Gathering around the crackling fire of an open hearth is a seasonal rite of passage.

But for many who are scraping by in rural, mountainous areas, wood fires are often all that stands between families and frostbite.

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Yet where there’s fire, there’s usually smoke. And that smoke could be aggravating your breathing problems.

Research suggests that Chronic Obstructive Pulmonary Disease (COPD) is significantly aggravated by exposure to wood smoke, including smoke from wildfires that also rage around this time of year.

Of the 1,861 mainly female former and current smokers (ages 40-75) enrolled in a University of Mexico study, 28 percent reported being exposed to wood smoke, whether from a fireplace, stove, or outdoor campfire. Those smokers and nonsmokers around wood smoke were 9 percent more likely to have trouble breathing — and specifically 11 percent more likely to suffer bronchitis symptoms.

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The effect is all the more worrisome given that COPD is the fourth leading cause of death in the U.S.

Study author Sood Akshay is board certified in pulmonary, critical care medicine and occupational medicine and a national leader in the field of occupational lung disease. He told LifeZette that the study results were surprising for a couple of reasons.

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“The important lesson is that the adverse respiratory effects exist in residences of rural mountainous communities across the United States,” said Dr. Akshay. “Before we thought that COPD was just (from) cigarette smoke, but now we can see that it’s really quite something more.”

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“We were surprised by the strength of the association, which was largely comparable to the effect size seen in developing countries,” Dr. Akshay added. “Our study was done in Albuquerque and surrounding communities and our suspicion is that wood smoke is higher in rural communities and mountainous locations, such as the Rocky Mountain Belt and Appalachia. Wood is used (there) to supplement other fuels for heating.”

Living in rural, mountainous areas comes with its own unique set of charms, as well as challenges. This writer spent years living in a rambling ranch house nestled in the Berkshire Mountains of western Massachusetts. Winters were long and the stacks of wood, piled high in the fall, were whittled away by the time snows melted in spring.

That is why, growing up with fires, I was taken aback when breathing became difficult as I hiked up mountains or sliced through thick snow blanketing our cornfield on cross country skis. The real culprit, it seems — in light of these new research findings — may have originated years earlier in my life, when I smoked a pack a day in my early twenties.

Dr. Akshay’s findings confirm the suspicion: “Smokers may be a uniquely susceptible population to the adverse respiratory effects of woodsmoke.”

So, “the first recommendation is to quit smoking,” he advised. “The second recommendation is that individuals who use wood stoves need to use dried wood, well maintained wood stoves and replace faulty wood stoves.”

This article was originally created by the Dole Nutrition Institute, with additions and updates by LifeZette.