British Columbia Medical Journal, December 2010 issue Please download or visit this entire issue online at http://bcmj.org/issue/december-2010

1. bc centre for
disease control
Smoky air and respiratory health in the 2010 forest fire season,
British Columbia
Catherine Elliott MD, CCFP,
FRCPC, Tom Kosatsky, MD 8 visits/day (10-year mean 4.5)
8 400
Physician services for COPD and asthma
n 2010 British Columbia had an ex-
I ceptional forest fire season. The
Daily mean PM 2.5 (ug/m3)
smoke was thicker and the number
(7 day rolling average)
6 300
of communities affected was greater
than in previous years. In the Interior,
communities experienced two smoky 4 Daily PM 2.5 200
258 ug/m3
periods, each lasting several days. The
first began in late July and the second
in early August. The highest measured 2 100
daily mean fine particulate matter in the
province occurred in Williams Lake,
0 0
with a peak of 258 ug/m3 on 19 August, 29 03 07 11 15 19 23 27 31 04 08 12 16 20 24 28
more than 20 times normal background June July August
Date 2010
levels. Since forest fire smoke travels
long distances, populations through- Figure 1. Physician services for respiratory illness and daily mean fine particulate matter in
out the province were exposed. the Cariboo-Chilcolten region of BC, 2010.
Forest fire smoke contains a mix-
ture of pollutants including fine partic- 150
Physician services for COPD and asthma
ulate matter (PM 2.5) and many toxic 114 visits/day
(10-year mean 99) 30
compounds.1 Exposure to forest fire
Daily mean PM 2.5 (ug/m3)
smoke has well-documented health ef-
(7 day rolling average)
fects,1 including asthma exacerbations2 100
and other respiratory complaints.3 This 20
summer, British Columbia was smoky
enough to observe these effects.
Daily PM 2.5
Indeed, MSP billings for physician 50 17.5 ug/m3
20
visits for COPD and asthma increased
following smoky days. The propor-
tional increase in visits is most pro-
nounced for regions where particulate 0 0
matter was highest, like Cariboo- 29 03 07 11 15 19 23 27 31 04 08 12 16 20 24 28
June July August
Chilcotin Health Service Area (Wil- Date 2010
liams Lake) ( Figure 1 ). After almost
Figure 2. Physician services for respiratory illness and daily mean fine particulate matter in
a week of smoky days in Cariboo- the Fraser North region of BC, 2010.
Chilcotin, starting in mid-August, the
PM 2.5 = fine particulate matter
daily number of visits increased by
100% (four visits) above the 10-year observed during the same period in the increase in the number of visits
mean. An increase in visits was also the Fraser North Health Service Area, was greater (15 visits, Figure 2 ). This
which includes New Westminster, increase in visits following smoky
This article has not been peer reviewed. Burnaby, and Coquitlam, even though days was consistently observed in
Dr Elliott is a federal field epidemiologist in PM 2.5 reached only 17.6 ug/m 3 smokier regions (data not shown).
Environmental Health Services at the BCCDC. ( Figure 2 ). Although the proportional While this is only a first glimpse at the
Dr Kosatsky is the medical director of Envi- increase in visits above the 10-year data, it does illustrate an important
ronmental Health Services at the BCCDC. mean was lower in Fraser North (14%), Continued on page 516
514 BC MEDICAL JOURNAL VOL. 52 NO. 10, DECEMBER 2010 www.bcmj.org

2. worksafebc
Continued from page 515
Evidence
Treatment Comments
Positive Negative Conflicting
Physical therapy
Traction or spinal decompression42,43 As a single treatment for any low back pain, with or without sciatica
Photonic stimulation44
Interferential stimulation45
Superficial heat or cold46 Short-term with small effect
Electromagnetic fields47 For knee osteoarthritis; however, the effect is not clinically significant
Electrotherapy48 In treating neck pain
For active or passive treatments in whiplash-associated disorders,
Conservative therapy49 Grades 1 or 2
Transcutaneous electrical nerve For knee osteoarthritis or chronic low back pain, or in reducing pain
stimulation50-54 among patients with rheumatoid arthritis of the hand
Low-level laser therapy55,56 In reducing pain among patients with nonspecific low back or neck pain
Complementary and alternative medicine
Touch therapy, including healing touch,
reiki, therapeutic touch57 In reducing pain; however, the effect is not clinically significant
Neuroreflexotherapy58 Short-term effect for nonspecific low back pain
For nonspecific neck pain
Massage 59,60
Small effect for subacute or chronic nonspecific low back pain
Evidence, short-term effect in acute headache or chronic
Acupuncture61-63 nonspecific low back pain
In treating shoulder pain
Herbal64,65 For rheumatoid arthritis and maybe low back pain
Vitamin D66
References
Available on request by e-mailing kukuh.noertjojo@worksafebc.com or calling 604 232-5883. An extended summary of
this review is accessible from the Evidence-based Medicine page on WorkSafeBC.com (www.worksafebc.com/evidence.)
—Kukuh Noertjojo, MD, MHSc, MSc; Craig Martin, MD, MHSc; Celina Dunn, MD, CCFP
WorkSafeBC Evidence-Based Practice Group
bccdc
Continued from page 514 that patients with chronic respiratory Acknowledgments
principle in the relationship between conditions such as COPD and asthma Thank you to Population Health Surveil-
air pollution and health: a small in- have rescue medication and emer- lance and Epidemiology, BC Ministry of
crease in exposure in large populations gency response plans, and know when Healthy Living and Sport, the Office of the
(Fraser North, population 597 659) to seek medical help. Public health res- Provincial Health Officer, and Sarah Hen-
can affect larger numbers of people ponses include issuing air quality health derson, environmental health scientist, BC
than a large increase in exposures in advisories, establishing air shelters, and Centre for Disease Control.
small populations (Cariboo-Chilcotin, evacuating those at risk during severe
population 26 646). smoke events. Partnerships between References
The evidence we present from this physicians and public health practi- 1. Naeher LP, Brauer M, Lipsett M, et al.
season serves as a reminder that forest tioners become particularly advanta- Woodsmoke health effects: A review.
fire smoke affects people all over the geous when novel scenarios arise, such Inhal Toxicol 2007;19:67-106.
province, even those distant from the as how to manage patients in hospitals 2. Brauer M, Hisham-Hashim M. Fires in
fires. Physicians and public health prac- when the indoor air becomes smoky. Indonesia. Environment Science Technol
titioners across BC can (and did) work Forest fires are the norm in British 1998;32S:404S-407S.
together to reduce the health effects of Columbia, and we can anticipate that 3. Moore D, Copes R, Fisk R, et al. Popula-
exposure to forest fires, particularly they will increase with global climate tion health effects of air quality changes
among those most at risk: firefight- change. Physicians and public health due to forest fires in British Columbia in
ers, young children, the elderly, and practitioners must continue to work 2003: Estimates from physician-visit
those with chronic respiratory disease. together to reduce the health impacts billing data. Can J Pub Health 2006;
Physicians play a key role in ensuring of forest fires. 97:105-108.
516 BC MEDICAL JOURNAL VOL. 52 NO. 10, DECEMBER 2010 www.bcmj.org