How to Deal with Wildfire Smoke Inhalation


Multiple wildfires burning in Colorado -- among them the Black Forest and Royal Gorge fires -- have cast ash and other irritants into the air, which may cause breathing problems for children, especially those with underlying respiratory problems. Vivek Balasubramaniam, MD, pediatric pulmonologist at Children's Hospital Colorado's Breathing Institute and at the Pediatric Heart-Lung Center, provides insight and advice on wildfire smoke inhalation.

What makes wildfire smoke a health hazard?

Wildfire smoke is different than a smoke you would inhale from a close fire because of the particulate matter in the smoke. We see most health effects in patients with a predisposition to respiratory problems, in the young and in the elderly.

Of those that have respiratory problems, patients with asthma are most common, and can have more symptoms if exposed to the particulate matter. In this case, they need to use their rescue medications more frequently.

Wildfire smoke can persist for days or even months, depending on the extent of the wildfire. Although the air may look clear, it may have particulate matter that can make asthma worse or trigger an attack.

What is the main concern for patients with respiratory problems?

Most of the time we worry about prolonged asthma attacks. During wildfires, these attacks can last longer than they normally would. If someone is having an asthma attack due to high smoke exposure from the outdoors, we recommend that they try to stay indoors. If they must go outdoors, they should use their rescue medications prior to going outside. If outdoors, they should try to limit the amount of vigorous activity.

What are some symptoms parents can look for?

  • Decreased activity level
  • Increased coughing
  • Wheezing and/or audible breathing sounds
  • Change in color or pallor of skin
  • Easily fatigued
  • Breathing hard
To see if a child is having problems breathing, observe if they breathing fast; in smaller children, look for their ribs sucking in (called retraction).

What are the first steps any parent should take - whether or not their child has a respiratory issue - if they suspect smoke inhalation?

With the dense smoke, anyone can start coughing and wheezing and have problems, whether or not they have an underlying respiratory problem.
  • Bring the child indoors and have him or her rest until symptoms subside.
  • If symptoms persist, seek medical opinion. In that case, the child may need an inhaler or another medication to help them during the exposure.
  • Parents should also seek medical attention if they notice their children using their rescue medications more often than normal (a good gauge is if they are using the medications as frequently as every four hours). 
  • If the smoke is especially thick outside and/or there's a lot of particulate matter in the air, and you've been outside, change your clothes once you come indoors. Kids will want to be close to you and could inhale the matter that comes off your clothes, especially if you work outdoors.
  • If children get red or itchy eyes - sometimes they can get soot in their eyes - rinse out the eyes just with water. With the heat, drink many fluids.

At what point should parents seek emergency care?

If they notice:
  • Any change in their child's behavior
  • Real difficulty breathing
  • Any change in their level of consciousness
  • Any concern for child

What about over-the-counter medications?

There aren't any good over-the-counter medications for exposure to smoke from a wildfire. The most important thing is to try to clear the secretions from your lungs, which your lungs will normally do. Keeping well hydrated is important, in that it keeps the mucus in your lungs thinner so they can clear out the secretions.

If you are concerned about your child's breathing and would like to speak to a nurse, call Children's Colorado's Parent Smart Healthline at 720-777-0123; the line is staffed by nurses 24/7. In case of emergency, call 911.