Impact of Wildfire Smoke on Pediatric Asthma: Insights from the 2023 Canadian Wildfires

A University of Vermont study linked summer 2023 Canadian wildfire smoke to worsened pediatric asthma control in Vermont and upstate New York, producing a measurable rise in symptom burden and care needs.

Compared with the relatively smoke-free summer of 2022, asthma-control metrics and healthcare utilization worsened across the Northeast in summer 2023. The authors used an electronic health record analysis to measure control metrics alongside visits and correlated higher ambient PM2.5 from cross-border smoke plumes with declines in control and increased exacerbation-related encounters.

Clinically, rescue inhaler refills, urgent clinic encounters, and emergency visits all rose during the smoke-heavy period. Clinics described surges in telehealth demand, higher urgent-visit volumes, constrained inhaler supplies and staffing pressures, and more short courses of oral corticosteroids alongside elevated telephone triage calls. These concurrent trends support reassessing population-level management and preemptively adapting care pathways during smoke seasons.

Children most affected were preschool-aged patients, those with poorly controlled asthma, children with comorbid respiratory disease, and families facing housing or socioeconomic exposure risks. Common red flags included escalating short-acting beta-agonist use, nocturnal symptoms, exercise intolerance, and any sign of hypoxia.

Practical, bedside-ready mitigation steps for families during regional smoke events include closing windows, creating an indoor clean-air room, using HEPA air purifiers when available, limiting outdoor activity, and ensuring an up-to-date asthma action plan with immediate access to quick-relief inhalers—measures that can reduce short-term exacerbation risk.

Key Takeaways:

• A regional EHR analysis associated summer 2023 cross-border wildfire smoke with measurable worsening of pediatric asthma control.
• Greatest impact seen in young children, patients with uncontrolled asthma or respiratory comorbidity, and socioeconomically vulnerable families.
• Expect higher urgent-care and telehealth demand during smoke events; incorporate smoke-exposure screening into routine visits and reinforce action plans and inhaler access.