Particulate matter and emergency visits for asthma: a time-series study of their association in the presence and absence of wildfire smoke in Reno, Nevada, 2013–2018

BACKGROUND: Health risks due to particulate matter (PM) from wildfires may differ from risk due to PM from other sources. In places frequently subjected to wildfire smoke, such as Reno, Nevada, it is critical to determine whether wildfire PM poses unique risks. Our goal was to quantify the difference in the association of adverse asthma events with PM on days when wildfire smoke was present versus days when wildfire smoke was not present. METHODS: We obtained counts of visits for asthma at emergency departments and urgent care centers from a large regional healthcare system in Reno for the years 2013–2018. We also obtained dates when wildfire smoke was present from the Washoe County Health District Air Quality Management Division. We then examined whether the presence of wildfire smoke modified the association of PM(2.5), PM(10–2.5), and PM(10) with asthma visits using generalized additive models. We improved on previous studies by excluding wildfire-smoke days where the PM concentration exceeded the maximum PM concentration on other days, thus accounting for possible nonlinearity in the association between PM concentration and asthma visits. RESULTS: Air quality was affected by wildfire smoke on 188 days between 2013 and 2018. We found that the presence of wildfire smoke increased the association of a 5 μg/m(3) increase in daily and three-day averages of PM(2.5) with asthma visits by 6.1% (95% confidence interval (CI): 2.1–10.3%) and 6.8% (CI: 1.2–12.7%), respectively. Similarly, the presence of wildfire smoke increased the association of a 5 μg/m(3) increase in daily and three-day averages of PM(10) with asthma visits by 5.5% (CI: 2.5–8.6%) and 7.2% (CI: 2.6–12.0%), respectively. We did not observe any significant increases in association for PM(10–2.5) or for seven-day averages of PM(2.5) and PM(10). CONCLUSIONS: Since we found significantly stronger associations of PM(2.5) and PM(10) with asthma visits when wildfire smoke was present, our results suggest that wildfire PM is more hazardous than non-wildfire PM for patients with asthma.