Wildfire Smoke Raises Respiratory Concerns Across Northeastern United States


Air quality in New York City was the worst in the world on Tuesday morning.

For days, a thick haze of smoke has blanketed the East Coast of the United States. The smoke has traveled thousands of miles from Canada, where wildfires are raging across Quebec and Ottawa with more than 9.3 million acres burned.

Wildfire smoke contains fine particulate matter—particles measuring 2.5 microns or less in diameter, or PM2.5—the smallest particles that pose the highest risk to health.1 When inhaled, these particles can penetrate lung tissue and enter the bloodstream, exacerbating respiratory conditions and causing a litany of long-term health problems.2 

Air quality warnings have been put in place from New England to Georgia and as far west as Chicago.1 On Tuesday evening, levels of air pollution in New York City were the second worst in the world, behind only New Delhi, India, with PM2.5 concentrations more than 10 times the World Health Organization guidelines.1 These warnings urge caution for members of “sensitive groups,” which includes children, older adults, immunocompromised individuals, and those living with asthma, COPD, or other pulmonary diseases.3 On Twitter, the National Weather Service shared a graphic outlining the symptoms of exposure to air pollutants, including headaches, difficulty breathing, chest pains, asthma attacks, fatigue, increased coughing, and irritated eyes, sinuses, and throats.

“If you can see or smell smoke, know that you’re being exposed,” said William Barrett, national senior director of clean air advocacy at the American Lung Association, told CNN.1 “It’s important that you do everything you can to remain indoors during those high, high pollution episodes, and it’s really important to keep an eye on your health or any development of symptoms.”

Resources from the American Lung Association include a wildfire safety fact sheet,4,5 which pharmacists can share with concerned patients. In addition to staying aware of local air quality through tools like airnow.gov, counsel patients to stay indoors and utilize clean air rooms when possible. Air conditioners set to recirculate will keep from pulling outside air in, and devices that contain HEPA filters will provide added protection.

Cloth masks, like those used to prevent the spread of COVID-19, may not provide much protection from smoke as they will not filter PM2.5 particles. Although N-95 masks are more suited to the task, they are difficult for individuals living with lung disease to use; patients with lung disease should consult with their health care provider before using an N-95 mask.

Individuals living with lung disease, chronic heart disease, or diabetes should be directed to check in with their health care provider regarding any potential changes in medications that may need to be made in response to smoky conditions. These patients should be encouraged to take their medications on schedule, and to use rescue medications when necessary. Patients on oxygen should also consult with their health care provider before making any adjustments to their oxygen levels.


  1. Van Dam D, Ramirez R. New York City’s air pollution among the world’s worst as Canada wildfire smoke shrouds Northeast. CNN. Updated June 7, 2023. Accessed June 7, 2023. https://www.cnn.com/2023/06/06/us/new-york-air-pollution-canada-wildfires-climate/index.html
  2. Particulate matter (PM) basics. US Environmental Protection Agency. Accessed June 7, 2023. https://www.epa.gov/pm-pollution/particulate-matter-pm-basics
  3. McCormack K. Why is it so smoky outside? Canada wildfires lead to air-quality alerts in Northeastern US. TIME. June 6, 2023. Accessed June 7, 2023. https://time.com/6285351/air-quality-northeast-us-explainer/
  4. Wildfires. American Lung Association. Accessed June 7, 2023. https://www.lung.org/clean-air/emergencies-and-natural-disasters/wildfires
  5. Protect your health during wildfires. American Lung Association. June 7, 2023. https://www.lung.org/getmedia/695663e2-bdb8-4a61-9322-02657f530b99/Protect-Your-Health-During-Wildfires-5-29-2020-(1).pdf
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