Pulmonologist: Those with lung disease need to protect selves from wildfire smoke, healthy people fine

Watertown Daily Times - 6/8/2023

Jun. 8—Northern New York residents with no underlying respiratory problems shouldn't see any long-term effects from the wildfire smoke polluting the air in the north country, health officials say. Those with chronic lung conditions are cautioned not to go outdoors if possible. But if they do, they are advised to protect themselves with an N95 respirator mask. Cloth or surgical masks are considered inadequate.

Dr. Frederic D. Seifer, a pulmonologist at St. Lawrence Health, said those with conditions such as asthma, COPD or bronchiectasis could see "an acute worsening of their baseline lung disease."

Dr. Andrew F. Williams, president of the St. Lawrence CountyBoard of Health, said there's been no rise in hospital admissions related to the current air pollution.

"At this time we have not seen an increase in hospital admissions for respiratory issues in St. Lawrence County. There is a concern for increased respiratory symptoms among patients with asthma and COPD — most are able to be managed as outpatients," he said.

"These patients are certainly going to be a vulnerable population right now, given the air quality," Dr. Seifer said.

According to the National Heart, Lung, and Blood Institute, "bronchiectasis is a condition that occurs when the tubes that carry air in and out of your lungs get damaged, causing them to widen and become loose and scarred. These tubes are called airways. Bronchiectasis usually results from an infection or other condition that injures the walls of your airways or prevents the airways themselves from clearing mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust, bacteria, and other small particles. In bronchiectasis, your airways slowly lose their ability to clear out this mucus. When mucus can't be cleared, it builds up and creates an environment in which bacteria can grow. This leads to repeated, serious lung infections."

Dr. Seifer said about half of the patients he treats for asthma or COPD also have bronchiectasis.

As of Wednesday afternoon, most of northern St. Lawrence County was seeing an air quality index around 200. An AQI of up to 50 is considered healthy air.

"We're talking about an AQI greater than 200 is the equivalent of smoking 10 cigarettes a day," he said. If a non-smoking, healthy person smoked 10 cigarettes for a week, it would have "absolutely no impact" on long-term health.

"An AQI greater than 100 can cause exacerbation or worsening (of lung diseases), necessitating visits to emergency room and possibly hospitalization," Dr. Seifer said.

According to the National Weather Service, AQI is a daily measure of air quality.

"The AQI focuses on health effects you may experience within a few hours or days after breathing polluted air," NWS's website says. "Environmental Protection Agency calculates the AQI for five major air pollutants regulated by the Clean Air Act: ground-level ozone, particle pollution (also known as particulate matter), carbon monoxide, sulfur dioxide, and nitrogen dioxide. For each of these pollutants, EPA has established national air quality standards to protect public health. Ground-level ozone and airborne particles are the two pollutants that pose the greatest threat to human health in this country."

Dr. Seifer said the AQI in St. Lawrence County is high enough that those with chronic lung disease will need to take steps to protect themselves.

"Stay inside right now. If they go outside, they're going to need an N95 mask and wear it properly," he said. "A cloth or surgical mask offers almost no protection — don't think that surgical mask is going to do anything to protect you. It won't."

"If they have an indoor air filter or hepa filter," he added, "I recommend they use it."

Dr. Williams additionally advised that those who are at risk closed their windows and doors while staying inside, and close the fresh air intake on any air conditioning units in a home or car.

"Avoid activities that increase indoor smoke. Avoid outdoor activities that are strenuous. Do not smoke cigarettes," Dr. Williams added.

Dr. Seifer said that those with lung diseases who need to buy necessities like food or medicine should try to find someone else to do it for them so they can stay indoors.

For those without lung conditions, he says, "I think it's important the general public just chills out, because it's not a problem, really."

He said in the north country, about 500 miles away from the wildfires causing the smoke, the particles in the air that find their way into the lungs are invisible to the naked eye, about 2.5 microns across. One micron is about 0.00004 of 1 inch. The human eye can start to see dust and debris around 25 microns across.

"These microparticles can cause inflammation in the lungs and even be absorbed in the bloodstream leading to exacerbations (worsening) of asthma, COPD or heart disease. Prolonged exposures can be associated with chronic heart, lung and other illnesses," Dr. Williams said. "The current levels of air pollution in St. Lawrence County are unlikely to cause significant issues for healthy individuals."

