When the Milli fire, located southwest of Sisters, flared up last Wednesday, growing from 260 acres to 3,500, smoke from the fire became a concern for residents in the area surrounding the fire.

For some, smoke causes minor eye and nose irritation, some develop headaches. But, for those with underlying health issues, smoke is much more than an inconvenience - it can be life-threatening and, at the very least, an irritant causing potentially serious medical concerns.

According to Dr. Rod Elliott-Mullens, pulmonologist at Bend Memorial Clinic in Bend, people with respiratory issues like chronic obstructive pulmonary disease (COPD) - including chronic bronchitis and emphysema, or asthma, and cystic fibrosis - any conditions impacting the free flow of oxygen in the body - can be seriously impacted by smoky conditions. Children and adults over 65 are usually considered at higher risk for problems - children because their breathing rate is more rapid and older adults because they often have one or more underlying medical conditions that may be exacerbated.

People don't even have to be in close proximity to a wildfire to be impacted. Smoke from the British Columbia fires that covered much of the Pacific Northwest earlier this month carried within it the pollutants that are inhaled when breathing smoky air.

Last Friday the air quality in Sisters was rated as "unhealthy" for everyone, improving to "unhealthy for sensitive groups" and then "moderate" later in the day.

Smoke monitoring information is available at: oregonsmoke.blogspot.com. Anyone concerned with the effects of smoke from the fires or who has possible health concerns related to smoke can go to this website to see smoke monitoring data and get additional information.

Particle pollution is a mix of miniscule solid and liquid particles suspended in air. Many of those particles are no larger than one-third the diameter of a human hair. When inhaled, they lodge deep in the lungs and can trigger asthma attacks, heart attacks, and strokes.

People who breathe the smoky air created by a wildfire can experience more coughing, wheezing, bronchitis, ear congestion, colds, and runny eyes and nose. Dr. Elliott-Mullens reported that he has seen a marked increase in patient visits for just such symptoms. He said they are keeping some hospitalized patients for a few extra days rather than sending them home to the smoky conditions currently plaguing Central Oregon.

Anyone in close proximity to the fires or around smoldering remains of a fire needs to be aware of the presence of carbon monoxide - a colorless, odorless gas that, if inhaled, reduces delivery of oxygen to the body's organs and tissues. This reduction of oxygen can cause headaches, nausea, dizziness, and, in high concentrations, death.

For those with any lower respiratory disease, Elliott-Mullens recommends increased use of your regular inhalers and nebulizers. Stay at home with windows and doors shut. If you must go outside, wear a mask, such as those available at hardware stores, to keep out the larger particulates. He recommends that everyone curtail any outside exercise such as running and biking.

Certain symptoms indicate medical attention should be sought. Being unable to sleep at night due to a shortness of breath, being unable to catch your breath after minimal exertion, and using a rescue inhaler more than two times a day are all indications that further medical intervention may be necessary.

Many people with respiratory conditions already have an action plan for when air quality decreases. If so, Elliott-Mullens says, use it. Utilizing air conditioners, particularly those with HEPA filters, can help filter out micro-particulates. If the action plan isn't working, contact your doctor.

Keep children from playing outside. Elliott-Mullens said letting children out on the school playground or at the park during smoky conditions is the same as having them smoke a massive quantity of cigarettes.