A Burning Issue: Gasping for breath - Fires are like a smoke bomb for vulnerable people
By DEBORAH SCHOCH - Center for Health Reporting
Posted: 05/14/2010 12:15:43 AM PDT
When 82-year-old Darrell McGillis steps outside to fetch the newspaper on a cool winter morning, his lungs serve as his personal barometer. If Chico's air is thick with chimney smoke, his nostrils and lungs begin to burn.
"If I spend any time out there, I have to take a breath of my inhaler when I get back inside," said McGillis, a cardiac patient, asthmatic and former smoker whose lungs are wracked with a chronic disorder. He relies on three separate prescription devices to ease his breathing. On smoky days, he stays indoors.
Kathryn Wright, 65, who also suffers from asthma, wears a scarf outside on cold nights so that if the smoke is thick, she can pull it across her face like an influenza mask. Without that scarf, she said, she's "been doubled over coughing for a half hour."
In Chico, wood smoke divides the healthy from the vulnerable.
Most of us inhale an average of 19,000 times a day without even noticing our lungs are at work. But for some residents, especially those with respiratory problems, each breath can be an effort, especially when the air they breathe is polluted by car and truck exhaust or smoke from local wood-burning stoves and fireplaces.
Medical researchers worldwide over two decades have determined that some particles like the kind found in wood smoke can inflame lung tissue and worsen chronic diseases such as asthma. Some can promote clot formation and increase the risk of heart attacks and strokes. Some are so tiny that they can permeate tissue, pass right through the walls of blood vessels and even damage DNA, which can be a precursor of cancer.
Those particles aren't the only reason that doctors worry.
Wood smoke contains hundreds of chemicals, some of which are found in cigarette smoke, some poisonous, some known to cause cancer. The World Health Organization's cancer research arm has classified smoke from wood fuel as a probable human carcinogen, but U.S. health agencies are still studying the issue.
Without exception, the nine researchers and other scientists interviewed for this story said that wood smoke can harm the health of both stove users and their neighbors.
While some differ on certain points — such as whether wood smoke can create or simply worsen specific conditions like asthma — they agreed that wood smoke is a public health problem.
"There are carcinogens. There are respiratory irritants. There are all sorts of bad things," said Dr. Mark Miller, a former Chico pediatrician who is now the director of the Pediatric Environmental Health Specialty Unit at UC San Francisco. He says that some children's lungs can be damaged if they are heavily exposed to wood smoke.
Adults and the elderly suffer, too, especially those with breathing problems such as chronic pulmonary lung disorder, or COPD, doctors said.
Locally, of the 10 Chico area physicians interviewed, only one, Oroville pulmonologist Dr. Charles Garretson, said that the health effects of wood-burning stoves may be overblown. Garretson reported that among his patients, he has seen more affected by rice burning than wood stoves, and he questions if stove regulations are necessary.
"Like any other government program, it can get overdone," Garretson said. "People should decide for themselves."
The nine other area physicians expressed deep concern about potential health effects of wood smoke in and around Chico.
"It's really not a good place to live in winter if you have chronic respiratory problems," said Chico pulmonologist Dr. Dinesh Verma, who urges his patients with lung disease to at least switch to other forms of heat.
"I see people who think they have allergies, but their noses are stuffed up from smoke," added Chico allergist Dr. L. Gretchen Wooding. "You can stuff up. You can't see. Your nose can run."
But some residents aren't convinced, even those who have young children but continue to heat with wood. Wooding finds that frustrating.
"I had a family in here today who had a son with some asthma and allergy problems," she said in a late April interview. "They were using a fireplace and I discussed that with them. And (the father) was pretty incensed. 'Oh, don't you tell me how to live my life,' kind of thing. I said, you know they are toxic fumes. There are toxic fumes getting into his lungs."
Even as health concerns mount, rising fuel costs in recent decades have boosted the popularity of wood heat nationwide. That presents a conundrum: Is cheaper heat worth potential medical risks?
Butte County homes contained nearly 15,000 free-standing wood stoves and fireplaces in 2008, including more than 7,000 concentrated in Chico, county assessor records show. Because of those stoves, wood smoke is a leading source of winter air pollution in the Chico area, according to the staff at the Butte County Air Quality Management District.
That is because a quirk of topography and climate can act trap so much wood smoke close to the ground that on some winter days, the air quality in Chico flunks federal standards.
Elsewhere, at least 16 of California's 35 air quality districts have responded to similar wood smoke pollution woes by limiting the days when residents can use older, more polluting wood stoves and fireplaces to heat their homes, state records show.
Yet to date, Butte County's air district board has shied away from imposing rules on burning, and while the city of Chico may propose its own rules, their effectiveness may be weakened by the absence of county support.
The debate over wood smoke is dividing local residents in other ways — by financial status, family tradition and suspicions about the cause and extent of north valley pollution.
For many during the current hard times, economics is the driving force for keeping their stoves lit and stoked.
"I can't afford not to burn wood," said Eleanore Reynolds, 85, of Gridley, who keeps her home at 65 degrees during the winter and wraps herself in warm clothes. "I'm just so grateful that I don't have to pay PG&E."
Others dislike the notion of government meddling in one of the last remaining staples in their everyday lives that is simple, relatively inexpensive and unmonitored by public agencies. While government rules seem to have ensnared most other essential tools in our lives — cars, trucks, gas furnaces, toilets, even farmers' diesel-powered irrigation pumps — only now are regulators turning to the humble wood stove.
Some wonder if wood smoke really is harmful, reporting that their parents and grandparents lived their whole lives alongside wood-burning stoves without developing lung disease or heart problems or cancer.
