That’s because the weather data does not measure many dangerous pollutants circulating in the air from smoke and wind, said pulmonologist Jeremy Falk, MD, associate professor of Medicine at Cedars-Sinai.

“People may think, ‘Well, I don’t see or smell smoke anymore, and it looks sunny like it normally does in Southern California,’ and be lulled into thinking everything is fine,” Falk said. “But much of what can harm us in situations like this doesn’t have an odor. The Air Quality Index system was developed for everyday pollution, and not necessarily to warn us about particles that are not typically in the air because of wildfires.”

Falk, along with Irina Dralyuk, MD, a Cedars-Sinai Guerin Children’s pulmonologist, and Daryl Banta, MD, pulmonologist and medical director of Pulmonology and Critical Care at Huntington Health, an affiliate of Cedars-Sinai, said it’s best to err on the side of caution and stay as safe as possible during periods of bad air quality—which will be around as long as the fires continue to burn.

About the Air Quality Index

An Air Quality Index level of 101-150 indicates that people in sensitive groups (such as those with lung disease, severe allergies or heart disease) could experience sore throats, wheezing or difficulty breathing. A level of 151-200 means even those without chronic breathing problems could experience health effects.

Still, the Air Quality Index can be deceiving, Falk said.

“Homes and buildings are full of all kinds of materials that are toxic when burned—plastics, oil products, metals—and the Air Quality Index does not pick up on that. Another limitation is in the unpredictable, shifting winds. You don't know if the air quality data that you're viewing is up to date. What may be an ‘acceptable’ level of air pollution one minute may be a very different level half an hour later. It's the unknown that makes this situation so dangerous.”

The South Coast Air Quality Management District is a good resource to check updated air quality in your area.

Benefits of Wearing a Mask

“What makes the air pollution associated with fires so dangerous is that the particles that seem to do the most damage are much smaller than even the microscopic droplets we saw with COVID-19,” Falk said. “Because the particles are so tiny, they can fit between the fibers of a simple paper mask or cloth mask and get far down into our airways, causing damage.”

The best masks to protect the lungs from microscopic particles found in dust, smoke, smog and particulate matter are N95 masks that can filter out really small particles, down to the 2.5-micron level. However, if KN95 masks are more readily available, they also are acceptable.

Banta advised wearers to make sure that their masks fit properly. 

“If there is any leak around the mask because of a beard or incorrect size, you may be exposing yourself to unhealthy air or smoke,” he said.

Safety Outside and Inside

“The longer you're outside breathing air that we know is not safe, the more you’re putting yourself at high risk,” Falk said. “While the fires are still happening, any exercise that could be moved to an indoor space is preferable. If you really do need to be outside for any reason, wearing the N95 mask is the best approach.”

When inside, Banta said, close windows, make sure any cracks are sealed and that there’s a good air filtration system. Check that any air conditioner is recirculating air that is in the structure and not pulling in air from the outside.  

“If there is significant smoke, ash or dust inside, wear masks indoors,” he said. 

Most modern cars also have a recirculating option, although drivers should check to make sure the automobile’s air filters have been changed recently.  

Parents should keep an eye on children who have a cough, wheezing, noisy breathing, chest tightness or pain, increased rate of breathing or increased heart rate, shortness of breath, retractions, labored breathing, gasping for air, throat irritation, hoarse voice, confusion, dizziness, or mental changes.

“It’s advisable for children of all ages to wear an N95 or KN95 mask when outside,” Dralyuk said. “Also, avoid outdoor sports or events, and evacuate the area if your child is having symptoms or the air quality is very poor, or if your child has risk factors for respiratory issues.”

If children have respiratory issues, make sure they take all scheduled medications as prescribed, and have rescue inhalers at home. Also, check expiration dates and number of puffs left, and get refills as necessary.

Watch for Symptoms

Direct, prolonged smoke inhalation or exposure is very dangerous.

