Wildfire Smoke and PH: ‘Like Elephants on My Chest’

Amy Samuelson

Every summer, Amy Samuelson keeps a close eye on the air quality index. It’s become second nature for Samuelson, who lives in Billings, Montana.

“In Montana, smoke season is a thing like winter is a thing,” says Samuelson, who wears oxygen full time. “In August, I just stay indoors for the most part.”

Several weeks ago, the AQI reached 198 in Billings, which is considered unhealthy. The smoke cast a creepy orange hue over her neighborhood.

When the air is that bad, Samuelson says she feels the air as well as smells it.

“It’s like elephants on my chest,” she says.

Coralynn Sack, MD

Poor air quality is a health risk for everyone, especially for people with chronic lung disorders like PH, says Coralynn Sack, MD, a pulmonologist and assistant professor at the University of Washington’s Department of Environmental and Occupational Health Sciences and School of Medicine.

The tiny solid particles in air pollution – known as particulate matter – can lodge themselves deep within the lungs, leading to inflammation and tissue damage in the alveoli, the small air sacs where oxygen exchange happens.

The tiniest smoke particles can even enter the bloodstream, causing problems throughout the body.

How it affects PH patients

When the air quality is especially bad, almost everyone can be affected, Sack says. Breathing in unsafe air can trigger a cough, sore throat, eye irritation or headache.

People with PH should pay attention to an uptick in chest pressure, shortness of breath, light-headedness, dizziness or a racing heart.

“These are signs specific to PH that could suggest something more serious is going on,” Sack says. “You need to get to clean air and get evaluated if your symptoms don’t improve.”

High winds can be unhealthy

As wildfires become more common, Greater Los Angeles PHA support group leader Monica Penaranda finds her mental health affected as well as her physical health.

“Wildfire smoke affects me very badly. I get extreme chest pain,” she says. “And so I’ve developed anxiety when it comes to fire.”

It’s not just smoke that can be problematic, she points out. Before the catastrophic Eaton fires in January 2025, she was on high alert due to the Santa Ana winds, which were blowing up to 80 mph.

Via Facebook and her support group, Penaranda made sure to alert fellow PH patients about the health hazards of high winds during drought. Pathogens like Valley fever and mold spores are more likely to be in the air.

Studying the risks

Worryingly, emerging evidence shows increased chronic exposure to air pollution may be associated with an increased risk of the development and progression of PH, as well as a slightly increased risk of dying from PH, Sack says.

To study the relationship, Sack and fellow researchers used data from the Pulmonary Hypertension Association Registry to examine possible impacts of long-term ambient air pollution exposure in people with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. The results were published in the Annals of the American Thoracic Society.

While the overall pattern wasn’t statistically significant, there were enough regional variations in the data to warrant more research, she says. Her study mostly included data in areas where people were predominantly exposed to air pollution from traffic and other industrial sources. Importantly, the long-term concentrations of these pollutants were relatively low and below current air quality standards.

“Wildfires are a different beast, because they’re very acute. They only last a few days, but it’s really high levels of pollution,” she says. “And we know from the data that wildfire smoke is associated with increased risk of hospitalization for worsening respiratory outcomes and even increased death.”

‘The irritants get you so fast’

Los Angeles resident Marisela Navarro, who has PH, knows about those risks firsthand. She became sick this summer from the Boyle Heights warehouse fire, which burned ferociously for a week in June. Numerous toxic chemicals in the air sickened many residents.

“I ended up having to go to the emergency room,” Navarro says. “I had bronchitis. I had a lot of inflammation in my chest. My nasal cavities also were super swollen and painfully irritated.”

She’s still recovering, months later.

This wasn’t her first experience with wildfires. Last year, she also endured the catastrophic Eaton fires. Although she lives about half an hour away and did everything she could to protect herself, the smoke was hard to escape. For her, it was a reminder that the air can become something you fear to breathe.

“The smoke was so heavy. It affected me more than I ever thought it would,” she says. “Those irritants get you so fast. The deeper you try to breathe, the more it burns.”