How do wildfires and their smoke exacerbate medical conditions?

Particularly, many respiratory and cardiovascular illnesses are especially likely to worsen for people in areas where wildfires are very common.

LOS ANGELES -- With wildfires and their thick, acrid smoke becoming a common occurrence across much of the West over the past few summers, experts are warning it can cause many health issues to worsen for those exposed.   

Notably, many respiratory and cardiovascular illnesses are especially likely to worsen for people in areas where wildfires are prevalent, says Dr. Reza Ronaghi, a pulmonologist at UCLA Health.

"In general, fires, as well as bad weather quality in general, can have a lot of side effects and problems for patients with not only lung disease, but those also without lung disease," Ronaghi said. "It just may not be very apparent to those people. And the reason for this is the small particles from the smoke or bad weather quality from smog or any other reason. These tiny particles are inhaled into our system and kind of get deep into the lung tissues. And that's where it starts to cause a lot of the problems."

These particles cause many symptoms to develop, and the patient becomes increasingly agitated, and their health worsens.

"They cause a lot of irritation, cause a lot of inflammation, which then subsequently leads to some of the symptoms," he said, adding symptoms can include tickling in the back of the throat, an increase in cough, shortness of breath, and more mucus production. "These are all symptoms, but it all starts with inhaling that initial particle and then kind of deeply embedded itself into the lung and kind of starts this cascade of an inflammatory process, which then leads to the side effects."

Long-term effects come from repeated exposure

Aside from these symptoms, patients repeatedly exposed to wildfires are also at risk of developing long-term health issues. 

"The general idea is that by being exposed to these fires once, twice or even once a year, you're not really going to have any long-term side effects," Ronaghi said. "Now, over prolonged periods of being exposed to fires or just bad air quality, if you live in a big metropolitan area, can have side effects. And these are going to be diseases like smoking, so patients can develop COPD; patients that can have an increased risk of cancer with repeated exposure to these over and over again. But once or twice will not have any long-term health side effects. It's more those immediate or within a few weeks of being exposed that we worry about seeing some of the side effects and the symptoms in patients."

But who exactly is most at risk? According to Dr. Ronaghi, patients with chronic bronchitis, asthma, COPD, interstitial lung disease, and cystic fibrosis are the patients he worries about most. 

"They already have some form of limitation, some form of damage in their lung from their intrinsic basic disease," he said. "Now, when we inhale these particles and start this cascade of inflammatory process, it may make that underlying disease worse, meaning it may make your symptoms worse. It can exacerbate that symptom."

Effects linger even after the fires are out

In addition, patients need to be aware of the risks that are still prevalent even after wildfire season. 

"In general, the past few years, unfortunately, California has had a lot of wildfires, which has been very tough on our patients. During the wildfire season, especially a few weeks after, because as the fires have gone, there's still smoke, and the ashes are still in the air leading to poor air quality," Rongahi said. "So it's not that once the fire is done, the quality improves right away. It does take weeks for that air quality to improve. So in the weeks following the fire season, we have seen an increase in patients coming into the hospital, increasing calls from our patients with lung disease. And that's just because no matter how much we try to avoid, unfortunately, we are surrounded by these fires, and they seem to be getting worse and worse, making it difficult for our patients. So we do around fire season, see an increasing number of patients in the hospital, unfortunately."

Masks can help, provided it's the right kind

However, there are steps patients with these diseases or people living in areas where wildfires are common can take to be proactive about these issues.

"First and foremost is to always check your air quality," he suggests. "On days that there is smoke or bad weather quality, it is really important to avoid being outdoors as much as possible. Really, it all comes down to not inhaling these particles. And so avoiding being outside is the best way. In the scenario that you have to go outside, it is trying to protect yourself as much as possible. So these are the masks that can protect you."

But he warns your COVID mask is not as effective against air quality issues.

"It is important to remember that I know we wear a lot of masks now because of COVID and just because of some of the restrictions that we have. But these masks are not going to be beneficial for fires or bad weather quality. And that's because we're talking micro micro micro millimeter-sized particles. These are the fire particles. These are the bad air quality particles. And so with your mask that has openings all around it, these particles can still make their way in through the upper respiratory system and into the lungs."

His suggestion is to find masks that give you a complete seal.

"Your N-95 masks are probably going to be the best if you had to be outside," he said. "And then, on the other hand, if you're inside, it's important to keep your doors closed, your windows closed doors. And remember, these particles are going to make it inside as much as possible. And then finally, if you have air purifiers, not only keeping your doors and windows closed but using air purifiers on the inside to filter out that air as much as possible will be beneficial in these times."