When Dr. David Beuther began working as a pulmonologist — that’s a lung doctor — in Colorado two decades ago, summer used to be the easy time.
In winter, his patients, holed up indoors and crowded together with others, caught viruses and developed coughs and struggled to breathe. Summer brought the relief of fresh air.
“They would look forward to the summer when they were generally better,” he said. “The stories we are hearing are different now. Now, you hear stories like, ‘I was doing fine until those fires.’”
For much of this week, Colorado has ranked among the worst places to breathe in the world. Wildfire smoke has blanketed much of the state. In the Denver metro area, especially, that smoke has combined with hot temperatures and high levels of ground-level ozone, which can also damage lungs and exacerbate breathing conditions like asthma or chronic obstructive pulmonary disease.
On Monday and Tuesday, Denver had the worst air quality of any U.S. city tracked by the company IQAir, and, at times, it broke into the top 10 globally. Wednesday brought a break, with weather changes and thunderstorms limiting fire growth and whisking away ozone. But parts of central and southern Colorado remained under an air quality alert for wildfire smoke.
With high temperatures forecast across Colorado by the weekend, the air quality woes are expected to return. Already this summer, the Colorado Department of Public Health and Environment has issued 20 ozone action alerts, compared with 30 for all of last year. (The ozone season officially runs until Aug. 31, though the state does sometimes issue alerts in September.)
To Beuther, who works at National Jewish Health, all of this suggests two things.
First, this year isn’t an anomaly — previous years have also brought periods of wildfire smoke and ozone. Patches of bad summer air quality are likely here to stay in Colorado.
So, second, it’s time to treat air quality the same way you would any other potential disaster you would prepare in advance for, like a fire or a flood.
“It’s time that people make this type of emergency plan for bad air quality,” Beuther said.
How can wildfire smoke affect my health?
In recent research, wildfire smoke is emerging as a significant public health threat with a wide variety of impacts.
“One of the problems with wildfire smoke is we always see the fire as an emergency, which it is,” said Sheryl Magzamen, an epidemiologist at Colorado State University who studies the effects of smoke on human and animal health. “But the smoke is an emergency as well. We’ve been calling that a silent epidemic.”
In that epidemic, it’s the small particles that get you.
The little bits of stuff wafting through smoke — known as PM 2.5, for how small they are — can penetrate deep within your lungs and lead to inflammation. They can also spread throughout the body, potentially worsening other types of chronic disease or even leading to cognitive changes.
Magzamen said smoke can be harmful in an acute sense — for instance, a wildfire nearby is flooding your neighborhood with smoke. But it can also be harmful when the fires are farther away, in part because people may not be as vigilant about protecting themselves.
Exactly how these risks measure up isn’t clear, in part because researchers are only just beginning to wrap their heads around the dangers of wildfire smoke. In the past, air quality studies and protections focused on human-created pollution like from smokestacks or vehicles.
“This is a huge paradigm shift for us,” Magzamen said.
Who is most at risk from bad air quality?
In general, people who suffer from chronic disease are most at risk, along with people who are older and people who are very young. (That last group is vulnerable because their lungs are still developing.)
For people with asthma, COPD or other chronic respiratory diseases, smoke and ozone pollution can make it hard to breathe.
But because the small particles in wildfire smoke are able to spread throughout the body, others are at heightened risk, too. Beuther said people with cardiovascular disease may suffer an increased risk of stroke or heart attack. Magzamen said people with other types of chronic disease may also see a worsening of those conditions due to greater inflammation and other harms.
Luke Montrose, a professor at CSU, has been studying the impacts on the reproductive health of male wildland firefighters. He’s found that firefighters see a decline in sperm quality during wildland fire season, though how much of that is due to smoke exposure versus other reasons is uncertain.
“That sperm quality rebounds to an extent in the post-season, but not fully,” Montrose said.
What symptoms are most concerning?
Beuther said for typically healthy people who don’t have a chronic condition common symptoms may include a scratchy throat, itchy eyes or even a little chest tightness. Those aren’t too worrisome but they are warning signs to heed.
“First thing is to be aware of it, slow down, get yourself indoors,” he said. “It’s probably not a time to start exercising more or pushing yourself too much.”
People can use a saltwater nasal rinse — either a homemade version or a store-bought version. Staying well hydrated can help, too.
But if symptoms turn more severe, such as having difficulty catching your breath, that’s when it’s time to go see a doctor. Beuther said approximately one-third of people with asthma don’t realize they have it, and bad air quality days can sometimes trigger their first big attack.
