Distressed patients are more and more frequently making the same panicked demand of Dr. David Beuther, a pulmonologist at National Jewish Health, as Front Range air bakes into choking stew of ozone and wildfire smoke.
鈥淲here am I going to live?鈥�
They take their medicine, they follow the expert advice of National Jewish, they put HEPA filters into their air conditioners. They thought Denver鈥檚 dry climate was a hedge against some allergens and irritants. And yet, with Front Range cities hitting 100 degrees this week and the foothills of Larimer and Boulder counties on fire, their asthma hits on more days each summer. Their chronic cough gets worse. Smoke particles inflame their sinus disease.
鈥淲hat I see in clinic is kind of an increasing despair, just 鈥榳here am I going to live?鈥� On Monday, I had probably four or five patients describe, 鈥極h, this is happening again. I basically have to suffer through more symptoms, not able to go outside, not able to do the things I want,鈥欌�� Beuther said. 鈥淔or several months every summer.鈥�
鈥淎nd they seriously think, well, maybe I should move somewhere else. But as we go through it, where are you going to move? There are problems with many other choices. There really seems to be nowhere to go.鈥�
Denver Health pulmonologist Dr. Anuj Mehta is telling patients the same thing: Expect increasing ozone and particulate alert days each year as the Front Range climate heats up, and wildfires from drying parts of the Pacific Northwest add to the volatile mix above metro Denver.
鈥淭his is not anything that鈥檚 going away. Every year we鈥檙e going to be dealing with some difficult air quality, both from a wildfire perspective and an ozone perspective. Potentially, it鈥檚 only going to get worse,鈥� Mehta said. Ever more important then, Mehta added, is 鈥渉aving plans and establishing plans, if you鈥檙e somebody with asthma, if you鈥檙e somebody with COPD (chronic obstructive pulmonary disease).鈥�
Here are some answers to frequent questions for top Front Range heart and lung doctors:
Should my children stay indoors instead of playing outside?聽
Children in metro Denver鈥檚 most vulnerable neighborhoods disproportionately impacted by historic pollution already suffer from higher rates of asthma and other illnesses. Parents who are getting ozone alerts in all neighborhoods on the Front Range wonder about the trade-offs.
It鈥檚 not just smoke particles and ozone that make afternoons dangerous, Mehta said 鈥� 100 degrees and a sunburn can hurt kids as well.
鈥淚 think it鈥檚 hard to keep young kids inside. We want them to be outside and playing, and not sitting in the house in front of screens. We know that鈥檚 healthy. So try and really think about the earlier morning hours when it鈥檚 cooler,鈥� Mehta said.
The first step to making these decisions, Beuther said, is having good medical care, knowing your family鈥檚 health status, and for those established as having a chronic condition, following the plan.
鈥淲hen our patients have an underlying condition that makes them more vulnerable, those are people that, when it gets into the orange and particularly the red zone, we start talking about staying indoors,鈥� Beuther said. (On the AirNow.gov air quality gauge calibrated for any ZIP code, the orange warning zone is 100 to 150 air quality indexI, and above 150 is the red danger zone.)
For a vulnerable person seeing the AQI creep into the orange, Beuther advised, 鈥渨indows and doors shut, HEPA filter on your furnace, running the air conditioning, keeping your rescue medications close and trying to limit your exposure to the outside as much as possible.鈥�
If I鈥檓 healthy, should I still avoid exercising in the worst part of the day?聽
Don鈥檛 stop breathin鈥�, don鈥檛 stop believin鈥�, pulmonologists say 鈥� if you鈥檙e a super athlete or just an Olympics-season dreamer, keep on running. But do it early in the morning if you can, or late after dinner if it鈥檚 safe, when temperatures are cooler and air quality indices are lower.
鈥淲hat I would tell an active healthy person in Colorado during these kind of orange, moderately bad air quality days, is that it鈥檚 probably safe for you to go and exercise at any time in the middle of the day if you want to, but I would probably try to avoid it. Is it going to hurt you? Probably not. If you feel bad, obviously that鈥檚 a signal,鈥� Beuther said.
