Portable air cleaners should be at the forefront of the public health response to landscape fire smoke.

Landscape fires can produce large quantities of smoke that degrade air quality in both remote and urban communities. Smoke from these fires is a complex mixture of fine particulate matter and gases, exposure to which is associated with increased respiratory and cardiovascular morbidity and mortality. The public health response to short-lived smoke events typically advises people to remain indoors with windows and doors closed, but does not emphasize the use of portable air cleaners (PAC) to create private or public clean air shelters. High efficiency particulate air filters and electrostatic precipitators can lower indoor concentrations of fine particulate matter and improve respiratory and cardiovascular outcomes. We argue that PACs should be at the forefront of the public health response to landscape fire smoke events.

Critical Review of Health Impacts of Wildfire Smoke Exposure.

BACKGROUND: Wildfire activity is predicted to increase in many parts of the world due to changes in temperature and precipitation patterns from global climate change. Wildfire smoke contains numerous hazardous air pollutants and many studies have documented population health effects from this exposure. OBJECTIVES: We aimed to assess the evidence of health effects from exposure to wildfire smoke and to identify susceptible populations. METHODS: We reviewed the scientific literature for studies of wildfire smoke exposure on mortality and on respiratory, cardiovascular, mental, and perinatal health. Within those reviewed papers deemed to have minimal risk of bias, we assessed the coherence and consistency of findings. DISCUSSION: Consistent evidence documents associations between wildfire smoke exposure and general respiratory health effects, specifically exacerbations of asthma and chronic obstructive pulmonary disease. Growing evidence suggests associations with increased risk of respiratory infections and all-cause mortality. Evidence for cardiovascular effects is mixed, but a few recent studies have reported associations for specific cardiovascular end points. Insufficient research exists to identify specific population subgroups that are more susceptible to wildfire smoke exposure. CONCLUSIONS: Consistent evidence from a large number of studies indicates that wildfire smoke exposure is associated with respiratory morbidity with growing evidence supporting an association with all-cause mortality. More research is needed to clarify which causes of mortality may be associated with wildfire smoke, whether cardiovascular outcomes are associated with wildfire smoke, and if certain populations are more susceptible. CITATION: Reid CE, Brauer M, Johnston FH, Jerrett M, Balmes JR, Elliott CT. 2016. Critical review of health impacts of wildfire smoke exposure. Environ Health Perspect 124:1334-1343; http://dx.doi.org/10.1289/ehp.1409277.

Time series analysis of fine particulate matter and asthma reliever dispensations in populations affected by forest fires.

BACKGROUND: Several studies have evaluated the association between forest fire smoke and acute exacerbations of respiratory diseases, but few have examined effects on pharmaceutical dispensations. We examine the associations between daily fine particulate matter (PM2.5) and pharmaceutical dispensations for salbutamol in forest fire-affected and non-fire-affected populations in British Columbia (BC), Canada. METHODS: We estimated PM2.5 exposure for populations in administrative health areas using measurements from central monitors. Remote sensing data on fires were used to classify the populations as fire-affected or non-fire-affected, and to identify extreme fire days. Daily counts of salbutamol dispensations between 2003 and 2010 were extracted from the BC PharmaNet database. We estimated rate ratios (RR) and 95% confidence intervals (CIs) for each population during all fire seasons and on extreme fire days, adjusted for temperature, humidity, and temporal trends. Overall effects for fire-affected and non-fire-affected populations were estimated via meta-regression. RESULTS: Fire season PM2.5 was positively associated with salbutamol dispensations in all fire-affected populations, with a meta-regression RR (95% CI) of 1.06 (1.04-1.07) for a 10 ug/m3 increase. Fire season PM2.5 was not significantly associated with salbutamol dispensations in non-fire-affected populations, with a meta-regression RR of 1.00 (0.98-1.01). On extreme fire days PM2.5 was positively associated with salbutamol dispensations in both population types, with a global meta-regression RR of 1.07 (1.04 - 1.09). CONCLUSIONS: Salbutamol dispensations were clearly associated with fire-related PM2.5. Significant associations were observed in smaller populations (range: 8,000 to 170,000 persons, median: 26,000) than those reported previously, suggesting that salbutamol dispensations may be a valuable outcome for public health surveillance during fire events.

