Attention to Respiratory Disorders Caused by Fires

TÜSAD emphasised that especially young children, elderly persons, and patients with asthma, COPD and heart disease need protection from fire smoke, noting that immediate medical attention is required in case of any exposure. Forest fires affecting Turkey have caused serious losses to the country's forest resources, while populations in affected regions suffered both loss of life and property. Additionally, many living organisms either perished or were forced to abandon their habitats. The Turkish Respiratory Research Association (TÜSAD) has drawn attention to another adverse effect of forest fires: respiratory problems. TÜSAD issued important warnings for citizens located in fire zones and exposed to smoke, noting that forest fires are also a public health issue and that the resulting air pollution will have very serious consequences. TÜSAD made the following statement on this matter: "Forest fires unfortunately destroy forests and their natural inhabitants while also severely damaging air quality. Small and large particles from fire smoke mix into the atmosphere. Death from poisoning by these gases is the most unwanted outcome. Especially young children, elderly persons, and patients with asthma, COPD and heart disease must be protected from fire smoke."  

ATTENTION TO RESPIRATORY PROBLEMS

TÜSAD Board Member Assoc. Prof. Onur Turan pointed out that the events and disasters arising from the climate crisis will lead to very serious health problems, stating: "For example, various smoke, gases and other inhalable substances produced during forest fires have particularly harmful effects on the lungs. Smoke-related lung damage varies depending on the type of burning material, the manner of combustion and the temperature of the heat produced. The majority of systemic effects caused by smoke are due to carbon monoxide poisoning. Additionally, hydrogen cyanide, acid, aldehyde gases and oxidants are among other compounds that damage the lungs and body. Death from smoke inhalation develops on average in 5 to 8 out of every 100 people, while early deaths usually result from airway obstruction and systemic-metabolic poisoning." Noting that smoke inhalation can cause damage and oedema in the upper respiratory tract, as well as widespread lung involvement, impaired lung function and even fatal outcomes, Turan issued the following warnings: "Exposure to smoke or similar irritant substances can reduce respiratory function, increase airway sensitivity and can trigger an airway disease such as asthma, as well as cause attacks in those with diseases such as asthma and COPD. In the event of a potential fire, protecting the respiratory system is particularly important, and covering the nose with a damp towel or cloth to avoid inhaling smoke is essential. We recommend using protective respiratory masks such as N95, which should be obtained beforehand, and seeking care at the nearest health facility if smoke has been inhaled."

ELDERLY AND CHILDREN AT RISK

TÜSAD Asthma and Allergy Working Group Head Prof. Zeynep Ferhan Özşeker warned that inhalation of fire smoke can worsen disease in asthma and COPD patients and cause attacks, providing the following information:

• Smoke can also cause diseases such as pneumonia and bronchitis. In heart patients, sudden deaths, heart attacks and cardiac rhythm disturbances may occur.
• The higher frequency of chronic respiratory tract and cardiovascular diseases in elderly persons puts them at greater risk.
• In children, since the respiratory tract and lungs are still developing, exposure to fire smoke can cause permanent damage and lead to asthma development in the future.
• To protect against fire smoke, first and foremost, children, pregnant women, elderly persons and those with chronic diseases such as asthma, COPD and heart disease should not plan travel to these areas unless necessary during periods of high forest fire risk.
• Additionally, when fires occur, measurements of fire smoke particles in the air, identification of the area where smoke spreads and communication of this information to the public should be ensured.
• For those located in fire smoke-affected areas with no fire risk, it is recommended that they remain indoors and keep doors and windows closed; if mandatory evacuation is necessary, they should leave the area as quickly as possible; all windows in vehicles should be kept closed and the vehicle should be ventilated through internal ventilation during travel.

RISK INCREASES SIGNIFICANTLY IN POWER PLANT FIRES!

TÜSAD Infection Working Group Head Prof. Berna Kömürcüoğlu noted that very fine particles of soot or smoke produced from combustion reaching the lungs can cause chemical pneumonia, permanent damage and respiratory failure. Regarding power plant fires, which came to the agenda when flames spread to the Kemerköy Thermal Power Plant during a forest fire in Milas district of Muğla, Kömürcüoğlu stated:

• In an area where a thermal power plant fire occurs, particularly high levels of carbon monoxide and sulphur dioxide pose a risk. Therefore, these must be monitored.
• The area should be evacuated before the fire reaches the power plant; if evacuation has not been possible, the area population should remain indoors as much as possible while the fire continues and homes should not be ventilated from outdoors.
• FFP2 and FFP3 masks with particulate filter properties should be preferred in outdoor environments.
• Since air quality already deteriorated due to regional fires can worsen further with a power plant fire, at-risk patients including those with asthma, COPD, restrictive lung disease and those requiring continuous home oxygen due to respiratory failure should preferably be removed from the fire area. Should they remain in the fire zone, it is recommended that they isolate their homes and remain, if possible, in an environment cooled by HEPA-filtered air conditioning (not ventilated from outdoors).
• Individuals exposed to fire and smoke should be monitored for symptoms for at least 24 hours. For individuals with respiratory symptoms, pulse oximetry alone will not be sufficient for CO poisoning assessment; carboxyhaemoglobin (COHb) levels should be evaluated together with arterial blood gas.

PANDEMIC MEASURES SHOULD NOT BE OVERLOOKED

Additionally, providing information on measures to be taken to prevent COVID-19 transmission in disaster areas, Prof. Berna Kömürcüoğlu stated: "Disaster areas, by their nature, create environments where COVID-19 precautions are most often overlooked and people come into close contact unprotected to support one another. We observed a significant increase in regional case numbers following the İzmir earthquake. For this reason, it is important that COVID-19 precautions are observed in gathering areas to the extent possible under disaster conditions, that people gather in open areas and maximum precautions are taken in eating areas." Assoc. Prof. Onur Turan also made the following reminders on this matter: "Being in tents or different accommodation areas following the fire disaster increases the risk of contact with COVID-19 positive cases and contacts, thus raising transmission risk for COVID-19. Therefore, personal protective measures should not be abandoned, the mask-distance-hygiene trio and compliance with pandemic rules should continue. The sanitation conditions of residential areas where affected citizens are staying should be improved, disinfection areas should be established and necessary medical care should be provided in case of suspected infection. Masks should be regularly provided to persons in this area, mask use should be monitored and HES code checks should be conducted. PCR testing should be performed when necessary for persons with complaints suggesting COVID-19, as provided by health teams in the area."