鈥淲hat I tend to tell my athlete-type patients is, as this air quality gets from moderate to severe, or even in the moderate, that鈥檚 probably not the day you want to do your long, extended exertion, because this is about irritant exposure. It鈥檚 not just the intensity of it, it鈥檚 also the duration. If I have to go run 10 miles sometime this week, I鈥檓 going to look at when the air quality is the best or make sure that that one鈥檚 in the morning. If I have to run a quick 3 miles in the middle of the day, I鈥檓 not going to worry about it if I鈥檓 healthy.鈥�
What should vulnerable elderly residents or their caregivers do?
Take a moment to consider the living situation of elderly family and friends, Mehta said.
鈥淔or people that don鈥檛 have air conditioning, right now is a really difficult time,鈥� he said. 鈥淭he cycle of heat can affect people鈥檚 breathing, even more so the elderly, they鈥檙e more likely to get dehydrated. And all of those are kind of like a vicious cycle. If you鈥檙e dehydrated, your breathing can get worse, and then you鈥檙e probably not going to be reaching for water.鈥�
鈥淚t鈥檚 important that we check on our neighbors, check on our friends, check on our family, make sure they鈥檙e doing OK,鈥� Mehta added. 鈥淚f they need a fan to be brought to them, or if you want to bring them over to your house, to give them a break in air conditioning, if you have it. I think that kind of societal caring for each other is really important in these difficult times.鈥�
Opening windows to cool the house down is tricky, Mehta said. It鈥檚 certainly not helpful to the lungs to sit right next to a window opening onto wildfire smoke and gaseous ozone, which permeates the Front Range on bad days.
鈥淏ut a lot of people rely on opening the windows to cool the house down. When air quality is really bad, it might be better to keep some of those windows closed, open ones in rooms that you鈥檙e not in, and just keep those fans going to circulate the air,鈥� he said.
Should I wear a mask on the worst days?聽
The loose, fairly cheap masks that became ubiquitous as handouts during COVID do not protect from either ozone or PM2.5 particles, one of the hazards carried by wildfire smoke, Beuther said. A better-built mask rated as N95 or KN95 will block a lot of PM2.5 if worn properly, tightly around the nose and mouth,.
Particulate pollution can be extra dangerous, Beuther said, because it doesn鈥檛 just impact the lungs, it鈥檚 also been shown to cause a more general inflammation inside the body that can exacerbate heart conditions. 鈥淚t has been associated, at least on a population basis, with heart disease and ER visits for heart attacks and other things,鈥� he said.
Ozone, on the other hand, does not respect even good masks, Beuther said.
鈥淥zone is kind of like this blob from Fort Collins down to Colorado Springs. You really can鈥檛 avoid it without going far away, and it can really get through the masks,鈥� he said. 鈥淪o just because you have an N95 doesn鈥檛 mean you can be a superhero and spend all day outside with bad lung disease and expect to be fine.鈥�
Doctors who are listening to their patients, Beuther added, need to take their increasing anxiety as a prod to work on protecting them in a broader, societal way.
鈥淭his directly affects our quality of life, and as the air quality gets worse, it鈥檚 not just an aesthetic thing for healthy people. When healthy people also start to get the chronic cough, the scratchy throat, the itchy eyes, that isn鈥檛 necessarily chronic disease yet, but we know on a population basis, the population will be less healthy because of the worsening air quality,鈥� he said. 鈥淚t鈥檚 directly in opposition to the goals of why we all came to live here in Colorado, for the beautiful outdoor scenery and activity.鈥�
Colorado has been doing some 鈥渉eavy work鈥� to improve things, Beuther said, but progress has been in part reversed by global temperature increases that broaden the allergy season and promote more wildfires.
鈥淪o we really ought to do more,鈥� he said. 鈥淎nd this is something that is increasingly visible to national and international pulmonary and respiratory groups, that we need to be more vocal, because we鈥檙e seeing a direct effect in our patients.鈥�
