PAHOA, Hawaii >> Malia Portia recently evacuated to escape the toxic fumes from the lava flow that is now just 5 miles from her home in Kapoho.

On top of her asthma and COPD — chronic obstructive pulmonary disease, which restricts airflow from the lungs — the 66-year-old says the dangerous gases from Kilauea Volcano are causing headaches, shallow breathing and congestion.

“I just can’t get a breath,” she said. “We woke up this morning and all we could smell is sulfur. It was so voggy we couldn’t see the trees. It smelled like eggs. My little doggy, his whole eyes are filled with goop. They have a very fragile, small respiratory system.”

Portia is among the disproportionate number of Puna residents suffering from respiratory illness and other chronic diseases worsened by high levels of sulfur dioxide and hydrogen sulfide billowing in the air. The most recent respiratory concern is “laze” — or lava haze — when hot lava mixes with cold seawater to produce a plume of steam laced with hydrochloric acid and glass particles.

Making matters worse, Puna residents had a higher incidence of respiratory illnesses prior to the recent lava eruption and tend to have fewer resources to deal with their illnesses.

The rate of COPD is higher in Puna’s adult population 45 years and older, with 1 in 10 living with the condition, compared with about 6 percent across the islands, according to the state Health Department. And about a fifth — or 20 percent of adults — and a quarter of children have been diagnosed with asthma, versus the statewide average of 17.5 percent and 16.8 percent, respectively.

Puna has the second-highest poverty rate in the state with nearly half of its residents living at or below 130 percent of the federal poverty level. The rural population of 45,000 has higher chronic disease risk factors largely because of the high rates of smoking — 22.4 percent compared with 13 percent of residents statewide, health officials said.

An estimated 32 percent, or 14,500, of Puna residents, are native Hawaiian, with a lifespan eight years less than the average, according to the nonprofit native Hawaiian health system, Papa Ola Lokahi.

“Hawaiians are overrepresented in the Puna population that’s most impacted by the current lava flows,” said Kim Birnie, Papa Ola Lokahi spokeswoman. “We’re looking at disparities under normal circumstances and now the volcano is presenting additional challenges.”

“There’s more poverty in the Puna and Kau districts than anywhere else in the state except for Waianae,” said state Sen. Josh Green (D, Kona-Kau), an emergency doctor on the Big Island. “If you take people already at a disadvantage because they have higher rates of asthma, heart disease and lung disease because of economic and ethnic disparities and on top of it you hit them with a volcanic eruption, now you’re talking about a crisis.”

Green said the volcanic emergency is worsening the health of Puna’s vulnerable population, particularly seniors, children and those with pre-existing respiratory illnesses. They are twice as likely to develop acute respiratory disease when exposed to high levels of dangerous sulfur dioxide, he said.

“We always have the need there, but in addition to that we’re going to have a lot more people with lung concerns and respiratory problems and concerns with mental illness and addiction. Now people are displaced from their homes, and we’re going to have a behavioral health crisis,” he added. “There has been historically a lot of challenges with drugs. All of these things create a perfect storm where people have disparities and now you displace them and expose them to toxic gas. That’s why we’re going to need to provide a lot of extra support just to keep them alive.”

Compounding the issue is a severe shortage of primary-care doctors and specialists. There are only three full-time doctors to cover the entire area and a handful of part-time providers, according to University of Hawaii professor Kelley Withy, who conducts an annual physician workforce survey.

“There aren’t enough doctors to take care of the population under normal circumstances, and this is far from normal,” she said.

Thousands of Puna residents have evacuated their homes because of toxic gases and fast-moving lava that has wiped out more than 40 structures. Amy Laurel Hegy, a spokeswoman for the American Red Cross, which opened three shelters to aid evacuees, said the organization has had more than 1,100 medical and mental health service visits with clients.

“We don’t get the medical support that we need,” Portia said. “So many people’s health is in jeopardy. It’s very stressful, but we’re all trying to get through it. I’m afraid that they are suffering and … the worst is yet to come.”