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Vertigan AE, Harvey ES, Beyene T, Van Buskirk J, Holliday EG, Bone SL, McDonald VM, Horvat JC, Murphy VE, Jensen ME, Morgan GG, Zosky GR, Peters M, Farah CS, Jenkins CR, Katelaris CH, Harrington J, Langton D, Bardin P, Katsoulotos GP, Upham JW, Chien J, Bowden JJ, Rimmer J, Bell R, Gibson PG. Impact of Landscape Fire Smoke Exposure on Patients With Asthma With or Without Laryngeal Hypersensitivity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3107-3115.e2. [PMID: 37329954 DOI: 10.1016/j.jaip.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Individuals with asthma experienced severe and prolonged symptoms after the Australian 2019 to 2020 landscape fire. Many of these symptoms, such as throat irritation, occur in the upper airway. This suggests that laryngeal hypersensitivity contributes to persistent symptoms after smoke exposure. OBJECTIVE This study examined the relationship between laryngeal hypersensitivity and symptoms, asthma control, and health impacts on individuals exposed to landscape fire smoke. METHOD The study was a cross-sectional survey of 240 participants in asthma registries who were exposed to smoke during the 2019 to 2020 Australian fire. The survey, completed between March and May 2020, included questions about symptoms, asthma control, and health care use, as well as the Laryngeal Hypersensitivity Questionnaire. Daily concentration levels of particulate matter less than or equal to 2.5 μm in diameter were measured over the 152-day study period. RESULTS The 49 participants with laryngeal hypersensitivity (20%) had significantly more asthma symptoms (96% vs 79%; P = .003), cough (78% vs 22%; P < .001), and throat irritation (71% vs 38%; P < .001) during the fire period compared with those without laryngeal hypersensitivity. Participants with laryngeal hypersensitivity had greater health care use (P ≤ .02), more time off work (P = .004), and a reduced capacity to participate in usual activities (P < .001) during the fire period, as well as poorer asthma control during the follow-up (P = .001). CONCLUSIONS Laryngeal hypersensitivity is associated with persistent symptoms, reports of lower asthma control, and increased health care use in adults with asthma who were exposed to landscape fire smoke. Management of laryngeal hypersensitivity before, during, or immediately after landscape fire smoke exposure might reduce the symptom burden and health impact.
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Affiliation(s)
- Anne E Vertigan
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia.
| | - Erin S Harvey
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Tesfalidet Beyene
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Joseph Van Buskirk
- Sydney School of Public Health and University Centre for Rural Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth G Holliday
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sarah L Bone
- Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Vanessa M McDonald
- Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jay C Horvat
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Megan E Jensen
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Geoffrey G Morgan
- Sydney School of Public Health and University Centre for Rural Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Graeme R Zosky
- Tasmanian School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia
| | - Claude S Farah
- Concord Clinical School, University of Sydney, Concord, New South Wales, Australia
| | - Christine R Jenkins
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia; Concord Clinical School, University of Sydney, Concord, New South Wales, Australia
| | - Constance H Katelaris
- School of Medicine, Western Sydney University, and Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - John Harrington
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - David Langton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, Victoria, Australia; Department of Thoracic Medicine, Frankston Hospital, Frankston, Melbourne, Victoria, Australia
| | - Philip Bardin
- Lung and Sleep Medicine, Monash University and Medical Centre, Clayton, Melbourne, Victoria, Australia
| | - Gregory P Katsoulotos
- St George Specialist Centre, Kogarah, Southern Sydney, New South Wales, Australia; St George and Sutherland Clinical School, University of New South Wales, Kogarah, Southern Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia; University of Queensland Frazer Institute, Woolloongabba, Brisbane, Queensland, Australia
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, New South Wales, Australia; School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey J Bowden
- Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, Adelaide, South Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia; St Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia
