Q&A: Serious lung health hazards of wildfires, poor air quality
Record high temperatures and raging wildfires, which are currently occurring in California and the western United States, can create dangerous air quality and serious health hazards for people with and without preexisting medical conditions.
Even people who live 25 to 40 miles away from an active wildfire face risks to the lungs and respiratory system.
Healio spoke with Zab Mosenifar, MD, lung specialist, medical director of the Women’s Guild Lung Institute and the Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine at Cedars-Sinai, to learn more about the health hazards of wildfires and poor air quality.
Question: What are the symptoms of exposure to wildfires and poor air quality?
Answer: The normal symptoms of exposure include cough, shortness of breath, sneezing, stuffiness, chest pain, congestion. People with asthma, young children, pregnant women, elderly, patients with heart disease and those with lung disease may experience more severe symptoms. People with asthma, particularly, may experience exacerbation of their symptoms due to poor air quality. People with asthma who inhale particulate matter already have propensity in their airway to be irritable and thus may have severe symptoms. Someone who has no underlying lung disease may experience some of the aforementioned symptoms, but those symptoms generally will not create a massive exacerbation and severe asthma-type reaction.
Q: What are the potential health hazards of wildfires and poor air quality on the lungs — both in the short and the long term?
A: In the short term, vulnerable populations may have increasing symptoms, increasing visits to the emergency department and reduced overall quality of life. Nonvulnerable populations may also have symptoms in the short term. In the long term, small airway dysfunction could develop. Published data have demonstrated that people who have been exposed to wildfires may develop small airway dysfunction and small airway disease years later because of exposure to fine particulate matter, smaller than 2.5 µm. There was a series of large fires in Australia and Indonesia years ago, and researchers were able to perform long-term follow-up following those fires and observed evidence of small airway disease in those people who were exposed to the large Indonesian fires. Fine particulate matter can travel hundreds of miles. When these particles are inhaled, they enter the large and very small airway systems in the lungs and can create a cascade of inflammatory reactions. And, those reactions may eventually lead to small airway disease.
Q: Which preexisting pulmonary conditions increase risk for serious adverse events following high levels of poor air quality?
A: Patients with asthma, congestive heart failure, chronic obstructive pulmonary disease, lung fibrosis, cystic fibrosis, individuals younger than 18 years, pregnant women and the elderly are some of those at the highest risk for poor outcomes. Asthma is at the top of my list, in terms of risk. I have seen a number of patients in the last few weeks due to symptoms from poor air quality and the wildfires in this region. In fact, I’m seeing a patient who lives in Pasadena, far from the last fire, that has a lot of symptoms.
Q: How can people protect themselves — both the general public and those with preexisting pulmonary conditions?
A: Generally, I encourage people to stay indoors. If you smell the fire, the particles are in your vicinity. Stay indoors, exercise indoors, try to use a mask when outside and limit activity outside. Limit exposure also for younger children and pets. Even people with no underlying conditions may have symptoms.
Q: What is the take-home message for health care professionals?
A: Close to 20% of the population have some form of airway disease, or irritable airways. Physicians should encourage patients with underlying lung disease in areas with poor air quality or active wildfires to stay indoors, make sure they take their inhalers properly and to protect themselves from exposure to these particles.
For more information:
Zab Mosenifar, MD, can be reached at zab.mosenifar@cshs.org.