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In flammable landscapes around the globe longer fire seasons with larger, more severely burnt areas are causing social and economic impacts that are unsustainable. The Australian 2019/20 fire season is emblematic of this trend burning over 8 million ha of predominately Eucalyptus forests over a six-month period. We calculated wildfire smoke-related health burden and costs in Australia for the most recent 20 fire seasons and found that the 2019/20 season was a major anomaly in the recent record, with smoke-related health costs of $1.95 billion. These were largely driven by an estimated 429 smoke-related premature deaths in addition to 3230 hospital admissions for cardiovascular and respiratory disorders and 1523 emergency attendances for asthma. This was well above the next highest estimate of $566 million in 2002/3 and more than 9 times the median annual wildfire associated costs for the previous 19 years of $211 million. There are substantial economic costs attributable to wildfire smoke and potential for dramatic increases in this burden as the frequency and intensity of wildfires increases with a hotter climate.

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Idiopathic pulmonary fibrosis (IPF) is one of the most common forms of interstitial lung disease presenting in persons 50 years and older. Through a comprehensive review of available studies, we aimed to assess health-related quality of life (HRQoL) of people living with IPF and the instruments used in this assessment.Searches were conducted up to May, 2020. Quality appraisal and data extraction were performed using pre-designed forms. Narrative synthesis approach was used to report results of the systematic review and a random effects model was used for the meta-analysis. A leave-one-out sensitivity analysis was performed, and a trim and fill method was used to assess publication bias.The review included 134 studies. The most used instruments to measure HRQoL were St George's Respiratory Questionnaire (SGRQ), Short Form 36 (SF36) and EuroQoL (EQ5D). Standardised mean scores (95% confidence interval) for these instruments were as follows: SGRQ total score: 44.72 (42.21–47.22); SF36 physical component score (PCS): 37.00 (34.74–39.26) SF36 mental component score (MCS): 50.18 (48.41–51.95); King's Brief Interstitial Lung Disease questionnaire total score: 58.38 (55.26–61.51); and EQ5D utility: 0.73 (0.68–0.79). Analysis of standardised means for both SGRQ and SF36 demonstrated worse scores in physical health domains as compared to mental health domains.This systematic review confirms that IPF negatively affected HRQoL, mostly impacting the physical health domains. This study also demonstrated that a diverse number of instruments are used to evaluate HRQoL. In view of this diversity, a standardised approach to measurement of HRQoL for IPF is important to ensure that comparisons made are reliable.

The island state of Tasmania has marked seasonal variations of fine particulate matter (PM2.5) concentrations related to wood heating during winter, planned forest fires during autumn and spring, and bushfires during summer. Biomass smoke causes considerable health harms and associated costs. We estimated the historical health burden from PM2.5 attributable to wood heater smoke (WHS) and landscape fire smoke (LFS) in Tasmania between 2010 and 2019. We calculated the daily population level exposure to WHS- and LFS-related PM2.5 and estimated the number of cases and health costs due to premature mortality, cardiorespiratory hospital admissions, and asthma emergency department (ED) visits. We estimated 69 deaths, 86 hospital admissions, and 15 asthma ED visits, each year, with over 74% of impacts attributed to WHS. Average yearly costs associated with WHS were of AUD$ 293 million and AUD$ 16 million for LFS. The latter increased up to more than AUD$ 34 million during extreme bushfire seasons. This is the first study to quantify the health impacts attributable to biomass smoke for Tasmania. We estimated substantial impacts, which could be reduced through replacing heating technologies, improving fire management, and possibly implementing integrated strategies. This would most likely produce important and cost-effective health benefits.

