Episode #54 After the Smoke: Wildfire Cleanup & Air Quality Concerns with Dr. Afif El-Hasan

Dr. Albert Rizzo:
Welcome back to Lungcast, the monthly respiratory health podcast series from the American Lung Association and medical news site HCP Live.com. I'm your host, Dr. Albert Rizzo, the chief medical officer for the American Lung Association.

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Wildfires are increasing in size and frequency worldwide due in part to hotter and drier conditions that are occurring globally. While heat from fires can cause bodily injury, the smoke is also concerning due to the large amounts of chemicals and toxins released into the air. As global temperatures rise, we expect the size, frequency, and severity of wildfires to increase in the years ahead.

Parts of the world already experiencing increases in weather extremes—from California, as we've recently seen, to the Siberian Arctic—have seen record-breaking wildfires.

Wildfires are unplanned fires that burn in forests, grasslands, and other ecosystems and, as we've seen recently, can encompass homes and communities. They can start with a natural event like a lightning strike or by accident as the result of human activity, which is unfortunately the case in close to 85% of wildfires. Campfires, discarded cigarettes, and electrical equipment like downed power lines all spark wildfires.

Hotter temperatures evaporate more moisture from soil and vegetation, drying out trees, shrubs, and grasses, and turning leaf litter and fallen branches into kindling. As noted by Dr. Tammy Thompson, a senior air quality scientist at the Environmental Defense Fund, larger fires have enough heat and upward momentum to send their plumes into the troposphere, above the ground-level layer of air, where there are fewer removal pathways and stronger upper-level winds. This is one reason wildfire smoke can travel such long distances.

To further discuss this topic and the impact on our health, we are lucky today to have Dr. Aif Elisan.

Dr. Albert Rizzo:
Dr. Elisan is a pediatrician with Kaiser Permanente in Orange County, California. He's been an active member of the organization's asthma care management team for more than 13 years, which strives to optimize the care of thousands of patients living with asthma.

He's a member of the Environmental Justice Advisory Group in the Southern California Air Quality Management District, which addresses poor air quality in low-income areas of Southern California. Dr. Elisan has a special interest in childhood asthma, and his areas of additional expertise include the health effects of air pollution, health impacts of smoking tobacco, children's lung health, lung health legislation and advocacy, youth smoking rates, vaccination, and the health impacts of extreme weather changes.

As busy as he sounds, he still finds time to volunteer for the American Lung Association and is currently on the national board of directors and acts as a national medical spokesperson for the organization.

Thank you for joining me today.

Dr. Aif Elisan:
Thank you for having me, Dr. Rizzo.

Dr. Albert Rizzo:
Before we begin the discussion regarding wildfires specifically and their toxic pollutants, would you please give some general advice to our listeners regarding the habit of monitoring air quality on a more regular basis due to extremes in weather?

Dr. Aif Elisan:
We know that day-to-day changes in PM2.5 and ozone occur in different parts of our country, and many of our patients are more vulnerable to these issues than others. I'm speaking about resources such as AirNow.gov. We also have our State of the Air report that comes out yearly from the American Lung Association.

The sites you mentioned are very important and are wonderful tools to use. But, especially in areas affected by wildfires, air quality can change very quickly. It’s important to find a local site—here in Southern California, I like the Air Quality Management District site—but there are different sites available that will give you air quality readings for your local area. Bear in mind, air quality can change street by street, so the more specific the data you have, the better for your health.

I also want to emphasize something very important: even if a site tells you the air in your area is healthy, trust the most important air quality indicator—yourself. If you can smell smoke or the air irritates your upper airways or lungs, there is an issue, even if the website says everything's great.

Dr. Albert Rizzo:
Great advice. We know that wildfire smoke is a mixture of a number of hazardous air pollutants. Air pollution from wildfires can cause and worsen cardiovascular and respiratory problems, including asthma attacks. Children, pregnant people, older adults, and people with chronic conditions like heart disease or lung diseases such as asthma or COPD are particularly vulnerable.

Can you please tell our listeners what is contained in wildfire smoke and how the components of this mixture affect our respiratory and cardiovascular health?

Dr. Aif Elisan:
Wildfire smoke actually contains a lot of different chemicals and particles. It has particles that can irritate the upper airway—the nose, the back of the throat—and get into the lungs. The size of those particles is important. The smaller the particle, the farther it gets into the lungs. You may have heard the term PM2.5; those are particles 2.5 microns in size, which can get past lung defenses and even enter the bloodstream.

We are also concerned about the chemicals that come from wildfires. These number in the thousands and can cause cancer, irritation, or other toxic effects. So it’s both a combination of the particles themselves causing irritation and the chemicals as well.

Dr. Albert Rizzo:
As you mentioned, large wildfires can destroy towns and burn homes and structures that contain human-made materials, releasing even more toxic pollutants. Aside from the chemicals contained in wildfire smoke, can you discuss some other toxins people should be aware of when returning to affected areas?

Dr. Aif Elisan:
Thank you for bringing that up. Homes are made of wood, metal, PVC pipes, and other materials that you don’t see in a forest. Hot fires create additional chemicals and pollution. These chemicals can include arsenic from homes, asbestos from older homes, lead, and byproducts of PVC pipes and drywall, which can be extremely toxic.

The danger doesn’t end when the fire ends. Soot remains in the area, posing risks for weeks or months. These particles can spread through wind or remain on the ground at the site of the burned homes.

Dr. Albert Rizzo:
Are there specific types of masks you recommend for individuals going back to these areas?

Dr. Aif Elisan:
I recommend N95 and N100 masks. They provide an airtight seal and protect against particles in the air. Masks with valves are more comfortable because they allow easier exhalation. Bandanas or regular dust masks are not enough.

Dr. Albert Rizzo:
Aside from acute effects, is there evidence for longer-term, chronic effects of wildfire exposure?

Dr. Aif Elisan:
Unfortunately, yes. Wildfire exposure can cause prolonged lung issues, exacerbate asthma, affect lung capacity, and worsen other lung diseases. It can also impact the heart and other organs. Studies show increased heart disease, lung disease, complications during pregnancy, and even higher rates of cancer after exposure to wildfires. It’s important to take long-term effects seriously.

Dr. Albert Rizzo:
Are there any other aspects of wildfires and air pollution you’d like to emphasize?

Dr. Aif Elisan:
Yes. First, mind your health. Have a plan with your physician if you anticipate being in an area with wildfires. Make sure medications are up-to-date, and you have enough supply so you don’t have to go out during a fire. Take preventive medications if you have asthma or lung disease.

Don’t ignore mental health—fires can affect emotional well-being, break up neighborhoods, and create financial stress. Seek help early if you need it.

Be careful with exercise and exposure in affected areas. Pay attention to EPA and local warnings. Even if you can’t smell smoke, you may still be exposed. Take recommended protective measures seriously and minimize your time in contaminated areas.

Dr. Albert Rizzo:
Great advice. Thank you for your time today and your volunteerism with the American Lung Association. To our listeners, for more discussions on respiratory health, check out our show archives, subscribe to Lungcast on your preferred platform, and visit Lung.org and HCP Live.com for more news and resources.

Until next time, I’m Dr. Albert Rizzo, reminding you that if you can’t breathe, nothing else matters.