| | - Rose Bell
- Asthma Australia, Melbourne, New South Wales, Australia
| | - Peter G Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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Shah S, Kim E, Kim KN, Ha E. Can individual protective measures safeguard cardiopulmonary health from air pollution? A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2023; 229:115708. [PMID: 36940818 DOI: 10.1016/j.envres.2023.115708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 05/09/2023]
Abstract
Evidence supporting the effect of individual protective measures (IPMs) on air pollution is relatively scarce. In this study, we performed a systematic review and meta-analysis to investigate the effects of air purifiers, air-purifying respirators, and cookstove changes on cardiopulmonary health outcomes. We searched PubMed, Scopus, and Web of Science until December 31, 2022, 90 articles and 39,760 participants were included. Two authors independently searched and selected the studies, extracted information, and assessed each study's quality and risk of bias. We performed meta-analyses when three or more studies were available for each IPMs, with comparable intervention and health outcome. Systematic review showed that IPMs were beneficial in children and elderly with asthma along with healthy individuals. Meta-analysis results showed a reduction in cardiopulmonary inflammation using air purifiers than in control groups (with sham/no filter) with a decrease in interleukin 6 by -0.247 μg/mL (95% confidence intervals [CI] = -0.413, -0.082). A sub-group analysis for air purifier as an IPMs in developing counties reduced fractional exhaled nitric oxide by -0.208 ppb (95% confidence intervals [CI] = -0.394, -0.022). However, evidence describing the effects of air purifying respirator and cook stove changes on cardiopulmonary outcomes remained insufficient. Therefore, air purifiers can serve as efficient IPMs against air pollution. The beneficial effect of air purifiers is likely to have a greater effect in developing countries than in developed countries.
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Affiliation(s)
- Surabhi Shah
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Eunji Kim
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kyoung-Nam Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Eunhee Ha
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea; Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Republic of Korea.
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Pelletier C, Ross C, Bailey K, Fyfe TM, Cornish K, Koopmans E. Health research priorities for wildland firefighters: a modified Delphi study with stakeholder interviews. BMJ Open 2022; 12:e051227. [PMID: 35115350 PMCID: PMC8814744 DOI: 10.1136/bmjopen-2021-051227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The increase in global wildland fire activity has accelerated the urgency to understand health risks associated with wildland fire suppression. The aim of this project was to identify occupational health research priorities for wildland firefighters and related personnel. DESIGN In order to identify, rank and rate health research priorities, we followed a modified Delphi approach. Data collection involved a two-stage online survey followed by semi-structured interviews. SETTING British Columbia, Canada. PARTICIPANTS Participants included any current or past wildland firefighter or individuals engaged in related roles. There were 132 respondents to the first survey. Responses to the first survey were analysed to produce 10 research topics which were ranked by 75 participants in the second survey (response rate: 84%). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the identification, ranking and level of agreement of research priorities through a two-round online survey. We contextualised these findings through deductive and inductive qualitative content analysis of semi-structured interviews. RESULTS The most important research priorities identified were (% consensus): effects of smoke inhalation on respiratory health (89%), fatigue and sleep (80%), mental health (78%), stress (76%) and long-term risk of disease (67%). Interviews were completed with 14 individuals. Two main themes were developed from an inductive content analysis of interview transcripts: (1) understanding the dynamic risk environment; and (2) organisational fit of mitigation strategies. CONCLUSIONS Participants expressed a general concern with the unknown mental and physical health impacts of their jobs, including the long-term risk of morbidity and mortality. Future research must address knowledge gaps in our understanding of the health impacts of wildland fire and work to develop appropriate mitigation strategies while considering the needs of workers and unpredictable workplace environment. TRIAL REGISTRATION NUMBER Open Science Framework, https://osf.io/ugz4s/.
