(1052) Pediatric Upper Airway Pathology Increases During Local Wildfires and Increased Particulate Matter (PM 2.5) Burden

Introduction: Fine particulate matter (PM 2.5) is generated as a component of wildfire smoke, with an increasing impact on air quality as wildfires worldwide increase in severity, size, duration, and frequency. Though the negative health effects of PM 2.5 on the pediatric lower airway are well-established, including the development and exacerbation of asthma, the effects of PM 2.5 on the pediatric upper airway are not well understood.

Methods: A retrospective cohort study was conducted, assessing pediatric patient presentations from 2013-2023 to a pediatric emergency department in Northern California during periods of elevated PM 2.5 burden associated with nearby wildfires. Patients presenting during these wildfire periods were identified as either presenting with or without upper respiratory pathology, including tonsillitis, epiglottitis, pharyngitis, and laryngitis. Matched controls were also assessed, established as occurring exactly 1 year prior to each exposure period, with confirmed normal air quality during these control periods. Additionally, periods of 1 week post-wildfire were analyzed, along with year-prior matched controls. Chi-squared analyses were conducted to determine significance.

Results: Over the past 10 years, during periods of increased wildfire-generated PM 2.5 burden, a significantly greater proportion of pediatric patients presented to the emergency department with upper airway pathology compared to matched controls during periods of healthy air quality (p < 0.05). No significant differences were seen in proportions of children presenting during the week following wildfire smoke exposure periods when compared to controls, suggesting that PM 2.5 induces upper airway symptoms acutely rather than subacutely. Further demographic analysis for exposed and symptomatic patients was also conducted to better characterize this population.

Conclusions: The clinical effects of wildfire-generated PM 2.5 exposures in children continue to be revealed, and appear to manifest as upper airway pathology in the acute exposure setting, clearly warranting further investigation.