As Canada wildfires raged last week, Maryland residents saw and smelt the impact. The air was hazy. A burning scent filled the air.

Across several Maryland counties, air quality index (AQI) levels reached 151, far exceeding a “good” AQI level between 0 and 50, or even a moderate AQI level between 51 and 100.

All outdoor programs offered at Anne Arundel County parks and facilities were canceled June 7 and June 8.

Wildfire smoke is a mix of gasses and fine particles from burning vegetation, building materials, and other materials. That smoke can make anyone sick.

Although the haze has dissipated from skies above the East Coast, the air quality threat posed by wildfires has not been extinguished.

What are the health risks? Two doctors from the University of Maryland Baltimore Washington Medical Center (UM BWMC) shared their thoughts.

“The air quality has taken a dramatic turn to the unhealthy side, particularly with the fires in Canada, and it produces a lot of small particles that can get carried in the air and those small particles can be inhaled and cause lots of issues,” emergency room physician Jonathan Wendell said on June 9.

Those small particles, also called fine particulate matter or PM2.5, can irritate the eyes and respiratory tract, cause reduced lung function and tax the heart. People living with chronic lung conditions that make it difficult to breathe — such as asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease — are particularly vulnerable to the adverse health effects of wildfire smoke.

The risks are worse for vulnerable groups such as pregnant women and those who have underlying heart conditions. Common symptoms for anyone include itchy eyes and nose, and throat scratching.

“The smaller particles can get deeper into the lungs as you inhale, and when they get deep into the lungs, they cause the same irritation process,” Wendell said. “When you get into the irritation process in the lungs, it leads to a bronchitis-type picture with difficulty breathing, often wheezing. Much like [with] asthma patients, it can cause bronchoconstriction and wheezing, and cause a lot of respiratory concerns, even in healthy people as the levels get too high.”

Krista Tookhan works as a pediatric hospitalist at UM BWMC. She said families and caregivers should be aware of these key signs a child might be experiencing respiratory distress:

  • Breathing rate. An increase in the number of breaths per minute may indicate that a person is having trouble breathing or not getting enough oxygen.
  • Increased heart rate. Low oxygen levels may cause an increase in heart rate.
  • Grunting or any other abnormal sounds, like wheezing.
  • Belly breathing. Using the abdomen muscles to help draw breath.
  • Nose flaring. The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breathe.
  • The chest appears to sink in just below the neck and/or under the breastbone and/or in between the ribs with each breath — one way of trying to bring more air into the lungs.
  • There may be increased sweat on the head, but the skin does not feel warm to the touch. More often, the skin may feel cool or clammy. This may happen when the breathing rate is fast.
  • A sound heard in the upper airway when the child breathes in.
  • Accessory muscle use. The muscles of the neck appear to be moving or your child's head is bobbing up and down when breathing in.
  • Changes in alertness. Low oxygen levels may cause your child to act more tired and may indicate respiratory fatigue.

Tookhan said it is important for caregivers and parents to know their child’s history so that they can recognize subtle changes in children with chronic respiratory illnesses like asthma and chronic lung disease.

If they are unsure if their children are showing signs of respiratory illness, or if the symptoms are mild, they can call their child's pediatrician to discuss next steps, or they can visit the nearest emergency room.

“Children who come in to the emergency department experiencing signs of respiratory distress may receive breathing treatments, nasal suctioning for infants and imaging, such as a chest X-ray, to help us see what’s happening in the lungs,” Tookhan said. “Here at UM BWMC, we recently implemented an innovative high flow nasal cannula treatment that quickly improves breathing and oxygen levels in children.”

If adults are having a severe respiratory irritation because of the air pollutants, doctors will often treat it with medications similar to those that are used to treat asthma.

“We treat it with nebulized albuterol, and often corticosteroids like Prednisone, to help decrease the inflammation and open the airways again,” Wendell said.

Anyone with concerning symptoms should call their primary doctor. If the symptoms are severe, call 911. The major medical systems, and some insurance carriers, have nurse triage lines to guide people in the right direction.

Wendell’s advice: listen to the experts and avoid being outside when the air quality is poor.

“If you have to go outside, the masks actually give you pretty good protection from these small particles, so it would be a good time to put on a mask outside when the levels get too high if you have to be out there,” Wendell said.

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