Bushfire survivor Danielle Monks says some days her lungs are so bad she struggles to turn over in bed.
Over a year after surviving the deadly Kangawalla fire, she blames the thick, toxic smoke it generated for destroying her health.
"I have trouble walking any distance over 50 metres, 100 metres. I have difficulty just doing anything that even exerts myself," she said.
"I know it's definitely shortened my life, like it's totally changed what I can do and what I can't do."
New research published by the Australian Institute of Health and Welfare this week lends more evidence to the belief that the medical effects of the fires will last long after the blazes were extinguished.
Hospital emergency data collated by the Institute shows there was a major increase in presentations for respiratory problems during last year's bushfire season, compared with the prior year.
The effect was even more intense in communities like Armidale and Glen Innes, that had major fires burning nearby.
The research also showed there was a spike in sales of inhalers used to combat shortness of breath.
Research published earlier this year found about 420 people died as a result of smoke-related medical ailments across NSW. Just 33 people were directly killed by the flames.
Dorothy Robinson, an Armidale-based researcher and PhD who has long studied the effects of smoke, said governments need to do more next time to make people aware of the risks of high-particulate pollution.
The simplest step is just measuring it, she said.
Armidale is the only city in the region where there is a smoke measuring station.
Dr Robison said her research shows low-cost measuring equipment is good enough to be effective during a bushfire crisis, and they should be rolled out in every small community region-wide.
In Glen Innes, where there is not a monitoring station, an asthmatic teenager died last November, with her parents blaming bushfire smoke.
One way government could help is to "provide high efficiency particle air filters which can be had for a few hundred dollars," she said.
"As well as having the warning systems we need simple recommendations that people can take action on, like closing windows, [and] having low-cost filtration systems inside your house.
"The young person who died of asthma in Glen Innes, she had absolutely no idea that there was going to be a problem. And if she's been alerted and if she'd had a filtration system in her house, I would imagine things would have turned out completely differently."
The long-term consequences of bushfire smoke are not yet known.
But Ms Monks assumes her health is likely to get worse as the years go on. Two people died in her village of Wytaliba last year, but she said more will probably succumb to the smoke it created.
"The younger people seem to have handled it much better than the older people, the older people have noticed it so much, their lungs.
"I could die from this fire, but I didn't die in the fire."