Fraser Health: Empower patients to prepare for wildfire smoke

By Prabjit Barn, PhD; Amy Lubik, PhD; and Emily Newhouse, MD, CM, MPH, FRCPC

Fraser Health Authority

Wildfires are becoming more common and severe in B.C. and around the world. Fires near and far can blanket communities with smoke for a few hours to several weeks, exposing an increasing number of people each year. Wildfire smoke is a complex mixture of pollutants, including fine particles (PM_2.5) that are particularly damaging to health because they can travel deep into the respiratory tract and enter the blood stream, causing local and systemic inflammation and oxidative stress. The public can benefit from more information about effective actions to reduce exposure. Pharmacists and pharmacy technicians are a trusted source of medical information,¹ and are well placed to empower patients to take action.  

Studies consistently link wildfire smoke exposure to increased respiratory-related emergency department visits and hospitalizations in adults and children.^2,3 Evidence from B.C. suggests a non-linear dose-response relationship between asthma-related physician visits and mean 24-hour outdoor PM_2.5 concentrations, with more visits occurring when concentrations are lower (10-30 µg/m³) versus higher (≥ 100 µg/m³). This is because i) more people are more frequently exposed to lower PM_2.5 concentrations and ii) PM_2.5 is a non-threshold pollutant, meaning effects are seen even at low concentrations.⁴ Research also links wildfire smoke exposure to increased risks of cardiovascular effects, and pregnancy and birth outcomes, such as gestational diabetes, low birth weight, and preterm birth. Emerging evidence suggests increased risk of diabetes-related complications, mental health impacts, and development of some cancers.² People most vulnerable to health impacts from wildfire smoke include those with respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD); cardiovascular and other chronic conditions, such as diabetes; babies and children; pregnant people; and older adults. Unhoused populations and outdoor workers may face higher smoke exposure.  

Help patients understand health risks and manage symptoms:  

• Proactively educate patients that are at higher risk of health impacts from wildfire smoke.
• Recommend keeping rescue/reliever inhaler medication on hand before the smoke season, and emphasize the importance of adherence to controller inhalers, when applicable. 
• Encourage patients to pay attention to how they feel during smoky periods and seek medical care as needed.

Inform patients about the Air Quality Health Index (AQHI):

• Inform patients about the Air Quality Health Index (AQHI), which provides online air quality ratings for communities. Checking the AQHI often during smoky periods can inform decisions about outdoor activities. 

Talk to patients about being in clean and cool spaces: 

• Let them know how they can create clean and cool air at home. They can use a combination of measures, including induct filters rated MERV 13 or higher in building ventilation systems, portable HEPA air cleaners, Do-It-Yourself air cleaners, and air conditioning. You can share BC Centre for Disease Control’s  series of factsheets that cover these topics and information from your local health authority, such as Fraser Health’s wildfire smoke webpage. 
• Have patients identify air-conditioned spaces in their community where they can spend time if their home is too smoky or hot. These spaces can include libraries, community centres, and faith-based centres. 
• Let them know about BC Hydro’s free air portable air conditioning program and that air cleaners and air conditioners may be claimed as medical expenses for tax purposes. 

Inform patients about mental health resources:  

• Bounce Back BC, a free skill-building program to help manage mild to moderate anxiety, stress and depression
• bc.211.ca, a free phone/texting service to help people learn about services and help near them.    
• Suicide crisis help line, 1-800-SUICIDE
• KUU-US First Nation and Indigenous crisis line, 1-800-588-8717 

Wildfire smoke will continue to impact our communities, but collectively we can help empower people, especially those most vulnerable, to better protect themselves each year.