Smoke Inhalation

Medically Reviewed by Zilpah Sheikh, MD on December 06, 2023
6 min read

The number one cause of death related to fires is smoke inhalation.

Smoke inhalation occurs when you breathe in the heated particles and gases produced by fire. Different fires produce a different combination of these harmful substances, depending on what's burned, the temperature of the fire, and the amount of oxygen available.

Smoke inhalation damages the body by depriving you of oxygen (asphyxiation) or causing irritation with heat or chemicals.

Causes of asphyxiation:

  • A fire can use up oxygen nearby and lead to death when there is no oxygen left to breathe.
  • Smoke can contain substances that cause no direct harm to you but take up the space needed for oxygen. Carbon dioxide, for instance, acts in this way.
  • Some chemicals produced by a fire can interfere with the way your cells use oxygen. Carbon monoxide, hydrogen cyanide, and hydrogen sulfide can do this. Carbon monoxide is the leading cause of death in smoke inhalation.

Causes of irritation

Fire can produce chemicals that hurt you when they contact your skin and the linings of your nose, mouth, throat, and other parts of your airway. This can potentially cause swelling, airway collapse, and breathing problems. Examples of chemical irritants found in smoke include sulfur dioxide, ammonia, hydrogen chloride, and chlorine.

In addition, the high temperature of the smoke can burn the airways.

If you inhale smoke, here are some of the symptoms you might have:

  • Cough: When the airway linings get irritated, they secrete more mucus. The muscles of your airways also may tighten up. These reactions can cause coughing.
  • Shortness of breath: You may have trouble breathing because of low oxygen levels.
  • Hoarseness or noisy breathing: Fluids may collect in your airways and cause a blockage. Also, chemicals may irritate your vocal cords, causing spasms, swelling, and tightening of your airways.
  • Eye irritation and burns: Your eyes may become red and irritated from the smoke. Your corneas may also have burns on them.
  • Skin color changes: Your skin might look unusually pale or turn bluish or cherry red.
  • Soot marks: Soot might collect around your nose and mouth.
  • Facial burns and singed nasal hair: These kinds of outward signs suggest that you've inhaled a lot of smoke.
  • Headache, nausea, and vomiting: People in fires often inhale carbon monoxide, which can cause these symptoms.
  • Mental changes: Low levels of oxygen can lead to confusion, fainting, seizures, and coma.

When someone breathes in a lot of smoke, it's a medical emergency. You should always call a doctor or get them to an emergency room for a symptom check. If they don't have symptoms, they might just get advice on what signs of trouble to watch for at home.

But you should call 911 if you have or see any of these symptoms:

  • Hoarse voice
  • Difficulty breathing
  • Drawn out coughing or choking spells
  • Mental confusion
  • Loss of consciousness
  • Dizziness
  • Chest pain or tightness
  • Wheezing
  • Ash or smoke around the nose or mouth
  • Burns inside the mouth, throat, or nose
  • Black or grey saliva
  • Nausea or vomiting
  • Blurry vision
  • Numbness or tingling in the hands or feet

Someone with symptoms of smoke inhalation can get worse quickly. Don't leave the victim alone while you wait for help. Don't let them drive and don't drive them to the hospital yourself.

At the hospital, a doctor will look at your airway for signs of damage and check how well you are breathing. You might also get some tests. The tests will vary, depending on how severe the symptoms are. They can include:

  • Chest X-ray: If you're coughing a lot or having trouble breathing, you probably will get a chest X-ray. You may get more than one because lung injuries can take time to show up.
  • Pulse oximetry: A light probe attached to your finger, toe, or earlobe can show how much oxygen is in your blood.
  • Blood tests: These can include tests to tell your doctor more about your oxygen levels, how your kidneys are working, and whether you show signs of carbon monoxide poisoning.

Smoke inhalation treatment at home

While you wait for an ambulance, there are things you can do to help someone with signs of smoke inhalation.

  • Get health information. If the person is alert, ask if they have a lung disease such as chronic obstructive pulmonary disease and asthma. If they do, see if they have an inhaler to use.
  • Get the person to safety. Move them into fresh air if you can do it safely. Sit or lay them down on their side, not their back, to reduce choking risks.
  • Give cardiopulmonary resuscitation (CPR). If the person is not breathing, give CPR. (Learn how to give CPR to children and adults so you'll be ready for emergencies.)
  • Look for shock. Signs of shock include pale and clammy skin, rapid and shallow breathing, glazed eyes, sweating, weakness, dizziness, and vomiting. Do what you can to treat the person for shock until help arrives. (Learn first aid for shock so you'll know what to do.)

Medical treatments

Medical professionals use a number of treatments for smoke inhalation. They can include:

  • Oxygen: You might get oxygen through a nose tube, mask, or tube down the throat. You might need a breathing tube if you have a lot of trouble breathing due to a swollen throat or other problems.
  • Bronchoscopy: A doctor may put a scope down your throat to get a better look at your airway and to suction out mucus and other debris. Usually, this is done after you get medications to sedate you and relieve pain.
  • Hyperbaric oxygenation: If you have carbon monoxide poisoning, you might spend time in a chamber where high air pressure allows your lungs to take in extra oxygen. It may speed up your recovery.
  • Medications: These can include drugs to clear up mucus and inhaled medicines called bronchodilators to ease wheezing and airway spasms. You might need painkillers, too.

Some people will be able to go home after getting tested and treated. Others will need to stay in the hospital.

After you leave the hospital, you may need follow-up care. If you get worse or don't improve after leaving an emergency visit, you should go back to the emergency department.

You might get medications to keep taking at home. It can take a while for lungs to heal. Some people deal with shortness of breath for the rest of their lives. Being around cigarette smoke or other polluted air can make things worse.

If you have lingering hoarseness, you might need more treatment. Surgery or therapy sessions where you learn to use your voice differently can help.

You can prevent smoke inhalation. Here's how:

  • Put smoke detectors in every room. When smoke is detected early, people can get out sooner.
  • Put carbon monoxide detectors in high-risk locations, such as near furnaces and garages.
  • Have escape routes and plans for what to do in case of fire. Review them every once in a while.
  • Put numbers for the police, fire department, and the local poison control center in visible places.
  • Prevent fires at home by never leaving a cooking fire unattended, replacing frayed appliance cords, and cleaning woodstoves and chimneys yearly.