Mortality associated with wildfire smoke exposure in Washington state, 2006-2017: a case-crossover study

Assessment of Left Lung Remodeling With Magnetic Resonance Imaging in a Murine Model Following Exposure to Douglas Fir Smoke

Wildland firefighters (WLFFs) experience lung function decline due to occupational exposure to fire smoke. WLFFs typically do not wear respiratory personal protective equipment, and if they do, it is a simple bandana, which is not effective at filtering smoke. To pinpoint the biological underpinnings of abnormal respiratory function following 3-7 years of WLFF service, we exposed mice to Douglas fir smoke (DFS) over 8 weeks. Following exposure, we assessed changes in lung structure through Magnetic Resonance Imaging (MRI) and histological analysis, which was supported by immunohistochemistry staining. With MRI, we found that the signal decay time, T2*, from ultrashort echo time (UTE) images was significantly shorter in mice exposed to DFS compared to air controls. In addition, the variation in T2* was more heterogeneously distributed throughout the left lung in DFS-exposed mice, compared to air controls. As confirmed by histological analysis, shorter T2* was caused by larger parenchyma airspace sizes and not fibrotic remodeling. Destruction of the alveolar spaces was likely due to inflammation, as measured by an influx of CD68+ macrophages and destruction due to enhanced neutrophil elastase. In addition, measurements of airspace dimensions from histology were more heterogeneously distributed throughout the lung, corroborating the enhanced relative dispersion of T2*. Findings from this study suggest that the decline in lung function observed in WLFFs may be due to emphysema-like changes in the lung, which can be quantified with MRI.

Practical considerations for using low-cost sensors to assess wildfire smoke exposure in school and childcare settings

BACKGROUND

More frequent and intense wildfires will increase concentrations of smoke in schools and childcare settings. Low-cost sensors can assess fine particulate matter (PM2.5) concentrations with high spatial and temporal resolution.

OBJECTIVE

We sought to optimize the use of sensors for decision-making in schools and childcare settings during wildfire smoke to reduce children's exposure to PM2.5.

METHODS

We measured PM2.5 concentrations indoors and outdoors at four schools in Washington State during wildfire smoke in 2020-2021 using low-cost sensors and gravimetric samplers. We randomly sampled 5-min segments of low-cost sensor data to create simulations of brief portable handheld measurements.

RESULTS

During wildfire smoke episodes (lasting 4-19 days), median hourly PM2.5 concentrations at different locations inside a single facility varied by up to 49.6 µg/m3 (maximum difference) during school hours. Median hourly indoor/outdoor ratios across schools ranged from 0.22 to 0.91. Within-school differences in concentrations indicated that it is important to collect measurements throughout a facility. Simulation results suggested that making handheld measurements more often and over multiple days better approximates indoor/outdoor ratios for wildfire smoke. During a period of unstable air quality, PM2.5 over the next hour indoors was more highly correlated with the last 10-min of data (mean R2 = 0.94) compared with the last 3-h (mean R2 = 0.60), indicating that higher temporal resolution data is most informative for decisions about near-term activities indoors.

IMPACT STATEMENT

As wildfires continue to increase in frequency and severity, staff at schools and childcare facilities are increasingly faced with decisions around youth activities, building use, and air filtration needs during wildfire smoke episodes. Staff are increasingly using low-cost sensors for localized outdoor and indoor PM2.5 measurements, but guidance in using and interpreting low-cost sensor data is lacking. This paper provides relevant information applicable for guidance in using low-cost sensors for wildfire smoke response.

COPD Exposed to Air Pollution: A Path to Understand and Protect a Susceptible Population

TOPIC IMPORTANCE

Air pollution poses a risk to the respiratory health of individuals with COPD. Long- and short-term exposures to higher levels of particulate-rich air pollution are associated with increased COPD exacerbation, hospitalization, and mortality, collectively implicating air pollution as a cause of adverse COPD-related outcomes.

REVIEW FINDINGS

This review summarizes the evidence for COPD as a phenotype that confers susceptibility for adverse health outcomes in the face of common air pollution. We highlight how typical contributors to compromised urban air quality, including that from traffic, wildfire smoke, and indoor biomass combustion, adversely affect the COPD patient population. Evidence underscoring the burden of ongoing air pollution exposure on patients with COPD is discussed. We then detail the detrimental impact of that exposure on COPD pathophysiology, which in turn increases the patient's susceptibility. We specifically propose that indoor air is a particularly rational target for increased monitoring and remediation to protect patients with COPD. Because COPD is a heterogeneous disease with several endotypes, future intervention studies need to better include control populations, to highlight COPD-specific risks and identify subpopulations within patients with COPD who will benefit the most from improved indoor air quality.

SUMMARY

Regulatory efforts must continue to broadly lower emission standards to protect this susceptible population from the negative health impacts of air pollution.

Data Linkages for Wildfire Exposures and Human Health Studies: A Scoping Review

Wildfires are increasing in frequency and intensity, with significant consequences that impact human health. A scoping review was conducted to: (a) understand wildfire-related health effects, (b) identify and describe environmental exposure and health outcome data sources used to research the impacts of wildfire exposures on health, and (c) identify gaps and opportunities to leverage exposure and health data to advance research. A literature search was conducted in PubMed and a sample of 83 articles met inclusion criteria. A majority of studies focused on respiratory and cardiovascular outcomes. Hospital administrative data was the most common health data source, followed by government data sources and health surveys. Wildfire smoke, specifically fine particulate matter (PM2.5), was the most common exposure measure and was predominantly estimated from monitoring networks and satellite data. Health data were not available in real-time, and they lacked spatial and temporal coverage to study health outcomes with longer latency periods. Exposure data were often available in real-time and provided better temporal and spatial coverage but did not capture the complex mixture of hazardous wildfire smoke pollutants nor exposures associated with non-air pathways such as soil, household dust, food, and water. This scoping review of the specific health and exposure data sources used to underpin these studies provides a framework for the research community to understand: (a) the use and value of various environmental and health data sources, and (b) the opportunities for improving data collection, integration, and accessibility to help inform our understanding of wildfires and other environmental exposures.

Health Impacts of Wildfire Smoke on Children and Adolescents: A Systematic Review and Meta-analysis

PURPOSE OF REVIEW

Wildfire smoke is associated with human health, becoming an increasing public health concern. However, a comprehensive synthesis of the current evidence on the health impacts of ambient wildfire smoke on children and adolescents, an exceptionally vulnerable population, is lacking. We conduct a systematic review of peer-reviewed epidemiological studies on the association between wildfire smoke and health of children and adolescents.

RECENT FINDINGS

We searched for studies available in MEDLINE, EMBASE, and Scopus from database inception up to October 11, 2022. Of 4926 studies initially identified, 59 studies from 14 countries were ultimately eligible. Over 33.3% of the studies were conducted in the USA, and two focused on multi-countries. The exposure assessment of wildfire smoke was heterogenous, with wildfire-specific particulate matters with diameters ≤ 2.5 µm (PM2.5, 22.0%) and all-source (22.0%) PM2.5 during wildfire period most frequently used. Over half of studies (50.6%) focused on respiratory-related morbidities/mortalities. Wildfire smoke exposure was consistently associated with enhanced risks of adverse health outcomes in children/adolescents. Meta-analysis results presented a pooled relative risk (RR) of 1.04 (95% confidence interval [CI], 0.96-1.12) for all-cause respiratory morbidity, 1.11 (95% Ci: 0.93-1.32) for asthma, 0.93 (95% CI, 0.85-1.03) for bronchitis, and 1.13 (95% CI, 1.05-1.23) for upper respiratory infection, whilst - 21.71 g for birth weight (95% CI, - 32.92 to - 10.50) per 10 µg/m3 increment in wildfire-specific PM2.5/all-source PM2.5 during wildfire event. The majority of studies found that wildfire smoke was associated with multiple adverse health outcomes among children and adolescents, with respiratory morbidities of significant concern. In-utero exposure to wildfire smoke may increase the risk of adverse birth outcomes and have long-term impacts on height. Higher maternal baseline exposure to wildfire smoke and poor family-level baseline birthweight respectively elevated risks in preterm birth and low birth weight associated with wildfire smoke. More studies in low- and middle-income countries and focusing on extremely young children are needed. Despite technological progress, wildfire smoke exposure measurements remain uncertain, demanding improved methodologies to have more precise assessment of wildfire smoke levels and thus quantify the corresponding health impacts and guide public mitigation actions.