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Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Christopher Ross
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Katherine Bailey
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Trina M Fyfe
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Katie Cornish
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Erica Koopmans
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
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Koopmans E, Cornish K, Fyfe TM, Bailey K, Pelletier CA. Health risks and mitigation strategies from occupational exposure to wildland fire: a scoping review. J Occup Med Toxicol 2022; 17:2. [PMID: 34983565 PMCID: PMC8725416 DOI: 10.1186/s12995-021-00328-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/24/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Due to accelerating wildland fire activity, there is mounting urgency to understand, prevent, and mitigate the occupational health impacts associated with wildland fire suppression. The objectives of this review of academic and grey literature were to: 1. Identify the impact of occupational exposure to wildland fires on physical, mental, and emotional health; and 2. Examine the characteristics and effectiveness of prevention, mitigation, or management strategies studied to reduce negative health outcomes associated with occupational exposure to wildland fire. METHODS Following established scoping review methods, academic literature as well as government and industry reports were identified by searching seven academic databases and through a targeted grey literature search. 4679 articles were screened using pre-determined eligibility criteria. Data on study characteristics, health outcomes assessed, prevention or mitigation strategies studied, and main findings were extracted from each included document. The results of this scoping review are presented using descriptive tables and a narrative summary to organize key findings. RESULTS The final sample was comprised of 100 articles: 76 research articles and 24 grey literature reports. Grey literature focused on acute injuries and fatalities. Health outcomes reported in academic studies focused on respiratory health (n = 14), mental health (n = 16), and inflammation and oxidative stress (n = 12). The identified studies evaluated short-term outcomes measuring changes across a single shift or wildland fire season. Most research was conducted with wildland firefighters and excluded personnel such as aviation crews, contract crews, and incident management teams. Five articles reported direct study of mitigation strategies, focusing on the potential usage of masks, advanced hygiene protocols to reduce exposure, fluid intake to manage hydration and core temperature, and glutamine supplementation to reduce fatigue. CONCLUSIONS While broad in scope, the evidence base linking wildland fire exposure to any one health outcome is limited. The lack of long-term evidence on changes in health status or morbidity is a clear evidence gap and there is a need to prioritize research on the mental and physical health impact of occupational exposure to wildland fire.
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Affiliation(s)
- Erica Koopmans
- Health Research Institute, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Katie Cornish
- Health Research Institute, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Trina M Fyfe
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Katherine Bailey
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Chelsea A Pelletier
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.
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Adetona O, Reinhardt TE, Domitrovich J, Broyles G, Adetona AM, Kleinman MT, Ottmar RD, Naeher LP. Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhal Toxicol 2016; 28:95-139. [PMID: 26915822 DOI: 10.3109/08958378.2016.1145771] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Each year, the general public and wildland firefighters in the US are exposed to smoke from wildland fires. As part of an effort to characterize health risks of breathing this smoke, a review of the literature was conducted using five major databases, including PubMed and MEDLINE Web of Knowledge, to identify smoke components that present the highest hazard potential, the mechanisms of toxicity, review epidemiological studies for health effects and identify the current gap in knowledge on the health impacts of wildland fire smoke exposure. Respiratory events measured in time series studies as incidences of disease-caused mortality, hospital admissions, emergency room visits and symptoms in asthma and chronic obstructive pulmonary disease patients are the health effects that are most commonly associated with community level exposure to wildland fire smoke. A few recent studies have also determined associations between acute wildland fire smoke exposure and cardiovascular health end-points. These cardiopulmonary effects were mostly observed in association with ambient air concentrations of fine particulate matter (PM2.5). However, research on the health effects of this mixture is currently limited. The health effects of acute exposures beyond susceptible populations and the effects of chronic exposures experienced by the wildland firefighter are largely unknown. Longitudinal studies of wildland firefighters during and/or after the firefighting career could help elucidate some of the unknown health impacts of cumulative exposure to wildland fire smoke, establish occupational exposure limits and help determine the types of exposure controls that may be applicable to the occupation.
