How to Stay Prepared for Wildfires When You Have a Chronic Lung Disease

Wildfires are becoming increasingly common and severe due to climate change. For individuals with chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), or pulmonary fibrosis, the threat posed by wildfire smoke is especially serious. The fine particulate matter in wildfire smoke can worsen respiratory symptoms, trigger exacerbations, and cause long-term harm. Preparing in advance and knowing how to respond during wildfire season is crucial for safeguarding your health.

This guide provides practical tips to help you stay prepared and protected if you have a chronic lung disease.

Understanding the Risks of Wildfire Smoke for Lung Disease

Wildfire smoke is a complex mixture of fine particulate matter, carbon monoxide, volatile organic compounds, and other harmful pollutants. These particles are small enough to penetrate deep into the lungs, exacerbating symptoms in individuals with chronic lung conditions.

For someone with asthma, wildfire smoke can trigger severe attacks. In people with COPD, it may lead to increased coughing, wheezing, and shortness of breath. Prolonged exposure can result in hospitalization or even life-threatening complications.

Preparation Is Key: Steps to Take Before Wildfire Season

Understanding the wildfire risk in your area is the first step to preparation. Sign up for alerts from local weather services, fire departments, or apps that provide real-time updates about air quality and wildfire activity. Websites like AirNow.gov offer air quality index (AQI) readings specific to your location, which can help you monitor smoke levels.

AirNow.gov air quality in LA, CA on 1/9/25

Ensure you have the necessary items to minimize smoke exposure and manage your chronic lung disease effectively. Your wildfire preparedness kit should include:

  • N95 or P100 Masks: Unlike cloth masks or surgical masks, N95 or P100 respirators provide effective protection against fine particulate matter.
  • Medications: Keep a 30-day supply of your prescribed medications, including inhalers, nebulizers, or steroids. Ensure they are not expired and stored properly.
  • Medical Devices: Ensure that essential medical devices, such as CPAP machines and oxygen concentrators, are in good working condition and have backup power options available in case of emergencies.
  • Emergency Contacts: Have a list of your doctors, pharmacies, and nearby emergency services readily available.

Your home should be a safe haven during wildfire season. Take steps to minimize smoke infiltration:

  • Seal Doors and Windows: Use weather stripping or caulk to seal gaps and prevent smoke from entering your home.
  • Switch to Recirculation Mode: Set your HVAC system to recirculate air rather than drawing it from outside. Ensure the system has a clean filter rated MERV 13 or higher.
  • Air Purifier: Invest in a high-efficiency particulate air (HEPA) purifier to reduce indoor air pollution.
  • Create a Clean Room: Designate one room in your house as a “clean air” room. Use an air purifier in this room and avoid activities like cooking or vacuuming that can increase indoor pollutants.

Have an evacuation plan tailored to your needs. This includes identifying safe locations to stay where air quality is better, arranging transportation, and informing friends or family members of your plan. Keep a “go bag” with your medical supplies and personal essentials ready at all times as described at the website resource ready.gov.

visual of go bag from ready.gov

Staying Safe During Wildfire Smoke Events

When wildfires are active, the air quality can deteriorate rapidly. Here’s how to protect yourself:

Check the AQI several times a day during wildfire season. The AQI scale ranges from 0 to 500, with higher numbers indicating worse air quality. If the AQI exceeds 100, individuals with lung conditions should take precautions. An AQI above 150 is unhealthy for everyone.

Limit outdoor activities, particularly during periods of heavy smoke. If going outside is unavoidable, wear an N95 or P100 mask to effectively filter out harmful particles. To ensure maximum protection, the mask must fit snugly around your face. These are the same high-efficiency masks widely used during the COVID-19 pandemic for optimal filtration.

  • Close all windows and doors.
  • Use an air purifier with a HEPA filter in your designated clean room.
  • Avoid activities that can worsen indoor air quality, such as burning candles, using fireplaces, or frying food.

Take all medications as directed by your doctor. If you use a rescue inhaler, ensure it is easily accessible at all times. Take your controller medications every day. Follow your asthma or COPD action plan if you notice worsening symptoms.

Long-Term Strategies for Managing Wildfire Smoke Risks

Staying healthy year-round can make your lungs more resilient during wildfire season. Regularly follow up with your doctor to optimize your treatment plan and address any changes in your condition. A balanced diet, hydration, and regular physical activity (as recommended by your doctor) can also support your lung health.

If wildfires are a frequent occurrence in your area, consider relocating to a region with lower wildfire risk. This is especially important for individuals with severe chronic lung conditions who may face repeated exacerbations.

Join community efforts to reduce local air pollution and promote forest management strategies that minimize wildfire risks. Policies that address climate change and prioritize public health can have long-term benefits for individuals with chronic lung diseases.