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Air Quality

Climate change is having an unprecedented influence on human health. Children's allergies and respiratory problems are increasing because of rising pollen levels and air pollution. School nurses are well positioned to prevent and treat allergies, asthma, and other respiratory conditions. Due to their consistent presence with the school setting, nurses can promote health, wellness, and academic productivity by addressing poor indoor and outdoor air quality. The purpose of this article is to increase understanding of how air quality affects the health of school-age children and to provide school nurses with primary, secondary, and tertiary prevention strategies for ensuring clean and healthy learning environments. This is the second in a series of articles aimed at raising awareness among school nurses about climate-associated illnesses and equipping them with the resources they need to protect students' health.

Clearing the air: evaluating institutions' social media health messaging on wildfire and smoke risks in the US Pacific Northwest

BACKGROUND

Wildfire smoke contributes substantially to the global disease burden and is a major cause of air pollution in the US states of Oregon and Washington. Climate change is expected to bring more wildfires to this region. Social media is a popular platform for health promotion and a need exists for effective communication about smoke risks and mitigation measures to educate citizens and safeguard public health.

METHODS

Using a sample of 1,287 Tweets from 2022, we aimed to analyze temporal Tweeting patterns in relation to potential smoke exposure and evaluate and compare institutions' use of social media communication best practices which include (i) encouraging adoption of smoke-protective actions; (ii) leveraging numeric, verbal, and Air Quality Index risk information; and (iii) promoting community-building. Tweets were characterized using keyword searches and the Linguistic Inquiry and Word Count (LIWC) software. Descriptive and inferential statistics were carried out.

RESULTS

44% of Tweets in our sample were authored between January-August 2022, prior to peak wildfire smoke levels, whereas 54% of Tweets were authored during the two-month peak in smoke (September-October). Institutional accounts used Twitter (or X) to encourage the adoption of smoke-related protective actions (82% of Tweets), more than they used it to disseminate wildfire smoke risk information (25%) or promote community-building (47%). Only 10% of Tweets discussed populations vulnerable to wildfire smoke health effects, and 14% mentioned smoke mitigation measures. Tweets from Washington-based accounts used significantly more verbal and numeric risk information to discuss wildfire smoke than Oregon-based accounts (p = 0.042 and p = 0.003, respectively); however, Tweets from Oregon-based accounts on average contained a higher percentage of words associated with community-building language (p < 0.001).

CONCLUSIONS

This research provides practical recommendations for public health practitioners and researchers communicating wildfire smoke risks on social media. As exposures to wildfire smoke rise due to climate change, reducing the environmental disease burden requires health officials to leverage popular communication platforms, distribute necessary health-related messaging rapidly, and get the message right. Timely, evidence-based, and theory-driven messaging is critical for educating and empowering individuals to make informed decisions about protecting themselves from harmful exposures. Thus, proactive and sustained communications about wildfire smoke should be prioritized even during wildfire "off-seasons."

Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD

Wildfires are a global natural phenomenon. In North America, wildfires have not only become more frequent, but also more severe and longer in duration, a trend ascribed to climate change combined with large fuel stores left from modern fire suppression. The intensification of wildfire activity has significant implications for planetary health and public health, as exposure to fine particulate matter (PM2.5) in wildfire smoke is linked to adverse health effects. This review focuses on respiratory morbidity from wildfire smoke exposure. Inhalation of wildfire PM2.5 causes lung injury via oxidative stress, local and systemic inflammation, airway epithelium compromise, and increased vulnerability to infection. Wildfire PM2.5 exposure results in exacerbations of pre-existing asthma and chronic obstructive pulmonary disease, with an escalation in healthcare utilization, including emergency department visits and hospitalizations. Wildfire smoke exposure may be associated with asthma onset, long-term impairment of lung function, and increased all-cause mortality. Children, older adults, occupationally-exposed groups, and possibly women are the most at risk from wildfire smoke. Future research is needed to clarify best practices for risk mitigation and wildfire management.

School and childcare facility air quality decision-makers' perspectives on using low-cost sensors for wildfire smoke response

BACKGROUND

During wildfire smoke episodes, school and childcare facility staff and those who support them rely upon air quality data to inform activity decisions. Where ambient regulatory monitor data is sparse, low-cost sensors can help inform local outdoor activity decisions, and provide indoor air quality data. However, there is no established protocol for air quality decision-makers to use sensor data for schools and childcare facilities. To develop practical, effective toolkits to guide the use of sensors in school and childcare settings, it is essential to understand the perspectives of the potential end-users of such toolkit materials.

METHODS

We conducted 15 semi-structured interviews with school, childcare, local health jurisdiction, air quality, and school district personnel regarding sensor use for wildfire smoke response. Interviews included sharing PM2.5 data collected at schools during wildfire smoke. Interviews were transcribed and transcripts were coded using a codebook developed both a priori and amended as additional themes emerged.

RESULTS

Three major themes were identified by organizing complementary codes together: (1) Low-cost sensors are useful despite data quality limitations, (2) Low-cost sensor data can inform decision-making to protect children in school and childcare settings, and (3) There are feasibility and public perception-related barriers to using low-cost sensors.

CONCLUSIONS

Interview responses provided practical implications for toolkit development, including demonstrating a need for toolkits that allow a variety of sensor preferences. In addition, participants expected to have a wide range of available time for monitoring, budget for sensors, and decision-making types. Finally, interview responses revealed a need for toolkits to address sensor uses outside of activity decisions, especially assessment of ventilation and filtration.

Continent-based systematic review of the short-term health impacts of wildfire emissions

This review systematically gathers and provides an analysis of pollutants levels emitted from wildfire (WF) and their impact on short-term health effects of affected populations. The available literature was searched according to Population, Exposure, Comparator, Outcome, and Study design (PECOS) database defined by the World Health Organization (WHO) and a meta-analysis was conducted whenever possible. Data obtained through PECOS characterized information from the USA, Europe, Australia, and some Asian countries; South American countries were seldom characterized, and no data were available for Africa and Russia. Extremely high levels of pollutants, mostly of fine fraction of particulate matter (PM) and ozone, were associated with intense WF emissions in North America, Oceania, and Asia and reported to exceed several-fold the WHO guidelines. Adverse health outcomes include emergency department visits and hospital admissions for cardiorespiratory diseases as well as mortality. Despite the heterogeneity among exposure and health assessment methods, all-cause mortality, and specific-cause mortality were significantly associated with WF emissions in most of the reports. Globally, a significant association was found for all-cause respiratory outcomes including asthma, but mixed results were noted for cardiovascular-related effects. For the latter, estimates were only significant several days after WF emissions, suggesting a more delayed impact on the heart. Different research gaps are presented, including the need for the application of standardized protocols for assessment of both exposure and adverse health risks. Mitigation actions also need to be strengthened, including dedicated efforts to communicate with the affected populations, to engage them for adoption of protective behaviors and measures.

Acute Health Effects of Wildfire Smoke Exposure During a Compound Event: A Case-Crossover Study of the 2016 Great Smoky Mountain Wildfires

In 2016, unprecedented intense wildfires burned over 150,000 acres in the southern Appalachian Mountains in the United States. Smoke from these fires greatly impacted the region and exposure to this smoke was significant. A bidirectional case-crossover design was applied to assess the relationship between PM2.5 (a surrogate for wildfire smoke) exposure and respiratory- and cardiovascular-related emergency department (ED) visits in Western North Carolina during these events. For 0-, 3-, and 7-day lags, findings indicated a significant increase in the odds of being admitted to the ED for a respiratory (ORs: 1.055, 95% CI: 1.048-1.063; 1.083, 1.074-1.092; 1.066, 1.058-1.074; respectively) or cardiovascular event (ORs: 1.052, 95% CI: 1.045-1.060; 1.074, 1.066-1.081; 1.067, 1.060-1.075; respectively) for every 5 μg/m3 increase in PM2.5 over a chosen cutpoint of 20.4 μg/m3. For all endpoints assessed except for emphysema, there were statistically significant increases in odds from 5.1% to 8.3%. In general, this increase was most pronounced 3 days after exposure. Additionally, individuals aged 55+ generally experience higher odds of heart disease at the 3- and 7-day lag points, and Black/African Americans generally experience higher odds of asthma at the 3-day lag point. In general, larger fires and increased numbers of fires within counties resulted in higher health burden at same day exposure. In a secondary analysis, the odds of an ED visit increased by over 40% in several cases among people exposed to days above the Environmental Protection Agency 24-hr PM2.5 standard of 35 μg/m3. Our findings provide new understanding on the health impacts of wildfires on rural populations in the southeastern US.

Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California

BACKGROUND

People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.

METHODS

We obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.

RESULTS

Among 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.

CONCLUSIONS

Our results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group.

Wildland fire, air pollution and cardiovascular health: is it time to focus on the microvasculature as a risk assessment tool?

Climate change favors weather conditions conducive to wildland fires. The intensity and frequency of forest fires are increasing, and fire seasons are lengthening. Exposure of human populations to smoke emitted by these fires increases, thereby contributing to airborne pollution through the emission of gas and particulate matter (PM). The adverse health outcomes associated with wildland fire exposure represent an important burden on the economies and health systems of societies. Even though cardiovascular diseases (CVDs) are the main of cause of the global burden of diseases attributable to PM exposure, it remains difficult to show reliable associations between exposure to wildland fire smoke and cardiovascular disease risk in population-based studies. Optimal health requires a resilient and adaptable network of small blood vessels, namely, the microvasculature. Often alterations of this microvasculature precede the occurrence of adverse health outcomes, including CVD. Biomarkers of microvascular health could then represent possible markers for the early detection of poor cardiovascular outcomes. This review aims to synthesize the current literature to gauge whether assessing the microvasculature can better estimate the cardiovascular impact of wildland fires.

Wildfire Smoke Monitoring for Agricultural Safety and Health in Rural Washington

OBJECTIVES

This study aimed to evaluate the performance of a low-cost smoke sampling platform relative to environmental and occupational exposure monitoring methods in a rural agricultural region in central Washington state.

METHODS

We co-located the Thingy AQ sampling platform alongside cyclone-based gravimetric samplers, a nephelometer, and an environmental beta attenuation mass (E-BAM) monitor during August and September of 2020. Ambient particulate matter concentrations were collected during a smoke and non-smoke period and measurements were compared across sampling methods.

RESULTS

We found reasonable agreement between observations from two particle sensors within the Thingy AQ platform and the nephelometer and E-BAM measurements throughout the study period, though the measurement range of the sensors was greater during the smoke period compared to the non-smoke period. Occupational gravimetric sampling methods did not correlate with PM2.5 data collected during smoke periods, likely due to their capture of larger particle sizes than those typically measured by PM2.5 ambient air quality instruments during wildfire events.

CONCLUSION

Data collected before and during an intense wildfire smoke episode in September 2020 indicated that the low-cost smoke sampling platform provides a strategy to increase access to real-time air quality information in rural areas where regulatory monitoring networks are sparse if sensor performance characteristics under wildfire smoke conditions are understood. Improving access to spatially resolved air quality information could help agricultural employers protect both worker and crop health as wildfire smoke exposure increases due to the impacts of climate change. Such information can also assist employers with meeting new workplace wildfire smoke health and safety rules.

Wildfire smoke exposure and emergency department visits in Washington State

Wildfires are increasing in prevalence in western North America due to changing climate conditions. A growing number of studies examine the impact of wildfire smoke on morbidity; however, few evaluate these impacts using syndromic surveillance data that cover many emergency departments (EDs). We used syndromic surveillance data to explore the effect of wildfire smoke exposure on all-cause respiratory and cardiovascular ED visits in Washington state. Using a time-stratified case crossover design, we observed an increased odds of asthma visits immediately after and in all five days following initial exposure (lag 0 OR: 1.13; 95% CI: 1.10, 1.17; lag 1-5 ORs all 1.05 or greater with a lower CI of 1.02 or higher), and an increased odds of respiratory visits in all five days following initial exposure (lag 1 OR: 1.02; 95% CI: 1.00, 1.03; lag 2-5 ORs and lower CIs were all at least as large) comparing wildfire smoke to non-wildfire smoke days. We observed mixed results for cardiovascular visits, with evidence of increased odds emerging only several days following initial exposure. We also found increased odds across all visit categories for a 10 μg m^-3 increase in smoke-impacted PM_2.5. In stratified analyses, we observed elevated odds for respiratory visits among ages 19-64, for asthma visits among ages 5-64, and mixed risk estimates for cardiovascular visits by age group. This study provides evidence of an increased risk of respiratory ED visits immediately following initial wildfire smoke exposure, and increased risk of cardiovascular ED visits several days following initial exposure. These increased risks are seen particularly among children and younger to middle-aged adults.

The COVID-19-wildfire smoke paradox: Reduced risk of all-cause mortality due to wildfire smoke in Colorado during the first year of the COVID-19 pandemic

BACKGROUND

In 2020, the American West faced two competing challenges: the COVID-19 pandemic and the worst wildfire season on record. Several studies have investigated the impact of wildfire smoke (WFS) on COVID-19 morbidity and mortality, but little is known about how these two public health challenges impact mortality risk for other causes.

OBJECTIVES

Using a time-series design, we evaluated how daily risk of mortality due to WFS exposure differed for periods before and during the COVID-19 pandemic.

METHODS

Our study included daily data for 11 counties in the Front Range region of Colorado (2010-2020). We assessed WFS exposure using data from the National Oceanic and Atmospheric Administration and used mortality counts from the Colorado Department of Public Health and Environment. We estimated the interaction between WFS and the pandemic (an indicator variable) on mortality risk using generalized additive models adjusted for year, day of week, fine particulate matter, ozone, temperature, and a smoothed term for day of year.

RESULTS

WFS impacted the study area on 10% of county-days. We observed a positive association between the presence of WFS and all-cause mortality risk (incidence rate ratio (IRR) = 1.03, 95%CI: 1.01-1.04 for same-day exposures) during the period before the pandemic; however, WFS exposure during the pandemic resulted in decreased risk of all-cause mortality (IRR = 0.90, 95%CI: 0.87-0.93 for same-day exposures).

DISCUSSION

We hypothesize that mitigation efforts during the first year of the pandemic, e.g., mask mandates, along with high ambient WFS levels encouraged health behaviors that reduced exposure to WFS and reduced risk of all-cause mortality. Our results suggest a need to examine how associations between WFS and mortality are impacted by pandemic-related factors and that there may be lessons from the pandemic that could be translated into health-protective policies during future wildfire events.

Air pollution and COPD: GOLD 2023 committee report

Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.

Prolonged smoldering Douglas fir smoke inhalation augments respiratory resistances, stiffens the aorta, and curbs ejection fraction in hypercholesterolemic mice

While mounting evidence suggests that wildland fire smoke (WFS) inhalation may increase the burden of cardiopulmonary disease, the occupational risk of repeated exposure during wildland firefighting remains unknown. To address this concern, we evaluated the cardiopulmonary function in mice following a cumulative exposure to lab-scale WFS equivalent to a mid-length wildland firefighter (WLFF) career. Dosimetry analysis indicated that 80 exposure hours at a particulate concentration of 22 mg/m3 yield in mice the same cumulative deposited mass per unit of lung surface area as 3600 h of wildland firefighting. To satisfy this condition, male Apoe-/- mice were whole-body exposed to either air or smoldering Douglas fir smoke (DFS) for 2 h/day, 5 days/week, over 8 consecutive weeks. Particulate size in DFS fell within the respirable range for both mice and humans, with a count median diameter of 110 ± 20 nm. Expiratory breath hold in mice exposed to DFS significantly reduced their minute volume (DFS: 27 ± 4; Air: 122 ± 8 mL/min). By the end of the exposure time frame, mice in the DFS group exhibited a thicker (DFS: 109 ± 3; Air: 98 ± 3 μm) and less distensible (DFS: 23 ± 1; Air: 28 ± 1 MPa-1) aorta with reduced diastolic blood augmentation capacity (DFS: 53 ± 2; Air: 63 ± 2 kPa). Cardiac magnetic resonance imaging further revealed larger end-systolic volume (DFS: 14.6 ± 1.1; Air: 9.9 ± 0.9 μL) and reduced ejection-fraction (DFS: 64.7 ± 1.0; Air: 75.3 ± 0.9 %) in mice exposed to DFS. Consistent with increased airway epithelium thickness (DFS: 10.4 ± 0.8; Air: 7.6 ± 0.3 μm), airway Newtonian resistance was larger following DFS exposure (DFS: 0.23 ± 0.03; Air: 0.20 ± 0.03 cmH2O-s/mL). Furthermore, parenchyma mean linear intercept (DFS: 36.3 ± 0.8; Air: 33.3 ± 0.8 μm) and tissue thickness (DFS: 10.1 ± 0.5; Air: 7.4 ± 0.7 μm) were larger in DFS mice. Collectively, mice exposed to DFS manifested early signs of cardiopulmonary dysfunction aligned with self-reported events in mid-career WLFFs.

