Chocolategravy
First Post
Exhaustion is probably the greatest, and I like @Hand of Evil's idea for using the Poisoned condition.
You might make a new version of the suffocation rules -- something along the lines of "Every round you are holding your breath and engaged in strenuous activity, make a DC 10 Con save. Failure means you are forced to take a breath and suffer the effects of whatever you breathe in."
And the smoke, when breathed in, causes whatever effects you like -- Exahsution, poison, some level of stunning/nauseation/slow, whaver feels right to you.
Can't really use saves which benefit from proficiency which why I went with ability check. A character can too easily turn a DC 10 save into "anything but a 1" and since you've hit the bound you get the problem of potentially failing in 1 round or having a high chance of being many many rounds, which isn't desirable behavior. Also it doesn't really make sense for levels (proficiency etc.) to give you breath holding ability.