Melbourne air quality this week has been categorised as ‘hazardous’ by the Environmental Protection Agency, and regarded as worst in the world. Associate Professor Vicki Kotsirilos AM, a practicing general practitioner with adjunct positions with La Trobe and Western Sydney Universities, shares her experience of how the bushfires have been affecting her patients in practice, and provides some useful guidance on how to protect ourselves. Vicki is an expert in Environmental Medicine, a Fellow of ACNEM and is also speaking on air pollution at the 2020 ACNEM conference.
As a GP, we have seen more patients present with health problems as a result of the fires.
Bushfire smoke reduces air quality and may affect people's health. Bushfire smoke is a mixture of different-sized particles and noxious gases. The larger particles contribute to the visible haze; the finer particles called Particulate Matter 2.5 (PM2.5) which means particulate matter of less than 2.5 micrometres in diameter, are more harmful to health. These particles are inhaled by the lungs and can enter deeper into the lungs and be absorbed into the blood stream affecting other organs of the body.
Both healthy and unhealthy people can be impacted by bush smoke. The most common presentation even in healthy people includes irritation of the eyes, sinus problems, runny nose, sore or itchy throat and cough.
I have also seen healthy people develop chest tightness, difficulty breathing, asthma and wheeze for the first time from exposure to the smoke.
Children, the elderly (over 65 years of age), smokers, people with pre-existing heart and lung disease, and pregnant women are more at risk of harm from exposure to smoke.
People with pre-existing heart and lung disease such as asthma, bronchitis and emphysema may get aggravation of their heart or lung disease. For example, patients may suffer more frequent and increase severity of their asthma, shortness of breath, difficulty breathing, angina, or suffer a heart attack.
There have been more hospitalisations and ambulance call outs with the bush fires.
Flow on effects from poor air quality
Bushfire smoke can impact people psychologically and physically.
Psychological effects of bushfire smoke:
When the air quality is poor, we should stay indoors to avoid inhalation of the smoke. Missing out on our usual exercise or routine can impact us psychologically. We may experience lowered moods or anxiety. Many people are feeling fear - not knowing when the fires will end, or they have suffered stress from worry, loss of a holiday property or their farm or a loved one from the fires. Many people who have been displaced by the fires need to find temporary homes and may suffer financial stress. It is not uncommon to suffer depression and post-traumatic stress disorder after bushfires.
The bushfires also impacted some people over their summer holidays. Their holidays were disrupted by the fires and they did not get the opportunity to relax. For others and particularly young people there is the fear of possible climate change happening, as Australia experienced its warmest and driest weather on record which have likely contributed to the extensive bushfires we are experiencing now.
Physical effects of bushfire smoke:
The larger particulate matters e.g. PM 10 are more likely to cause upper respiratory health effects such as irritation of the nasal passages, runny nose, phlegm, sore or itchy throat, sinusitis and cough.
When the finer particulate matters e.g. PM2.5 enter into the blood stream, they can impact other organs in the body such as the heart causing aggravation of heart disease such as angina or precipitate a heart attack; cause headaches, inflammation, poor concentration, and aggravation of diabetes and kidney disease. For people with pre-existing cardiovascular disease there is a higher chance of suffering a heart attack, stroke and even death (increase mortality).
It is likely we may observe other long-term effects that we are not aware of now. The longer the bushfires continue, the more likely harmful the effects are on the body.
Most of the effects are temporary especially if we take more care during this period. However, if the bushfires continue into February and March, it is likely we will witness more health concerns amongst our patients. More research is required to better understand the long term ramifications of bushfire smoke.
How to protect ourselves from bushfire smoke
Stay calm and relax knowing the bushfires will stop at some point. Eat well, rest, aim to sleep well, stay close to family or friends, and when the air quality improves, consider gentle outdoor exercise.
The main advice is to stay indoors with windows and doors sealed well and closed, and use air conditioning to "recycle" air to avoid outside air from coming indoors. When the air quality outside improves, open your windows and doors to circulate fresh air indoors.
Air purifiers can be helpful for clearing air quality indoors but they may not clear the finer gases, are expensive and only clear small areas of buildings.
Do less strenuous exercise outside as deep and rapid inspiration with exercise causes the finer particles to penetrate deeper into the lungs. If you need to go outdoors when the air quality is poor, use a special "P2 mask" which fits well and don't exert yourself. There is no guarantee the masks work 100% well. You can purchase the masks from local chemists and hardware stores.
Wear protective eyewear when outdoors such as large sunglasses to protect the eyes from airborne irritants.
For those with pre-existing health conditions such as asthma make sure your treatment plans are up to date. Speak to your GP for preventative advice.
If your home becomes too hot or smoky, visit a friend or family or go to the movies or a community library that may have air conditioning.
Patient Resource: How to protect yourself and and others from bushfire smoke