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Affiliation(s)
- Olorunfemi Adetona
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA .,b Division of Environmental Health Sciences , College of Public Health, the Ohio State University , Columbus , OH , USA
| | - Timothy E Reinhardt
- c AMEC Foster Wheeler Environment & Infrastructure, Inc , Seattle , WA , USA
| | - Joe Domitrovich
- d USDA Forest Service, Missoula Technology and Development Center , Missoula , MT , USA
| | - George Broyles
- e SDA Forest Service, San Dimas Technology and Development Center , San Dimas , CA , USA
| | - Anna M Adetona
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA
| | - Michael T Kleinman
- f Center for Occupational and Environmental Health, University of California , Irvine , CA , USA , and
| | - Roger D Ottmar
- g USDA Forest Service, Pacific Northwest Research Station , Seattle , WA , USA
| | - Luke P Naeher
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA
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Jones L, Burgess JL, Evans H, Lutz EA. Respiratory protection for firefighters--Evaluation of CBRN canisters for use during overhaul II: In mask analyte sampling with integrated dynamic breathing machine. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2016; 13:177-184. [PMID: 26554925 DOI: 10.1080/15459624.2015.1091964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
According to the National Fire Protection Association there were 487,500 structural fires in the U.S. in 2013. After visible flames are extinguished firefighters begin the overhaul stage where remaining hot spots are identified and further extinguished. During overhaul, a significant amount of potentially hazardous chemicals can remain in the ambient environment. Previous research suggests that the use of air purifying respirators fitted with chemical, biological, radiological, and nuclear (CBRN) canisters may reduce occupational exposure. This study used large scale burns of representative structural materials to perform side-by-side, filtering, and service-life evaluations of commercially available CBRN filters using two head forms fitted with full-face respirators and a dynamic breathing machine. Three types of CBRN canisters and one non-CBRN cartridge were challenged in repetitive post-fire environments. Tests were conducted with two different breathing volumes and rates for two sampling durations (0-15 min and 0-60 min). Fifty-five different chemicals were selected for evaluation and results indicate that 10 of the 55 chemicals were present in the post-fire overhaul ambient environment. Acetaldehyde and formaldehyde were found to be the only two chemicals detected post filter but were effectively filtered to below ACGIH TLVs. Counter to our prior published work using continuous flow filter evaluation, this study indicates that, regardless of brand, CBRN filters were effective at reducing concentrations of post-fire ambient chemicals to below occupational exposure limits. However, caution should be applied when using CBRN filters as the ambient formaldehyde level in the current study was 8.9 times lower than during the previous work.
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Affiliation(s)
- Leaton Jones
- a Division of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson , Arizona
| | - Jefferey L Burgess
- a Division of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson , Arizona
| | - Heath Evans
- b Northwest Fire District, Training Battalion , Tucson , Arizona
| | - Eric A Lutz
- a Division of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson , Arizona
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Jones L, Lutz EA, Duncan M, Burgess JL. Respiratory protection for firefighters--evaluation of CBRN canisters for use during overhaul. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:314-322. [PMID: 25738516 DOI: 10.1080/15459624.2014.989363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the United States, there are approximately 366,600 structural fires each year. After visible flames are extinguished, firefighters begin the overhaul stage of firefighting to smother remaining hot spots and initiate investigations. Typically during overhaul significant ambient concentrations of chemical contaminants remain. However, previous research suggests that the use of air purifying respirators (APR) fitted with chemical, biological, radiological, and nuclear (CBRN) canisters may reduce occupational respiratory exposures. This pilot study used large-scale prescribed burns of representative structural materials to perform simultaneous, side-by-side, filtering and service-life evaluations of commercially available CBRN filters. Three types of CBRN canisters and one cartridge were challenged in repetitive post live-fire overhaul exposure tests using a sampling manifold apparatus. At a flow rate of 80 L/min, nine tests were conducted in the breathing zone for three different exposure durations (0-15 min, 0-30 min, and 0-60 min). Fifty different chemicals were identified for evaluation and results indicate that 21 of the 50 chemicals tested were in the air of the overhaul environment. Respirable particles and formaldehyde were consistently present above the American Conference of Governmental Industrial Hygienists (ACGIH®) recommended exposure level (REL) and threshold limit ceiling value (TLVc), respectively. Each filter effectively reduced concentrations for respirable particulates below the maximum recommended level. Formaldehyde was reduced, but not consistently filtered below the TLVc. These results were consistent across all exposure durations. This study indicates that, regardless of brand, CBRN filters provide protection from the vast majority of particle and gas-phase contaminants. However, due to formaldehyde breakthrough, CBRN filters do not provide complete protection during firefighter overhaul.
