care to keep an eye on the air quality forecast and change my outdoor activities accordingly,” Bender said. “If you have asthma, you have that baseline amount of swelling in your airways. They’re just extra sensitive to pollutants that can lead to asthma symptoms or exacerbations.”
Some populations are more vulnerable to unhealthy levels of particle pollution as well, Bender said, such as children, the elderly, patients with heart and lung disease and people who work or spend a lot of time outdoors.
People who live in areas with limited access to health care as well as communities that have been redlined or underinvested also are at risk, in addition to people of color and people with low incomes, Bender said.
“You might even be living in an area that’s exposed to unhealthy levels of air pollution already, and this is adding to an already too high burden,” Bender said.
Despite these challenges, people can take steps to mitigate the impact of poor air quality due to wildfires, Bender said.
“Stay indoors when you can. If you have to go outdoors, it’s not a perfect solution, but a well-fitted N95 or KN95 mask that fully covers your face can help filter out some of that particulate matter,” Bender said.
These masks should fit securely, according to the Lung Association, and they do not work for children or people with beards. Also, the Lun Association advised, patients should not use dust or surgical masks because they do not filter out harmful particles.
Patients with asthma who do not need to evacuate from areas impacted by wildfire smoke also can create indoor spaces in their homes where they keep the air as clean as possible by keeping doors and windows shut, running a properly sized air purifier with a HEPA filter, and setting central air conditioning systems to recirculation, Bender said.
“Spend as much time in there as possible to avoid as much of the outdoor smoke coming in as you can,” she said.
Physicians can guide their patients through these mitigation measures, including resources available at lung.org/wildfires, Bender said, in addition to developing an asthma action plan.
“It’s an individualized worksheet that gives the patient the steps they need to take to keep their asthma from getting worse — what to do when there’s an exacerbation, when to call their providers or go to the ER,” Bender said. “It’s especially important in times of these levels of wildfire smoke.”
Physicians should work with patients to ensure their asthma is well controlled by taking all recommended medications as well.
“They can also recommend their patients put together an emergency kit — food, water, first aid kit, medications, respirator and mask,” Bender said.
Beyond helping individual patients, Bender encouraged physicians to join the fight against climate change, which she said is driving these wildfires.
“Climate change makes conditions for major wildfires more likely,” Bender said. “Climate change is leading to hotter temperatures and more droughts.”
Overall, Bender said, advocates can build on the work that the federal and state governments already have accomplished to reduce the emissions that cause climate change.
“The Lung Association sets as our north star a zero-emission future,” Bender said. “We need to be cleaning up sources of emissions that are not only driving climate change but also adding more particle pollution on top of what we’re seeing from the fires.”
People listen when physicians speak up, Bender said.
“I always like to encourage health professionals — providers, nurses, everyone — that they have a lot of expertise to contribute and that their voices are valued,” Bender said. “We consistently see polling that nurses and doctors are among the most trusted voices in the country, and we know that policymakers value their voices.”
The Lung Association website offers resources for advocacy at lung.org/healthyair. The organization’s efforts include meetings with lawmakers, testimonies before the EPA, scientific studies, public opinion polls, media campaigns and litigation.
Lung Association priorities include the elimination of health disparities and the building of health equity; increased funding for research, prevention, diagnosis, treatment and cures for all lung diseases; and increased funding for public health infrastructure and programs that impact lung health.
In addition to protecting lung health from the impacts of climate change, the Lung Association supports up-to-date clean air standards and the Clean Air Act; cleaning up sources of outdoor air pollution; reducing radon and other indoor air pollutants; and increasing funding for lung-related behavioral and environmental research and training.
“It is so important that health professionals use their voices and their experiences to advocate for the health of their patients because, as we’re seeing with these wildfire events, there’s only so much that we can control in the medical office and inside our own homes,” Bender said.
Reference:
- National Wildland Fire Situation Report. https://cwfis.cfs.nrcan.gc.ca/report. Published June 21, 2023. Accessed June 29, 2023.
For more information:
Laura Kate Bender can be reached at laura.bender@lung.org.