The impact of fire-specific PM2.5 calibration on health effect analyses

The quantification of PM_2.5 concentrations solely stemming from both wildfire and prescribed burns (hereafter referred to as 'fire') is viable using the Community Multiscale Air Quality (CMAQ), although CMAQ outputs are subject to biases and uncertainties. To reduce the biases in CMAQ-based outputs, we propose a two-stage calibration strategy that improves the accuracy of CMAQ-based fire PM_2.5 estimates. First, we calibrated CMAQ-based non-fire PM_2.5 to ground PM_2.5 observations retrieved during non-fire days using an ensemble-based model. We estimated fire PM_2.5 concentrations in the second stage by multiplying the calibrated non-fire PM_2.5 obtained from the first stage by location- and time-specific conversion ratios. In a case study, we estimated fire PM_2.5 during the Washington 2016 fire season using the proposed calibration approach. The calibrated PM_2.5 better agreed with ground PM_2.5 observations with a 10-fold cross-validated (CV) R² of 0.79 compared to CMAQ-based PM_2.5 estimates with R² of 0.12. In the health effect analysis, we found significant associations between calibrated fire PM_2.5 and cardio-respiratory hospitalizations across the fire season: relative risk (RR) for cardiovascular disease = 1.074, 95% confidence interval (CI) = 1.021-1.130 in October; RR = 1.191, 95% CI = 1.099-1.291 in November; RR for respiratory disease = 1.078, 95% CI = 1.005-1.157 in October; RR = 1.153, 95% CI = 1.045-1.272 in November. However, the results were inconsistent when non-calibrated PM_2.5 was used in the analysis. We found that calibration affected health effect assessments in the present study, but further research is needed to confirm our findings.

Environmental justice analysis of wildfire-related PM2.5 exposure using low-cost sensors in California

The increasing number and severity of wildfires is negatively impacting air quality for millions of California residents each year. Community exposure to PM_2.5 in two main population centers (San Francisco Bay area and Los Angeles County area) was assessed using the low-cost PurpleAir sensor network for the record-setting 2020 California wildfire season. Estimated PM_2.5 concentrations in each study area were compared to census tract-level environmental justice vulnerability indicators, including environmental, health, and demographic data. Higher PM_2.5 concentrations were positively correlated with poverty, cardiovascular emergency department visits, and housing inequities. Sensors within 30 km of actively burning wildfires showed statistically significant increases in indoor (~800 %) and outdoor (~540 %) PM_2.5 during the fires. Results indicate that wildfire emissions may exacerbate existing health disparities as well as the burden of pollution in disadvantaged communities, suggesting a need to improve monitoring and adaptive capacity among vulnerable populations.

Effects of wildfire smoke PM2.5 on indicators of inflammation, health, and metabolism of preweaned Holstein heifers

Wildfires are a growing concern as large, catastrophic fires are becoming more commonplace. Wildfire smoke consists of fine particulate matter (PM2.5), which can cause immune responses and disease in humans. However, the present knowledge of the effects of wildfire PM2.5 on dairy cattle is sparse. The present study aimed to elucidate the effects of wildfire-PM2.5 exposure on dairy calf health and performance. Preweaned Holstein heifers (N = 15) were assessed from birth through weaning, coinciding with the 2021 wildfire season. Respiratory rate, heart rate, rectal temperatures, and health scores were recorded and blood samples were collected weekly or twice a week for analysis of hematology, blood metabolites, and acute phase proteins. Hourly PM2.5 concentrations and meteorological data were obtained, and temperature-humidity index (THI) was calculated. Contribution of wildfires to PM2.5 fluxes were determined utilizing AirNowTech Navigator and HYSPLIT modeling. Mixed models were used for data analysis, with separate models for lags of up to 7 d, and fixed effects of daily average PM2.5, THI, and PM2.5 × THI, and calf as a random effect. THI ranged from 48 to 73, while PM2.5 reached concentrations up to 118.8 µg/m3 during active wildfires. PM2.5 and THI positively interacted to elevate respiratory rate, heart rate, rectal temperature, and eosinophils on lag day 0 (day of exposure; all P < 0.05). There was a negative interactive effect of PM2.5 and THI on lymphocytes after a 2-d lag (P = 0.03), and total white blood cells, neutrophils, hemoglobin, and hematocrit after a 3-d lag (all P < 0.02), whereas there was a positive interactive effect on cough scores and eye scores on lag day 3 (all P < 0.02). Glucose and NEFA were increased as a result of combined elevated PM2.5 and THI on lag day 1, whereas BHB was decreased (all P < 0.05). Contrarily, on lag day 3 and 6, there was a negative interactive effect of PM2.5 and THI on glucose and NEFA, but a positive interactive effect on BHB (all P < 0.03). Serum amyloid A was decreased whereas haptoglobin was increased with elevated PM2.5 and THI together on lag days 0 to 4 (all P < 0.05). These findings indicate that exposure to wildfire-derived PM2.5, along with increased THI during the summer months, elicits negative effects on preweaned calf health and performance both during and following exposure.

The choice of message and messenger to drive behavior change that averts the health impacts of wildfires: an online randomized controlled experiment

BACKGROUND

To reduce the negative health effects from wildfire smoke exposure, effective risk and health communication strategies are vital. We estimated the behavioral effects from changes in message framing and messenger in public health messages about wildfire smoke on Facebook.

METHODS

During September and October 2021, we conducted a preregistered online randomized controlled experiment in Facebook. Adult Facebook users (n = 1,838,100), living in nine wildfire-prone Western U.S. states, were randomly assigned to see one of two ad versions (narrative frame vs. informational frame) from one of two messengers (government vs. academic). We estimated the effects of narrative framing, the messenger, and their interactions on ad click-through rates, a measure of recipient information-seeking behavior.

RESULTS

Narrative frame increased click-through rates by 25.3% (95% CI = 22.2, 28.4%), with larger estimated effects among males, recipients in areas with less frequent exposure to heavy wildfire smoke, and in areas where predominant political party affiliation of registered voters was Republican (although not statistically different from predominantly-Democrat areas). The estimated effect from an academic messenger compared to a government messenger was small and statistically nonsignificant (2.2%; 95% CI = - 0.3, 4.7%). The estimated interaction effect between the narrative framing and the academic messenger was also small and statistically nonsignificant (3.9%; 95% CI = - 1.1, 9.1%).

CONCLUSIONS

Traditional public service announcements rely heavily on communicating facts (informational framing). Shifting from a fact-focused, informational framing to a story-focused, narrative framing could lead to more effective health communication in areas at risk of wildfires and in public health contexts more broadly.

TRIAL REGISTRATION

Date registered: August 19, 2021; Registration DOI: https://doi.org/10.17605/OSF.IO/JMWUF.

Catastrophic PM2.5 emissions from Siberian forest fires: Impacting factors analysis

With increased forest fires due to climate change, PM_2.5 emissions also intensified. Record PM_2.5 emissions according to Copernicus Atmosphere Monitoring Service in Russia amounted to 8 megatons (Mt) in 2021, which is 78% higher than the average level of 2004-2021 (4.5 Mt). Seven federal subjects (the constituent entities) with vast forest areas without fire protection produced 86% of emissions (6.8 Mt) in 2021, the major losses (6.1 Mt) in Yakutia (Sakha Republic). The ambient temperature in Eastern Siberia is increasing, especially in months of winter and spring seasons (up to +3.6 °C) in 1990-2020 compared to 1901-2020 (CEDA Archive); climate change has affected meteorological conditions leading to increased forest fires. The results of the SARIMAX model study for PM_2.5 emissions considering meteorological factors using ERA5 and burnt forest area using MODIS (MCD64A1), establishing a significant dependence of PM_2.5 emissions on the lack of precipitation and the associated parameters of complete and potential evaporation. This influence long before the fire season (up to 9 months), as it affects the snow cover and the dryness of the fuel by the beginning of forest fires. In turn, high PM_2.5 emission values are accompanied by a drop in 2 m air temperature and surface solar radiation downwards due to the aerosol saturation with suspended particles. The average COR for seven federal subjects was 0.79, with the highest forecast result in Yakutia (0.95), indicating the maximum propensity for record emissions due to weather conditions. In combination with forest management without fire protection, meteorological parameters have caused an increase in PM_2.5 emissions in recent years in Siberia. The forest needs other ways to manage under the pressures of climate change to reduce environmental pollution associated with PM_2.5 emissions from vast Siberian fires.

