Gabrielle Wenman is used to spending her long Australian summer holidays outdoors – swimming, walking and doing anything but being locked up inside.

This summer has been different. To go outside in vast areas of Australia this summer has been to step out into a world with an obscured skyline, a red sun, the inescapable smell of smoke, and heavy air.

Many, like Wenman, have spent their summer break largely indoors.

Asthmatic teacher Gabrielle Wenman has spent her summer break mostly indoors. Photograph: Mike Bowers/The Guardian

“It’s supposed to be my biggest holiday of the year and I don’t feel like I’ve really done anything,” the Sydney high school teacher says. “It’s really impacted the way I’m sort of going about my usual business.”

The ongoing bushfire crisis in Australia has left large parts of the east and south of the continent blanketed in smoke for days on end over the past few months. Sydney, Melbourne and Canberra have reported some of the worst air quality in the world.

“I’ve got a constant asthma cough and I’m constantly breathless, and my throat is really impacted as well,” Wenman says.

People on their morning commute are now checking the air quality ratings on their phone. All of a sudden everyone is discussing safe PM2.5 levels.

PM2.5 particles are particles in the air like smoke that are less than 2.5 micrometers in diameter, and are small enough to be breathed into the lungs. They can make it difficult for people to breathe, particularly those with asthma or other related respiratory issues.

“Those particles are small enough to get to the smallest airways that participate in gas exchange in the lung,” Prof John Wilson, the president-elect of the Royal Australian College of Physicians and a respiratory physician at the Alfred hospital, says.

“The increase in load of particulate matter in the distal airway is associated with an increase in presentations to emergency departments by people with established lung disease and advanced cardiac disease.

Slovenia’s Dalila Jakupović during the coughing fit that forced her to retire during her Australian Open qualifying match. Photograph: ESPN

“There’s also evidence that mortality is increased on days for which there is significant air pollution.”

Melbourne this week experienced two hazardous rating days of smoke. Horse racing events were cancelled, public pools and gyms were closed. At the Australian Open qualifiers, Slovenia’s Dalila Jakupović suffered a coughing fit halfway through her qualifying match against Switzerland’s Stefanie Vögele and was forced to retire.

The defending men’s champion, Novak Djokovic, has suggested delaying the flagship tennis tournament given the smoke conditions.

Protective P2 face masks are in short supply, with shelves at the Bunnings hardware stores in and around the Melbourne CBD sold out this week. Some have taken to ordering more high-end fashionable masks online.

Bunnings has sold out of P2 masks across Melbourne and don’t know when they’ll get new stock. I have heard reports that they’re prioritising fire effected areas (1/2) pic.twitter.com/kpU1Jcva89 — Joshua Badge (@joshuabadge) January 13, 2020

Wenman says that, before the current crisis, she never thought to check the air quality index. Now she has an app on her phone for it and it determines whether she feels she can step outside.

“Since the bushfire crisis it’s become a frequent occurrence,” she says. “I check it not only in the morning but throughout the day as well.”

At the fire fronts, it’s even worse. Some firefighters have been in the field for close to three months this fire season. Although there is some protective face masks, the masks are less effective at the frontline and the extended fire season is taking its toll.

You wake up feeling like your chest has been stomped on, coughing up crap all the time. Greg Hodges, volunteer firefighter

“The whole of Sydney is whinging about fucking smoke all over the town and how bad it is, but not one of them gives a second thought about us trying to put the fires out,” Greg Hodges, a volunteer firefighter and the strike team leader, says. “I’m a smoker anyway but you wake up feeling like your chest has been stomped on, coughing up crap all the time. I’ve got guys who aren’t smokers who are coughing like they’ve been smoking 20 years.”

Asthma Australia has been conducting a survey during the bushfire crisis on the impact of the smoke on people with asthma, and in the few weeks it has been running has received close to 12,000 responses.

Hospital admissions have been relatively low, with just two reported at the Alfred in Melbourne this week so far. The majority of people with asthma turn to their GPs.

There has been a doubling in ambulance call-outs in Victoria. At the peak of the poor air quality in Melbourne this week, Ambulance Victoria said it had made 167 breathing-related callouts in one day to 4pm, compared with the usual average of around 88 per day to 4pm.

Two people so far have been reported to have died from breathing issues that have been associated with the smoke this bushfire season – an elderly woman who stepped off a plane in Canberra during the worst of the days in the capital, and a 19-year-old Glenn Innes woman, whose family said she suffered an asthma attack in bed.

Greg Hodges says firefighters have been coughing like they have been smoking for 20 years. Photograph: Jessica Hromas

Asthma Australia has called on the federal, state and territory governments to implement real-time and consistent air quality reporting for PM2.5 and 10 nationally. There is currently an inconsistency between the states over how frequently air quality reports are updated. Some only update once a day, while Tasmania and Victoria report hourly averages.

The federal government is poised to launch a national inquiry into the bushfires, and the states have also flagged their own potential reviews after the bushfire season is over.

There have been dozens of reviews related to the government response to bushfires in the past, but little focus on the short and long term impact on people breathing in bushfire smoke.

Wilson says the reviews should be a starting point for research into the impact of smoke.

“We do have an enormous gap in knowledge in terms of the cause of these symptoms and what appropriate prevention we can enact,” he says. “For some time there has been speculation that exposure to particulate carbon and carbon products emanating from fires may have more serious health consequences than worsening asthma and emphysema.”

Wenman says she would like to see the government make it easier and cheaper to buy asthma medication. While Ventolin can be bought over the counter for $8, she is spending around AU$84 a month at the moment on preventer puffers, which require a prescription from a GP.

“I think it would help asthmatics a lot more if medications were more easily accessible,” she says.

Wenman returns to school later this month and says she is concerned about her health, and the health of her students if the smoke is still lingering.

“It was a real challenge for me as a teacher going into work when the smoke was particularly bad,” she says. “I had to make sure I changed all my classrooms to airconditioned rooms just to get that airflow through – that’s disruptive when you’ve got to move your students.

“I know a lot of parents are feeling that anxiety about sending their kids back as well.”