Smoky air and respiratory health in the 2010 forest fire season, British Columbia

Issue: BCMJ, vol. 52, No. 10, December 2010, Page 514 BC Centre for Disease Control

Forest fires BC

In 2010 British Columbia had an ex­ceptional forest fire season. The smoke was thicker and the number of communities affected was greater than in previous years. In the Interior, communities experienced two smoky periods, each lasting several days. The first began in late July and the second in early August. 

The highest measured daily mean fine particulate matter in the province occurred in Williams Lake, with a peak of 258 ug/m3 on 19 August, more than 20 times normal background levels. Since forest fire smoke travels long distances, populations throughout the province were exposed. 

Forest fire smoke contains a mixture of pollutants including fine partic­ulate matter (PM 2.5) and many tox­ic compounds.[1] Exposure to forest fire smoke has well-documented health ef­fects,[1] including asthma exacerbations[2] and other respiratory complaints.[3] This summer, British Columbia was smoky enough to observe these effects.

Indeed, MSP billings for physician visits for COPD and asthma increased following smoky days. The proportional increase in visits is most pronounced for regions where particulate matter was highest, like Cariboo-Chilcotin Health Service Area (Wil­liams Lake) (Figure 1). After almost a week of smoky days in Cariboo-Chilcotin, starting in mid-August, the daily number of visits increased by 100% (four visits) above the 10-year mean. 

An increase in visits was also observed during the same period in the Fraser North Health Service Area, which includes New Westminster, Burnaby, and Coquitlam, even though PM 2.5 reached only 17.6 ug/m3 (Figure 2). Although the proportional increase in visits above the 10-year mean was lower in Fraser North (14%), the increase in the number of visits was greater (15 visits, Figure 2). 

This increase in visits following smoky days was consistently observed in smokier regions (data not shown). While this is only a first glimpse at the data, it does illustrate an important principle in the relationship between air pollution and health: a small in­crease in exposure in large populations (Fraser North, population 597659) can affect larger numbers of people than a large increase in exposures in small populations (Cariboo-Chilcotin, population 26646).

The evidence we present from this season serves as a reminder that forest fire smoke affects people all over the province, even those distant from the fires. Physicians and public health practitioners across BC can (and did) work together to reduce the health effects of exposure to forest fires, particularly among those most at risk: firefight­ers, young children, the elderly, and those with chronic respiratory disease. 

Physicians play a key role in ensuring that patients with chronic res­piratory conditions such as COPD and asthma have rescue medication and emergency response plans, and know when to seek medical help. Public health res­ponses include issuing air quality health advisories, establishing air shelters, and evacuating those at risk during severe smoke events. Partnerships be­tween physicians and public health practitioners become particularly ad­vantageous when novel scenarios arise, such as how to manage patients in hospitals when the indoor air becomes smoky. 

Forest fires are the norm in British Columbia, and we can anticipate that they will increase with global climate change. Physicians and public health practitioners must continue to work together to reduce the health impacts of forest fires.

Thank you to Population Health Surveillance and Epidemiology, BC Ministry of Healthy Living and Sport, the Office of the Provincial Health Officer, and Sarah Henderson, environmental health scientist, BC Centre for Disease Control.

This article has not been peer reviewed.


1. Naeher LP, Brauer M, Lipsett M, et al. Woodsmoke health effects: A review. Inhal Toxicol 2007;19:67-106. 
2. Brauer M, Hisham-Hashim M. Fires in Indonesia. Environment Science Technol 1998;32S:404S-407S.
3. Moore D, Copes R, Fisk R, et al. Population health effects of air quality changes due to forest fires in British Columbia in 2003: Estimates from physician-visit billing data. Can J Pub Health 2006;97:105-108.


Dr Elliott is a federal field epidemiologist in Environmental Health Services at the BCCDC. Dr Kosatsky is the medical director of Environmental Health Services at the BCCDC.

Catherine Elliott, MD,, Tom Kosatsky, MD, MPH. Smoky air and respiratory health in the 2010 forest fire season, British Columbia. BCMJ, Vol. 52, No. 10, December, 2010, Page(s) 514 - BC Centre for Disease Control.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply