Portable air cleaners should be at the forefront of the public health response to landscape fire smoke

Barn, Prabjit; Elliott, Catherine; Allen, Ryan; Kosatsky, Tom; Rideout, Karen; Henderson, Sarah B.

doi:10.1186/s12940-016-0198-9

Cited by 51 publications

(44 citation statements)

References 20 publications

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“…This epidemiologic evidence helps strengthen the association between wildfire smoke exposure and cardiovascular disease outcomes and highlights the increased risk to the older population. These findings, along with others, support the need for clinical research to assess the clinical and public health value of interventions to decrease exposure to particulate matter, and particularly to wildfire smoke, among those at highest risk 11, 12, 55, 57, 58, 59. As wildfire season intensity and duration is projected to increase in California, understanding adverse health impacts of wildfire smoke and identifying the most susceptible populations is relevant to a broad group of stakeholders, including state and local officials responsible for land and air quality management, environmental scientists, policy makers, public health officials, and frontline public health and healthcare practitioners.…”

Section: Discussionsupporting

confidence: 65%

Cardiovascular and Cerebrovascular Emergency Department Visits Associated With Wildfire Smoke Exposure in California in 2015

Wettstein

Hoshiko

Fahimi

et al. 2018

JAHA

178

146

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BackgroundWildfire smoke is known to exacerbate respiratory conditions; however, evidence for cardiovascular and cerebrovascular events has been inconsistent, despite biological plausibility.Methods and ResultsA population‐based epidemiologic analysis was conducted for daily cardiovascular and cerebrovascular emergency department (ED) visits and wildfire smoke exposure in 2015 among adults in 8 California air basins. A quasi‐Poisson regression model was used for zip code‐level counts of ED visits, adjusting for heat index, day of week, seasonality, and population. Satellite‐imaged smoke plumes were classified as light, medium, or dense based on model‐estimated concentrations of fine particulate matter. Relative risk was determined for smoky days for lag days 0 to 4. Rates of ED visits by age‐ and sex‐stratified groups were also examined. Rates of all‐cause cardiovascular ED visits were elevated across all lags, with the greatest increase on dense smoke days and among those aged ≥65 years at lag 0 (relative risk 1.15, 95% confidence interval [1.09, 1.22]). All‐cause cerebrovascular visits were associated with smoke, especially among those 65 years and older, (1.22 [1.00, 1.49], dense smoke, lag 1). Respiratory conditions were also increased, as anticipated (1.18 [1.08, 1.28], adults >65 years, dense smoke, lag 1). No association was found for the control condition, acute appendicitis. Elevated risks for individual diagnoses included myocardial infarction, ischemic heart disease, heart failure, dysrhythmia, pulmonary embolism, ischemic stroke, and transient ischemic attack.ConclusionsAnalysis of an extensive wildfire season found smoke exposure to be associated with cardiovascular and cerebrovascular ED visits for all adults, particularly for those over aged 65 years.

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Section: Discussionsupporting

confidence: 65%

Cardiovascular and Cerebrovascular Emergency Department Visits Associated With Wildfire Smoke Exposure in California in 2015

Wettstein

Hoshiko

Fahimi

et al. 2018

JAHA

178

146

View full text Add to dashboard Cite

show abstract

“…While recommending interventions to limit exposure to wildland fire smoke is prudent, particularly among those at highest risk, studies are needed to evaluate the benefits of such interventions. Considering the available data portable air filters have been advocated as a public health response to wildfire smoke (Barn et al, 2016). Fisk and Chan (Fisk and Chan, 2016) further advanced this concept by estimating the health benefits expected of in-home interventions that improve the quality of the indoor air during wildfires.…”

