Cedars-Sinai, Huntington Health Pulmonologists Explain How to Avoid Breathing Unhealthy Particles in Smoke

The best masks to protect the lungs from microscopic particles found in dust, smoke, smog and particulate matter are N95 masks that can filter out really small particles, according to Cedars-Sinai experts. Image by Getty.

As wildfires rage throughout Los Angeles County, the air quality is unhealthy-even if the Air Quality Index listed on smartphone weather reports indicates otherwise.

That's because the weather data does not measure many dangerous pollutants circulating in the air from smoke and wind, said pulmonologist Jeremy Falk, MD, associate professor of Medicine at Cedars-Sinai.

"People may think, 'Well, I don't see or smell smoke anymore, and it looks sunny like it normally does in Southern California,' and be lulled into thinking everything is fine," Falk said. "But much of what can harm us in situations like this doesn't have an odor. The Air Quality Index system was developed for everyday pollution, and not necessarily to warn us about particles that are not typically in the air because of wildfires."

Falk, along with Irina Dralyuk, MD, a Cedars-Sinai Guerin Children's pulmonologist, and Daryl Banta, MD, pulmonologist and medical director of Pulmonology and Critical Care at Huntington Health, an affiliate of Cedars-Sinai, said it's best to err on the side of caution and stay as safe as possible during periods of bad air quality-which will be around as long as the fires continue to burn.

An Air Quality Index level of 101-150 indicates that people in sensitive groups (such as those with lung disease, severe allergies or heart disease) could experience sore throats, wheezing or difficulty breathing. A level of 151-200 means even those without chronic breathing problems could experience health effects.

Still, the Air Quality Index can be deceiving, Falk said.

"Homes and buildings are full of all kinds of materials that are toxic when burned-plastics, oil products, metals-and the Air Quality Index does not pick up on that. Another limitation is in the unpredictable, shifting winds. You don't know if the air quality data that you're viewing is up to date. What may be an 'acceptable' level of air pollution one minute may be a very different level half an hour later. It's the unknown that makes this situation so dangerous."

The South Coast Air Quality Management District is a good resource to check updated air quality in your area.

"What makes the air pollution associated with fires so dangerous is that the particles that seem to do the most damage are much smaller than even the microscopic droplets we saw with COVID-19," Falk said. "Because the particles are so tiny, they can fit between the fibers of a simple paper mask or cloth mask and get far down into our airways, causing damage."

The best masks to protect the lungs from microscopic particles found in dust, smoke, smog and particulate matter are N95 masks that can filter out really small particles, down to the 2.5-micron level, Banta said.

He advised wearers to make sure that their N95 masks fit properly.

"If there is any leak around the mask because of a beard or incorrect size, you may be exposing yourself to unhealthy air or smoke," Banta said.

"The longer you're outside breathing air that we know is not safe, the more you're putting yourself at high risk," Falk said. "While the fires are still happening, any exercise that could be moved to an indoor space is preferable. If you really do need to be outside for any reason, wearing the N95 mask is the best approach."

When inside, Banta said, close windows, make sure any cracks are sealed and that there's a good air filtration system. Check that any air conditioner is recirculating air that is in the structure and not pulling in air from the outside.

"If there is significant smoke, ash or dust inside, wear masks indoors," he said.

Most modern cars also have a recirculating option, although drivers should check to make sure the automobile's air filters have been changed recently.

Parents should keep an eye on children who have a cough, wheezing, noisy breathing, chest tightness or pain, increased rate of breathing or increased heart rate, shortness of breath, retractions, labored breathing, gasping for air, throat irritation, hoarse voice, confusion, dizziness, or mental changes.

"It's advisable for children of all ages to wear an N95 mask when outside," Dralyuk said. "Also, avoid outdoor sports or events, and evacuate the area if your child is having symptoms or the air quality is very poor, or if your child has risk factors for respiratory issues."

If children have respiratory issues, make sure they take all scheduled medications as prescribed, and have rescue inhalers at home. Also, check expiration dates and number of puffs left, and get refills as necessary.

Direct, prolonged smoke inhalation or exposure is very dangerous.

"If you have severe symptoms, such as severe cough, shortness of breath, chest pain, dizziness or confusion after smoke exposure, seek immediate medical attention," Banta said.

Milder symptoms can include irritated or watery eyes, runny nose, scratchy throat, wheezing, headache, dry eyes, phlegm or irritated sinuses. Older people and very young children can be more susceptible to these effects, as well as people who have preexisting lung or heart problems.

For people with chronic medical conditions, exposure to smoke and unhealthy air could potentially increase the risk for stroke, heart attacks and lung conditions. People exposed to prolonged amounts of particulate matter also may be at increased risk for lung cancer.

"If the air outside is bad to breathe, do what you can to not breathe it," Falk said. "There's nothing high tech about it. Just use common sense-that's going to be our best way out of this."

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