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Breathing Easier (Part 2): Wildfires and Asthma

(Smoke in Yakima, Washington on August 20, 2018 in, taken by Paul Crawford. © Yakima Herald-Republic, used with permission.)

In 2018, we have seen some of the fiercest wildfires in the history of the country. And smoke from the fires reached as far away as Ohio and beyond. The increase of warmer, drier summers has contributed to an increase of fires that are harder to contain. This summer, California had 1,000 fires in just one week in July—more than three times the average.

Days with “smoke waves” can be extremely hazardous or even deadly—especially for people with asthma. Even days with moderate levels of smoke can impair the freedom to go outside if you have asthma.

Snapshot of smoke patterns, NOAA, August 20, 2018. The map from the NOAA depicts the High-Resolution Rapid Refresh Smoke (HRRR-Smoke) model, “an experimental model showing both upper level or near-surface smoke.”

Asthma in Washington State

Our first installment on asthma focused on Philadelphia. Here, we’re focusing on Washington state, which has some of the highest rates of asthma in the country. According to the Washington State Department of Health, more than 600,000 people in the state have asthma. Nearly 120,000 of these are children. What’s more, only about 27% of adults with asthma in the state have it “well-controlled.”

And as in many other parts of the country, vulnerable communities have felt the impact of high rates of asthma. For example, Washington State’s American Indian/Alaska Native population has a high prevalence of asthma, the majority of whom live in urban and suburban areas. According to the Washington Department of Health, one-quarter of American Indians/Alaska Natives in the state who are at or below 200 percent of poverty level have asthma.

It’s also a state that’s been hit hard by wildfires burning inside and outside the state. In 2018, fires burned over 107,000 acres on public lands on the state. There were some days this summer in which Seattle had some of the worst air quality in the world. And places like the Yakima Valley—a key agricultural region in central Washington—can have a “double whammy” of smoke from both local and regional wildfires.

“I had a lot of members unable to leave their homes in August due to the air quality,” said Kari Chapman, an Optum community health worker based in Seattle. “There were a lot of people who couldn’t get to their doctor’s office or pick up prescriptions. It really disrupted quality of life for them.”

All Hands on Deck to Treat Asthma

The solutions to fix the air quality from PM2.5 particles and other pollutants are complex. The trend towards drier, hotter wildfire seasons in the Western United States and Canada shows no sign of abating. A recent study looking at projections of the health effects from wildfire smoke indicated that “some communities may suffer higher exposure to wildfire smoke, and thereby face higher health risks, due to fuel load, climate conditions such as humidity and temperature. The relative impact on communities will depend not only on their change in exposure to wildfire-specific PM2.5, but also their population growth.”

In the short term, providing quality indoor air, particularly for vulnerable populations, can be an important first line of defense. Similar to the CAPP program in Philadelphia, home visits and education can be a powerful tool. In terms of outdoor air quality, it might involve continued collaboration on a local, state and national level to integrate public health, environmental policy, and wildfire management. For example, the fact that (according to the National Park Service) as many as nine out of ten wildfires are human-caused means that “upstream” solutions to better air quality through education and enforcement are possible.

Ferguson Fire, Sierra National Forest, California, July 2018. Photo source: U.S. Forestry Service/Kari Greer

These partnerships based on sound science are crucial because smoke waves don’t follow local borders. A wildfire in one place can affect asthma sufferers hundreds of miles away. Caring for the most vulnerable members affected with asthma takes targeted, holistic interventions. This approach can offer the best clinical outcomes—especially as these air-quality risks in places like Washington have the possibility to increase.

Want to Learn More about Asthma?

Read about the first part of our series on asthma, focusing on an effective asthma management program in Philadelphia that goes into patient’s homes to fix common asthma triggers.