Breathing in the aftermath: Enduring effects of wildfire smoke

SMOKE THAT STICKS. Drawing by Priscilla Duggan

Health & Wellness, by Priscilla Duggan

It has been approximately two months since fires swept across the greater Los Angeles area, causing devastating loss and persistent disorientation. As we grapple with the consequences of the fires and navigate our way forward, it is more important than ever to attend to the well-being of ourselves, our loved ones and our greater community.

This month’s piece includes an interview with Dr. Sari Eitches, an internal medicine physician in Los Angeles with an integrative approach to the treatment and prevention of chronic illness. She is board certified by both the American Board of Internal Medicine and the American Board of Integrative Holistic Medicine. In February, I had the chance to ask her a bit about the enduring health effects of the L.A. fires:

In addition to respiratory issues, have you observed any increases in cardiovascular conditions or mental health problems linked to the wildfire smoke?

Yes, exposure to wildfire smoke doesn’t just affect the lungs — it can also strain the heart, increasing the risk of strokes and heart attacks. Beyond the physical effects, many people experience heightened anxiety and stress. Those who have lost their homes, been displaced, or had to evacuate can also experience Acute Stress Disorder, which has similar symptoms to PTSD, such as hypervigilance, trouble with sleep and nightmares or flashbacks.

What should L.A. residents know about the potential lingering health effects of wildfire smoke from the past few months or even years?

Now that the literal and proverbial dust has settled and we have had a few cleansing rainy days, we can generally go back to enjoying the outdoors safely. There will always be baseline air pollution in Los Angeles, so pay attention to the local and surrounding Air Quality Index when deciding to exercise outdoors, especially for vulnerable groups. Trust your senses. If you see ash or smell smoke, it is not a good time to exercise outdoors. Ash and toxins settle into the environment and can get kicked back up into the air over time. Indoor air quality can also be affected for weeks or months, so continuing to use air purifiers and being mindful of exposure is important.  In the burn areas and their nearby surroundings, sediment and Volatile Organic Compounds can settle. The monitoring that followed the 2018 Camp Fire showed that these toxins can take around six months to clear from the immediate water supply.

For individuals concerned about the long-term effects of smoke exposure, what tests or screenings would you recommend to monitor their health over time?

Regular check-ups with your doctor can help monitor for any changes, especially if you have a history of respiratory or heart conditions. Standard lab tests usually include screening for blood, kidney and liver health as well as metabolic and cardiac risk. I am also screening my patients who have been affected for additional inflammatory markers and heavy metal levels. For those with lingering respiratory symptoms, a simple lung function test (spirometry) can be helpful, and some patients might benefit from lung imaging, such as a chest X-ray.

What role does local government and community action play in mitigating the health impacts of poor air quality?

Local government plays a big role in keeping air quality at the forefront — whether through monitoring, public health education or policy changes that reduce emissions. On a community level, we can help by advocating for cleaner air initiatives, supporting emergency preparedness plans and looking out for our more vulnerable neighbors. The government also provides some of our best methods for air quality monitoring such as airnow.gov.

Looking ahead to wildfire seasons in California, what measures can individuals, healthcare providers and communities take to better prepare for and respond to the health challenges posed by air pollution?

Preparation is key. A high quality indoor air purifier is an excellent investment. I recommend ones with both a HEPA filter (for particulate matter) and a carbon filter (for gases). I have one in each bedroom at home, one in the common area and one in my office. We Angelenos spend a lot of time in our cars and our roads are a major source of baseline air pollution, so don’t forget to check your car’s air filter as well. Clean or change it when needed. Keep N95 or P100 masks handy just in case, and stay informed about air quality. Healthcare providers can guide patients on protective measures and communities can work on emergency response plans to ensure that everyone, especially vulnerable groups, has access to clean air and healthcare when they need it.

What do you foresee in terms of healthcare needs for the Los Angeles area as the region continues to face the effects of climate change and increased wildfire activity?

We’ll likely see more people needing long-term respiratory care, cardiovascular monitoring and mental health support due to ongoing wildfire exposure. Public health efforts will need to focus on prevention, early intervention and making sure our communities are equipped to handle future challenges.

An ending note from Dr. Eitches: There are so many toxins and pollutants in our urban environment that it is easy to feel overwhelmed and fearful. I try to emphasize to my patients practical advice to minimize our toxic exposures, while also accepting the reality that Los Angeles, with all its charm, is a sprawling metropolis with inherently worse than average air pollution. This is a huge public health issue that should be mitigated on the community and public health level. On an individual level, we are empowered to make many decisions every day to optimize our health and resilience. In addition to the air concerns discussed, we can limit further toxins at home by emphasizing whole, unprocessed foods in our diets, exercising regularly, managing sleep and stress, and filtering our drinking water.

Category: People