Health promotion as practiced by public health inspectors: the BC experience.

OBJECTIVE: To explore the experiences of British Columbia's (BC's) Public Health Inspectors in practicing health promotion. METHODS: We administered a mixed qualitative-quantitative survey to 15 BC Public Health Inspectors (in BC, titled Environmental Health Officers--EHOs), selected to represent different levels of authority, areas of work and geographic regions. We queried whether and how they practice health promotion, strategies utilized, how health promotion relates to their enforcement mandates, perceived effectiveness of health promotion, and barriers and enabling factors affecting its adoption. RESULTS: Fourteen respondents (93%) practiced health promotion. Common practices included building healthy public policy, developing personal skills, and creating environments that support health. Health promotion was most often applied as " part of enforcement"; EHOs first attempted to educate and create environments that support regulatory standards and best practices, utilizing enforcement measures should the former prove ineffective. Enforcement was recognized as an important tool. Most respondents did not feel that their enforcement mandate limited their use of health promotion; however barriers exist where the EHO is perceived unfavourably as an "enforcer". The majority felt that an increased use of health promotion would make their protection work more effective. Strategies to facilitate its application include practical training in implementation, clear expectations and accountability at all levels of planning, resources, and relationships with stakeholders. CONCLUSION: EHOs engage in a broad and varied health promotion practice. Practical training with a focus on health promotion implementation in the BC context, and clear and consistent direction regarding expectations and accountability, would facilitate greater involvement.

Burden of mortality due to ambient fine particulate air pollution (PM2.5) in interior and Northern BC.

OBJECTIVES: Our objective was to estimate the burden of mortality attributable to long-term exposure to ambient fine particulate matter (PM2.5) among adults in two rural regions of British Columbia, the Interior and the North, in order to provide information for public health professionals setting health priorities. METHODS: We used the standard method to calculate the fraction of all-cause mortality among adults (> or = 30 years old) attributable to long-term exposure to ambient PM2.5 as described in the World Health Organization global burden of disease study. PM2.5 concentration was either locally measured using tapered element oscillating microbalance (TEOM) continuous monitors or estimated for unmonitored cities. For the base case, we used a conservative PM2.5 threshold (5.0 ug/m3); for sensitivity analysis, we set the threshold to estimate all mortality attributable to anthropogenic PM2.5 (3.1 ug/m3). We conducted sensitivity analysis for PM2.5 concentrations estimated in unmonitored cities. RESULTS AND CONCLUSIONS: Mean annual PM2.5 concentration ranged from 3.1 to 7.4 ug/m3 across local health areas in Northern and Interior BC. Sixty percent of the adult population lived in monitored regions. PM2.5 was estimated to cause 0.20% of all-cause mortality among adults (16 deaths/year). Anthropogenic PM2.5 was estimated to cause 0.93% of all-cause mortality among adults (74 deaths/year). Estimates were sensitive to both PM2.5 threshold and estimated PM2.5 in unmonitored communities. This demonstrates that ambient PM2.5 air pollution does have an important mortality burden, even in a region with relatively low PM2.5 concentrations.

Management and prevention of herpes zoster: A Canadian perspective.

Varicella-zoster virus reactivation leads to herpes zoster - the main complication of which is postherpetic neuralgia (PHN). Rapid antiviral therapy initiated within 72 h of rash onset has been shown to accelerate rash healing, reduce the duration of acute pain and, to some extent, attenuate the development and duration of PHN. Other adjunctive therapies such as analgesics, antidepressants and some anticonvulsants are frequently required in the management of severe PHN. A live, attenuated zoster vaccine has been recently shown to significantly decrease herpes zoster incidence, PHN and the overall burden of illness when administered to adults older than 60 years of age. This new prophylactic modality has been reported to be cost-effective in the Canadian context, especially in the 60- to 75-year-old age group.