"Wildfires typically produce particulate matter in the 2.5-micron range. That is what people are inhaling, whether you are a sensitive group ... we're breathing in the same stuff," Dr. Seifer said.

For normal, healthy lungs, "the long-term effects will be negligible. I would be very surprised if there was any measurable long-term effects," according to Dr. Seifer, and Dr. Williams agrees.

"Is it safe to go outside? I'm not modifying my habits ... to the general public that does not have underlying lung disease, I would not recommend changing your lifestyle at this point," Dr. Seifer said.

"Healthy people may experience things like itchy, burning eyes, irritated throat or runny nose. It's up to them whether they want to go outside."

"Everyone has a different threshold," he added.

Endurance athletes who run or bike for long distances "probably wouldn't perform as well" with the current air quality in St. Lawrence County.

"St. Lawrence County generally enjoys very healthy air quality — while it is important to be mindful during the few days when there is pollution — make sure to enjoy outdoor activities throughout the rest of the year. Outdoor physical activity is one of the best ways to stay healthy," Dr. Williams wrote in an email. "There is an excellent (free) app from the EPA called AirNow — this is a good way to monitor the air pollution level in your area."

The same advice applies to Jefferson County residents, where the AQI on Wednesday hovered between 200 and 300.

"People who are vulnerable, with a heart or lung disease, older adults, and children should avoid any physical activity outside," said Lisa Lagos, a Jefferson County Public Health Department health educator. "The more vulnerable people should stay indoors."

Ms. Lagos said healthy people should avoid all outdoor physical activity while the air is polluted with wildfire smoke, although healthy people aren't likely to suffer any long-term effects of inhaling the smoke particles.

"The state health department recommends if people do have to be outdoors, wear a respirator like an N95, she said, adding that those with cardiac or pulmonary issues should consider staying inside until the air quality improves.

"If someone has COPD, (wear an N95 mask) it is going to make it harder to breathe, makes it more difficult."

She's suggesting the vulnerable reach out to family or neighbors to get necessities that require being outside for them

"If they have family or neighbor who can run out and get groceries, or medication, if they can hold off a couple of days while the pollution is like this," it would be helpful, according to Ms. Lagos. She said those who are vulnerable and have to leave home to get a required medication should call their doctor, or call the pharmacy and see if they can get it delivered.

She said everyone, vulnerable and healthy, should avoid physical activity outside.

"When you're breathing heavier, these particles can go deep into the respiratory system because the particles are so small. So no physical activity where you'll be breathing deep, pulling in that pollution," Ms. Lagos said.

She said people concerned about health effects from the smoke should reach out to a doctor, or consider going to the emergency room if it becomes difficult for them to breathe.

"If they're having concerns, if they're able to call their primary care, we recommend that first. If it's a true emergency, don't hesitate to call 911 or go to the emergency department," Ms. Lagos said.

When it comes to the health effects of this migrating smoke on our pets, the same rules mainly apply to them as it does for humans, according to Dr. Chris Gordon, medical director of VCA North Country Animal Hospital, 16760 State Route 3, Watertown.

Those rules include keeping pets inside during times of poor air quality and keeping animals, especially those with asthma or respiratory infections, in areas where an air purifier is in use.

"And limiting outside time," Dr. Gordon said. "For example, I've got to walk my dog to go to the bathroom, but we don't go for long walks. We just go to do what we need to do and then come back inside."

Like humans, poor air quality may be especially difficult for pets with compromised immune systems or for those that already have "respiratory pathology" issues.

"Cats, for instance, can get asthma, dogs can get lower airway disease which is similar to asthma," Dr. Gordon said. "Those animals are going to be obviously more susceptible to poor air quality."

Birds, Dr. Gordon said, are very susceptible to changes in air quality.

"Obviously, most of them aren't going outdoors but if they got to come in for an appointment, people may need to take extra precautions like covering their cages and eliminating that air exposure."

When it comes to tips to avoid that poor quality air exposure, the VCA North Country office did treat at least one lucky dog on Wednesday.

"I had a client come in today and she actually had a little mask for the dog, which I didn't realize they made, but they do," Dr. Gordon said. 'It went right over the muzzle and attached to a head collar."

Times staff writer Chris Brock contributed to this report

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