Patient education: Smoke inhalation (The Basics)

What is smoke inhalation? — 

This is when you breathe in the air, smoke, heat, or fumes from a fire. Particles in the air and the chemicals in the fumes can damage your lungs.

You can have smoke inhalation if you are in or near a fire, or if you breathe in smoke from wildfires. You can be affected by smoke from wildfires even if you are many miles away. Smoke inhalation can make heart or lung problems worse.

How does inhaling smoke cause problems? — 

When you breathe in smoke, the tissues in your "respiratory system" are exposed to harmful chemicals. The respiratory system includes the nose, mouth, throat, windpipe, and lungs (figure 1). The heat from a fire can also harm your respiratory system, even if the fire never burns you.

Your brain and body need oxygen to work properly. Fires in enclosed spaces use the oxygen in the air. Then, there is less oxygen for you to breathe in. Fire also produces a gas called carbon monoxide ("CO"). The CO can take the place of oxygen in your bloodstream. When certain things like insulation, plastics, or rubber burn, this can produce something called cyanide. Cyanide prevents the cells in your body from being able to use the oxygen in your bloodstream. All this can decrease your oxygen level. Going without oxygen for too long can cause permanent brain damage or death.

Smoke, chemicals, and heat can damage the cells in your nose, mouth, throat, and lungs. They can also destroy the tiny hairs in your respiratory system that help your body get rid of dirt and soot. Your airways in your mouth, nose, and throat can swell and make it hard to breathe. Smoke, chemicals, and heat can also trigger an asthma attack.

What are the symptoms of smoke inhalation? — 

Common symptoms include:

●Coughing and hoarseness

●Wheezing and problems breathing

●Ashes from the fire getting into the nostrils or throat

●Sore throat, or trouble swallowing or talking

●Headache

●Feeling dizzy, faint, or confused

●Nausea or vomiting

More severe symptoms can include:

●Passing out, seizures, or stroke

●Shortness of breath, or the lungs not working

●Swelling of the throat and airways, which can cause a high-pitched sound when breathing

●Low blood pressure

●An abnormal heartbeat or the heart stopping

Will I need tests? — 

Yes. If your doctor or nurse thinks you might have smoke inhalation, they will order tests. Examples might include:

●Blood tests – Different tests can be done on the blood, including one to check for CO. Testing for cyanide is not usually done, because results take a long time. But you might get blood tests to check for the effects of cyanide.

●Pulse oximetry – This uses a small device to measure how much oxygen is in your blood.

●Chest X-ray or CT scan – These are imaging tests. They create pictures of the inside of your body.

●Laryngoscopy or bronchoscopy – These are procedures in which a doctor uses a thin tube to look inside your throat and airways.

How is smoke inhalation treated? — 

Mild cases of smoke inhalation only cause mild irritation to the airways. They might need only a little treatment. More serious cases need to be treated at a hospital, at least at first. It can take a day or so to develop signs of serious lung problems.

The main treatment for smoke inhalation is to make sure you get enough oxygen. Oxygen can be given in different ways, including:

●A mask placed over your nose and mouth

●A breathing machine – This is a machine that helps you breathe through a tube that goes down your throat.

Other treatments depend on the situation. For example:

●Some treatments help keep your airways open, reduce mucus in your lungs, and clear your airways. This can help prevent a lung infection called pneumonia.

●In very severe cases, you might need treatment with "extracorporeal membrane oxygenation" ("ECMO"). This is a form of life support. It uses a machine to do the work of your lungs and make sure your blood gets enough oxygen.

●If you might have CO poisoning, you might get treatment in a "hyperbaric oxygen chamber." This is a full-body chamber with high pressure inside. It helps prevent brain damage that can be caused by CO.

●If you might have cyanide poisoning, you might get treated with a medicine called "hydroxocobalamin."

Can smoke inhalation be prevented? — 

You can take steps to try and prevent smoke inhalation injuries.

●If there are wildfires nearby:

•Limit your time outside.

•Wear a face mask when outside (figure 2).

•Keep windows and doors closed as much as possible.

•Use an air filter, if you have one.

●Take steps to prevent fires:

•Have a working smoke detector in your home where you sleep. Check the batteries at least twice a year.

•Do not leave lit candles, cigarettes, or fires unattended.

•Keep matches and lighters out of reach of children.

●Heat your home safely:

•Have a working CO detector in your home.

•Do not use portable chemical heaters indoors. Never use a gas range or oven to heat your home.

•Never use charcoal, outdoor grills, or portable gas heaters indoors.

•Make sure all fireplaces and stoves are vented. Get fireplaces cleaned and checked every year. Make sure the air flows freely through the chimney.

•Do not use generators indoors.

More on this topic

Patient education: Smoke inhalation – Discharge instructions (The Basics)
Patient education: Carbon monoxide (CO) poisoning (The Basics)
Patient education: How to use a pulse oximeter (The Basics)
Patient education: Diagnostic bronchoscopy (The Basics)
Patient education: Breathing tubes and ventilators (The Basics)
Patient education: Pneumonia in adults (The Basics)
Patient education: Pneumonia in children (The Basics)
Patient education: Extracorporeal membrane oxygenation (ECMO) (The Basics)

Patient education: Flexible bronchoscopy (Beyond the Basics)
Patient education: Pneumonia in adults (Beyond the Basics)