Smoke Over the Bronx
Canadian wildfire smoke raises PM2.5 across New York whenever the plume settles in. Expect more respiratory and cardiovascular complaints in a population with a high baseline asthma burden.
View NYS DEC advisory ↗Bronx baseline
The Bronx has a high burden of asthma and chronic cardiopulmonary disease. Smoke adds another trigger to patients already exposed to traffic pollution, poor housing conditions and limited access to consistent outpatient care.
Ask whether the patient works outdoors, spent prolonged time outside or cannot keep smoke out of the home.
What may present
- Eye, nose or throat irritation
- Cough, wheeze or shortness of breath
- Headache, fatigue or reduced exercise tolerance
- Asthma or COPD exacerbation
- Chest pain, palpitations or heart failure symptoms
Read the AQI
At AQI 151–200, air quality is unhealthy for everyone. Everyone should reduce prolonged or strenuous outdoor activity. Sensitive groups should avoid strenuous outdoor activity and move activities indoors when possible. AQI estimates exposure risk. It does not grade an individual patient's illness.
Treat the exacerbation in front of you.
Wildfire smoke may be the trigger. The ED diagnosis remains asthma, COPD, ACS, heart failure, arrhythmia or another clinical process. Do not let today's haze explain away hypoxemia, focal findings, fever, syncope or ischemic symptoms.
ED approach
- Exposure timing, time outdoors and symptom onset
- Asthma, COPD, CAD, heart failure and pregnancy
- Rescue use, controller access and prior severe attacks
- SpO2, work of breathing and cardiopulmonary exam
- Testing follows the syndrome, not the AQI
Usual pathways apply
TREAT THE CLINICAL PHENOTYPE
- Bronchodilators and steroids for asthma or COPD when indicated
- Oxygen and ventilatory support based on severity
- Standard evaluation and treatment for ACS, heart failure or arrhythmia
- No specific antidote for wildfire PM2.5 exposure
Alarm signs
- Hypoxemia or worsening work of breathing
- Respiratory fatigue, silent chest or altered mental status
- Ischemic chest pain, syncope or arrhythmia
- Failure to improve after initial treatment
- Unsafe discharge environment or no access to medications
Reduce the next exposure
- Close windows and doors while smoke remains elevated
- Avoid smoking, vaping, candles, incense and frying
- Avoid unnecessary vacuuming and strenuous outdoor activity
- Wear a well-fitting N95 or P100 respirator if outdoor exposure cannot be avoided
- Confirm access to prescribed rescue and controller medications
If the home is hot or cannot remain closed, use an air-conditioned public space or call 311.