The American Lung Association’s chief medical officer Tuesday encouraged West Maui residents who are returning to the Lahaina burn zone to wear protective gear.

Dr. Albert A. Rizzo said the air quality may be good, but cleaning up and sifting through the ashes could expose one to long-term health issues.

“You’re not only stirring up the ash, but anything else that was burnt, including chemicals and asbestos,” he said.

Rizzo, in town for a meeting of pulmonary doctors at the Hawai‘i Convention Center, took time out from his meeting to speak at a special event sponsored by the American Lung Association in Hawaii.

Top of mind Tuesday were the pulmonary consequences of the deadliest wildfire in the United States in more than a century. The Aug. 8 Lahaina fire killed at least 98 people and destroyed more than 2,000 buildings, most of them homes.

Residents have begun returning to survey the remains of their property and collect any belongings they can find.

In September the state Department of Health reported that sampling and monitoring of the burn sites did not show evidence of poor air quality or any hazardous levels of contaminants in the air.

But county officials warned that ash “may contain toxic, cancer-causing chemicals with debris including broken glass, exposed electric wire and other objects.”

Rizzo said that when cleaning up, people should wear a mask to keep the ultrafine particles out of their lungs. Make it a nicely fitting N95 mask, he said, not the surgical masks that were popular during the pandemic.

Those with preexisting lung conditions, he said, should make sure they have their medications and an adequate supply of rescue inhalers in case they start to express symptoms.

“If you have a condition like that, you may not be the best person to be up there cleaning up,” the physician said, “but not everybody has the luxury of having someone to do it for them.”

Asked about what conditions and ailments those who were exposed to the massive fire for an extended period might expect, he responded: “If you know what happens to people who smoke, you know what happens to people exposed to a wildfire.

“If you had a cough, a wheeze or are short of breath, those systems should fade — unless you have an underlying condition.”

Rizzo said it’s important to keep the lines of communication open with your doctor regarding your condition.

“If you didn’t have one of those symptoms but now you do, it’s very important to talk to your physician, because exposure to wildfire smoke or particles may trigger the very first symptoms of asthma or another respiratory disease.”

Rizzo said those at greatest risk from wildfire smoke exposure are children, older adults, pregnant women, the socioeconomically disadvantaged and homeless folks.

Rizzo was asked about whether it was safe for the reopening of Lahaina’s schools, which sit near the burn area. He said that if the air quality has returned to pre-fire levels, it should be fine.

“Assuming that ashes and debris are not being stirred up near the school, it should be safe.” But, he added, children and teachers should be made aware that it someone is coughing, short of breath, parents should be notified so that the child can be examined for issues.

Lahainaluna High opens to students Monday, while Lahaina Intermediate starts Tuesday. Oct. 18 marks the return of students from Princess Nahienaena Elem­entary as well as King Ka­meha­­meha III Elementary, which was destroyed by the fire. Students from both schools will share the Princess Nahienaena Elementary campus until a temporary school for King Kamehameha III Elementary students can be built in Pulelehua.

Pedro Haro, executive director of the American Lung Association in Hawaii, said his organization is working with officials to bring support to the Lahaina schools, including the American Lung Association’s Open Airways for Schools program, which offers asthma management education.

In addition, Haro said he hoped to obtain a grant from the Hawaii Community Foundation, which administers the Maui Strong Fund, to help bring in and install heavy-duty air purifiers in select schoolrooms.

“Children can go in there, and if they are feeling like they are having respiratory problems, they know that there are clean areas, whether it’s a library or a classroom, where they can breathe air that has been cleaned through one of those devices,” he said.

Haro, who grew up in Lahaina, said the lung and health issues associated with the Lahaina fire and its cleanup could prove to be unprecedented — or maybe even similar to the 9/11 cleanup in New York. He said his organization is considering lobbying state and federal lawmakers to create a health registry of those exposed to the fire and its cleanup, similar to the one in New York.