Indoor Air Quality Considerations for Laboratory Animals in Wildfire-Impacted Regions-A Pilot Study

Wildfire events are increasing across the globe. The smoke generated as a result of this changing fire landscape is potentially more toxic than air pollution from other ambient sources, according to recent studies. This is especially concerning for populations of humans or animals that live downwind of areas that burn frequently, given that ambient exposure to wildfire smoke cannot be easily eliminated. We hypothesized that a significant indoor air pollution risk existed for laboratory animal facilities located proximal to fire-prone areas. Here, we measured real time continuous outdoor and indoor air quality for 28 days at a laboratory animal facility located in the Rocky Mountain region. We demonstrated that during a wildfire event, the indoor air quality of this animal facility is influenced by ambient smoke events. The daily average indoor fine particulate matter value in an animal room exceeded the Environmental Protection Agency's ambient annual standard 14% of the time and exceeded the World Health Organization's ambient annual guideline 71% of the time. We further show that specialized cage filtration systems are capable of mitigating air pollution penetrance and could improve an animal's microenvironment. The potential effects for laboratory animal physiology that occur in response to the exposure levels and durations measured in this study remain to be determined; yet, even acute wildfire exposure events have been previously correlated with significant differences in gene regulatory and metabolic processes in vivo. We believe these findings warrant consideration for indoor laboratory animal facility air quality monitoring and development of smoke exposure prevention and response protocols, especially among facilities located downwind of fire-prone landscapes.

Outdoor and indoor fine particulate matter at skilled nursing facilities in the western United States during wildfire and non-wildfire seasons

Wildfire activity is increasing in parts of the world where extreme drought and warming temperatures contribute to fireprone conditions, including the western United States. The elderly are among the most vulnerable, and those in long-term care with preexisting conditions have added risk for adverse health outcomes from wildfire smoke exposure. In this study, we report continuous co-located indoor and outdoor fine particulate matter (PM_2.5 ) measurements at four skilled nursing facilities in the western United States. Throughout the year 2020, over 8000 h of data were collected, which amounted to approximately 300 days of indoor and outdoor sampling at each facility. The highest indoor 24 h average PM_2.5 recorded at each facility was 43.6 µg/m³ , 103.2 µg/m³ , 35.4 µg/m³ , and 202.5 µg/m³ , and these peaks occurred during the wildfire season. The indoor-to-outdoor PM_2.5 ratio and calculated infiltration efficiencies indicated high variation in the impact of wildfire events on Indoor Air Quality between the four facilities. Notably, infiltration efficiency ranged from 0.22 to 0.76 across the four facilities. We propose that this variability is evidence that PM_2.5 infiltration may be impacted by modifiable building characteristics and human behavioral factors, and this should be addressed in future studies.

Potential impacts of Washington State's wildfire worker protection rule on construction workers

Driven by climate change, wildfires are increasing in frequency, duration, and intensity across the Western United States. Outdoor workers are being exposed to increasing wildfire-related particulate matter and smoke. Recognizing this emerging risk, Washington adopted an emergency rule and is presently engaged in creating a permanent rule to protect outdoor workers from wildfire smoke exposure. While there are growing bodies of literature on the exposure to and health effects of wildfire smoke in the general public and wildland firefighters, there is a gap in knowledge about wildfire smoke exposure among outdoor workers generally and construction workers specifically-a large category of outdoor workers in Washington totaling 200,000 people. Several data sources were linked in this study-including state-collected employment data and national ambient air quality data-to gain insight into the risk of PM2.5 exposure among construction workers and evaluate the impacts of different air quality thresholds that would have triggered a new Washington emergency wildfire smoke rule aimed at protecting workers from high PM2.5 exposure. Results indicate the number of poor air quality days has increased in August and September in recent years. Over the last decade, these months with the greatest potential for particulate matter exposure coincided with an annual peak in construction employment that was typically 9.4-42.7% larger across Washington counties (one county was 75.8%). Lastly, the 'encouraged' threshold of the Washington emergency rule (20.5 μg m-3) would have resulted in 5.5 times more days subject to the wildfire rule on average across all Washington counties compared to its 'required' threshold (55.5 μg m-3), and in 2020, the rule could have created demand for 1.35 million N-95 filtering facepiece respirators among construction workers. These results have important implications for both employers and policy makers as rules are developed. The potential policy implications of wildfire smoke exposure, exposure control strategies, and data gaps that would improve understanding of construction worker exposure to wildfire smoke are also discussed.

New seasonal pattern of pollution emerges from changing North American wildfires

Rising emissions from wildfires over recent decades in the Pacific Northwest are known to counteract the reductions in human-produced aerosol pollution over North America. Since amplified Pacific Northwest wildfires are predicted under accelerating climate change, it is essential to understand both local and transported contributions to air pollution in North America. Here, we find corresponding increases for carbon monoxide emitted from the Pacific Northwest wildfires and observe significant impacts on both local and down-wind air pollution. Between 2002 and 2018, the Pacific Northwest atmospheric carbon monoxide abundance increased in August, while other months showed decreasing carbon monoxide, so modifying the seasonal pattern. These seasonal pattern changes extend over large regions of North America, to the Central USA and Northeast North America regions, indicating that transported wildfire pollution could potentially impact the health of millions of people.

Growing emissions from Pacific Northwest wildfires have increased atmospheric carbon monoxide in August, raising questions about potential health impacts as the seasonal pattern of air quality changes for large regions of North America.

Excess emergency department visits for cardiovascular and respiratory diseases during the 2019-20 bushfire period in Australia: A two-stage interrupted time-series analysis

The health effects of the unprecedented bushfires in Australia in 2019-20 have not been fully examined. We aimed to examine the excess emergency department (ED) visits related to the 2019-20 bushfires in New South Wales (NSW). We obtained weekly data of ED visits for cardiovascular and respiratory diseases in all the 28 Statistical Area Level 4 (SA4) regions in NSW during the bushfire seasons from 2017 to 2020. A two-stage interrupted time-series analysis was applied to quantify the excess risk for ED visits in 2019-20. The total number of excess ED visits, excess percentages, and their empirical confidence intervals (eCIs) were calculated to estimate the impacts of the bushfire season. A total of 416,057 records of cardiorespiratory ED visits were included in our analysis. The bushfire season in 2019-20 was significantly associated with a 6.0% increase (95% eCI: 1.9, 10.3) in ED visits for respiratory diseases and a 10.0% increase (95% eCI: 5.0, 15.2) for cardiovascular diseases, corresponding to 6177 (95% eCI: 1989, 10,166) and 3120 (95% eCI: 1628, 4544) excess ED visits, respectively. The percentage of excess ED visits was higher in regions with lower SES and high fire density. In the context of climate change, more targeted strategies should be developed to prevent adverse bushfire effects and recover from such extreme environmental events.

Impact of Wildfires on Meteorology and Air Quality (PM2.5 and O3) over Western United States during September 2017

In this study, we investigated the impact of wildfires on meteorology and air quality (PM2.5 and O3) over the western United States during the September 2017 period. This is done by using Weather Research and Forecasting model coupled with Chemistry (WRF-Chem) to simulate scenarios with wildfires (base case) and without wildfires (sensitivity case). Our analysis performed during the first half of September 2017 (when wildfire activity was more intense) reveals a reduction in modelled daytime average shortwave surface downward radiation especially in locations close to wildfires by up to 50 W m−2, thus resulting in the reduction of the diurnal average surface temperature by up to 0.5 °C and the planetary boundary layer height by up to 50 m. These changes are mainly attributed to aerosol-meteorology feedbacks that affect radiation and clouds. The model results also show mostly enhancements for diurnally averaged cloud optical depth (COD) by up to 10 units in the northern domain due to the wildfire-related air quality. These changes occur mostly in response to aerosol–cloud interactions. Analysis of the impact of wildfires on chemical species shows large changes in daily mean PM2.5 concentrations (exceeding by 200 μg m−3 in locations close to wildfires). The 24 h average surface ozone mixing ratios also increase in response to wildfires by up to 15 ppbv. The results show that the changes in PM2.5 and ozone occur not just due to wildfire emissions directly but also in response to changes in meteorology, indicating the importance of including aerosol-meteorology feedbacks, especially during poor air quality events.