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Affiliation(s)
- Leaton Jones
- a Division of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health , University of Arizona , Tucson , Arizona
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Youssouf H, Liousse C, Roblou L, Assamoi EM, Salonen RO, Maesano C, Banerjee S, Annesi-Maesano I. Non-accidental health impacts of wildfire smoke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11772-804. [PMID: 25405597 PMCID: PMC4245643 DOI: 10.3390/ijerph111111772] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/23/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Abstract
Wildfires take a heavy toll on human health worldwide. Climate change may increase the risk of wildfire frequency. Therefore, in view of adapted preventive actions, there is an urgent need to further understand the health effects and public awareness of wildfires. We conducted a systematic review of non-accidental health impacts of wildfire and incorporated lessons learned from recent experiences. Based on the literature, various studies have established the relationship between one of the major components of wildfire, particulate matter (particles with diameter less than 10 µm (PM10) and less than 2.5 µm (PM2.5)) and cardiorespiratory symptoms in terms of Emergency Rooms visits and hospital admissions. Associations between wildfire emissions and various subclinical effects have also been established. However, few relationships between wildfire emissions and mortality have been observed. Certain segments of the population may be particularly vulnerable to smoke-related health risks. Among them, people with pre-existing cardiopulmonary conditions, the elderly, smokers and, for professional reasons, firefighters. Potential action mechanisms have been highlighted. Overall, more research is needed to better understand health impact of wildfire exposure.
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Affiliation(s)
- Hassani Youssouf
- Department of Epidemiology of Respiratory and Allergic Disease (EPAR), UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, National Institute for Health and Medical Research (INSERM), 27 Rue Chaligny, 75012 Paris, France.
| | - Catherine Liousse
- Laboratory of Aerology, National Center for Scientific Research (CNRS), University of Toulouse, 14 Avenue Edouard Belin, 31400 Toulouse, France.
| | - Laurent Roblou
- Laboratory of Aerology, National Center for Scientific Research (CNRS), University of Toulouse, 14 Avenue Edouard Belin, 31400 Toulouse, France.
| | - Eric-Michel Assamoi
- Laboratory of Aerology, National Center for Scientific Research (CNRS), University of Toulouse, 14 Avenue Edouard Belin, 31400 Toulouse, France.
| | - Raimo O Salonen
- Environmental Epidemiology Unit, National Institute for Health and Welfare, P.O. Box 95, FI-70701 Kuopio, Finland.
| | - Cara Maesano
- Department of Epidemiology of Respiratory and Allergic Disease (EPAR), UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, National Institute for Health and Medical Research (INSERM), 27 Rue Chaligny, 75012 Paris, France.
| | - Soutrik Banerjee
- Department of Epidemiology of Respiratory and Allergic Disease (EPAR), UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, National Institute for Health and Medical Research (INSERM), 27 Rue Chaligny, 75012 Paris, France.
| | - Isabella Annesi-Maesano
- Department of Epidemiology of Respiratory and Allergic Disease (EPAR), UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, National Institute for Health and Medical Research (INSERM), 27 Rue Chaligny, 75012 Paris, France.
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Oldenburg M, Wilken D, Wegner R, Poschadel B, Baur X. Job-related stress and work ability of dispatchers in a metropolitan fire department. J Occup Med Toxicol 2014. [DOI: 10.1186/s12995-014-0031-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schermer TR, Malbon W, Adams R, Morgan M, Smith M, Crockett AJ. Change in lung function over time in male metropolitan firefighters and general population controls: a 3-year follow-up study. J Occup Health 2013; 55:267-75. [PMID: 23796594 DOI: 10.1539/joh.12-0189-oa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Previous studies in firefighters have been contradictory regarding their course of lung function over time. The aim of this ongoing study is to investigate how changes in lung function over time in male metropolitan firefighters compare with those in population controls, and to explore associations between firefighters' use of personal respiratory protection devices during occupational exposures and their risk of accelerated lung function decline. METHODS A prospective comparison of FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) was performed between 281 firefighters and 933 population controls. Logistic regression models were used to compare changes from baseline of FEV1 and FVC after 3 years and risk of accelerated decline between the cohorts. Within the firefighter cohort, risk of accelerated decline was compared between subgroups based on use of respiratory protection devices. RESULTS Controls showed similar mean annual declines for FEV1 and FVC across age categories, whereas firefighters aged <45 years showed increasing values over time (p=0.040). Firefighters had a lower odds of accelerated FEV1 decline compared with controls (OR=0.60, 95%CI 110.44; 0.83), but firefighters who never or rarely used respiratory protection during fire knockdown had a higher odds of accelerated FEV1 decline compared with those who used it often or frequently (OR=2.20, 95%CI 1.02; 4.74). CONCLUSIONS Younger generations of firefighters showed an increase in lung function relative to older colleagues, while population controls consistently showed decline of lung function across all ages. Firefighters who reported to be incompliant in using respiratory protection showed an increased risk of accelerated FEV1 decline.