“If you have severe symptoms, such as severe cough, shortness of breath, chest pain, dizziness or confusion after smoke exposure, seek immediate medical attention,” Banta said.

Milder symptoms can include irritated or watery eyes, runny nose, scratchy throat, wheezing, headache, dry eyes, phlegm or irritated sinuses. Older people and very young children can be more susceptible to these effects, as well as people who have preexisting lung or heart problems.

For people with chronic medical conditions, exposure to smoke and unhealthy air could potentially increase the risk for stroke, heart attacks and lung conditions. People exposed to prolonged amounts of particulate matter also may be at increased risk for lung cancer.

“If the air outside is bad to breathe, do what you can to not breathe it,” Falk said. “There’s nothing high tech about it. Just use common sense—that’s going to be our best way out of this.”

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here.  

While colder temperatures during winter can trigger asthma symptoms such as wheezing and tightness in the chest, Dralyuk told L.A. Parent it’s important to manage the condition year-round.

“Every asthmatic will have their own sets of triggers,” Dralyuk told L.A. Parent. “For some kids, it could be changes in the weather, allergies or dust, while others may be more sensitive to viral episodes like respiratory syncytial virus (RSV) or influenza that can lead to an exacerbation of their asthma.”

Dralyuk told L.A. Parent that there are various treatment options for asthma and that a pediatrician or pulmonologist can help control symptoms. Children can use rescue medications to quickly open the airways during acute episodes. Controller medications, which are taken on a regular basis, can help children manage chronic asthma problems.

“First and foremost, ensure that your child is following the appropriate maintenance medication regimen,” Dralyuk said. “Even with meticulous efforts to manage environmental factors at home, it can be nearly impossible without the right medication.”

She added that parents should know what triggers their child’s asthma and keep a close eye on symptoms that get worse. 

“If a child is breathing rapidly with deep, gasping breaths or exhibiting shallow breathing, and if they’re unable to speak in full sentences, these are all concerning signs that warrant immediate attention,” Dralyuk told L.A. Parent. “If you observe a combination of frequent wheezing, persistent coughing, and the child struggling to catch their breath, these signs can collectively signal a serious situation. Waiting until the child appears extremely fatigued is a risky delay; instead, it’s advisable to call 911.”

Click here to read the complete article from L.A. Parent.

And for approximately 4.2 million children coping with asthma or other respiratory conditions, seasonal weather changes can pose severe, persistent, and potentially life-threatening risks. According to the National Institutes of Health, asthma is the most prevalent chronic childhood disease.

Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children's, emphasizes the importance of controlling asthma in children through all seasons, as poorly managed cases can lead to serious complications.

“Every asthmatic will have their own sets of triggers,” said Dralyuk. “For some kids, it could be changes in the weather, allergies or dust, while others may be more sensitive to viral episodes like respiratory syncytial virus (RSV) or influenza that can lead to an exacerbation of their asthma.”

Ahead of the American Academy of Pediatrics 2023 national conference Oct. 20-24 in Washington, D.C., Dralyuk spoke with the Cedars-Sinai Newsroom about pediatric asthma and offers guidance on treatment options.

What is asthma?

Asthma is a chronic condition affecting individuals of all ages, characterized by a recurring pattern of respiratory symptoms. These symptoms can vary in frequency, severity, and duration, and they differ from one patient to another. At its core, asthma involves heightened airway sensitivity to specific triggers, leading to a pronounced response known as bronchospasm. This heightened response can manifest as symptoms like coughing, wheezing, and shortness of breath, albeit in unique combinations for everyone.

What are the signs of asthma in children?

You may observe a child who coughs in specific situations, experiences wheezing, or develops shortness of breath. These situations can include weather changes; cold temperatures; vigorous physical activity; exposure to dust, strong odors, certain animals; excitement; or emotional responses. Suddenly, you may notice the onset of respiratory issues in such scenarios.

What treatment options are best for children with asthma?

