The smoke that settled in the Inland Northwest sky this weekend is not just gloomy – it’s potentially hazardous to human health.

Since late Saturday morning, the air quality in the Spokane area has been rated as hazardous and has not moved from this rating, meaning the entire population, not just those at-risk, are more likely to experience serious health effects from the polluted air.

Experts from public health officials to pulmonologists agree that the wildfire smoke, especially in the midst of a respiratory disease pandemic, adversely impacts people’s health, particularly in their airways and lungs.

Dr. Jiten Patel, a pulmonologist with Providence Health Care in Spokane, expects he and other pulmonologists to be busy in the coming weeks, following record-setting hazardous air levels in Spokane.

“There will be a crescendo,” Patel said.

Wildfire smoke emits tiny particles, called particulate matter or “PM” for short, which can cause adverse health outcomes, like exacerbated airways or the potential to develop chronic obstructive pulmonary disease.

PM2.5 is the tiniest particulate matter measured by clean air meters, and it is also the most concerning to scientists for its effects on human health. PM2.5 is so small that particles only measure a fraction of the diameter of a piece of hair in length, so small that even the cloth face coverings are not enough to keep them out.

The Air Quality Index measures the levels of several air pollutants including particulate matter, PM10 and PM2.5, as well as ozone.

On Sunday afternoon, PM2.5 levels peaked at 499 in Spokane. The 300-500 range is considered “hazardous.” The 0-50 range is considered good air quality.

Wildfire smoke is composed of more than just PM 2.5, but exposure to particulate matter can lead to a decrease in lung function, even in individuals who do not have asthma or other respiratory conditions.

Researchers from Colorado State University have also connected an increase in hospitalizations to wildfire events and particularly bad levels of air quality in Washington state. Using hospital admissions data from 2012 during the wildfire season, they found an increase in hospitalized patients seeking treatment for respiratory-related outcomes on days when there was an increase of smoke or decreased air quality.

“We found a significant relationship between exposure to wildfire smoke PM2.5 and an increase in the risk for hospital admission for pulmonary outcomes, asthma, COPD and pneumonia,” the study says.

More research needed

While studies have been conducted for those with frequent occupational exposures to wildfire smoke, the long-term effects of wildfire smoke on health require more research.

Only one long-term study has looked at the longitudinal effects of wildfire smoke on health, Dr. Colleen Reid at the University of Colorado notes in her recent review of research conducted on the health impacts of wildfire smoke. The study assessed the health of men who were adults during 1997 wildfires in Indonesia and found that they had decreased lung function a decade after the fires.

Short-term health impacts of wildfire smoke from hospitalization to lung irritation have been well-documented, but longer term effects of wildfire smoke constitute a wide gap in knowledge, in a field growing rapidly more important as the planet warms and the climate changes.

Some local research is currently underway to assess the effects of wildfire smoke on college-age students with asthma in the West.

Julie Postma, an associate professor at the Washington State University School of Nursing is trying to learn how college-age students with asthma can mitigate and prevent their risks of adverse health impacts from wildfire smoke using a phone application.

“We wanted to capitalize on their tech savviness and test an app that would help them understand their risk,” Postma said.

Study participants must have asthma and are asked to use a spirometer to monitor their lung function. Participants also record what medications they take for their asthma and when they take them. Postma and a team at Urbanova created an app that allows young adults to have access to information, tips and strategies to reduce their risk of exposure if the air quality is poor.

Postma and other researchers are assessing whether having access to the app and spirometer readings changes behavior of young adults with asthma when the air quality is good or bad.

The app shows participants other users and whether or not their lung function is being affected by the air quality outside. Researchers will also use GPS data to see if participants heed the advice or tips given on the app, in essence answering the question “if they know the air quality is bad, will they stay home?”

Previously, Postma studied what affects asthma primarily in indoor environments, but her work was just the beginning of a larger study, she said, to explore how air quality and monitoring one’s symptoms can help prevent adverse health impacts.

“I am so motivated because our world is changing, and this is an ongoing risk now,” she said.

Her study is still recruiting young adults, ages 18 to 26, who have asthma and are living in wildfire-prone regions of the country to participate.

Smoke and COVID-19

Wildfire smoke and the novel coronavirus present a difficult challenge in tandem. Only one kind of mask, an N95 respirator, can effectively keep PM2.5 particles at bay. Those masks are in high demand, however, and reserved primarily for health care providers treating COVID-19 patients.

On a biological scale, COVID-19 and wildfire smoke both can affect a person’s airways.

As Lacy Fehrenbach, deputy secretary of health for Washington’s COVID-19 response, told reporters last week: “Breathing in wildfire smoke itself is harmful to one’s health. If you have COVID-19, breathing in wildfire smoke may make your symptoms worse, and wildfire smoke can also make you more susceptible to respiratory infections, like COVID-19.”

Some of the same people most at-risk of contracting COVID-19 with severe symptoms are also individuals who are more at-risk from developing symptoms from wildfire smoke.

There’s no way to know exactly how COVID-19 patients will react to wildfire smoke, but health officials strongly encourage residents to stay home. On Monday, the Spokane Regional Health District encouraged local businesses to have all employees work from home that could due to the polluted air.

Patel encouraged patients experiencing respiratory symptoms to seek care sooner versus later.

“I am worried that those people won’t ask for help if they have increasing respiratory distress,” he said, noting that if they do it might be too late when they do.

Much like COVID-19, Reid points out that wildfire smoke does not affect all populations equally.

“People who have means can escape to other homes in places away from the smoke, they can buy a HEPA filter to clean the air in their home, they have air conditioning and don’t worry about paying their electric bills and thus can escape the extreme heat,” she wrote in an email.

“Those who have fewer means are more likely to have higher exposures to heat and smoke, just like they are more likely to have exposure to COVID-19 because they are more likely to have a job that requires they work outside the home and interacts with the public, thus increasing their likelihood of exposure.”

While current air quality levels are at historic hazardous highs, this is likely not the worst of it.

Andrew Wineke, a communications manager with the Air Quality Program at the Department of Ecology, repeated his comments from a couple years ago when wildfire smoke floated down to the state from Canada: “No, this isn’t the new normal, it could get worse as more acres burn. “

The levels of particulate matter in the air is decreasing nationally, except in the Pacific Northwest, researchers at the University of Washington have found.

Their analysis predicts that most areas in the Northwest, with the exception of the Portland-Seattle corridor, show a positive growth trend in PM2.5 due to wildfires.

The realities of climate change will be present for the foreseeable future. With temperatures continuing to rise and more wildfires expected in years to come, understanding the impacts of smoke on health is becoming increasingly important.

“As climate change progresses, the probability of wildfires is likely to increase in many places, making it more important than ever to understand the health effects of wildfire smoke exposure,” Reid wrote in her review.