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Wednesday, July 2, 2008

Smoke Gets In My Eyes…and Lungs!

If you have asthma or COPD, which is worse:

  • smoke from 4th of July fireworks
  • smog from automotive exhaust
  • smoke from a nearby wildfire
  • ash from a volcano
  • living with a smoker

When a person with asthma or COPD inhales smoke and fumes from any of these products of combustion, their airways will become more inflamed for at least 24 yours after the exposure is over. Bronchospasm, or airway narrowing, will begin with the first breath of smoke, and will last for at least an hour. Airway inflammation, with mucus production and airway swelling will begin within a few hours, and will last for up to two days without treatment.

Starion, who frequents the WebMD asthma message board, and her family all have asthma. If they stay in Honolulu during New Year’s Eve celebrations, they all experience asthma exacerbations due to the heavy smoke from Chinese fireworks in the city, so they stay in a motel in rural Oahu or Kauai. It’s common for emergency department physicians to treat a larger number of patients with asthma or COPD on the 4th or July or New Year’s Day due to inhalation of smoke from fireworks. If you must go to see the fireworks, make sure that you have taken your asthma controller inhalers, stay upwind from the fireworks displays, and keep your albuterol rescue inhaler handy.

Wildland fires usually rage during the summertime throughout the United States. Some occur near the urban-forest interface, so the smoke and fumes from the fires are often blown over highly populated areas. Those with asthma or COPD (or both) have “twitchy” airways which are more sensitive than others to the effect of smoke inhalation. The Department of Environmental Quality (DEQ) in most states operates air quality monitors. When the concentration of respirable particles in the air (PM-10, PM2.5, or simply smoke) exceeds thresholds, they issue health alerts to the media. If your nose isn’t congested, go outside and you can often smell the smoke, and see it in the air.

While most of us who fly frequently have become accustomed to a Code Orange terrorist “alert,” if you (or a child or grandparent for whom you are the caretaker) has asthma or COPD, Code Orange or Code Red air quality notices are alerts from the government that you should take seriously. Use the media to determine the source of the smoke. The National Weather Service can track the direction of the smoke plume, so find out if it’s headed in your direction.

If your asthma is poorly controlled that day, strongly consider a mini-vacation to stay with friends or relatives, or even a motel, in a location away from the smoke. If you must stay in the smoky area, start taking those inhalers faithfully again. Refill those prescriptions if you’ve run out again. Find the written asthma action plan that your doctor gave to you. Consider asking that she call a prescription for five days of prednisone (for example, twenty 20mg pills) in case your asthma control falls from the green zone into the yellow, orange, or red zones.

If you must stay in a smoky area outdoors, consider wearing an N-95 respirator (NIOSH-approved dust mask). When worn appropriately, these will remove 95% of the smoke particles from the air that you are inhaling. If you are staying indoors (or in a newer model vehicle), run the air conditioner on recirculate (which does not introduce outside air). Many new cars and SUVs have a HEPA air cleaner “for the cabin” (like those used in modern aircraft). The standard air filters for home air conditioners are designed to merely keep dust and hair from clogging the motor and coils, but you can retrofit them with better filters which will remove some smoke particles. Better yet, buy a large and quiet HEPA room air cleaner and run it continuously in the room in which you are working or sleeping. These filters remove almost all of the smoke in a room every six minutes. If air is blowing from them, they are working.

To finish answering my original question, studies following the Mt. Saint Helens volcano eruption found that inhaling the cool grey ash was relatively harmless. Dozens of studies of urban smog caused by vehicles in the United States show only a modest effect on children with asthma. Of course, smog levels in many developing countries are much worse than those now experienced in the U.S. At the other end of the spectrum, living with a smoker is without a doubt, the worst – probably because the second-hand exposure is constant for many hours day and night, for many years. It’s nearly impossible to escape if you are an infant or child. Whenever I see a baby in a car seat with a smoker at the wheel, I feel like calling Child Protection Services, because it ought to be a crime.

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Posted by: Paul Enright MD at 10:11 pm


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