Exposure to mine fire related particulate matter and mortality: A time series analysis from the Hazelwood Health Study

BACKGROUND

In 2014, the Morwell brown coal mine, located in the Latrobe Valley of South eastern Australia, caught fire covering nearby areas in plumes of smoke over a 6-week period.

AIMS

To investigate the association between exposure to mine fire related air pollution and the risk of mortality.

METHODS

Time series models were used to evaluate the risk of mortality during the first 30 days of the mine fire, when the smoke was most intense, and in the following six months. Associations were also investigated between mine fire related PM_2.5 and mortality.

RESULTS

During the 30-day mine fire period, there was an increased risk of death from injury in the most exposed town of Morwell, however no increased risk was observed for all-cause, cardiovascular or respiratory mortality. In the broader Latrobe Valley, males and residents aged 80 and above were at greatest risk of death from injury during the mine fire. In Morwell, during the six months after the mine fire there was an increased risk of all-cause mortality and death from Ischaemic Heart Disease (IHD). Males and residents aged 80 and above in the broader Latrobe Valley, were at increased risk of death from IHD six months after the fire.

CONCLUSIONS

Coal mine fire exposure was associated with an increase in injury deaths during the mine fire and cardiovascular deaths in the six months after the fire. These findings assist in identifying at risk groups, and improving targeted health advice for future air pollution exposures in the community.

Performance and Deployment of Low-Cost Particle Sensor Units to Monitor Biomass Burning Events and Their Application in an Educational Initiative

Biomass burning smoke is often a significant source of airborne fine particles in regional areas where air quality monitoring is scarce. Emerging sensor technology provides opportunities to monitor air quality on a much larger geographical scale with much finer spatial resolution. It can also engage communities in the conversation around local pollution sources. The SMoke Observation Gadget (SMOG), a unit with a Plantower dust sensor PMS3003, was designed as part of a school-based Science, Technology, Engineering and Mathematics (STEM) project looking at smoke impacts in regional areas of Victoria, Australia. A smoke-specific calibration curve between the SMOG units and a standard regulatory instrument was developed using an hourly data set collected during a peat fire. The calibration curve was applied to the SMOG units during all field-based validation measurements at several locations and during different seasons. The results showed strong associations between individual SMOG units for PM_2.5 concentrations (r² = 0.93-0.99) and good accuracy (mean absolute error (MAE) < 2 μg m^-3). Correlations of the SMOG units to reference instruments also demonstrated strong associations (r² = 0.87-95) and good accuracy (MAE of 2.5-3.0 μg m^-3). The PM_2.5 concentrations tracked by the SMOG units had a similar response time as those measured by collocated reference instruments. Overall, the study has shown that the SMOG units provide relevant information about ambient PM_2.5 concentrations in an airshed impacted predominantly by biomass burning, provided that an adequate adjustment factor is applied.

A novel weighting method to remove bias from within-subject exposure dependency in case-crossover studies

BACKGROUND

Case-crossover studies have been widely used in various fields including pharmacoepidemiology. Vines and Farrington indicated in 2001 that when within-subject exposure dependency exists, conditional logistic regression can be biased. However, this bias has not been well studied.

METHODS

We have extended findings by Vines and Farrington to develop a weighting method for the case-crossover study which removes bias from within-subject exposure dependency. Our method calculates the exposure probability at the case period in the case-crossover study which is used to weight the likelihood formulae presented by Greenland in 1999. We simulated data for the population with a disease where most patients receive a cyclic treatment pattern with within-subject exposure dependency but no time trends while some patients stop and start treatment. Finally, the method was applied to real-world data from Japan to study the association between celecoxib and peripheral edema and to study the association between selective serotonin reuptake inhibitor (SSRI) and hip fracture in Australia.

RESULTS

When the simulated rate ratio of the outcome was 4.0 in a case-crossover study with no time-varying confounder, the proposed weighting method and the Mantel-Haenszel odds ratio reproduced the true rate ratio. When a time-varying confounder existed, the Mantel-Haenszel method was biased but the weighting method was not. When more than one control period was used, standard conditional logistic regression was biased either with or without time-varying confounding and the bias increased (up to 8.7) when the study period was extended. In real-world analysis with a binary exposure variable in Japan and Australia, the point estimate of the odds ratio (around 2.5 for the association between celecoxib and peripheral edema and around 1.6 between SSRI and hip fracture) by our weighting method was equal to the Mantel-Haenszel odds ratio and stable compared with standard conditional logistic regression.

CONCLUSION

Case-crossover studies may be biased from within-subject exposure dependency, even without exposure time trends. This bias can be identified by comparing the odds ratio by the Mantel-Haenszel method and that by standard conditional logistic regression. We recommend using our proposed method which removes bias from within-subject exposure dependency and can account for time-varying confounders.

Efficacy of Communication Techniques and Health Outcomes of Bushfire Smoke Exposure: A Scoping Review

Public health officials communicate the relevant risks of bushfire smoke exposure and associated health protection measures to affected populations. Increasing global bushfire incidence in the context of climate change motivated this scoping review. English-language publications related to adverse health outcomes following bushfire smoke exposure and publications relating to communication during natural disasters were included. Bushfire smoke events potentially increase healthcare contact, especially presentations triggered by respiratory illness. At-risk populations include those with underlying cardiorespiratory disease, elderly, paediatric, pregnant persons, and First Nations people. We found that social media, television, and radio are among the most common information sources utilised in bushfire smoke events. Message style, content, and method of delivery can directly influence message uptake and behaviour modification. Age, rurality, and geographical location influence information source preferences. Culturally and linguistically diverse groups and those with hearing, vision, and mobility-related disabilities may benefit from targeted health recommendations. This review emphasises the health effects of bushfire smoke exposure and related communication recommendations during and after bushfire smoke events. Additional investigation may further clarify the health effects of bushfire smoke exposure and efficacy of related health messaging, particularly in at-risk populations. Quantitative comparison of communication methods may yield more specific recommendations for future bushfire smoke events.

Estimated Mortality and Morbidity Attributable to Smoke Plumes in the United States: Not Just a Western US Problem

As anthropogenic emissions continue to decline and emissions from landscape (wild, prescribed, and agricultural) fires increase across the coming century, the relative importance of landscape-fire smoke on air quality and health in the United States (US) will increase. Landscape fires are a large source of fine particulate matter (PM2.5), which has known negative impacts on human health. The seasonal and spatial distribution, particle composition, and co-emitted species in landscape-fire emissions are different from anthropogenic sources of PM2.5. The implications of landscape-fire emissions on the sub-national temporal and spatial distribution of health events and the relative health importance of specific pollutants within smoke are not well understood. We use a health impact assessment with observation-based smoke PM2.5 to determine the sub-national distribution of mortality and the sub-national and sub-annual distribution of asthma morbidity attributable to US smoke PM2.5 from 2006 to 2018. We estimate disability-adjusted life years (DALYs) for PM2.5 and 18 gas-phase hazardous air pollutants (HAPs) in smoke. Although the majority of large landscape fires occur in the western US, we find the majority of mortality (74%) and asthma morbidity (on average 75% across 2006-2018) attributable to smoke PM2.5 occurs outside the West, due to higher population density in the East. Across the US, smoke-attributable asthma morbidity predominantly occurs in spring and summer. The number of DALYs associated with smoke PM2.5 is approximately three orders of magnitude higher than DALYs associated with gas-phase smoke HAPs. Our results indicate awareness and mitigation of landscape-fire smoke exposure is important across the US.

Associations between exposure to landscape fire smoke and child mortality in low-income and middle-income countries: a matched case-control study

BACKGROUND

The prevalence of landscape fires has increased, particularly in low-income and middle-income countries (LMICs). We aimed to assess the impact of exposure to landscape fire smoke (LFS) on the health of children.

METHODS

We conducted a sibling-matched case-control study and selected 552 155 children (aged <18 years) from Demographic and Health Surveys in 55 LMICs from 2000 to 2014. Each deceased child was matched with their sibling(s). The exposure indicators were fire-sourced PM_2·5 and dry-matter emissions. We associated these exposure indicators with child mortality using conditional regressions, and derived an exposure-response function using a non-linear model. Based on the association, we quantified the global burden of fire-attributable child deaths in LMICs from 2000 to 2014.

