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Health Effects of Wildland Fire Smoke: Insight from Public Health Science Studies

Health Effects of Wildland Fire Smoke: Insight from Public Health Science Studies

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Southern Fire Exchange Fact Sheet 2012-8

This fact sheet describes the current knowledge of the health effects of wildland fire smoke.
Southern Fire Exchange Fact Sheet 2012-8

This fact sheet describes the current knowledge of the health effects of wildland fire smoke.

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Published by: Southern Fire Exchange on Feb 11, 2013
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SFE Fact Sheet 2012-8
Health Effects of Wildland Fire Smoke:Insight from Public Health Science Studies
 John M. Diaz
OVERVIEW
Exposure to smoke from wildland fire is an importantpublic health concern. While fire managers can minimizeprescribed fire smoke impacts by identifying smoke-sensitive areas and using appropriate burn techniques,smoke exposure is an inevitable side effect of some pre-scribed fires and many wildfires. People who come incontact with smoke often have questions about what theyare breathing and how it will affect their health.Federal and state agencies and public health organiza-tions, such as the Environmental Protection Agency(EPA), Departments of Public Health, the National Insti-tute of Environmental Health Sciences, and the AmericanLung Association provide valid and credible informationto answer these questions (See Additional Resources sec-tion for examples).In addition, a variety of research studies have exploredthese questions to gain a better understanding of howsmoke exposure affects public health. These studies haveevaluated physician visits and hospital admission recordsduring or following several wildland fire events to moni-tor the diagnosis of respiratory and cardiovascular illnessfor individuals exposed to smoke. Several studies alsolooked at the relationship of premature mortality and ex-posure to smoke. To provide insight on the health effectsof exposure to wildland fire smoke, this fact sheet brieflydescribes the pollutants in wildland fire smoke and thensummarizes five studies that have documented health ef-fects of wildland fire smoke in the United States, Canada,and Australia.
Questions about smoke and its effects on health arecommon during both prescribed burns and wildfires.
PHOTO BY SC FORESTRY COMMISSION.
KEY RESULTS
Due to the composition and dispersion of wildland fire smoke, particulate matter is the principal pollutant of publichealth concern. Effects will vary based on the source of smoke but predominantly impact local communities in thesame way. Studies of the effects of PM from non-fire sources show that long-term exposure can reduce lungfunction and cause the development of chronic bronchitis. Short-term exposure (hours or days), typical of wildlandfire events, can aggravate lung disease, leading to asthma attacks and acute bronchitis. These effects can alsoincrease the susceptibility to respiratory infections. Healthy children and adults may not suffer serious effects fromshort-term exposures, although temporary minor irritation may occur when particulate matter levels are elevated.Short-term exposure effects on cardiovascular health outcomes are more variable and may be related to previous di-agnoses of heart disease. Pre-mature mortality cannot be ruled out as a possible health outcome, but in a study evalu-ating a population of over two million people, there was no significant correlation between such mortality and in-creased smoke exposure.
 
