Climate change and human activities have drastically altered the natural wildfire balance in the Western US and increased population health risks due to exposure to pollutants from fire smoke. Using dynamically downscaled climate model projections, we estimated additional asthma emergency room visits and hospitalizations due to exposure to smoke fine particulate matter (PM2.5) in the Western US in the 2050s. Under the ICLUS A2 population scenario, we estimated the smoke-related asthma events could increase at a rate of 15.1 visits per 10 000 persons in the Western US, with the highest rates of increased asthma (25.7–41.9 per 10 000) in Idaho, Montana, Oregon, and Washington. Estimated healthcare costs of smoke-induced asthma exacerbation to be over $1.5 billion during a single future fire season. Open access article link here.