People Exposed to Harmful Wildfire Smoke Often Live Far from Lung Specialists

People Exposed to Harmful Wildfire Smoke Often Live Far from Lung Specialists

Smoke began to billow into the skies in northwestern Nevada in September. It clouded the mountains, dimmed the sun, and quashed residents’ hopes of being spared wildfires or the terrible air quality that blazes create.

The lung-irritating particles were blowing in from burning forests in California and settling in Douglas County, Nevada, home to nearly 50,000 people, prompting warnings that air quality had reached hazardous levels.

These levels indicated that the air was very unhealthy. This raises alarms about people’s immediate health and asks whether pollution is causing long-term health problems. These risks could increase as climate change causes wildfires, droughts, and floods to become more common in the U.S., and around the world.

Some people feel powerless.

” There’s nothing we can do about it,” said Serrell smokey , chairman, Washoe Tribe of Nevada/California. The tribe’s land straddles the border between California and Nevada near Lake Tahoe and extends into Douglas County, about 60 miles south of Reno.

Tribe members, and other area residents, are among millions people nationwide who will experience poor air quality this year due to wildfires. In September, as smoke settled over Nevada, fire-related air quality alerts were dispatched in six other states: California, Idaho, Montana, Oregon, Washington, and Wyoming.

Yet, Douglas County residents are more fortunate than those who live in other areas that have been hard hit. Douglas County residents must drive 30 minutes, on average, for medical care from lung specialists called pulmonologists. However, patients in the West and Upper Midwest must drive for at least an hour to receive medical care from pulmonologists. This is according to data that GoodRx ,, a website that tracks prescription drug prices, and conducts research.

Specifically, the research found that about 5.5 million Americans live in the 488 counties where drive times to pulmonologists are an hour or more. Many parts of Nevada and Montana fall within these gaps. These are places that have recently dealt with wildfires that filled the air with smoke and ash that can cause lung problems, or exacerbate existing ones.

Allergies, asthma, and similar issues are often handled by primary care physicians, but patients are sent to pulmonologists when problems escalate–think severe asthma; chronic obstructive pulmonary disease, or COPD; or emphysema.

Data from the Association of American Medical Colleges shows the number of pulmonary disease specialists in the U.S. dropped nearly 11% from 2014 to 2019. The Washington, D.C.-based group represents the academic medicine community and noted that the decline may not be as severe as it seems because some doctors are choosing to practice pulmonary critical instead of pulmonology. Many of these pulmonologists work in hospital-intensive care units.

About 15,000 pulmonologists are practicing in the U.S., according to the GoodRx report. However, large swathes of the country still have few or no . pulmonologists. According to the GoodRx report.

“New Mexico only has one pulmonologist in the entire southeastern region, not counting Las Cruces which is closer to El Paso,” said Dr. Victor Test ,, a pulmonologist at Texas Tech Physicians.

Test, one of 13 pulmonologists in the Lubbock, Texas, region, said that his patients from within Texas sometimes drive four hours for an appointment and that other people travel from “New Mexico, Oklahoma, even far western Kansas.”

An increase in wildfires, and their intensity, will likely increase the need for pulmonologists.

“Climate change is going to affect lung disease,” said Dr. Nicholas Kenyon, a professor of pulmonary, critical care, and sleep medicine at the University of California-Davis School of Medicine in California, where he and several other researchers are tracking the effects of wildfires. Kenyon stated that he sees patients from all parts of California, including Eureka which is five hours away from Sacramento.

The short-term effects that breathing in smoke can have on your health are well-known. Kenyon stated that people come to emergency rooms with asthma attacks, exacerbation or COPD, bronchitis and even pneumonia. Some suffer from chest pains or other cardiac problems.

” But we don’t know much about what happens long-term,” he said. Is it possible to have worsening asthma or COPD if people are exposed to wildfires for two to three weeks? We don’t know .”


Fires emit multiple pollutants, including carbon monoxide and carbon dioxide, as well as chemicals like benzene. All fires release particles into the atmosphere. Particulate matter 2.5 is a tiny part of the air that health researchers and air quality experts are most concerned with. Far smaller than a human hair, the particles can lodge deep in the lungs and have been linked to heart and lung conditions.

Increases in those tiny particles are associated with a greater risk of death from all causes, excluding accidents, homicides, and other non-accidental causes, for up to four days after a population is exposed, according to a 2020 New England Journal of Medicine overview.

The concentration of fine particulate material is one of five indicators used to calculate the Air Quality Index. This numerical and color-coded index allows the public to know the level of local air pollution. Green denotes good air quality and is given if the total index is 50 or less. When the measurement exceeds 100, the air quality gets an orange label and may be bad for certain groups. Levels over 200 get a red label and are considered unhealthy for everyone.

Government agencies keep track of these levels, as well as people who use apps and websites to determine if it’s safe to venture outside.

When the AQI rises above 150, Dr. Farah Madhani-Lovely, a pulmonologist, said Renown Regional Medical Center in Reno shuts its outpatient pulmonary rehabilitation clinic because it doesn’t want to encourage patients to drive in. Some Douglas County residents choose to receive care close to home, which is about an hour away. Madhani-Lovely stated that patients shouldn’t be exposed to smoke because even a minute can cause an exacerbation in their chronic diseases.

Smokey stated that it can be difficult for Washoe Tribe members to connect with pulmonologists, especially those who live on California’s side of the reservation. He said, “We can’t find providers for them.” “We end up referring people out and sending them hundreds to get the care they should be able .”


It has been difficult to recruit specialists to rural areas and smaller cities. Test stated that a specialist could be the only one in a rural area or smaller city, so it is difficult to find specialists.

Another concern is that doctors tend to be trained in larger cities and want to practice in the same places. Even recruiting pulmonary physicians to Lubbock, a city of 260,000 in West Texas, is a challenge, Test said.

” I love Lubbock,” said he. “But I tell people who’ve never been here, I tell them, ‘It really flat’ until they get there .”


In Nevada on bad days, Washoe tribal members use fan-made air purifiers made from duct tape and air filters.

Longer-term, Smokey and other tribal leaders have been pushing the Indian Health Service for a northern Nevada specialty care hospital. The closest specialty care hospital for Washoe tribal members is more than 700 miles away, in Phoenix.

It’s hard because “there’s an need we should be taking care,” Smokey stated. “But we must fight for it. Sometimes that fight can take years, years, and even years to win .”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information to the nation on health issues.


    Julie Appleby is a senior correspondent for KHN who reports on the health law’s implementation, health care treatments and costs, trends in health insurance, and policy affecting hospitals a

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