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House Call: Dealing with smoke season

Although the smoke has finally cleared up here in Spokane, fire season in Washington generally doesn’t end until late September when the mountain rain and snow starts. That means there’s still a pretty good chance for more smoky days. Even if you don’t have heart or lung disease (e.g. heart disease, chronic obstructive pulmonary disease, or asthma) you should still be careful on days of poor air quality. Although children, pregnant women, and elderly are also especially vulnerable to the effects of smoke exposure, the following advice applies to all of us.

Check the air quality routinely. You should be able to get this information from the local news. Also, Washington State has a website – – you can get air quality information from and so does the Environmental Protection Agency – I recommend staying indoors as much as possible if it looks or smells smoky outside.

If you do have to be outside and you feel like the air quality is bad enough that you should be wearing a mask, please be aware that a paper dust mask or surgical mask does not offer any meaningful protection. To get masks with adequate protection, look for masks labeled N-95 or P100 at a hardware store or online. Symptoms to be on the lookout for during smoky times are persistent cough, phlegm, wheezing, and difficulty breathing.

Even if you do stay indoors, you should take steps to keep the air inside as clean as possible. Keep windows and doors shut if you are able, and if you have an air conditioner make sure the filter is clean before you run it. A non-ozone producing air cleaner is a good way to reduce air pollution indoors too. Measure the room you are going to use it in before you purchase one so that you are sure to buy the correct size. If you don’t have air conditioning or your home is drafty and letting in too much smoke, I’d say you should consider staying with relatives or friends until the air improves, especially if you have heart or lung disease.

Individuals who have asthma or other lung disease typically manage their condition with medication. You should be sure you always have at least five-days-worth of your medication on hand. I’ve found that patients who are usually pretty well controlled may have needed to have the intensity of their treatment increased during the times of poor air quality; for some that will mean adding an inhaled steroid to keep inflammation down in the lungs. For others it may mean taking prescription oral cortisone for a period of time when conditions are bad. It is especially important to follow your treatment action plan on smoky days to avoid aggravating your condition. People that have heart disease should also follow their treatment action plans. Both groups should call their care providers if symptoms worsen.

While we’re on the topic of inhaled steroids for asthma, I will add that we have gotten more aggressive with their use in recent years for patients with asthma. We used to think that if you could make an asthma rescue inhaler like albuterol last a month your control was OK. Newer research has led us to say that if you need a shot of your rescue inhaler more than once a week you should be on a preventive inhaler, and for the most part that is a cortisone inhaler. They decrease inflammation and scarring in the lungs and lead to better outcomes, control, and function.

I like a sunny day as much as anyone, but I’m hoping for some rain (hold the lightning please) to moisten our forests and keep more of our region from going up in smoke. Feel free to join me.

Dr. Bob Riggs is a family medicine physician practicing at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.