For people with a chronic condition, self-awareness and staying on top of their disease become more important.
“We try to control chronic conditions so that minor irritations and disturbances don’t cause immediate problems,” he said.
Sometimes, this means that problems caused by wildfire smoke expose underlying problems — Are people taking their medications? Does their prescription need to be adjusted?
“If we’ve maximized or optimized therapy, then it’s about avoidance,” he said.
In other words: Time to make a plan to escape the bad air.
How do I make a plan for bad air quality?
Everybody’s plan to avoid unhealthy air is going to be different.
“I think there’s probably no perfect strategy,” Beuther said. “We just have to empower people with all these different ideas.”
Step one is evaluating your needs and your resources.
Are you especially vulnerable to cruddy air quality? Then make sure you have plenty of medication on hand and have made a gameplan with your healthcare provider on what to do when the smoke hits.
That could include hunkering down indoors or upping your dose of medication if it’s safe. Or it could include heading out of town to stay with a friend or family member. Beuther suggested people who are especially vulnerable could even have a packing list or a prepacked bag — similar to a go-bag that folks in wildfire-prone areas keep.
For people who aren’t as vulnerable or for folks who can’t travel to avoid bad air, keeping your indoor air clean is important. Montrose conducted research at skilled nursing facilities in Idaho during a bad wildfire smoke year and found that the air quality inside could be worse than the air quality outside.
So, if you are able, keep the windows shut and run the air conditioning. Outdoor exercise can be shifted to the early morning hours, when air quality is generally better, or moved indoors entirely.
If you can’t avoid the outside air — for instance, you work outdoors — a properly fitted N95 or KN95 mask can help, Magzamen said. Beuther said taking indoor breaks is also important to limit exposure.
How do I know how bad the air quality is?
There are a number of ways to check air quality.
Websites such as AirNow, PurpleAir and IQAir.com provide live and local looks at air quality. Weather apps on your phone often come with air quality measures, too.
And for an even more local look, Montrose recommends a small, portable air quality monitor. (He uses this one, but there are others available.)
While the monitors aren’t as accurate as more professional models, he said they can provide a general sense of whether the air quality around you is good or bad.
“Data is one of the first things we can do to empower ourselves,” he said.
How do I keep my house cool and my indoor air healthy without air conditioning?
This is the double-whammy many Coloradans face in the summer. When it’s hot and smoky outside and you don’t have air conditioning, what do you do?
“I don’t know if there’s a great solution if you don’t have air conditioning,” Beuther said.
Magzamen said people in this situation should consider where they can go during the day to escape the heat — a public library, a rec center, a cooling center or some other indoor space.
Beuther said people can try to keep the heat down in their homes by closing shades and running fans. But there comes a point where the heat is more dangerous than the smoke, so opening windows to bring in cool air may be a tradeoff worth making.
“We really have to be careful about not being too strict on keeping your windows shut,” he said.
“Some people don’t have the means,” he said. “We talk about doing the best you can.”
How do I keep the air clean inside my house during wildfire smoke?
Filtration is the foundation.
If you have air conditioning, this means making sure you have a good filter in your HVAC system. Magzamen recommends one that’s rated MERV 13 or higher. That’s on the upper end of what you’ll find in the hardware store, so expect to spend a little more money.
Evaporative coolers may also come with filters that can be upgraded, she said.
Indoor air purifiers can also help. And if you don’t have one of those, you can make an ad-hoc version from a box fan and a furnace filter.
Do I need to move out of Colorado because of the air quality?
Who among us has not looked at the sky during a fire and wondered what the future holds for our state? And Beuther does sometimes advise patients that they may want to relocate — but not often.
“It’s a rare day when I say you have to move out of Colorado,” he said. “This stuff is happening globally.”
By that, he means climate-related disasters are increasing across the globe. But also that wildfire smoke can drift and cause harm far from where the fire is burning. At one point in 2021, for instance, Denver had the worst air quality of any city in the world — and it was due to fires burning outside the state, not inside it.
“It’s getting hard to outrun this,” Beuther said. “There’s probably no perfect place to live and if there is it’s probably too expensive.”
Is there anything to be hopeful about?
Let’s just acknowledge that this can all feel pretty bleak.
“I think climate grief is real,” Magzamen said.
But, on Wednesday, she was not hunkered inside her house, hiding from the outside air. Instead, she reminded others that fires and smoky air aren’t the only things that define our state.
“We have shown we are an adaptable species, and we will need to continue to adapt,” she said. “But I think there is also this wonderful collective spirit in Colorado to protect and enjoy our environment. So I think that gives me hope.”