FINDINGS

Each 1 μg/m³ increment of fire-sourced PM_2·5 was associated with a 2·31% (95% CI 1·50-3·13) increased risk of child mortality. The association was robust to different models. The exposure-response function was superlinear and suggested per-unit exposure to larger fires was more toxic. Based on our non-linear exposure-response function, we estimated that between 2000 and 2014, the five countries with the largest number of child deaths associated with fire-sourced PM_2·5 were Nigeria (164 000 [126 000 to 209 000] annual deaths), Democratic Republic of the Congo (126 000 [95% CI 114 000 to 139 000] annual deaths), India (65 900 [-22 200 to 147 000] annual deaths), Uganda (30 200 [24 500 to 36 300] annual deaths), and Indonesia (28 900 [19 100 to 38 400]).

INTERPRETATION

Exposure to landscape fire smoke contributes substantially to the global burden of child mortality.

FUNDING

National Natural Science Foundation of China, Ministry of Science and Technology of China, Peking University, UK National Institute for Health Research Health Protection Research Unit, Leverhulme Center for Wildfires, Environment and Society, and National Environment Research Council National Capability funding to National Centre for Earth Observation and Energy Foundation.

Short-term health effects from outdoor exposure to biomass burning emissions: A review

Biomass burning (BB) including forest, bush, prescribed fires, agricultural fires, residential wood combustion, and power generation has long been known to affect climate, air quality and human health. With this work we supply a systematic review on the health effects of BB emissions in the framework of the WHO activities on air pollution. We performed a literature search of online databases (PubMed, ISI, and Scopus) from year 1980 up to 2020. A total of 81 papers were considered as relevant for mortality and morbidity effects. High risk of bias was related with poor estimation of BB exposure and lack of adjustment for important confounders. PM10 and PM2.5 concentrations originating from BB were associated with all-cause mortality: the meta-analytical estimate was equal to 1.31% (95% CI 0.71, 1.71) and 1.92% (95% CI -1.19, 5.03) increased mortality per each 10 μg m^-3 increase of PM10 and PM2.5, respectively. Regarding cardiovascular mortality 8 studies reported quantitative estimates. For smoky days and for each 10 μg m^-3 increase in PM2.5 concentrations, the risk of cardiovascular mortality increased by 4.45% (95% CI 0.96, 7.95) and by 3.30% (95% CI -1.97, 8.57), respectively. Fourteen studies evaluated whether respiratory morbidity was adversely related to PM2.5 (9 studies) or PM10 (5 studies) originating from BB. All found positive associations. The pooled effect estimates were 4.10% (95% CI 2.86, 5.34) and 4.83% (95% CI 0.06, 9.60) increased risk of total respiratory admissions/emergency visits, per 10 μg m^-3 increases in PM2.5 and PM10, respectively. Regarding cardiovascular morbidity, sixteen studies evaluated whether this was adversely related to PM2.5 (10 studies) or PM10 (6 studies) originating from BB. They found both positive and negative results, with summary estimates equal to 3.68% (95% CI -1.73, 9.09) and 0.93% (95% CI -0.18, 2.05) increased risk of total cardiovascular admissions/emergency visits, per 10 μg m^-3 increases in PM2.5 and PM10, respectively. To conclude, a significant number of studies indicate that BB exposure is associated with all-cause and cardiovascular mortality and respiratory morbidity.

Field measurements of PM2.5 infiltration factor and portable air cleaner effectiveness during wildfire episodes in US residences

Wildfires have frequently occurred in the western United States (US) during the summer and fall seasons in recent years. This study measures the PM2.5 infiltration factor in seven residences recruited from five dense communities in Seattle, Washington, during a 2020 wildfire episode and evaluates the impacts of HEPA-based portable air cleaner (PAC) use on reducing indoor PM2.5 levels. All residences with windows closed went through an 18-to-24-h no filtration session, with five of seven following that period with an 18-to-24-h filtration session. Auto-mode PACs, which automatically adjust the fan speed based on the surrounding PM2.5 levels, were used for the filtration session. 10-s resolved indoor PM2.5 levels were measured in each residence's living room, while hourly outdoor levels were collected from the nearest governmental air quality monitoring station to each residence. Additionally, a time-activity diary in minute resolution was collected from each household. With the impacts of indoor sources excluded, indoor PM2.5 mass balance models were developed to estimate the PM2.5 indoor/outdoor (I/O) ratios, PAC effectiveness, and decay-related parameters. Among the seven residences, the mean infiltration factor ranged from 0.33 (standard deviation [SD]: 0.06) to 0.76 (SD: 0.05). The use of auto-mode PAC led to a 48%-78% decrease of indoor PM2.5 levels after adjusting for outdoor PM2.5 levels and indoor sources. The mean (SD) air exchange rates ranged from 0.30 (0.13) h-1 to 1.41 (3.18) h-1 while the PM2.5 deposition rate ranged from 0.10 (0.54) h-1 to 0.49 (0.47) h-1. These findings suggest that staying indoors, a common protective measure during wildfire episodes, is insufficient to prevent people's excess exposure to wildfire smoke, and provides quantitative evidence to support the utilization of auto-mode PACs during wildfire events in the US.

Wildfire Burn Patients: A Unique Population

In the past ten years wildfires have burned an average of 6.8 million acres per year and this is expected to increase with climate change. Wildfire burn patient outcomes have not been previously well characterized. Wildfire burn patients from the Tubbs or Camp wildfires and non-wildfire burn matched controls were identified from the burn center database and outcomes were compared. The primary outcome was mortality. Secondary outcomes included length of stay (LOS), intensive care unit (ICU) LOS, readmission and development of wound infections. Time of presentation and operating room use after wildfires was evaluated. Sixteen wildfire burn patients were identified and matched with 32 controls. Wildfire burn patients trended towards higher mortality (19% wildfire vs. 9% non-wildfire, p=0.386), longer LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), longer ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991), increased readmission (19% wildfire vs. 3% non-wildfire, p=0.080) and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.468). The majority of wildfire patients (88%) presented within 24 hours of the wildfire reaching a residential area. Operating room time within the first week was 13 hours 44 minutes for the Tubbs Fire and 19 hours 1 minute for the Camp Fire. Patients who sustain burns in wildfires are potentially at increased risk of mortality, prolonged LOS, wound infection and readmission.

Respiratory Impacts of Wildland Fire Smoke: Future Challenges and Policy Opportunities. An Official American Thoracic Society Workshop Report

Wildland fires are diminishing air quality on a seasonal and regional basis, raising concerns about respiratory health risks to the public and occupational groups. This American Thoracic Society (ATS) workshop was convened in 2019 to meet the growing health threat of wildland fire smoke. The workshop brought together a multidisciplinary group of 19 experts, including wildland fire managers, public health officials, epidemiologists, toxicologists, and pediatric and adult pulmonologists. The workshop examined the following four major topics: 1) the science of wildland fire incidence and fire management, 2) the respiratory and cardiovascular health effects of wildland fire smoke exposure, 3) communication strategies to address these health risks, and 4) actions to address wildland fire health impacts. Through formal presentations followed by group discussion, workshop participants identified top priorities for fire management, research, communication, and public policy to address health risks of wildland fires. The workshop concluded that short-term exposure to wildland smoke causes acute respiratory health effects, especially among those with asthma and chronic obstructive pulmonary disease. Research is needed to understand long-term health effects of repeated smoke exposures across fire seasons for children, adults, and highly exposed occupational groups (especially firefighters). Other research priorities include fire data collection and modeling, toxicology of different fire fuel sources, and the efficacy of health protective measures to prevent respiratory effects of smoke exposure. The workshop committee recommends a unified federal response to the growing problem of wildland fires, including investment in fire behavior and smoke air quality modeling, research on the health impacts of smoke, and development of robust clinical and public health communication tools.

Policy Implications for Protecting Health from the Hazards of Fire Smoke. A Panel Discussion Report from the Workshop Landscape Fire Smoke: Protecting Health in an Era of Escalating Fire Risk

Globally, and nationally in Australia, bushfires are expected to increase in frequency and intensity due to climate change. To date, protection of human health from fire smoke has largely relied on individual-level actions. Recent bushfires experienced during the Australian summer of 2019–2020 occurred over a prolonged period and encompassed far larger geographical areas than previously experienced, resulting in extreme levels of smoke for extended periods of time. This particular bushfire season resulted in highly challenging conditions, where many people were unable to protect themselves from smoke exposures. The Centre for Air pollution, energy and health Research (CAR), an Australian research centre, hosted a two-day symposium, Landscape Fire Smoke: Protecting health in an era of escalating fire risk, on 8 and 9 October 2020. One component of the symposium was a dedicated panel discussion where invited experts were asked to examine alternative policy settings for protecting health from fire smoke hazards with specific reference to interventions to minimise exposure, protection of outdoor workers, and current systems for communicating health risk. This paper documents the proceedings of the expert panel and participant discussion held during the workshop.

