In North America, over 5000 persons die or are injured by residential fires. Rarely do casualties result from major burns and their consequences but mostly from smoke inhalation. This is an under recognised problem in which particulate matter are absorbed by the bronchoalveolar tree and injure normal mucosa in a process similar to irritant gases. Acute exposure to steam and heated soot suspended in air at 350 to 500 degrees causes injury by transfer of heat to the respiratory tract. Cyanide and carbon monoxide are often thought of the main culprit for this syndrome but neither is irritating to the lungs in nature and cause toxicity by other mechanisms. These poisons can be secondary insults to a smoke injury and should be at least suspected in every case to determine the likelihood of their presence.

Hantson P, Butera R, Clemessy J, et al. Early complications and value of initial clinical and Para clinical observations in victims of smoke inhalation without burns. Chest. 1997;111:671-675.
Park GY, Park JW, Jeong DH, Jeong SH. Prolonged airway and systemic inflammatory reactions after smoke inhalation. Chest. 2003;123:475-80.
Reske A, Bak Z, Samuelsson A, Morales O, et al. Computed tomography - a possible aid in the diagnosis of smoke inhalation injury? Acta Anaesthesiol Scand. 2005;49:257-60.