The Oregon Department of Environmental Quality extended an air-quality advisory Friday to more than 10 counties across the state, including Deschutes and Jefferson. The DEQ originally issued the advisory on Tuesday with guidance that it might be lifted Wednesday. However, with wildfires burning around the state and subsequent smoke enveloping many places, the Air Quality Index has risen into moderate and severe levels, per the ratings set forth by the U.S. Environmental Protection Agency’s AQI tool.
The AQI has six ranges. A green AQI value of 50 or below represents good air quality, while an AQI value over 300, represented by maroon, represents hazardous air quality.
Dr. Ian Smith, head of pulmonary medicine at St. Charles Health System, hopes to raise awareness about how being outside during high AQI levels, or allowing poor-quality outside air into homes, can lead to new or worsening health issues.
“I’m currently in my office in Bend, and we also see patients up in Redmond. It seems like the air quality’s been worse north of town, so a lot of our patients that are calling in lately have tended to be more from that area,” he said. “We take care of a lot of people with chronic lung disease, asthma, and chronic obstructive pulmonary disease or COPD, emphysema. Those are probably the majority of our patients, and we’re getting more calls from them about triage. Some of them get triage to come in for urgent visits. Some of them we can help over the phone. Some of them have symptoms significant enough that they need to get more urgent attention, like at an urgent care or the ER. I would say those have gone up.”
We asked Smith a few questions about air quality and steps that Central Oregonians can take to minimize the adverse affects of wildfire smoke and poor air quality.
the Source: For people that don’t already have chronic or existing issues, what kind of issues might people be experiencing due to poor air quality?
Ian Smith: The most common symptoms people have are eye irritation, nasal congestion, cough. We have cough receptors in our upper throat and then down into the lungs. A lot of people complain about a kind of a tickle in the throat or a dry cough. Other symptoms that are common, but that aren’t as intuitive, are just a sense of feeling really fatigued, having a headache, just feeling yucky. We give the analogy of almost feeling like you have a hangover from alcohol, and there is some physiology behind that. The biggest danger of the wildfire smoke is really particulate matter. There are these things called PM 2.5 and PM 10. And those are by the microns.
The PM 2.5 are these tiny little particulates that are small enough to get through pores in the lung and enter the bloodstream, and those can give you kind of an inflammatory state. That’s analogous to drinking too much alcohol, where your body just feels really yucky. That’s something I think the general population isn’t so aware of. The way the lung works, it gets oxygen from the environment through these little pores, and then we breathe out carbon dioxide. Those are the ways we keep ourselves alive. And unfortunately, those pores are large enough to allow these particulates to enter the body, and they can cause problems with other organs, not just your lungs.
tS: What are the steps that someone should take if they’re feeling those symptoms and at what point should they perhaps go to an urgent care or an ER?
IS: The wildfire smoke exposures for people who are healthy, who don’t have heart and lung conditions, don’t tend to be emergency situations. It’s not like you breathe in a toxic vapor and then you need to go right to the ER to get attention. The symptoms that would make someone really need to go to urgent care or the ER are a sense of difficulty breathing, chest discomfort that is atypical, that doesn’t go away quickly, and just using common sense if something is just really not right.
The most important thing with wildfire smoke is prevention. One of my goals talking to the media is really awareness, because people who live in Central Oregon tend to be very outdoorsy, and there’s a risk and benefit to everything you do in life. We certainly don’t want people not exercising and not going about their lives, but they have to be aware that when you’re out for prolonged exposures to wildfire smoke, depending on the degree of the wildfire smoke, and then your underlying health, you do put yourself at risk. So really, I think a lot of the education is around prevention, and what that means is really making sure, first of all, that your home is as well-insulated from wildfire smoke particulates as possible. And some of it’s just common sense. It’s not opening your windows at night, which, you know, a lot of people love to do in Central Oregon because it’s cooler, and making sure there are really good seals on the windows and that people aren’t opening and closing their doors, especially with young children. I remember when my kids were little, they were always going in and out. It’s just trying to really keep the home air quality good and having updated air filters on air conditioning (units) and considering buying a HEPA filter. HEPA stands for high efficiency particulate air filter. Those can be bought at any big store like Home Depot. There also are indoor air quality meters. We actually have one in our clinic.