Health Impact Assessment of the 2020 Washington State Wildfire Smoke Episode: Excess Health Burden Attributable to Increased PM2.5 Exposures and Potential Exposure Reductions

Major wildfires starting in the summer of 2020 along the west coast of the United States made PM2.5 concentrations in this region rank among the highest in the world. Washington was impacted both by active wildfires in the state and aged wood smoke transported from fires in Oregon and California. This study aims to estimate the magnitude and disproportionate spatial impacts of increased PM2.5 concentrations attributable to these wildfires on population health. Daily PM2.5 concentrations for each county before and during the 2020 Washington wildfire episode (September 7-19) were obtained from regulatory air monitors. Utilizing previously established concentration-response function (CRF) of PM2.5 (CRF of total PM2.5) and odds ratio (OR) of wildfire smoke days (OR of wildfire smoke days) for mortality, we estimated excess mortality attributable to the increased PM2.5 concentrations in Washington. On average, daily PM2.5 concentrations increased 97.1 μg/m3 during the wildfire smoke episode. With CRF of total PM2.5, the 13-day exposure to wildfire smoke was estimated to lead to 92.2 (95% CI: 0.0, 178.7) more all-cause mortality cases; with OR of wildfire smoke days, 38.4 (95% CI: 0.0, 93.3) increased all-cause mortality cases and 15.1 (95% CI: 0.0, 27.9) increased respiratory mortality cases were attributable to the wildfire smoke episode. The potential impact of avoiding elevated PM2.5 exposures during wildfire events significantly reduced the mortality burden. Because wildfire smoke episodes are likely to impact the Pacific Northwest in future years, continued preparedness and mitigations to reduce exposures to wildfire smoke are necessary to avoid excess health burden.

Extreme Weather and Climate Change: Population Health and Health System Implications

Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm's way could alter this trend. Long-term changes to Earth's energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now.

Health effects of wildfire smoke in children and public health tools: a narrative review

Wildfire smoke is an increasing environmental health threat to which children are particularly vulnerable, for both physiologic and behavioral reasons. To address the need for improved public health messaging this review summarizes current knowledge and knowledge gaps in the health effects of wildfire smoke in children, as well as tools for public health response aimed at children, including consideration of low-cost sensor data, respirators, and exposures in school environments. There is an established literature of health effects in children from components of ambient air pollution, which are also present in wildfire smoke, and an emerging literature on the effects of wildfire smoke, particularly for respiratory outcomes. Low-cost particulate sensors demonstrate the spatial variability of pollution, including wildfire smoke, where children live and play. Surgical masks and respirators can provide limited protection for children during wildfire events, with expected decreases of roughly 20%  and 80% for surgical masks and N95 respirators, respectively. Schools should improve filtration to reduce exposure of our nation's children to smoke during wildfire events. The evidence base described may help clinical and public health authorities provide accurate information to families to improve their decision making.

Wildfire particulate matter in Shasta County, California and respiratory and circulatory disease-related emergency department visits and mortality, 2013-2018

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Wildfire smoke harms health. We add to this literature by evaluating the health effects of California’s 2018 Carr Fire and preceding wildfire seasons in Shasta County.

Differences in the Estimation of Wildfire-Associated Air Pollution by Satellite Mapping of Smoke Plumes and Ground-Level Monitoring

Wildfires, which are becoming more frequent and intense in many countries, pose serious threats to human health. To determine health impacts and provide public health messaging, satellite-based smoke plume data are sometimes used as a proxy for directly measured particulate matter levels. We collected data on particulate matter <2.5 μm in diameter (PM_2.5) concentration from 16 ground-level monitoring stations in the San Francisco Bay Area and smoke plume density from satellite imagery for the 2017–2018 California wildfire seasons. We tested for trends and calculated bootstrapped differences in the median PM_2.5 concentrations by plume density category on a 0–3 scale. The median PM_2.5 concentrations for categories 0, 1, 2, and 3 were 16, 22, 25, and 63 μg/m³, respectively, and there was much variability in PM_2.5 concentrations within each category. A case study of the Camp Fire illustrates that in San Francisco, PM_2.5 concentrations reached their maximum many days after the peak for plume density scores. We found that air pollution characterization by satellite imagery did not precisely align with ground-level PM_2.5 concentrations. Public health practitioners should recognize the need to combine multiple sources of data regarding smoke patterns when developing public guidance to limit the health effects of wildfire smoke.

Wildfire Smoke: Opportunities for Cooperation Among Health Care, Public Health, and Land Management to Protect Patient Health

Preventing the adverse health impacts of wildfire smoke involves helping people understand if they are at risk, and the actions they can take to limit exposure. Cooperation between land managers, public health officials, and the health care system could alert the public to take actions that reduce wildfire smoke-related health risks.

Combined Burden of Heat and Particulate Matter Air Quality in WA Agriculture

Objectives: To evaluate the combined burden of heat and air quality exposure in Washington State agriculture by (1) characterizing the spatiotemporal pattern of heat and PM_2.5 exposures during wildfire seasons; (2) describing the potential impact of these combined exposures on agricultural worker populations; and (3) identifying data gaps for addressing this burden in rural areas.

METHODS

We combined county-level data to explore data availability and estimate the burden of heat and PM_2.5 co-exposures for Washington agricultural workers from 2010 to 2018. Quarterly agricultural worker population estimates were linked with data from a weather station network and ambient air pollution monitoring sites. A geographical information system displayed counties, air monitoring sites, agricultural crops, and images from a smoke dispersion model during recent wildfire events.

RESULTS

We found substantial spatial and temporal variability in high heat and PM_2.5 exposures. The largest peaks in PM_2.5 exposures tended to occur when the heat index was around 85°F and during summers when there were wildfires. Counties with the largest agricultural populations tended to have the greatest concurrent high heat and PM_2.5 exposures, and these exposures tended to be highest during the third quarter (July-September), when population counts were also highest. Additionally, we observed limited access to local air quality information in certain rural areas.

CONCLUSION

Our findings inform efforts about highest risk areas, times of year, and data availability in rural areas. Understanding the spatiotemporal pattern of exposures is consistent with the precision agriculture framework and is foundational to addressing equity in rural agricultural settings.

Air pollution and chronic obstructive pulmonary disease

There is considerable epidemiological evidence indicating that air pollution has adverse effects on human health and is closely related to respiratory diseases, including chronic obstructive pulmonary disease (COPD). These effects, which can be divided into short- and long-term effects, can manifest as an exacerbation of existing symptoms, impaired lung function, and increased hospitalization and mortality rates. Long-term exposure to air with a high concentration of pollutants may also increase the incidence of COPD. The combined effects of different pollutants may become more complex in the future; hence, there is a need for more intensive research on specific at-risk populations, and formulating corresponding protective strategies is crucial. We aimed to review the epidemiological evidence on the effect of air pollution on COPD, the possible pathophysiological mechanisms underlying this effect, as well as protective measures against the effects of air pollutants in patients with COPD.

Wildfire and prescribed burning impacts on air quality in the United States

Air quality impacts from wildfires have been dramatic in recent years, with millions of people exposed to elevated and sometimes hazardous fine particulate matter (PM _2.5 ) concentrations for extended periods. Fires emit particulate matter (PM) and gaseous compounds that can negatively impact human health and reduce visibility. While the overall trend in U.S. air quality has been improving for decades, largely due to implementation of the Clean Air Act, seasonal wildfires threaten to undo this in some regions of the United States. Our understanding of the health effects of smoke is growing with regard to respiratory and cardiovascular consequences and mortality. The costs of these health outcomes can exceed the billions already spent on wildfire suppression. In this critical review, we examine each of the processes that influence wildland fires and the effects of fires, including the natural role of wildland fire, forest management, ignitions, emissions, transport, chemistry, and human health impacts. We highlight key data gaps and examine the complexity and scope and scale of fire occurrence, estimated emissions, and resulting effects on regional air quality across the United States. The goal is to clarify which areas are well understood and which need more study. We conclude with a set of recommendations for future research.

IMPLICATIONS

In the recent decade the area of wildfires in the United States has increased dramatically and the resulting smoke has exposed millions of people to unhealthy air quality. In this critical review we examine the key factors and impacts from fires including natural role of wildland fire, forest management, ignitions, emissions, transport, chemistry and human health.