While most of the largest U.S. wildfires occur in the Western U.S., almost three-quarters of the smoke-related deaths and visits to the emergency room for asthma occur east of the Rocky Mountains.

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Smoke exposure, whether from wildfires or local burning, contributes to health problems across the U.S., but the impacts vary by region. A new study finds that smoke contributes to a larger percentage of health problems in the West, but affects greater numbers of people in the East — possibly when they aren’t even aware of the smoky air.

The new study was published in GeoHealth, AGU’s journal investigating the intersection of human and planetary health for a sustainable future.

In the West, where population density is generally lower and smoke concentrations are typically higher, smoke played a larger role in the number of asthma complaints and ER visits, contributing to more than 1% of annual visits in some years. In the East, with its high population density and lower smoke concentrations, there were a higher number of visits overall, even though a smaller percentage were related to smoke (0.3% to 0.6%).

The researchers estimate that long-term smoke exposure results in about 6,300 extra deaths each year, with the highest numbers occurring in the most populous states. Only 1,700 of those deaths occurred in the West.

Fires throw tremendous amounts of pollutants into the air, including toxic gases and soot. Smoke contains tiny particles smaller than 2.5 microns, called PM2.5, that enter the lungs and contribute to multiple health problems. Short-term exposure to PM2.5 from smoke is linked to respiratory health problems, like asthma attacks, and the long-term effects of PM2.5 from smoke are not fully understood. Research on PM2.5 from urban pollution suggests that exposure is linked to lung cancer, heart disease and an overall higher chance of death.

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