As a person with COPD, Peggy Clymore catches the air-quality reports on the early-morning news and adjusts accordingly. On dirtier-air days, she tends her flower and vegetable gardens soon after rising or in the evening, when she finds it easier to breathe outdoors than during midday. But under recent smoky skies in Spokane as a massive wildfire raged in north-central Washington, Clymore, 71, stayed indoors all day, windows clamped shut and swamp cooler running. For someone with COPD, or chronic obstructive pulmonary disease – or asthma, emphysema or other respiratory ailments – smoky air can lead to serious complications.