What to Do in Case of Emergency

Despite your best preparations, emergencies can happen. If you experience severe symptoms such as extreme shortness of breath, persistent chest pain, or confusion, seek medical attention immediately. During evacuations, prioritize locations with better air quality.

Resources for Ongoing Support

Several organizations provide resources to help individuals with chronic lung conditions during wildfire season:

Conclusion

Living with a chronic lung disease requires vigilance, especially during wildfire season. By preparing in advance, staying informed, and taking proactive measures, you can significantly reduce your risk of exposure to harmful wildfire smoke. Whether it’s sealing your home, investing in an air purifier, or having an emergency plan, each step you take empowers you to protect your health and well-being.

Remember, your lungs are precious, and every effort to shield them from the impact of wildfires is an investment in your quality of life. With the right preparation and support, you can navigate wildfire season with greater confidence and peace of mind.

Whether you are dealing with nearby wildfires or prepping for life’s challenges, protecting your lung health has never been more critical. At Hootenanny Joy, we understand the challenges of breathing well in a changing world, and we’re here to help. Our health programs are designed to empower you with practical tools and personalized support to improve your knowledge, enhance your overall wellness, and regain control over your health. Don’t let environmental challenges hold you back — join us to breathe easier and live better, every single day. Let’s take the first step together toward thriving health and a more resilient you.

Understanding Severe Asthma: A Guide for Healthcare Professionals

Gina Hoots, Respiratory Therapist and Health Coach

Originally posted on https://medium.com/@ginahoots

Understanding Severe Asthma: A Guide for Healthcare Professionals

I recently had the honor of hosting an educational session on biologics for asthma control — a topic that was new to me as a respiratory therapist. The mechanisms, pathways, and drug names can be complex, so I turned to writing as a way to deepen my understanding and make sense of the information. If this blog helps your understanding, please comment!

Asthma is no longer seen as a single disease but rather an umbrella term for multiple conditions that may appear similar but have distinct underlying mechanisms. This evolving perspective has revolutionized asthma management, emphasizing the importance of identifying phenotypes (clinical presentations) and endotypes (biological pathways) to guide more precise treatments. Today, managing asthma involves much more than simply prescribing albuterol.

Phenotypes vs. Endotypes: The Key to Precision Treatment

Asthma phenotypes categorize patients based on observable characteristics, such as age of onset, allergen sensitivity, or comorbid conditions. Some common asthma phenotypes include:

  • Allergic asthma — Early-onset, often associated with IgE-mediated allergies.
  • Late-onset eosinophilic asthma — Typically non-allergic, driven by eosinophilic inflammation.
  • Aspirin-exacerbated respiratory disease (AERD) — Triggered by aspirin or NSAIDs.
  • Obesity-related asthma — More common in adults, often without clear signs of inflammation.

While phenotypes help clinicians describe asthma presentations, endotypes provide deeper insight into the biological mechanisms driving the disease. The two primary endotypes are:

  • T2-high asthma — Driven by Type 2 inflammation, involving eosinophils, IgE, and cytokines such as IL-4, IL-5, and IL-13.
  • T2-low asthma — Characterized by neutrophilic or paucigranulocytic inflammation, often linked to infections, pollution, or metabolic factors like obesity.

Understanding which endotype a patient has allows for more effective, targeted treatment strategies.

The Role of T2 Inflammation in Severe Asthma

T2 inflammation is present in 55–70% of patients with severe asthma and plays a major role in airway inflammation and obstruction. This process begins when allergens or irritants activate the immune system, leading to:

  1. TSLP activation — The cytokine thymic stromal lymphopoietin (TSLP) initiates T2 inflammation by triggering immune responses.
  2. T-helper type 2 (Th2) and innate lymphoid cells (ILC2) activation — These cells release cytokines such as IL-4, IL-5, and IL-13, driving inflammation.
  3. Eosinophilic airway inflammation and mucus overproduction — IL-5 supports eosinophil growth, while IL-13 contributes to mucus hypersecretion and airway remodeling.

Common biomarkers for T2-high asthma include:

  • Elevated blood eosinophil count (AECs) (e.g., AEC ≥150–300 cells/μL for biologic therapy eligibility)
  • Increased FeNO (fractional exhaled nitric oxide) (≥25 ppb)
  • Elevated IgE levels or positive allergen-specific IgE tests

These biomarkers help identify candidates for biologic therapies targeting specific pathways in T2 inflammation.

Non-T2 Inflammation: The Less Understood Pathway

Unlike T2-high asthma, T2-low asthma lacks eosinophilic inflammation and does not respond well to corticosteroids or biologics targeting IL-4, IL-5, or IgE. Instead, neutrophilic or paucigranulocytic inflammation is often involved, driven by factors such as:

  • Infections or pollution exposure — Triggering immune responses dominated by neutrophils.
  • Obesity or metabolic factors — Affecting airway function without classic inflammation.
  • Smoking-related airway remodeling — Leading to fixed obstruction and poor bronchodilator response.

