Smoke inhalation injury causes severe morbidity and death. In the United States, the majority of fatalities from fire and burns occur because of inhalation of smoke. Medical treatment is only supportive; there is no known antidote to the damaging effects of smoke toxicants on pulmonary tissue. Without question, minimization of the morbidity and mortality that are caused by smoke inhalation is best accomplished by prevention of the injury. Effective prevention programs depend on a thorough and detailed understanding of the mechanism of damage caused by smoke, as well as of the available options for efficacious prevention. This summary presents details of smoke production from structure fires, the effects of smoke on physiology, and the devices currently in use to prevent damage and death from smoke.