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Affiliation(s)
- Tjard R Schermer
- Discipline of General Practice, School of Population Health, The University of Adelaide
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Finlay SE, Moffat A, Gazzard R, Baker D, Murray V. Health impacts of wildfires. PLOS CURRENTS 2012; 4:e4f959951cce2c. [PMID: 23145351 PMCID: PMC3492003 DOI: 10.1371/4f959951cce2c] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Wildfires are common globally. Although there has been considerable work done on the health effects of wildfires in countries such as the USA where they occur frequently there has been relatively little work to investigate health effects in the United Kingdom. Climate change may increase the risk of increasing wildfire frequency, therefore there is an urgent need to further understand the health effects and public awareness of wildfires. This study was designed to review current evidence about the health effects of wildfires from the UK standpoint. Methods A comprehensive literature review of international evidence regarding wildfire related health effects was conducted in January 2012. Further information was gathered from authors' focus groups. Results A review of the published evidence shows that human health can be severely affected by wildfires. Certain populations are particularly vulnerable. Wood smoke has high levels of particulate matter and toxins. Respiratory morbidity predominates, but cardiovascular, ophthalmic and psychiatric problems can also result. In addition severe burns resulting from direct contact with the fire require care in special units and carry a risk of multi - organ complications. The wider health implications from spreading air, water and land pollution are of concern. Access to affected areas and communication with populations living within them is crucial in mitigating risk. Conclusion This study has identified factors that may reduce public health risk from wildfires. However more research is needed to evaluate longer term health effects from wildfires. An understanding of such factors is vital to ensure preparedness within health care services for such events.
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Firefighters’ multiple exposure assessments in practice. Toxicol Lett 2012; 213:129-33. [DOI: 10.1016/j.toxlet.2012.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 04/19/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
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Lung function and health status in metropolitan fire-fighters compared to general population controls. Int Arch Occup Environ Health 2010; 83:715-23. [PMID: 20364266 DOI: 10.1007/s00420-010-0528-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess health status of South Australian (SA) metropolitan fire-fighters in terms of lung function and health-related quality of life, compare these with general population controls, and explore associations between fire-fighters' self-reported occupational exposure and health status. METHODS The study was a cross-sectional comparison of (respiratory) health indices between 501 fire-fighters and 1,324 general population controls taken from the North West Adelaide Health Study (NWAHS). All were men aged 21 to 61. Measurements included spirometry (i.e., forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), mid-expiratory flow (FEF(25-75)) and the Short Form 36 (SF-36) health-related quality of life questionnaire. RESULTS Health status in the fire-fighters was generally better than in NWAHS controls. Mean % predicted FEV(1) and FVC were 103.4% [SD 12.1] versus 89.5% [13.7] and 110.0% [11.6] versus 88.5% [12.5] (both p < 0.001 in linear regression analysis, adjusted for age, smoking, BMI, and FEV(1) % predicted). FEV(1)/FVC and FEF(25-75) were significantly lower in the fire-fighters (p < 0.003). A total of 93 (18.6%) fire-fighters and 82 (6.2%) controls had an FEV(1)/FVC < 70% (p < 0.001). The SF-36 Mental Health scale was the only scale on which fire-fighters had a lower mean score (p = 0.009), but none of the SF-36 scales showed clinically meaningful differences between the cohorts. Fire-fighters exposed > 6 h/week to dust, smoke, and fire showed lower FEV(1), FEV(1) % predicted, and FVC values compared to those who were less exposed (p < 0.05). CONCLUSIONS Male metropolitan fire-fighters showed better general health, better lung health, and similar mental health compared to general population controls. The high rate of fire-fighters with FEV(1)/FVC values below the recommended cut-point for airflow obstruction illustrates the inappropriateness of this clinical cut-point for use in populations preselected on their physical fitness. The observed dose-effect relationship between self-reported occupational exposure and fire-fighters' lung function warrants further investigation.