T2-low asthma can be challenging to treat, as traditional asthma therapies are less effective. Tezepelumab (Tezspire) is the only biologic currently available that does not require biomarker testing and has shown efficacy in both T2-high and T2-low asthma.

Biologic Therapies: Matching the Right Treatment to the Right Patient

Biologic therapies have revolutionized asthma management by targeting specific inflammatory pathways. When considering a biologic, healthcare professionals should evaluate the patient’s:

  • FDA-indicated phenotype (eosinophilic asthma, allergic asthma, or OCS-dependent asthma)
  • Biomarkers (AECs, FeNO, IgE, allergen sensitivity)
  • Comorbid conditions (e.g., nasal polyps, atopic dermatitis, eosinophilic esophagitis)
  • Dosing preferences and adherence potential

The effectiveness of biologic therapies varies depending on the patient’s underlying asthma phenotype and endotype.

Table of Common Biologic Agents for Type 2 Asthma

When Is a Patient a Candidate for Biologic Therapy?

A patient with persistent symptoms despite high-dose inhaled therapy would be considered a candidate for biologic therapy. Key indicators for biologic therapy in severe asthma include:

  1. Frequent Exacerbations — Two or more asthma exacerbations per year requiring systemic corticosteroids suggest poor control and a need for a targeted approach.
  2. High Oral Corticosteroid (OCS) Use — Patients who rely on long-term OCS therapy may benefit from biologics as a steroid-sparing option.
  3. Elevated Biomarkers — Blood eosinophil count (AEC), FeNO, IgE levels, and allergen sensitivity help determine the best biologic choice.
  4. Poor Lung Function (FEV1 Reduction) — A low FEV1 despite appropriate inhaled therapy suggests uncontrolled inflammation.
  5. Comorbidities That Worsen Asthma — Conditions like nasal polyps and chronic rhinosinusitis may indicate a need for biologic therapy.

By addressing these factors, healthcare professionals can better determine the right biologic therapy for each patient.

Closing Thoughts and Call to Action

Severe asthma management has evolved significantly, moving from a generalized treatment approach to a more precise, biomarker-driven strategy. By identifying phenotypes and endotypes, selecting the most appropriate biologic therapy, and incorporating shared decision-making, healthcare professionals can provide more effective, personalized care.

As research continues to advance, staying informed about emerging treatments and best practices is crucial. Consider attending asthma-focused conferences, engaging in professional development, and following the latest clinical guidelines. The more we learn, the better we can support our patients in achieving optimal asthma control and improving their quality of life.

Asmtha Guidelines – The Latest from Gina

Asthma Guidelines: The Latest From GINA

 

The Global Initiative for Asthma, or GINA, guidelines are considered
the gold standard for asthma care worldwide. This provides an
overview of the key updates and takeaways of the most effective
strategies to gain and maintain control of asthma. While asthma is a
chronic disease, following the recommendations from leading experts
can help your patients breathe easier and enjoy life fully.

Key Changes in the 2023 GINA Asthma Guidelines

 The latest GINA guidelines for 2023 bring important updates for the management of asthma. The GINA Science Committee reviewed over
3,000 recent studies, and several key changes have been made.

     Of significance, there is new terminology for asthma medications to provide more clarity. The terms “maintenance treatment” and “ICS-containing treatment” now replace “controller medications”. “Anti-inflammatory relievers” or “AIR” refers to inhalers like ICS-formoterol that provide quick relief while reducing inflammation. Distinguishing between using an AIR alone or as “maintenance and reliever therapy” (MART) with an ICS is key.

 GINA also added guidance on explaining the “asthma management cycle” of assessing symptoms, adjusting treatment, and reviewing the response to patients. This reminds clinicians and patients of the essential elements of good asthma control.

 The 2023 GINA guidelines provide the latest recommendations to help people effectively manage their asthma. Following these
guidelines can help reduce symptoms, prevent attacks, and maintain good lung function and quality of life. Patients should talk to their doctors about the options in the new guidelines and develop an asthma action plan tailored to their needs.

Asthma Medication Terminology Explained

 Maintenance medications, also known as ‘controllers,’ are taken regularly to control asthma symptoms and reduce inflammation in the airways. The most common are inhaled corticosteroids (ICS), which can be combined with long-acting beta agonists (LABA) for more severe asthma. ICS are considered the most effective maintenance treatment for controlling asthma.

 Relievers, such as short-acting beta agonists (SABA), provide quick relief of asthma symptoms. Common in the United States, genericalbuterol includes brand names include Ventolin and Proair. Relievers should only be used occasionally and as directed.