Treatment options for asthma vary based on the condition's severity and insurance coverage. There are several approaches available, with two primary categories: rescue medications and controller medications. These represent the initial steps in managing asthma.

In cases of acute symptoms, where there's bronchoconstriction or airway tightening, we turn to a class of drugs known as bronchodilators. One well-known medication in this category is albuterol. It acts swiftly, providing rapid relief during asthma attacks or acute symptoms. Albuterol's effects are short-lived, but it effectively opens up the airways by targeting the smooth muscles.

During emergency room visits, albuterol is often administered to children, either through a nebulizer or an inhaler.

For individuals with exercise-induced bronchospasm, bronchodilators like albuterol can be beneficial before physical activity. However, as a more comprehensive management approach, inhaled corticosteroids play a vital role. They serve as the cornerstone of asthma treatment for individuals with mild, moderate, or severe asthma.

Can my child play sports, exercise or participate in recess if they have asthma?

I want to emphasize that asthma should not deter individuals from engaging in physical activity; however, it's crucial that they exercise comfortably and safely. If they experience breathing difficulties during physical activities, they should stop immediately.

It's essential for schools to be aware of students' asthma conditions. Physicians can provide documentation for this purpose, ensuring that the school is informed. If a young student cannot self-administer medication, school staff should be trained in its proper use.

It's vital that schools avoid pushing asthmatic students through their symptoms. There's a misconception that they should "push harder," but for asthmatics, it's essential to stop, catch their breath, take their prescribed medication, and restore their breathing capacity before resuming physical activities.

Our goal is for students to be active and participate in sports once their asthma is well-controlled.

For students with symptoms during physical activities, we advise taking albuterol 15 minutes before the activity, with teachers and coaches aware of this plan. If symptoms persist during practice, students should know they can take a second dose as needed.

How can parents support children with asthma at home?

There are several steps you can take at home to manage your child's asthma effectively. A knowledgeable healthcare provider, whether a general pediatrician or a pulmonologist, can assist parents in this endeavor to minimize the need for emergency room visits and prevent severe asthma episodes. The primary goal is to maintain optimal asthma control.

First and foremost, ensure that your child is following the appropriate maintenance medication regimen. This step is crucial, especially for children with severe, persistent asthma. Even with meticulous efforts to manage environmental factors at home, it can be nearly impossible without the right medication.

Some factors, like weather changes and the risk of catching viral colds, cannot be entirely controlled. While good hygiene practices can help reduce the risk, children may still contract colds when attending school. Pollution levels, another uncontrollable factor, can also impact asthma symptoms, especially in places like Los Angeles, which presents unique challenges for asthma management.

While certain factors are beyond our control, it's essential to emphasize the importance of being on the correct controller medication to maintain baseline inflammation control, tailored to the child's asthma severity level.

Understanding your child’s asthma triggers is crucial for providing specific assistance.

For example, while weather may not affect one child, dust could be a significant trigger. Therefore, it's essential to adopt a precise approach to household dusting, such as starting with wet dusting before proceeding with dry dusting. Additionally, regularly replacing air filters and monitoring whether activities like using the air conditioner or heating system worsen the child's symptoms are important. It's also necessary to consider the impact of pets in the home—does the child have allergies to specific types of pets, and how severe are these allergies? If the allergies are moderate and manageable, there may still be viable options.

When to seek emergency care?

If a child is breathing rapidly with deep, gasping breaths or exhibiting shallow breathing, and if they're unable to speak in full sentences, these are all concerning signs that warrant immediate attention. I strongly advise against disregarding these symptoms; it's crucial to consider them as indicators for seeking emergency medical care. Additionally, while wheezing can be a common asthma symptom, it's important to recognize that it's not the only factor to monitor. If you observe a combination of frequent wheezing, persistent coughing, and the child struggling to catch their breath, these signs can collectively signal a serious situation. Waiting until the child appears extremely fatigued is a risky delay; instead, it's advisable to call 911 promptly.

Read more on the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them