The 2020 wildfires throughout the United States West Coast present another challenge for patients with chronic lung disease. Smoke exposure particulates can penetrate deep into lung tissue leading to decreased immunity, COPD or asthma exacerbations, myocardial infarctions or heart attacks, and even death in the most severe cases.
Even healthy adults can develop symptoms including shortness of breath, cough, wheezing, and sinus congestion. Over time, a small subset may end up developing chronic lung disease. Smoke exposure in children can hinder lung development, increase the chances of developing asthma, and predispose them to acute viral infections. What can be done about this and what have I been advising my patients in our clinic?
First of all, know the conditions in your community. Follow your local authorities and evacuate if instructed to do so. Assuming there’s no active wildfire in your community, stay updated about the air quality in your area. The air quality index is a number reported by the Environmental Protection Agency ranging from 0-500. Higher scores indicate more pollution and hazardous air quality. A score of 0-50 is considered safe, and a score above 100 is considered unhealthy for patients with chronic lung disease. Airnow.gov is a convenient website to track your community’s air quality index.
Simply enter your zip code, and you will know the current local air quality index. Check this number daily. Minimize outdoor exposure especially in the late morning to evening when the air quality index is over 100. Keep doors and windows shut, and avoid indoor pollution from fireplaces and candles. Consider buying an air filter for your home, and set the air conditioner on recirculation mode. These actions together will minimize your exposure to poor air quality and protect your lung health.
On top of minimizing smoke exposure, it’s important for patients with chronic lung disease to plan ahead. Smoke or pollution can be the trigger that worsens COPD or asthma symptoms for certain patients. Consider asking your pulmonologist if having a stronger inhaler medication, extra rescue inhalers, or a home nebulizer machine for wildfire season would be beneficial. Have a plan of communication with your physician in case you develop an acute exacerbation requiring oral steroids or antibiotics to be prescribed. Be aware of alarm symptoms such as a cough that feels different, increased shortness of breath, persistent wheezing, lightheadedness, and chest pain. Know when you should seek care in the emergency department, especially when alarm symptoms continue to worsen.
Finally, be aware about the potential for power outages. Utility companies often have planned power outages to decrease the risk of wildfires. This can put patients requiring chronic oxygen therapy in a precarious situation. Talk with your doctor about having a backup oxygen supply, and coordinate with your utility company to have your power turned on at the earliest possible time. Coordinate with your utility company and doctor’s office to see if you qualify for a Medical Baseline Allowance program for decreased monthly gas and electric bills.
Kelly Fan, MD
Dr. Fan is a pulmonologist and critical care attending physician with clinical expertise in advanced asthma, bronchiectasis, bronchoscopy, COPD, interstitial lung disease, lung cancer, lung infections, pleural disease, and pulmonary vascular disease. Dr. Fan is a Doctorpedia Founding Medical Partner and the Chief Medical Officer of Doctorpedia's Lung Health channel.