Wildfires cause extensive damage comparable to devastations caused by hurricanes, tornadoes and other natural disasters. Like ambient air pollution, wildfire smoke contains numerous pollutants such as “polycyclic aromatic hydrocarbons, carbon monoxide, aldehydes, organic acids, gases, free radicals and inorganic materials,” (Zelikoff J. , et al. 2003) which are particles that could act as triggers for asthma. Asthma is a chronic inflammatory disease of the lungs and the respiratory airways. Asthma is a condition where increased mucus production and restriction of the airways make delivery of oxygen to the body difficult.
There are many factors that contribute to a person getting asthma, but one important trigger is the surrounding environment. Respiratory difficulties in children are more serious than adults, because pediatric patients, who experience relatively mild symptoms, might not realize the severity of asthmatic attacks. They may be inadequate in describing how they feel. Their dynamic developmental physiology creates unique risks for children exposed to hazards that can alter normal function and structure. Children have smaller lungs compared to adults therefore, a build up of particles and mucus may lead to hypoxia in children. Wildfire triggers various respiratory problems due to the production of Particulate matters or. PM of 2. 5 and 10. Researchers think that the increasing incidence of wildfires is not only increasing the pollutants in the air, but also plays a primary role in increasing the incidence of childhood asthma. Scientific literature for studies of wildfire smoke exposure on children and on their respiratory health were reviewed and examined in this paper.
The relationship between wildfire occurrences and incidences of asthmatic attacks are increased due to increased particulate matter levels in the smoke. In a study by Kunzli N et al. (2006), based on the October 2003 Southern California fires, they investigated the health consequences of exposure to wildfire smoke on children, using a questionnaire done on two study groups. One group of high school students, originally enrolled in 1996 and a group of elementary school children, recruited in 2002. The high school students and parents of the elementary school children received the fire questionnaires, in which they reported the number of days they were exposed to fire smoke smell, indoor air, time spent outdoors, if a mask was worn, if air conditioners were used, their symptoms, hospital visits, and other variables. The researchers used a mean of peak 5 days, with a PM value of 10.
The level of these particulate matters in the air is referred as the PM values. A high PM value in air an important contributing factor in triggering asthmatic attacks. To analyse the effect of fire and asthmatic status, they used several indicator variables such as exposure to 6 days of fire smell, less than 6 days, no exposure to fire smell, preventive actions taken, age group, and asthmatic status. In their study, the prevalence of reported symptoms was much higher among children with asthma than non-asthmatic children. In addition, physician visit and administration of medicine were more frequent among elementary school children. They observed more symptoms among students who did not take preventive action as compared to those who did.
The source of Bias in the study by Kunzli N et al. (2006) are as follows, because many high school students and parents of the elementary school children completed the fire questionnaire several months after the fire incident, there may be recall and selection biases. In a study by Catherine T. Elliott et al (2013), based on BC wildfires, they investigated the asthmatic outcomes of fire-affected and non-fire affected populations. Ms. Elliott et al. (2013), examined the associations between daily fine particulate matter (PM 2. 5) and pharmaceutical dispensations for salbutamol in the two populations. The study by Catherine T. Elliott et al (2013), followed the number of patients prescribed salbutamol during their hospital attendances or family doctor visits. Daily counts of salbutamol dispensations between 2003 and 2010 were extracted from the BC PharmaNet database. The researchers were 95% certain that there was a true correlation between the number of salbutamol dispensations and the incidence of fire; this relationship was amplified when looking at population of children. Particulate matter in the air, which increases as a cause of wildfires is a principle trigger for asthmatic attacks.