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The Evaluation of CBRN Canisters for Use by Firefighters during Overhaul. ACTA ACUST UNITED AC 2009; 53:523-38. [DOI: 10.1093/annhyg/mep025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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De Vos AJBM, Reisen F, Cook A, Devine B, Weinstein P. Respiratory irritants in Australian bushfire smoke: air toxics sampling in a smoke chamber and during prescribed burns. ARCHIVES OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2009; 56:380-388. [PMID: 18712497 DOI: 10.1007/s00244-008-9209-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 07/21/2008] [Indexed: 05/26/2023]
Abstract
Bushfire smoke contains an array of organic and inorganic compounds, including respirable and inspirable particles, aldehydes, and carbon monoxide. These compounds have been found to be a health hazard for firefighters in the United States. Despite the high frequency of bushfires in Australia, analyses of bushfire smoke components are scarce. As part of an occupational health study investigating the respiratory health effects of bushfire smoke in firefighters, air toxics sampling was undertaken in a smoke chamber and during prescribed burns. Levels of formaldehyde and acrolein were demonstrated at respectively 60% and 80% of the Short Term Exposure Limit in the smoke chamber. Carbon monoxide levels exceeded the peak limit of 400 ppm significantly. Although concentrations were lower during the prescribed burns, the study shows that Australian bushfire smoke contains air toxics of concern and provides justification for further research into the levels of air toxics measured at bushfires and the associated health impacts.
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Affiliation(s)
- Annemarie J B M De Vos
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
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De Vos AJBM, Cook A, Devine B, Thompson PJ, Weinstein P. Effect of protective filters on fire fighter respiratory health: field validation during prescribed burns. Am J Ind Med 2009; 52:76-87. [PMID: 18946878 DOI: 10.1002/ajim.20651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bushfire smoke contains a range of air toxics. To prevent inhalation of these toxics, fire fighters use respiratory equipment. Yet, little is known about the effectiveness of the equipment on the fire ground. Experimental trials in a smoke chamber demonstrated that, the particulate/organic vapor/formaldehyde (POVF) filter performed best under simulated conditions. This article reports on the field validation trials during prescribed burns in Western Australia. METHODS Sixty-seven career fire fighters from the Fire and Emergency Services Authority of Western Australia were allocated one of the three types of filters. Spirometry, oximetry, self-reported symptom, and personal air sampling data were collected before, during and after exposure to bushfire smoke from prescribed burns. RESULTS Declines in FEV(1) and SaO(2) were demonstrated after 60 and 120 min exposure. A significant higher number of participants in the P filter group reported increases in respiratory symptoms after the exposure. Air sampling inside the respirators demonstrated formaldehyde levels significantly higher in the P filter group compared to the POV and the POVF filter group. CONCLUSIONS The field validation trials during prescribed burns supported the findings from the controlled exposure trials in the smoke chamber. Testing the effectiveness of three types of different filters under bushfire smoke conditions in the field for up to 2 hr demonstrated that the P filter is ineffective in filtering out respiratory irritants. The performance of the POV and the POVF filter appears to be equally effective after 2 hr bushfire smoke exposure in the field.
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Affiliation(s)
- Annemarie J B M De Vos
- School of Population Health M431, The University of Western Australia, Crawley, Western Australia, Australia.
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