Who is at Increased Risk of Health Effects from Wildfire Smoke Exposure?

Based on epidemiologic studies, certain populations and people in particular lifestages may be at greater risk of experiencing health effects and may experience more severe effects due to wildfire smoke. These groups are referred to as at-risk populations or “sensitive groups” (the term used in the AQI).

Evidence indicates that the risk of PM_2.5-related health effects varies throughout a lifetime. Risk is generally higher during childhood and middle age through old age than during young adulthood. As people age, they are also more likely to be affected by heart and lung disease, hypertension and diabetes. These people should be particularly diligent about limiting exposure to wildfire smoke.  

All your patients, but especially those who are members of at-risk populations, should follow recommendations to reduce smoke exposures, which will be discussed later in this course. The following section details those populations and lifestages that are at risk (in bold) of experiencing health effects in response to smoke exposure, why they are at risk and, in some cases, the types of health effects they may  experience.

People with chronic diseases   

•  Asthma and other lung diseases

  Smoke exposure can trigger severe breathing responses in people with lung diseases.

  Effects: Trouble breathing (e.g., coughing, wheezing, chest tightness). Worsening of chronic
  lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD), that require a trip to the emergency department or a hospital stay and can be fatal.

• Cardiovascular disease

  Smoke exposure can trigger severe cardiovascular events in people with underlying cardiovascular diseases and related conditions (e.g., diabetes or obesity).

  Effects: May include heart attacks and strokes that require a trip to the emergency department or a hospital stay and can be fatal.

Lifestages  

• Children

  Children up to 18 years of age are at greater risk of smoke-related health effects, because their lungs are still growing. In addition, compared to adults, they are more likely to be exposed to smoke because they spend more time outdoors. Children also engage in more vigorous activity and inhale more air per pound of body weight than adults, both of which affect the dose of smoke they experience and their risk of a health effect.

  Effects: May include coughing, wheezing, trouble breathing, chest tightness and decreased lung function in all children. Children with asthma may have worsened asthma symptoms or asthma attacks.

• Older adults

  Adults ages 65 and older are at greater risk, because they are more likely to already have chronic heart or lung disease. In addition, the body’s ability to respond to health challenges generally declines with age.

  Effects: May include cardiovascular events (e.g., heart attacks or stroke) and respiratory events (e.g., asthma attacks or COPD events) that require a trip to the emergency department or a hospital stay and can be fatal.

•  Pregnant women

  Changes in the body that happen with pregnancy (e.g., increased breathing rates) may increase sensitivity to smoke exposure. During pregnancy, the fetus may be more sensitive to smoke exposure.

  Effects: Some evidence suggests that smoke exposure may lead to pregnancy and birth outcomes such as gestational diabetes, high blood pressure during pregnancy, low birth weight and preterm birth.

People with higher exposure may experience worsening of underlying health conditions. Higher smoke exposures could lead to increased risk of respiratory- or cardiovascular-related trips to the emergency department or hospital stays and to death. These groups include:

•  People from some ethnic and racial minority groups

  Ethnic and racial minority groups can experience economic, social, environmental and other factors that may limit their ability to reduce their exposure to wildfire smoke.

• People with lower incomes

  People with fewer financial resources often have less access to health care, which can lead to untreated or inadequately treated underlying health conditions (e.g., asthma or diabetes). They may also have higher smoke exposure due to less access to measures to reduce wildfire smoke exposure (e.g., ability to work from home, use air cleaners), living in poor quality housing that can lead to higher indoor smoke concentrations (or being unhoused), or spending more time outside traveling to work.

• Outdoor workers

Outdoor workers can be exposed to high concentrations of smoke for extended periods of time.

For more information, see the At-Risk Groups of People fact sheet. 

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