Particulate matter refers to the particles in the air. A PM of 10 refers to coarse dust particles and soot that are 2. 5 to 10 micrometers in diameter (These are small enough to be inhaled and get past our defensive nose hairs and into our lungs. A PM 2. 5 indicates the fine particles in the air that are 2. 5 micrometers in diameter or smaller, and can only be seen with an electron microscope. A PM of 2. 5 can pass from our alveoli into our blood supply and circulate throughout the body. In a study by Alman BL et al (2016) based on 2012 wildfire in Colorado, they investigated the relationship of local PM2. 5 levels with the number of emergency room visits and hospitalizations for respiratory and cardiovascular problems. They used statistical analysis techniques to analyse the relationship between PM2. 5 level and emergency department visits during the wildfire period (June 5, 2012 to July 6, 2012). In the study by Alman BL et al. (2016), they observed a positive relationship between PM 2. 5 and asthma/ wheezing and COPD. But cardiovascular problems had no association.
They evidenced that wildfire PM2. 5 is an important source for respiratory distress. In a study by Louis-Francois Tetreault el al (2016) who followed asthmatic children in Quebec over a period of fifteen years and found positive and significant associations between severe asthma exacerbation in children, and time dependent PM2. 5, NO2 and O3 levels. A few studies also assessed the effect of long-term exposure to air pollutants on asthma events in children, regardless of their asthmatic status. A cohort study conducted in the Netherlands (Wildhaber, J. 2007) reported odds ratios with wheeze for two years old children, of 1. 16 per 10. 6 µg/m3 of NO2 and 1. 20 per 3. 3 µg/m3 of PM2. 5.
In Germany in 2006 the researchers reported similar odds ratios with wheezing for the same age-group of 1. 10 per 1. 04 µg/m3 of PM2. 5 (Morgenstern et al. 2006). Prolonged exposure to nitrogen dioxide can be classified as a type of poisoning, which depends on frequency, intensity and duration of exposure. Since NO2 is mucous membrane irritant, it causes pulmonary diseases such as COPD and asthma which could result in death in fatal cases; the dose inhaled determines the toxicity. This potential poisoning is a pertinent issue that should be discussed by wilderness councils and the government. Climate change is likely to increase the frequency of wildfires, warranting a need for enhanced public health support. A better understanding of the impacts of the wildfire exposure has important public health implications for the present day and future.
According to the above findings the pediatric population is at high risk of asthmatic exacerbations and the preventive actions reduced the incidence of respiratory problems among the people exposed to wildfire smoke. enhanced public education system is necessary to educate residents about the preventive measures such as staying indoors and using air-conditions and wearing masks during a wildfire situation. Parents and caretakers need to be educated to identify the early signs of respiratory distress especially in pediatric population. Early administration of SABA medication is important to reduce the severity of damage to the lungs during asthmatic attack. SABA is a prescription drug, during wildfire situation the demand for SABA increase. Purchase of Short-acting Beta 2- agonist(SABA) is permitted in Australia without doctors prescription (Douglass J. A. et al. , 2012). Public health and the government could make a consensus agreement on availability of SABA in fire prone areas. SABA being a prescription drug increase emergency room visits during fire periods.
There have been several incidents such as 1987 fire period in California (Duclos P et al. , 1990), 2003 wildfire in San Diego (Viswanathan S et al. , 2006) and during Large fires in Lithuania (Ovadnevait J et al. , 2006) where the emergency room visits have increased tremendously. Wildfire exposure and the resultant respiratory problems pose a economic burden on the healthcare system and impact on quality of life. Preventive actions needs to be taken to reduce the impact on children to prevent development of chronic respiratory disease. Wildfires pose a true risk for residents near fire-prominent areas. Children are even more vulnerable given their immature and still developing respiratory system. The soot and smaller particulate matter from the fires have been shown to pollute the surrounding air and trigger asthmatic attacks. PM levels mentioned above are precarious and can cause long term and short term health effects, including asthma. This can be concluded given the myriad of studies showing a positive relationship between fire incidents and number of doctor visits, which also unsurprisingly correspond to the dispensation of salbutamol prescribed to these patients. Considering this compelling evidence, the government should invest in spreading awareness in preventing large forest fires and how residents can protect themselves against its dire effects.
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