Wildfire smoke has become more common in the summer. Poor-quality air is unhealthy, especially for vulnerable people, including those with asthma or heart conditions, as well as younger kids and older adults.

The poor air quality, often the result of wildfires in Canada, is something you can actually feel. When air quality is poor, experts say you should consider limiting your time outside, especially if you are exercising or doing strenuous tasks; keeping your windows closed at home; and wearing a high-quality N95 or KN95 mask if you need to go out. Those most at risk should stay indoors.

In this Q&A, Linda Rogers, MD, Director of the Adult Asthma Program, and Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) at the Icahn School of Medicine at Mount Sinai, explains how to protect yourself when air quality is poor.

Linda Rogers, MD, Professor of Medicine  (Pulmonary, Critical Care and Sleep Medicine)

How can I tell what the air quality is like in my neighborhood right now?

A good way to see what the air quality is like right now, where you live, is the website AirNow.gov or the AirNow app created by the U.S. Environmental Protection Agency and available for download for free, where you get your apps for your of phone. This site offers a composite score for what we call the big five pollutants—ground-level ozone, particulate matter, carbon monoxide, sulfur dioxide, and nitrogen dioxide. A good score is less than 50. On an average day in New York, we are around 30; we have pretty good air quality. Once it starts getting up over 50, there may be risks for sensitive people. If the score reaches 100-150, due to a combination of heat, humidity, and pollution, the risk for sensitive individuals rises. If it rises above 150, sensitive groups may experience more serious health effects, and some members of the general public may also experience health effects. In recent years, the score has risen to over 100 due to the wildfires. Any of the common weather apps people have on their phones are also a good source of this information.

What does it mean when the air quality reaches the unhealthy levels?

That’s the red zone. That’s where even healthy members of the general public are going to feel it. The effects on the general public may be mild; it may just be a matter of feeling irritation in your nose or throat. But for really sensitive groups, this is a level that could trigger an asthma attack or flare-ups of other lung diseases such as COPD, or chronic obstructive pulmonary disease. It can also pose a risk for those already at risk for heart attacks and strokes. During times of high pollution level, there is a well-established pattern of increased risk of emergency room visits for these types of cardiovascular events 48 to 72 hours after exposures to high pollutant levels.

What safety precautions should I take when air quality is at an unhealthy level?

The best thing to do is stay inside with the windows closed. If you have to go outside, make it as short as possible. I don’t think anybody should exercise outdoors while the air quality is poor. When you’re exercising, you are taking in more of these contaminants. It depends on your personal circumstances, but when levels are between 100 and 150, you may want to consider limiting outdoor exercise, especially for young children.

Should I wear a mask?

You should consider wearing a high-quality mask, such as an N95 or KN95 mask. Surgical-style masks will not be helpful. Those masks offer at least partial protection from viruses transmitted by droplets, but they do not protect you from the extremely small particle pollutants. And even the N95 and KN95 masks cannot protect you from the gases, such as carbon monoxide, that are produced by wildfires.

What about working outside?

I think it depends on your underlying health, your age, your circumstances, what the work involves, and what the air quality is in the area that you’re working. If you have to work outside, a high-quality N95 mask will be a great idea if it’s possible for you.

Does it help to use my air conditioner?

Air conditioners vary tremendously in terms of how old they are, how they’re built, and what kind of filters they have in their use. Closing your windows and using an air conditioner is better than having the windows open. Ideally, your air conditioning system has a high-efficiency filter. Air purifiers can also help.

Who is most at risk?

Young children are more at risk because they tend to breathe at faster rates with higher volumes. When there’s an elevated pollution level, they’re generally getting more exposure. The elderly are at higher risk for heart and lung disease and have other underlying health conditions. Those with lung diseases, notably asthma and chronic obstructive pulmonary disease (or COPD), are often sensitive to environmental triggers like this, or changes in weather, temperatures, and humidity. Many of those with asthma, for example, often reach out to their doctors in advance to make sure they have emergency medication on hand. But it can be different for those with heart conditions.

What should people with heart disease know about this?

People with heart disease may not be aware that they are at increased risk, but these high levels of pollutants have been linked to visits to emergency rooms with cardiovascular conditions. People who are at risk may want to consider staying indoors to the extent possible. It’s also important to note that there may be a lag in the onset of symptoms. It may take a while for the contaminants you are breathing in to have an effect on your blood vessels. That is why we may sometimes see a lag in visits to the emergency department. The health effects can persist and escalate from 24 to 48 hours after the air quality levels are at their worst.

What are the signs that the air quality is affecting a typical, healthy person?

When the air quality index gets above 100, and then over 150, as has happened in recent years, you’re going to feel throat irritation, nasal irritation, nasal congestion, runny nose, sore throat—almost cold-like symptoms except without a fever. Some people may feel chest discomfort and headaches. These aren’t particularly dangerous. But for those with underlying conditions, such as lung disease and allergies, they can cause more severe debilitating symptoms. The air is unhealthy for everyone, but some groups are at risk of significant health effects.

