Feeling the burn

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.

Polluted air feels “heavier,” said Clymore, who lives on the North Side. “To me, it seems like you’re blowing up a balloon that has a slow leak in it – you can’t get it full. … You’re breathing in, but you can’t get enough air.”

“Sensitive groups,” including people with respiratory and heart diseases, are urged to stay inside and take other safety measures when smoky air invades. When the air gets bad enough, those recommendations from health care providers and the region’s clean-air agency apply to everyone. The particles in smoke are tiny invaders, able to bypass the body’s filtering system and penetrate deep into the lungs.

As the National Weather Service’s forecast stretched ahead to at least Friday with temperatures in the 90s or higher in Central and Eastern Washington, red flag warnings – signalling conditions ideal for wildland blazes – and fire restrictions were in place in many areas in the region. Several large wildland fires continued to burn.

“With a wildfire, you’re kind of at the mercy of the weather,” said Lisa Woodard, public information officer for the Spokane Regional Clean Air Agency.

When the air gets dirty enough to lead to health warnings in Spokane, it’s usually because of a particular event, Woodard said. In the winter, that might be a temperature inversion, in which pollutants get trapped close to the earth. The clean air agency can respond by restricting wood heating. Not so with a wildfire.

The public health concern lies in smoke’s tiny particles of solid matter – smaller than dust, and able to move deep into the respiratory system. Wildfire smoke also contains carbon monoxide and hazardous chemicals, but they’re mostly dispersed by the time the smoke travels just a short distance from a blaze, according to the U.S. Forest Service.

People with respiratory disorders are more vulnerable to those tiny invaders. Their airways already may be inflamed and irritated, and extra mucus makes it more difficult to clear particles from their lungs.

“They’re already fighting a battle to be able to breathe well as it is,” said Sheri Watkins, a respiratory therapist in the pulmonary program at St. Luke’s Rehabilitation Institute. “When these pollutants get in there, it makes it even harder. And their immune systems are already down.”

Pollution-related calls from sick patients tend to come a few days after the event that causes it, said Dr. Steven Kernerman, of the Spokane Allergy and Asthma Clinic.

Patients report more wheezing, coughing and shortness of breath. They’re using their rescue inhalers more often.

“When those very small particles get in there, they cause even more inflammation, even more irritability,” Kernerman said.

Doctors might prescribe steroids or nebulizers, machines that turn liquid medicine into a mist that’s inhaled.

“They might end up in the hospital,” Kernerman said.

The Spokane clean-air agency updates the Air Quality Index hourly on its website ( www.spokanecleanair.org/ current-air-quality), divided into six color-coded categories ranging from good to hazardous, depending on the air’s potential to make people sick.

The index assigns concentrations of pollutants a value from 0 to 500. Air quality with a value of 101 to 150 is considered unhealthy for people in “sensitive” groups: babies and children, older adults and people with heart and lung conditions.

There’s been one of those “orange” days so far this year: July 17, when the area was inundated by regional wildfire smoke. There were two in 2013 (both because of trapped wood smoke) and three in 2012 (one caused by community fireworks near an air-quality monitoring station and two, both in September, caused by wildfire smoke).

But sometimes the air gets so bad the clean-air agency advises everyone, not just those at greater risk of pollution-related health problems, to stay inside.

There’s been no such “red” day so far this year. In 2013, the clean-air agency reported one day of across-the-board unhealthy air (caused by a dust storm). It reported no red days in 2012.

“If it gets past that 150 mark, it’s unhealthy for anyone,” Kernerman said. “And not just a nuisance unhealthy, but it’s unhealthy for any breathing thing. You are going to be breathing in these particles. You are going to have them deposit in your lungs. You’re going to be at risk to develop a respiratory condition.”