SMOKE AND OTHER AIR POLLUTANTS
The components of wildland fire smoke that are most haz-ardous to human health are carbon monoxide, a group of gases called aldehydes, and particulate matter (PM)
 — 
tinyparticles of solid matter that are small enough to be inhaled.Particulate matter is the main pollutant of concern, as car-bon monoxide, aldehydes, and the hundreds of other com-pounds emitted by wildland fires are found in very lowconcentrations at short distances away from a fire. Peoplewith heart or lung disease, children, and older adults are themost likely to be affected by breathing particulate matter.However, even healthy individuals may experience tempo-rary symptoms from exposure to elevated levels of particlepollution. Forest fire smoke is a prominent source of partic-ulate matter pollution, but its public health effects are chal-lenging to assess because smoke exposure is sporadic, short-lived, and rare in densely-populated areas.
HEALTH EFFECTS
Five case studies were chosen to evaluate and identify thehealth effects associated with the exposure to wildland firesmoke. The selected studies provide insight to the chronicand acute health effects of multiple fires and fire seasons.The first are from three widely separated locations in theUnited States. The last two add an international perspectiveto the general results and conclusions.
Case 1: Peat Bog Wildfire Smoke Exposurein Rural North Carolina
For a six-week period in 2008, a lightning-ignited wildfirein dry peat swamps in eastern North Carolina producedheavy smoke that mostly drifted off the coast. However, inone 3-day period winds reversed and created dense smokeexposures across 18 counties, with several ground monitorsrecording particulate matter concentrations over 200
μ
g/m
3
.The National Ambient Air Quality Standard for PM
2.5
 (particles 2.5 micron diameter or less) is 35
μ
g/m
3
for a 24-hour period.Research professionals used this fire as an opportunity toinvestigate associated health effects of wildfire smoke ex-posure, collecting data on emergency room (ER) visits forcardiac and respiratory conditions. Relative risk for the 3-day exposure window was compared to adjacent countiesthat were not exposed to the smoke and to periods beforeand after in the affected counties.The North Carolina study found that exposure to particulatematter from the peat bog smoke increased ER visits forasthma, chronic obstructive pulmonary disease (COPD),pneumonia, acute bronchitis, and heart failure in the affect-ed counties. Similar to other studies, asthma-related out-comes were most prevalent (44% of all respiratory ER ad-missions), especially among adult women. The study alsodemonstrated a significant association between smoke ex-posure in the 3-day period and an increase in ER visits forheart failure. It was not clear if this unique finding was dueto the high particulate matter concentrations, or peat as thesource of the smoke, or some other combination of factorsthat might have made this fire different from more typicalforest fires where health effects have been studied.
Case 2: Respiratory and Cardiovascular Hospital Admis-sions during the 2003 Southern California Wildfires
This study evaluated the relationship of cardiorespiratoryhospital admissions to wildfire-related particulate matter(PM
2.5
) concentrations during a series of catastrophic wild-fires that occurred in California in October 2003. Exposureto smoke was estimated using many different methods tounderstand particulate matter concentrations in affectedareas. During the fires, there was a strong association be-tween smoke exposure and respiratory admissions. Com-munities experienced average increases in PM
2.5
of 70
μ
g/ m
3
during heavy smoke conditions. These conditions werecompared with PM
2.5
concentrations in the pre-wildfire pe-riod and showed an increase of 34% in asthma admissions.The strongest associations between PM
2.5
in smoke andhospital admissions were for people over 65 years old (10%increase per 10
μ
g/m
3
PM
2.5
) and under 5 years old (8% per10
μ
g/m
3
PM
2.5
). Acute bronchitis admissions increasedacross all ages by 10% for every 10
μ
g/m
3
in wildfire-related PM
2.5
. Chronic obstructive pulmonary disease ad-missions for ages 20
 – 
64 years also increased by 7% andpneumonia admissions for ages 5
 – 
18 years increased by64%. There was limited evidence of a small impact of wild-fire-related PM
2.5
on cardiovascular admissions. Ultimately,the findings showed that wildfire-related PM
2.5
led to in-creased respiratory hospital admissions, especially asthma.These results highlight the need for better preventivemeasures to decrease smoke exposure and respiratory ail-ments among vulnerable populations during wildfires.
In 2008, researchers investigated health effects of wildfiresmoke exposure from peat bogs burning in eastern NorthCarolina.
PHOTO BY US FISH AND WILDLIFE SERVICE.
 