Details of the air quality index from the federal government’s AirNow.gov site.

Stenosis in general occurs when the spinal canal (which houses the spinal cord and its nerves) narrows, giving the spinal cord and nerves less room to move. This pressure on the spinal cord and nearby nerves can cause pain, numbness, weakness, bowel/bladder changes, and can even make standing or walking painful. Lumbar spinal stenosis is a narrowing of the spinal canal in your lower back. 

In this Q&A, Alexander M. Crawford, MD, MPH , a fellowship trained spine surgeon and Assistant Professor, Orthopedics,  Icahn School of Medicine at Mount Sinai, discusses the causes and treatments for lumbar spinal stenosis, how to relieve pain, restore your mobility and improve your quality of life. 

Alexander M. Crawford, MD, MPH

“If you are experiencing lower back pain, sciatica, difficulty walking, or weakness in the legs, it’s time to see a specialist who can evaluate your condition, make a diagnosis, and develop the best treatment options to alleviate pain and improve your quality of life,” says Dr. Crawford. He treats the full spectrum of spinal disorders, including degenerative conditions such as arthritis and disc herniations, scoliosis, trauma, tumors, and complex revision surgeries. He offers both traditional open and advanced minimally invasive surgical approaches. 

What causes lumbar spinal stenosis? 

The spine is divided into three sections: the cervical spine (your neck), the thoracic spine (your mid back), and the lumbar spine (your low back). Your lumbar vertebrae stabilize your spine, supports most of your body weight, and helps maintain balance. With intricately affiliated nerves, muscles, and ligaments, this area of your spine controls your ability to walk, run, sit, lift, go to the bathroom, and move in all directions. Causes of spinal stenosis include:  

• Arthritis and bone spurs 

• Bulging or herniated discs 

• Unstable segments of your spine, otherwise known as “slipped” discs 

• Traumas, fractures, and tumors 

How does lumbar spinal stenosis relate to aging? 

Most commonly, spinal stenosis results from a degenerative aging process. As we age, our spinal ligaments may thicken and calcify, or our bones and joints (including those in your spine) may swell and develop bone spurs. Two forms of arthritis (osteoarthritis and rheumatoid arthritis) can also wear away the surface cartilage and cause an overgrowth of the bone that narrows the spinal canal. For most people, symptoms develop over time and can include one or more of the following: 

• Back pain 

• Numbness and cramping in the feet or legs 

• Difficulty walking more than a few blocks 

• A burning pain from the buttock down the leg that is often referred to as sciatica  

How is lumbar spinal stenosis diagnosed? 

To diagnose lumbar spinal stenosis, we start by taking your medical history and conducting a physical exam to assess your pain and symptoms. We also use an imaging test, such as an X-ray, magnetic resonance imaging (MRI) scan, or computerized tomography (CT) scan. 

What are the nonsurgical treatment options for lumbar spinal stenosis? 

To address early symptoms of lumbar stenosis, doctors prescribe nonsurgical treatments including: 

• Physical therapy to strengthen the back, stomach, and leg muscles 

• Application of ice and/or heat to affected areas 

• Anti-inflammatory drugs  

These treatments help to reduce inflammation, can relieve some pressure on the nerves, and can offer pain relief. 

Another nonsurgical option is a series of spinal injections. Several types of injections may be used, varying by the medication delivered and the specific area targeted. Most often, patients receive a steroid injection—a strong anti‑inflammatory medication—directly into the irritated area to help reduce inflammation and ease pressure.  

What are the surgical options for lumbar spinal stenosis? 

We generally consider surgery only if these other methods are not effective at relieving pain or if you have severe weakness. When indicated, there are various types of lumbar surgery that are customized to different spinal disorders. These include: 

• Microdiscectomy 

• Laminectomy  

• Fusion treatments using the most advanced techniques, including minimally invasive spine surgery, robotics, and microsurgery. 

Microdiscectomy: This is one of the most performed spinal decompression procedures. The spinal surgeon may remove some or all the damaged disc, depending on the patient’s needs. We typically perform this surgery when spinal stenosis is caused by one bulging disc. Symptoms of a bulging disc include: 

• Significant back pain 

• Weakness or numbness in the leg or foot 

• More pain in the leg or foot than in the back (i.e., sciatica) 

Most patients experience considerable relief shortly after surgery. Patients typically return to work within two to six weeks of the procedure. 

Laminectomy: This is another form of spinal decompression surgery for lumbar spinal stenosis. During this procedure, the surgeon removes all or part of the lamina, the portion of bone that forms the roof of the spinal canal. By relieving pressure, the spinal nerves have more space to heal. A laminectomy can relieve pain or other symptoms caused by conditions that affect your nerves and spinal column. In certain circumstances, there is even an option for a minimally invasive form of laminectomy to reduce your recovery time and help you feel better sooner.