Biomonitoring of smoke exposure in firefighters: A review

Biomonitoring of exposures to toxic contaminants from environmental smoke is important due to their deleterious impacts on human health, including cardiorespiratory diseases and cancer. This is particularly relevant for firefighters who are prone to extensive dermal exposure to smoke despite using personalized protective equipment. Reliable methods are needed for the analysis of sensitive yet specific biomarkers reflecting occupational smoke exposure, given various background sources. This review focuses on biomarkers used for measuring acute smoke exposure after fire suppression activities, such as biotransformed hydroxylated polycyclic aromatic hydrocarbons and their isomers in urine. Major challenges include developing optimal sampling approaches to capture transient smoke exposures, evaluating genetic and lifestyle contributions that modify risk assessment, as well as integrating clinically relevant biomarkers associated with oxidative stress, inflammation, and/or genotoxicity. Herein, we focus on robust biomarkers of recent smoke exposures and future perspectives aimed at implementing effective mitigation strategies for workplace protection of firefighters.