Wildfires in Canada are resulting in yellow skies above the Northeastern United States —and posing health risks for people with underlying lung conditions.

“These kinds of bad air quality days can worsen symptom control,” says Jimmy Johannes, MD, a pulmonologist and critical care medicine specialist at MemorialCare Long Beach Medical Center in Long Beach, CA. “A lot of our patients with chronic lung disease tend to feel worse on poor air quality days, especially our patients with chronic obstructive lung disease like asthma or COPD [chronic obstructive pulmonary disease].”

Based in California, Johannes has guided patients through situations similar to that of the current Northeast smog.

“It's stressful for our patients and people who have chronic conditions—older and younger,” says Johannes. 

 

How does smog hurt people’s lungs?

 

When it comes to poor air quality impacting people’s lungs, the prime culprits are particulate matter, CO2, and ozone fumes, says Kara Wada, MD, adult allergy and immunology physician at the Ohio State University Wexner Medical Center. Particulate matter can contain debris found in smoke, burned ash, black carbon, vehicle exhaust, and pollen. June’s smog comes at the tail end of the East Coast allergy season—longer and more severe in 2023 than in years past, due to increased CO2 levels and climate change—adding aggressors to the list, Wada adds.

“When we have an increase in the particulate in the air due to wildfires or smog or increased air pollution of any kind, that adds insult to injury for patients [who] are already struggling,” she says.

Particulate inhalation can induce symptoms like sneezing, swollen eyes, burning sensations, and nasal congestion, Wada adds. Vulnerable groups, including people with underlying lung conditions, may experience more extreme symptoms of coughing, wheezing, difficulty breathing, and shortness of breath.

“The body sees particulates as an enemy; it's trying to filter all of that out so it doesn't reach our lungs,” says Wada. “So it's common to get irritation of our nasal passageways or sinuses when breathing it in.”

Repeated exposure to poor air can also weaken lungs and accelerate lung aging, she adds. Air pollution has also been studied to increase the prevalence of adult eczema and immune system dysfunction.

Fadadu RP, Abuabara K, Balmes JR, Hanifin JM, Wei ML. Air Pollution and Atopic Dermatitis, from Molecular Mechanisms to Population-Level Evidence: A Review. Int J Environ Res Public Health. 2023 Jan 31;20(3):2526. doi: 10.3390/ijerph20032526. PMID: 36767891; PMCID: PMC9916398.

 

 

How can people protect themselves from smog?

 

Those most vulnerable to poor air quality include people with underlying lung conditions like asthma or chronic obstructive pulmonary disease (COPD); people with conditions such as diabetes or heart disease; older adults; and children or teens “with more delicate lungs,” says Wada.

People in these groups should heed caution when participating in outdoor activities if an area’s air quality index (AQI) values are 100 or above, she says.

“Even for folks that are quote, unquote ‘healthy,’ if you're a marathon runner and you're planning on going out to do your long run, plan that on another day,” says Wada.

Some measures to take to mitigate risk include:

• Staying indoors.

• Wearing a fitted N95 mask when outdoors.

• Taking a shower immediately after coming inside to wash particles from the body. 

• Using an HVAC filter or an air filter—with an MERV rating—to filter out particles. (Wada recommends aiming for a filter with a  rating of 9 or above. The higher the MERV rating the better the filter is at trapping particles.)

• Minimizing gas stove use.

“The general advice is to use an HVAC system—hopefully with that high-quality air filter—or go to some sort of indoor facility, like a mall, where you can hopefully get some reft of the air,” Johannes says. “It's not a great time to be going outside.”

 

How can practitioners best guide patients through smoggy situations?

 

In areas with high AQI levels, practitioners should keep an ear and eye out for asthma attacks and sinus infections among vulnerable patients, Wada says.

How exactly these exacerbations are expressed can vary greatly, so it’s important to tend to each case individually, adds Johannes. Going over a patient’s medical history to make sure you are aware of their underlying conditions or how they have responded to poor air quality in the past can be helpful for guiding treatment.

Depending on individual needs, treatment interventions may include rescue inhalers or, in some cases, steroid interventions. Steroid interventions may be looked at as a “burst treatment” for people with COPD and are sometimes given as a medium dose of prednisone or another medication for about five to seven days, he adds.

 

How to stay ahead of future trends

 

It’s hard to predict the future, and it’s not a practitioner’s responsibility to do so, either. Educating patients about precautionary measures and the importance of masking and staying in when skies look murky can be a good way to help prepare for the unknown, Wada says.

Furthermore, having a plan in place for poor air quality days can help expedite treatment if and when needed, Johannes says. It is also important to educate people on day-to-day symptom management, such as how to use a maintenance inhaler if prescribed, he adds.

“A lot of our patients are very familiar with their condition, and they become very savvy about how to manage these situations,” says Johannes. “For patients who are less savvy, they need to make sure to talk to a healthcare provider, get evaluated, and get a diagnosis—if there is one—to help with symptom management.”