Background: Emergency services working to protect communities from harm during wildfires aim to provide regular public advisories on the hazards from fire and smoke. However, there are few studies evaluating the success of public health communications regarding the management of smoke exposure. We explored the responses to smoke-related health advisories of people living in a severely smoke-affected region during extensive wildfires in Tasmania, Australia early in 2019. We also evaluated the acceptability of portable high efficiency particle air (HEPA) cleaners used in study participant's homes during the smoky period. Methods: We conducted semi-structured interviews with 24 households in the Huon Valley region of Tasmania following a severe smoke episode. These households were initially recruited into a HEPA cleaner study. Interviews were recorded, transcribed, and analyzed for common themes using an inductive framework approach. Results: Public health messaging during the 2019 wildfire event in Tasmania was widely shared and understood, with social media playing a central role. However, some participants expressed concerns about the timeliness and effectiveness of the recommended interventions, and some would have appreciated more detailed information about the health risks from smoke. Public messages and actions to protect households from wildfire threat were, at times, contradictory or dominated in coverage over the smoke messaging, and many participants were conflicted with the multiple public messages and action relating to the more serious perceived threat from the fire. Conclusions: Public messaging about smoke and health should continue to use multiple avenues of communication, with a focus on simple messages provided through social media. Messaging about the smoke hazard should be available from a trusted central source regarding all aspects of the wildfire emergency, with links to more detailed information including local air quality data alongside interpretation of the associated health risks.

Background Smoke from uncontrolled wildfires and deliberately set prescribed burns has the potential to produce substantial population exposure to fine particulate matter (PM 2•5 ). We aimed to estimate historical health costs attributable to smoke-related PM₂ • ₅ from all landscape fires combined, and the relative contributions from wildfires and prescribed burns, in New South Wales, Australia.Methods We quantified PM 2•5 from all landscape fire smoke (LFS) and estimated the attributable health burden and daily health costs between July 1, 2000, and June 30, 2020, for all of New South Wales and by smaller geographical regions. We combined these results with a spatial database of landscape fires to estimate the relative total and per hectare health costs attributable to PM 2•5 from wildfire smoke (WFS) and prescribed burning smoke (PBS).

The Australian 2019/2020 bushfires were unprecedented in their extent and intensity, causing a catastrophic loss of habitat, human and animal life across eastern-Australia. We use a regional air quality model to assess the impact of the bushfires on particulate matter with a diameter less than 2.5 μm (PM 2.5 ) concentrations and the associated health impact from short-term population exposure to bushfire PM 2.5 . The mean population Air Quality Index (AQI) exposure between September and February in the fires and no fires simulations indicates an additional ∼437,000 people were exposed to "Poor" or worse AQI levels due to the fires. The AQ impact was concentrated in the cities of Sydney, Newcastle-Maitland, Canberra-Queanbeyan and Melbourne. Between October and February 171 (95% CI: 66-291) deaths were brought forward due to short-term exposure to bushfire PM 2.5 . The health burden was largest in New South Wales (NSW) (109 (95% CI: 41-176) deaths brought forward), Queensland (15 (95% CI: 5-24)), and Victoria (35 (95% CI: 13-56)). This represents 38%, 13% and 30% of the total deaths brought forward by short-term exposure to all PM 2.5 . At a city-level 65 (95% CI: 24-105), 23 (95% CI: 9-38) and 9 (95% CI: 4-14) deaths were brought forward from short-term exposure to bushfire PM 2.5 , accounting for 36%, 20%, and 64% of the total deaths brought forward from all PM 2.5. Thus, the bushfires caused substantial AQ and health impacts across eastern-Australia. Climate change is projected to increase bushfire risk, therefore future fire management policies should consider this. Plain Language SummaryThe Australian 2019/2020 bushfires were unprecedented in their size and intensity, resulting in a catastrophic loss of habitat and human and animal life across eastern-Australia. We use an air pollution model (WRF-Chem) to quantify the impact of the bushfires on particulate matter with a diameter less than 2.5 μm (PM 2.5 ) concentrations. We run the model with and without emissions from the fires so their impact on PM 2.5 can be isolated. We find that between September and February an additional ∼437,000 people were exposed to "Poor" or worse air quality index levels due to the fires across eastern-Australia. Short-term exposure to high PM 2.5 concentrations has been linked to negative health impacts. Therefore, we estimate the health impact of population exposure to bushfire PM 2.5 across eastern-Australia, regionally and at city level. Our estimate indicates that between October and February 171 deaths were brought forward due to exposure to PM 2.5 from the fires. Regionally, most deaths were brought forward in New South Wales (109 deaths brought forward), Queensland (15), and Victoria (35). Within these regions, the most deaths were brought forward in Sydney (65), Melbourne (23), and Canberra-Queanbeyan (9) as large populations were exposed to high PM 2.5 concentrations due to the bushfires.