Case 3: Wildfire Air Pollution and Daily Mortalityin a Large Urban Area
The two previous studies looked at both respiratory andcardiovascular health effects from wildland fire smoke,while excluding premature mortality from analyses. TheUnited States Department of Environmental and Occupa-tional Health Science, along with the University of Wash-ington School of Public Health and Community Medi-cine, explored whether acute increases in PM concentra-tions from wildfire smoke caused acute increases in dailymortality. The daily occurrence of non-accidental deathsand daily cardio-respiratory deaths for June of 2002 in theDenver metropolitan area were examined and comparedto those in two nearby counties in Colorado that were notaffected by wildfire smoke.Abrupt increases in particulate matter concentrations inDenver occurred on two different days in June as a resultof wildfire smoke drifting over the Denver area. One-hour measurements indicated peak concentrations of PM
10
and PM
2.5
were 372
μ
g/m
3
and 200
μ
g/m
3
, respec-tively, on June 9
th
and 316
μ
g/m
3
and 200
μ
g/m
3
, respec-tively, on June 18
th
. Small peaks in mortality correspond-ed to both of the PM peaks, but the first mortality peak also corresponded to a peak of mortality in the controlcounties, and cardio-respiratory deaths began to increaseon the day before the second peak. This point details theprobability that other weather related factors may havecontributed to these mortality peaks. Further, there wasno detectable increase in cardio-respiratory deaths in thehours immediately following the PM peaks.Although the findings from this study do not rule out thepossibility of small increases in mortality due to abruptand dramatic increases in PM concentrations from wild-fire smoke, in a population of over 2 million people noobservable increases in daily mortality could be attributedto such events.
Case 4: Three Measures of Forest Fire Smoke Expo-sure and Their Associations with Respiratory and Car-diovascular Health Outcomes in British Columbia
During the summer of 2003, numerous wildfires burnedin British Columbia, Canada, with significant smoke in-cursions in residential areas. The School of Environmen-tal Health and the School of Population and Public Healthat the University of British Columbia conducted a studyto examine the associations between respiratory and car-diovascular physician visits and hospital admissions us-ing three measures of smoke exposure over a 92-daystudy period.The study monitored exposure utilizing air quality moni-tors, a smoke-related dispersion model, and a smoke ex-posure metric for plumes visible in satellite images. The-se measures sought to gain insight into the effects of in-creases in the total concentration of particulate matter andthe presence or absence of exposure to smoke on all res-piratory and cardiovascular physician visits and hospitaladmissions during the study period. More specific anal-yses were also conducted for physician visits for asthma,acute upper respiratory infections, and non-hypertensivecardiovascular diagnoses. The study assessed the effect of age, sex, socioeconomic status, and possible pre-existingsensitivity (based on numbers of respiratory or cardiovas-cular physician visits in the prior year).Overall, the study found that increased particulate mat-ter exposure was associated with increased respiratoryphysician visits and hospital admissions, but not with car-diovascular physician visits or hospital admissions. Of the 34,771 respiratory physician visits, 5,496 (16%) were
coded as “asthma” and 21% were coded as “acute bron-chitis” or “acute upper respiratory infection.” This study
observed a 5% increase in hospital admissions and a 6%increase in respiratory physician visits related to a 10
μ
g/ m
3
increase in PM
10
(particles 10 micron diameter or less)from a wildland fire event. In the most similar study todate (Case 2, above), a 10 parts per million increase inPM
2.5
produced a 3% increase in the rate of respiratoryhospital admissions. Hospital visits and related healthoutcomes were significant only in cases where there wasa drastic increase in particulate matter exposure (greaterthan or equal to 30
μ
g/m
3
).Days of smoke coverage ranged from 1 to 24 (out of 92)within the study group. The majority of study areas hadparticulate matter values close to zero, on most days,while observations of high values were observed in studyareas very near active fires. This study observed no cleardifferences by sex, socioeconomic status, or possible pre-existing sensitivity. Results indicating effects of firesmoke on respiratory ailments are consistent with previ-ous studies. Short-term exposure effects on cardiovascu-lar health outcomes are more variable and may be relatedto previous diagnoses of heart disease.
Scientists use specialized equipment to measure fire emis-sions and air quality.
PHOTO BY TIMOTHY MOLO.

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