 Anti-inflammatory relievers (AIR) have dual purposes, reducing inflammation and relieving symptoms. Inhaled corticosteroid-formoterol (ICS-formoterol) and inhaled corticosteroid-short-acting beta agonist (ICS-SABA) inhalers can be used as both maintenance and reliever therapy for asthma. Using an AIR inhaler for both purposes is known as maintenance and reliever therapy (MART). For example, budesonide-formoterol (Symbicort) can be taken regularly to control asthma and used as needed to relieve symptoms.

 When starting or adjusting treatment, the asthma management cycle involves assessing symptoms, adjusting medications based on GINA guidelines, and reviewing response. Understanding these terms and the cycle of care can help patients better manage their asthma.

 Using the correct terminology and understanding the different types of asthma medications is key to properly managing this chronic respiratory disease. Caregivers should work closely with doctors to determine the best asthma action plans for their patients based on symptom severity and lifestyle factors. With the right approach, people of all ages can keep their asthma well-controlled and live active lives.

 Ongoing Discussion About Defining Mild Asthma

 There is ongoing discussion in the medical community about clearly defining mild asthma. The current definition is retrospective, based on a patient’s symptoms and lung function over the previous few weeks. However, doctors use the term “mild asthma” in various ways during diagnosis, education, and treatment.

 GINA continues to discuss this issue with patients, primary care physicians, and specialists. They aim to provide interim guidance for using the term “mild asthma” appropriately in different contexts. For example, during diagnosis of a new patient, a doctor may describe asthma as mild based on symptoms and initial tests. When educating health professionals, a standard definition helps ensure patients get the same quality of care.

 In studies and clinical trials, a precise definition of mild asthma is necessary to evaluate treatment effects. However, no consensus has emerged on a universal definition. Factors like symptom frequency, nighttime awakenings, medication use, and lung function all provide insight, but no single measure is definitive. A patient’s own perception of “mild” symptoms may also differ from their doctor’s assessment.

 Resolving this complex issue will require ongoing collaboration between GINA, health organizations, and the asthma community. An updated, comprehensive definition of mild asthma could help improve communication, education, and the development of tailored treatment plans for patients. Patients would also benefit from a better understanding of how doctors diagnose and categorize the severity of their asthma.

New Advice for Managing Severe Asthma

 New biologic therapies for severe asthma are providing more treatment options, especially for those with allergic or eosinophilic
inflammation. According to the updated GINA guidelines, these advanced treatments should only be considered for patients with severe asthma whose symptoms remain uncontrolled despite optimized standard treatment.

Some biologics are approved for children as young as 6 years old. However, as with any medication, the risks and benefits must be carefully considered for each patient before prescribing biologic therapy, especially in pediatrics. Close monitoring is needed to determine if treatment goals are being met and whether adjustments or alternative treatments may be needed.

For the most severe and refractory asthma cases, newer biologics targeting other inflammatory pathways may provide relief when other treatments have failed. But the high cost of these advanced biologics underscores the need for improved access to affordable, essential asthma medications worldwide. Overall, biologics have expanded options for managing severe asthma, but should only be used when standard treatments are not enough. Careful patient selection and close monitoring remains key.

 Asthma Management Cycle

 The GINA 2023 report summarizes the asthma management cycle in seven steps. First, assess the patient’s symptoms and risk factors to determine their asthma control and severity. Then, select initial treatment based on asthma severity, and provide the patient with an action plan for managing exacerbations.

 Regular follow-up is needed to monitor the patient’s symptom control and risk factors, and adjust treatment as needed. At each visit, healthcare professionals should review the patient’s symptom control and risk factors, lung function, inhaler technique, and adherence. Adjustments to treatment may involve stepping up or stepping down therapy depending on the level of symptom control.

For patients with persistent symptoms and/or exacerbations despite regular treatment, consider alternative diagnoses or triggers, as well as difficult-to-treat asthma. Adjustments may also be needed for life changes like pregnancy or older age.

The asthma management cycle aims to empower patients to achieve and maintain good symptom control, optimize their lung function and quality of life, and reduce the risk of asthma exacerbations. By routinely following this cycle, doctors and patients can work together to find and adjust treatment plans tailored to the patient’s needs. The key is to take an individualized, patient-centered approach.

 GINA continues to update asthma guidelines based on the latest research to provide the best care and management
recommendations for people living with asthma. The most recent updates cover diagnosis and management of asthma for both
children and adults. The guidelines are meant to be a helpful reference for doctors and caregivers.

 For caregivers, the guidelines highlight the importance of creating asthma action plan, ensuring proper use of inhalers and spacers, reducing asthma triggers in the home, and helping manage asthma in schools or workplaces. Patient education and open communication with doctors are key. While asthma cannot be cured, with the right treatment and management, people can live active and unrestricted lives.