The most important thing is keeping your home well insulated, because we spend a lot of time there, including sleeping there, and then based on the air-quality index outside, making decisions of risk and benefit. There are guidelines, and there’s a website called airnow.gov that gives the air quality index, which is AQI levels and recommendations. I recommend following those, but also thinking about how you feel. Patients might look at the air quality index and it’s 54, and so they go out for a walk like they do every day of the year, and all of a sudden they feel awful after the walk or they’re wheezing while they’re walking or short of breath. That’s a real lesson that even that air quality alone is not healthy for that person, because I think it is a bit individual.
tS: I’ve heard people say “Oh, it’s just a little hazy. It’s not dangerous.” What do you say to that?
IS: I think that’s a lack of awareness, and that’s where I think that we, as a medical profession, need to increase awareness, and then people will make their choices. I think the question I would have is how many of those people out there are aware, and if they’re aware and they’re doing that, then that’s their decision. But my worry is that a lot of people are not aware, and so really, looking at the guidelines, my recommendation for heavier exercise is to curtail any heavier exercise (when AQI is) over 150. I personally do it over 100.Whenever you do higher-intensity exercise, you can increase the amount of air you’re ventilating through your lungs up to 20 times. That just filters a lot more of these particulates into your lungs and into your bloodstream. The higher intensity exercise is one of the (things) I really have concerns about.
While the air (quality is poor), what you’re trying to do is go out there and breathe as little of it as possible. The way you could do that is A, don’t spend a lot of time out there, and then B, if you are out there, consider using an N95 or an N100 mask. Those are called that because they filter out 95% of the particulates, the N95, and then close to 100% with the N100. I think people hopefully will learn that when they go out and they do feel really yucky afterwards, it’s probably the wildfire smoke. I hope people have learned behavior from that, and I think as much as we can (raise) awareness that when they’re out there, they’re taking a risk, and then that’s a risk-benefit discussion.
tS: Beyond the immediate symptoms and health issues, are there long-term issues that can result from exposure?
IS: I think there’s more research going into this, but there’s definitely evidence of increased risk of heart attacks, especially for people who have underlying heart disease. The reason for that again is that the particulates are going into the bloodstream and creating an inflammatory state. There are also studies that show increasing risks of cancers — lung cancer, lymphoma and other cancers — for people who live in an area with intense wildfire smoke versus those who don’t.
There’s also data that people with chronic lung disease have worsening of their underlying conditions when they’re exposed repeatedly to wildfire smoke. I’m raising kids here, so I definitely have a concern about it. A lot of the soccer teams and other places have guidelines for when they don’t have the kids playing because young children and people at the extremes of age are more susceptible to wildfire smoke due to the size of their lungs in proportion to their body, among other things. So, I think the answer to your question is yes, prolonged exposure is associated with an increased cancer risk, worsening heart conditions, lung conditions and also kidney disease. The reason is these particulates are going into your bloodstream and filtering through your body.
tS: When you do go outside, do the masks like many wore during Covid provide any benefit?
IS: Unfortunately, the surgical masks that a lot of people wore during Covid are not thought to give much meaningful protection because the particulates are so small that they can pass right through the mask. There’s probably some protection against bigger particulates. The recommended mask is either the N95 or the N100 because of the 95 filtering out 95% of the particulates and the N100 close to 100%. That’s about the best you can do, but the catch with those is they have to be well-fitted to your face. So if people have a beard, they’re not thought to be very effective because the air just seeps right around the beard. My worry about the surgical masks is that people might think they’re safe to go out and exercise and to do what they’re doing, and it’s probably not having much effect. If people are trying to go out and spend a long time in air that’s low quality, I’d recommend an N95 or N100.
tS: We do a lot of prescribed burns around the area, and we do them throughout the year, I’ve heard it discussed that it’s extending the potential for poor air quality. Do you see evidence of that in visits, and what are steps people can take year-round to avoid health issues?
IS: That’s an area I’ve definitely thought a lot about, and I don’t know enough to know the pros and cons of controlled burns. There are people who know much more about the forest than I do, but I do know that when they do have those, the AQI can go into unhealthy ranges, so it’s not just the summer that we worry about. My recommendations around those times would be just to think about it the same way we think about it during the intensity of the summer. There are micro climates all over Central Oregon. And so, you know, there might be a controlled burn in La Pine, but we feel fine here (in Bend). The idea is any time any of that’s going on, it’s important to look at the AQI and then also just think about how your body feels when you’re out for a while and look out for symptoms.
MAKE LOCAL JOURNALISM HAPPEN
Republish our articles for free, online or in print, under a Creative Commons license.
