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“Wildfire smoke is not a fleeting inconvenience. It is a lasting, insidious threat,” said Mary McGowan, CEO of the Foundation for Sarcoidosis Research (FSR), Chicago, in a statement.

As the effects of wildfires persist in several parts of the United States, McGowan highlighted a public health alert published online earlier this year in which the FSR, a nonprofit organization, outlined immediate action needed to help prevent future adverse health outcomes in the wake of wildfires.

“As the smoke settles, it brings with it a long tail of health consequences, including the risk of chronic inflammatory diseases such as sarcoidosis,” McGowan said in the statement. “Exposure to environmental toxins — especially inhaled fine particulate matter like that found in wildfire smoke — is widely recognized as a contributing factor to this disease,” she said. A spike in sarcoidosis diagnoses occurred among firefighters and rescue workers exposed to dust and smoke at Ground Zero after the 9/11 disaster in New York; however, public perception of the sarcoidosis risks associated with smoke exposure remains limited, she added.

Policy Priorities

“Public messaging tends to focus on the immediate: Evacuations, air quality alerts, temporary masks and, in many cases, for good reasons. But for those living near the fire zone — or working within it — the health risks certainly don’t vanish when the skies clear; they accumulate,” McGowan said in her statement. “Firefighters, cleanup crews, and nearby residents continue to breathe in particles that may settle deep in the lungs and trigger inflammation that doesn’t show up on a scan until years later,” she said.

No widespread campaign currently exists to help people understand the long-term health consequences of wildfire smoke, and there is no comprehensive medical guidance for what recovery and monitoring should look like in the months and years following high exposure, McGowan said in her statement. The science continues to support the case for concern, but public health has not kept up, she added.

“To protect lung health during wildfires, policy initiatives should focus on improving air quality monitoring, including measurement of the risk of breathing in small particular matter,” McGowan said in an interview. Other protective measures include providing access to respiratory protection both during and after fires and promoting public education and awareness about the risk of small particulate matter not only in smoke but also in the ashes that need to be cleaned up after a fire, she said.

Points for Physicians and Patients

For those living in areas of exposure to wildfires and/or their cleanup, McGowan emphasized precautions including monitoring air quality and avoiding outdoor activities when air quality is poor if possible.

Other precautions include wearing a N95 or P100 respirator when outdoors, as these products are designed to filter fine particles effectively. Staying hydrated, continuing with prescribed medications such as oxygen therapy and inhaler use, and sealing indoor spaces add a level of protection as well, McGowan told Medscape Medical News.

Finally, those exposed to wildfire smoke should be attentive to their health and seek medical attention for symptoms such as difficulty breathing, chest pain, persistent cough or sneezing, eye irritation, or dizziness or confusion, she said.

Diagnostic Clues and Treatment Strategies

A study previously reported by Medscape Medical News showed an association between climate and respiratory health. McGowan also cited a study showing an association between air pollution and lung function in sarcoidosis in particular.

Individuals who develop sarcoidosis after wildfire exposure may present with nonspecific symptoms that resemble asthma or bronchitis, which is a common barrier to the early identification of sarcoidosis, said Rohit Gupta, MD, director of the Sarcoidosis Program at Temple University Hospital, Philadelphia, in an interview.

The patient’s symptoms could be caused by exposure to environmental factors, but a more thorough workout is needed if the patient has persistent disease or imaging findings, Gupta said. “Some patients also might need to be their own advocate to see if they need imaging or a referral to a specialist in this field,” Gupta noted. Insurance and other socioeconomic factors can also present as barriers to early identification of sarcoidosis, he said.

Monitoring symptoms of individuals exposed to wildfire smoke is essential, Gupta told Medscape Medical News. “If a patient’s symptoms resolve, then we know it was the environmental exposure causing those symptoms. If symptoms persist, then physicians have to be aggressive about ordering further imaging or biopsy to get the correct diagnosis,” he said. For those in areas with wildfire smoke who are not first responders, prevention of exposure by staying indoors, wearing masks, and monitoring the local air quality is the best way to reduce the risk, said Gupta.

As for additional research, prospective studies by a larger entity such as the National Heart, Lung, and Blood Institute; American Thoracic Society; or American Lung Association to explore an association between air pollution and respiratory illness and whether decreased exposures reduce the disease burden, Gupta told Medscape Medical News. “In the long term, hopefully we can prevent wildfires, address climate change and take action on those bigger policies,” he said.

McGowan and Gupta had no financial relationships to disclose.