John Bossard, 66, of Chico, recalled that as a boy living next to a local orchard, he watched black smoke billowing from the smudge pots that farmers lit to protect their trees from freezing. The smoke darkened his mothers' good linen drapes, and, by the end of the day, he and his relatives would all have soot lodged inside their noses.
Today, he remains in good health, with no lung problems, he said. He suspects that bureaucrats are vilifying Chico's air quality as a ploy to get grant money. "It's just like climate change. I don't believe any of it."
Some blame the poor air quality on cars, or trucks, or farm operations, or residents who burn leaves and other yard trimmings.
"We just came down from Almanor. We're coming down Highway 32, and we can see seven plumes of smoke from the orchards and the rice fields burning. You could not even see the snow-capped mountains.
That's where the issue is instead of the wood smoke," Lori Grady, 53, reported in a phone message to the Enterprise-Record.
Grady said she saw the plumes on March 27, a day when agricultural burning was legal and both orchard prunings and rice fields were being burned, said Jim Wagoner, Butte County air pollution control officer.
On an average winter day, residential wood burning accounts for fully half the particulate pollution in the Chico area, Wagoner said. So even if agricultural burning were banned in the winter, Chico would still have an air pollution problem, he said.
Whatever the source, a striking number of county residents do suffer from respiratory illnesses, according to a new statewide report from the state Department of Public Health on 2006-08 mortality rates, released two weeks ago.
Butte County ranked seventh worst among the state's 58 counties in lung cancer deaths and eighth worst in deaths from chronic lower respiratory disease — a term that includes chronic obstructive pulmonary disorder and chronic bronchitis — the report states. While the death rate for both diseases dropped throughout California compared to the years 2003-05, the rates in Butte County went up.
"The amount of lung disease around here is just terrible," said Dr. Verma, who largely blames a history of heavy cigarette use among older farmers. And smoke from wood stoves and agricultural burning, he said, just makes things worse for residents with weakened lungs, whether old or young.
For some children with asthma, wood smoke can be as serious an irritant as second-hand smoke, said Dr. James Wood, medical director at the Enloe Children's Health Center.
He says that if he learns that an asthmatic child he is treating lives in a wood-burning household, he acts just as he would if that child lived with cigarette smokers.
He tells the parents bluntly "that they'd better knock it off."
Chico mothers were among the first to speak out, lobbying the air district board to restrict wood burning, and now they're turning to the city.
"We definitely should have mandatory 'no burn' days when the air gets bad," said Deva Winona, 36, whose older son, Ethyn, suffered from asthma as a child. "It surprises me just how unwilling people are to change, when it comes to our most vulnerable citizens getting sick over what is essentially a luxury."
Susan M. Pike, 50, said that her daughter, now 16, developed asthma after moving to Chico. Her daughter is active in sports, and while her asthma has improved, she still has sensitive lungs, Pike said.
"Obviously the air quality made it worse. If that's the main reason she got it, I don't know," said Pike, who was surprised to learn about Chico's polluted air. "I was shocked. I was really surprised."
People who burn wood are not considering its health effects, Pike said. "I understand that people feel very strongly that it's their right. I just think it's selfish."
At the Enloe Children's Health Center, Wood says he can tell if a child's family heats with wood the moment he walks into an exam room.
"You can smell it on their clothes, just as you can smell cigarette smoke on their clothes," said Wood, who is the 17-year medical director at the clinic for babies and young people run by Enloe Medical Center. The clinic offers treatment regardless of families' ability to pay the bills.
Asthma is the most common chronic condition treated at the clinic, which sees 70 to 110 babies and children a day for all health problems.
Asthma inflames air passages in both children and adults. They can suffer attacks — usually wheezing and breathlessness — because of "triggers" such as illness, exercise, dust, or pet dander. Particles in wood smoke are also triggers, inflaming tissue and causing airways to spasm, much as if you were squeezing them like a straw.
"The more you can smell smoke in the house, the more it's a problem," Wood said. "If you can smell it, that's particulate matter that's circulating." If a child has asthma, he would like to see the parents invest in an EPA-approved stove or a pellet stove or switch fuels altogether.
He is not optimistic. Last year in his clinic, fully 83 percent of the children's bills were covered by Medi-Cal, the federal and state program to aid low-income families.
"It would be like telling them, if they had an old car, that they had to trade up to a Cadillac," Wood said. "It's not going to happen."
So if parents cannot afford a new stove, he advises them to at least shut their children's doors to keep the smoke out.
The Butte-Glenn Medical Society did not take sides last year when the county's air district board debated whether to regulate burning.
This time, that may change. The society, with 135 members in the two counties, is expected to take a position at its May 18 meeting, said its president, Dr. Mark Lundberg, who is also the Butte County public health officer.
"We want to be advocates of good health in our society," Lundberg said last week. He believes that wood smoke does have health effects that could be eased by city burning restrictions.
Other local doctors agree. "For the benefit of the health of the society, it behooves them to regulate it," said Chico allergist Dr. Norman McCann.
Even if Chico does institute burning rules, that doesn't mean that residents with health problems or parents of asthmatic children will automatically change their burning habits, some doctors cautioned.
"I saw one lady in here today who uses a fireplace, not to heat her house," said allergist Dr. Wooding. "It's because she likes the idea of having a fire and she had significant lung disease. She wasn't aware of it. She'd had a chronic cough since January. It was probably aggravating her problem &
"It's hard. It's like the patient that keeps smoking although they have lung disease. I'll probably just have to keep plugging ahead and keep educating. It's all that I can do."
Tomorrow: The economics of wood.
Staff writer Larry Mitchell contributed to this report.