How wildfires in Canada affected breathing in Central Illinois

A study released late last month by the Centers for Disease Control and Prevention found that asthma-related ER visits increased by 17% nationally during a period from April 30 to Aug. 4, when thick wildfire smoke affected air quality in the U.S. The study drew data from about 4,000 hospitals.

The data is consistent with what happened at Midwest Allergy Sinus + Respiratory locations, said Dr. Dareen Siri, an asthma and immunology specialist with the organization. It has offices in Normal and Springfield, and satellite locations in Morton, Jacksonville and Carlinville. 

"In specific to asthma, all of our locations had an increase in patient visits because of respiratory conditions, and it's not really that common during that time of the year," Siri said. "In spring we typically have more allergy-like conditions … but not asthma, as it's not one of the seasons where we see a lot of asthma kick up. That's typically the fall, winter and harvest seasons."

The days recorded in the CDC study had an Air Quality Index — which is the Environmental Protection Agency's metric for reporting air quality — of 101 or higher, meaning the air quality was considered "unhealthy" for people with pre-existing or other conditions.

Wildfire smoke is a mixture containing gases and particles, where particular matter — which is generally 2.5 micrometers in diameter or smaller — is the pollutant of most health concern because it can exacerbate existing cardiovascular, metabolic, and respiratory conditions, and can lead to increased emergency department visits and hospitalizations.

The CDC's data reveals that the region involving Delaware, District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia experienced the highest total amount of wildfire smoke days for any region with five days in total. New Jersey and New York, as well as parts of the Midwest including Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin, experienced a total of four wildfire smoke days.

Hospital traffic rose more dramatically in some parts of the country: 46% higher in New York and New Jersey.

In the Midwest, the drifting smoke led to days of warnings from the National Weather Service and health experts who warned people with asthma and other respiratory conditions to stay inside. A number of events were canceled, and the Chicago area recorded its highest air quality index levels in at least 24 years. 

Siri said both their Bloomington and Springfield offices and hospitals across Central Illinois experienced a noticeable influx of patients with respiratory conditions, like asthma and chronic obstructive pulmonary disease (COPD), who were coughing and having breathing problems.

In a lot of these cases, Siri said, patients were administered rescue treatment steroids like prednisone to help alleviate symptoms and told to limit their time outside as well as monitor the air quality daily.

Dr. Lucas Kimmig, an assistant professor of medicine and program director of the Pulmonary Disease & Critical Care Medicine Fellowship at the University of Chicago, said asthma in general is a disease that affects the trachea and could lead to the muscles surrounding the body's airway tightening up from agitators like particulates or allergens.

"In general, we do see people, especially folks who have (a) very allergic type of asthma, have other symptoms like seasonal allergies, hay fever, eczema, or chronic sinus issues from allergies," Kimmig said. "Those are folks who, if they have asthma, they have a more allergic type than those who may developed it at an early age."

Dr. Ted Clark, chief medical officer at Decatur Memorial Hospital, recalled when the city reached an air quality index level of 301, one of the highest in the nation at the time. He said he saw patients reporting that their eyes and skin were itching and burning, in addition to having difficulty breathing.

Clark did not have data on the number of patients with such complaints during that period, but said the hospital was seeing more patients with respiratory issues or preexisting conditions.

"The wildfires were a little bit out of season at least in a way that they affect the central United States," Clark said. "That was something new but it was something new that looked a lot like something old, which is seasonal variations, winter viral effect and that sort of thing.

"It's just another opportunity for our environment to bring out our respiratory issues," he added. 

Several other Central Illinois hospitals did not report a significant increase in people with asthma reporting to ERs during the smoky period. 

"We do commonly see asthma and asthma-type presentation all throughout the summer, and particularly with heat, humidity and all of the environmental allergens throughout town, it's not uncommon for us to see folks with the same types of symptoms," said Lori Ritter, emergency and trauma coordinator at Carle BroMenn Medical Center in Normal. 

From April 30 through Aug. 4, the hospital's emergency department saw 7,986 visits and 37 of those visits were related to asthma or some sort breathing conditions as the chief complaint, Ritter said. During the same period last year, the ER saw 33 asthma-related visits.

Because of other factors and different conditions people could have, Ritter and other local experts said they could not identify wildfire smoke as the definitive cause of any hospitalizations. 

"We would have our respiratory influx that we're used to about around November, December, January and we always get an increase in respiratory complaints," said Dr. Julie Lewis, director of emergency medical services at OSF HealthCare St. Joseph Medical Center. "This wouldn't have been a typical time period where we would have seen a lot of respiratory complaints generally in the summer, so I think that made it easier to adapt to any situation because it didn't compound on top of another catastrophe." 

OSF St. Joseph had 8,351 emergency department visits from May 1 through July 31, with 124 of those visits related to asthma or breathing-related issues. That was actually lower than the prior year, when there were 277 visits related to asthma or breathing-related issues.

Dr. Joe Burton, medical director of the emergency department at Sarah Bush Lincoln Medical Center in Mattoon, said the emergency department also did not see that many more patients than they normally experience and mainly visits of preexisting conditions.

"Most of the respiratory complaints that we saw were our normal emphysema, COPD, asthma, and really anything smoking-related but that's normally what our respiratory related cases are during that time in the spring and summer," Burton said. "It's not often, but at times you can have people who die from their asthma episode. It can be severe."

Clark and others have said the only real way to mitigate issues of asthma is to reduce exposure, either by wearing a mask or staying indoors. 

Climate scientists have predicted an increase in wildfires in coming years, as global warming is expected to lead to hotter, drier conditions. Kimmig, the University of Chicago professor, said people should brace themselves. 

"I think due to climate changes, we're probably going to see this happen more frequently," he said. "There's a couple of ways that people can decrease the likelihood of getting asthma flareups during these times — something like just monitoring the air quality and keeping an eye out if it is very poor as well as limiting the time that you spend outdoors."

Siri said that other preventive measures — paying attention to the weather, wearing a mask that can block particulates like N95 and KN95 masks, taking all necessary medications and getting vaccinations as well as simply washing your hands and taking showers in the evening — can all help with managing respiratory conditions.

"If people have any kind of underlying lung condition or genetic predisposition, they should really consider whether they are cleaning the cat litter or going outside and standing next to a fire pit," Siri said. "People with respiratory disorders don't always recognize that they should protect their lungs because they don't have the same amount lung capacity they were born with."