Section: Public Health Guidance and Interventionsmentioning

confidence: 99%

Wildland fire smoke and human health

Cascio

2018

Science of The Total Environment

415

349

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The natural cycle of landscape fire maintains the ecological health of the land, yet adverse health effects associated with exposure to emissions from wildfire produce public health and clinical challenges. Systematic reviews conclude that a positive association exists between exposure to wildfire smoke or wildfire particulate matter (PM) and all-cause mortality and respiratory morbidity. Respiratory morbidity includes asthma, chronic obstructive pulmonary disease (COPD), bronchitis and pneumonia. The epidemiological data linking wildfire smoke exposure to cardiovascular mortality and morbidity is mixed, and inconclusive. More studies are needed to define the risk for common and costly clinical cardiovascular outcomes. Susceptible populations include people with respiratory and possibly cardiovascular diseases, middle-aged and older adults, children, pregnant women and the fetus. The increasing frequency of large wildland fires, the expansion of the wildland-urban interface, the area between unoccupied land and human development; and an increasing and aging U.S. population are increasing the number of people at-risk from wildfire smoke, thus highlighting the necessity for broadening stakeholder cooperation to address the health effects of wildfire. While much is known, many questions remain and require further population-based, clinical and occupational health research. Health effects measured over much wider geographical areas and for longer periods time will better define the risk for adverse health outcomes, identify the sensitive populations and assess the influence of social factors on the relationship between exposure and health outcomes. Improving exposure models and access to large clinical databases foreshadow improved risk analysis facilitating more effective risk management. Fuel and smoke management remains an important component for protecting population health. Improved smoke forecasting and translation of environmental health science into communication of actionable information for use by public health officials, healthcare professionals and the public is needed to motivate behaviors that lower exposure and protect public health, particularly among those at high risk.

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“…Outdoor PM 2.5 can infiltrate indoors in buildings even with closed windows and merely staying indoors provides limited protection against outdoor PM [20]. Many past studies have concluded that wildfire PM 2.5 are important sources of adverse respiratory health outcomes [21,22,23] and staying indoors combined with the use of air cleaners can effectively reduce PM 2.5 exposure during wildfire seasons [19,24,25,26]. In many communities, the use of air cleaning technology is often overlooked due to cost and a lack of information.…”

Section: Introductionmentioning

confidence: 99%

Impact of Outdoor Air Pollution on Indoor Air Quality in Low-Income Homes during Wildfire Seasons

Shrestha

Humphrey

Carlton

et al. 2019

IJERPH

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Indoor and outdoor number concentrations of fine particulate matter (PM2.5), black carbon (BC), carbon monoxide (CO), and nitrogen dioxide (NO2) were monitored continuously for two to seven days in 28 low-income homes in Denver, Colorado, during the 2016 and 2017 wildfire seasons. In the absence of indoor sources, all outdoor pollutant concentrations were higher than indoors except for CO. Results showed that long-range wildfire plumes elevated median indoor PM2.5 concentrations by up to 4.6 times higher than outdoors. BC, CO, and NO2 mass concentrations were higher indoors in homes closer to roadways compared to those further away. Four of the homes with mechanical ventilation systems had 18% higher indoor/outdoor (I/O) ratios of PM2.5 and 4% higher I/O ratios of BC compared to other homes. Homes with exhaust stove hoods had PM2.5 I/O ratios 49% less than the homes with recirculating hoods and 55% less than the homes with no stove hoods installed. Homes with windows open for more than 12 hours a day during sampling had indoor BC 2.4 times higher than homes with windows closed. This study provides evidence that long-range wildfire plumes, road proximity, and occupant behavior have a combined effect on indoor air quality in low-income homes.

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Portable air cleaners should be at the forefront of the public health response to landscape fire smoke

Cited by 51 publications

References 20 publications

Cardiovascular and Cerebrovascular Emergency Department Visits Associated With Wildfire Smoke Exposure in California in 2015

Cardiovascular and Cerebrovascular Emergency Department Visits Associated With Wildfire Smoke Exposure in California in 2015

Wildland fire smoke and human health

Impact of Outdoor Air Pollution on Indoor Air Quality in Low-Income Homes during Wildfire Seasons

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