THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
About a month ago, the sky in many parts of Southern California was as orange as it has ever been due to the unfortunate wildfires in Canada. For people living in and around California, sub-optimal air quality is not a new thing. However, things are different this year, as many regions of the United States with no previous history of dangerous air quality reached a “code purple” alert. Before you ask, a code purple alert denotes the second worst air quality possible, according to the US Environmental Protection Agency’s Air Quality Index.
To understand how seriously this should be taken, the level just above code purple is code red, and that denotes when air quality is so bad it is treated as an emergency environmental situation. A code red significantly increases the risk of health issues for everyone, with children and older adults being at an extremely high risk of serious health conditions.
When I say many regions of the US are posting historically bad air quality figures, I mean up to 11 states received a code purple for the first time in their history. You can imagine how scary a sight that is for the Environmental Protection Agency (EPA). But it is an even scarier sight for Physicians nationwide. I will explain why, but first, a short detour into the general effects of wildfire smoke on the environment and the body.
As you will imagine, the obvious effects of wildfire smoke are irritated eyes and throats, as well as varying levels of breathing difficulties. And everyone feels these effects pretty quickly, too. The effect on the environment is not as immediate but much worse. According to the EPA, wildfire smoke causes particulate matter below 2.5 microns in diameter (PM2.5) to fill the atmosphere. The other common class of airborne particulate matter is PM10, and these describe particles below 10 microns in diameter. These particulate matter are readily inhalable because of their minute size, with PM2.5 being up to 30 times smaller than a hair strand. Those are ridiculous levels of small.
While both inhalable particulate matter are dangerous, PM2.5 has the capacity to go into deeper parts of the lungs than its PM10 compatriot. In fact, the WHO estimates that PM2.5 is linked to the highest proportion of adverse conditions related to air pollution. This is justified by PM2.5’s strong relationship with early deaths, serious respiratory and cardiovascular issues, and an increased frequency of visits to emergency rooms. And all these are just for acute exposure. It gets even worse with long-term exposure. In short, PM2.5 is the bad guy of the air.
Now to why physicians are worried about the increasing PM2.5 levels following wildfire smokes – a comprehensive study has revealed that higher residential PM2.5 levels, particularly from wildfire and agriculture, are associated with higher rates of incident dementia. When I say comprehensive, I mean a study that collected data from close to 28,000 people for 19 years. That’s about as thorough as we can hope for, really.
What’s more, researchers found that lowering the levels of particulate matter in the air may lower the number of older people who develop dementia. I mean, of course!
You may wonder why wildfire smoke is associated with dementia, considering respiratory and cardiovascular issues are the primary culprits. Well, I was too, and apparently, researchers worldwide are, too, so it may be a little frustrating to hear the answer to that question, which is – no one knows. Yeah, that’s it; no one knows for sure why PM2.5 is increasing the risk of dementia in the latter stages of life.
Some postulate that the particles are sufficiently small to enter the brain and trigger a toxic reaction, while others believe it is a lot more complicated and linked to cardiovascular issues, which in turn increases the risk for dementia. Whichever the case, we can all agree that reducing exposure to PM2.5 is an absolute priority for people living in high-risk regions, like the East Coast and Southern California. How to do this is not as clear.
Experts suggest that smokestacks, air purifiers, and tailpipes may not be enough. Nonetheless, it certainly does not hurt to take precautionary measures, like – hear me out – wearing a mask. Hey, don’t hate me. I am only a messenger of the CDC. And common sense, of course. It is also smart to reduce driving during periods of wildfire smoke and stay indoors as much as possible.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist & Board Certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ & House call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://edition.cnn.com/2023/09/17/us/air-quality-wildfire-pollution-allergy-dg/index.html
- https://www.bu.edu/sph/news/articles/2023/wildfire-smoke-may-increase-risk-of-dementia/#:~:text=Amidst%20an%20unprecedented%20wildfire%20season,associated%20with%20greater%20dementia%20risks.
- https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2808088?guestAccessKey=41afaad4-70b6-4cac-a49b-1b6de01b83d4&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=0814
- https://ww2.arb.ca.gov/resources/inhalable-particulate-matter-and-health
