How to handle asthma during the winter months

Many people with asthma find their symptoms get worse in the winter months. So how can asthma be managed as the days get colder, and what can you do to avoid triggers?

It's natural to feel a bit of trepidation as winter approaches. As the days get colder, darker and gloomier, many of us would secretly prefer to hunker down and hide away till spring.

However, if you suffer with asthma you may be feeling this more than most. Many people find their asthma symptoms get worse during the colder months, meaning you might be dealing with irritated airways on top of all the usual seasonal bugs and wintertime blues.

Although not all asthma sufferers have the same triggers, a seasonal pattern to your asthma is very common. A 2014 study found that hospital admissions for asthma increased during the winter months, while some research from Asthma UK found that December and January are the deadliest months for people with asthma.

Even if your symptoms aren't too severe, you may find the seasonal change affects your quality of life. In one study from chilly Sweden, two thirds of asthma patients said the cold was a factor in causing breathing difficulties, while over a third avoided going out during the winter.

Why does asthma get worse in the winter?

"Asthma is an inflammatory condition made worse by triggers that make your airways oversensitive," explains Dr Jeff Foster, medical director at H3 Health. "Walking from a hot room to the cold air outside can make asthma worse - it triggers your smaller airways to tighten as they try not to let that nasty cold air deep into the lungs. However, the asthmatic lung inappropriately tightens, which can trigger an attack."

Cold air can also prompt the airways to produce histamine - the same hormone released during allergic reactions - which can trigger a bout of wheezing. In addition, the body is likely to ramp up its production of mucus, in an attempt to create a warm environment and filter the air entering the lungs.

"An increase in mucus can make asthma feel worse," says Abbas Kanani, pharmacist at Chemist Click. "Colds, flu, and chest infections are also more prevalent during the colder months. Symptoms include a stuffy nose, cough, inflamed airways, and a general increase in mucus production, all of which can exacerbate symptoms of asthma."

Staying in all the time may not help either. Just being in a centrally heated house can be bad for asthma, as the heating dries out the natural moisture in the air, making it harder to breathe. Conversely, damp and mouldy environments produce spores, which can trigger asthma symptoms.

"People also tend to light fires, candles and other devices in winter - these are direct lung irritants and can be much worse for someone who has asthma," says Foster.

How to reduce asthma triggers

Before you despair (or book your one-way ticket to the Bahamas), be aware there are lots of practical ways of avoiding triggers and managing symptoms. The first step is to protect your airways from the cold, for instance by wrapping a lightweight scarf around your mouth.

It may also be wise to exercise indoors on very cold days. Remember, staying fit is really important for your overall lung function, so don't let the perishing weather be a reason not to break a sweat.

"When it is cold outside, try to breathe through your nose. Cold air is warmed as it makes its way from the nose through the throat, and then into the airways," adds Kanani.

If you have mould at home, you should try to deal with the cause (do you have leaks or an issue with condensation?). Opening doors and windows and using extractor fans can make a big difference, as can closing doors where condensation is likely.

"Dehumidifiers can also help, but make sure you use them at the right time when there is a high chance of condensation," warns Kanani. "Using a dehumidifier too often can dry the air, making asthma symptoms worse. If you spend time in your garden, clear leaves on a regular basis, as they are a hotspot for mould spores."

Regarding coughs and colds, you may not be able to avoid every bug that's going round this winter. But you can take precautions, such as washing your hands regularly and wearing a mask in crowded settings. It goes without saying you should also get the flu vaccine and COVID-19 booster - you are eligible for both if you have asthma.

"Asthma patients are at higher risk of severe asthma attacks and pneumonia if they get flu or COVID - but we can reduce the risk through a simple vaccine. Some asthmatic patients will be eligible for a pneumonia vaccine as well," says Foster.

Create an asthma action plan

Whatever the time of year, if you've noticed your asthma getting worse, now might be the time for an asthma review. Make a note of what's going on around you when symptoms occur and book a GP appointment to discuss your personal triggers.

"They can help you to manage your asthma action plan, to keep your asthma under control as best as possible. Asthma action plans lower the chances of experiencing an asthma attack," says Kanani. 

In milder cases, pharmacists can play a role too, for instance by helping you go through your inhaler technique, identify triggers, and offer advice on minimising flare-ups.

"Pharmacist prescribers are becoming more common, and you may even find that a pharmacist conducts your asthma review at your surgery," says Kanani.

Foster adds that asthma management has moved more towards prevention than relief. Your prevention inhaler (if you've been prescribed one) is your secret weapon during the winter months, making your airways less sensitive and lowering the risk of an asthma attack. You should also take your reliever inhaler with you wherever you go.

"If you are finding you are needing your reliever inhaler more than a few times a month you should really be seeing your doctor to get an asthma review," says Foster. "Also keep an emergency oral steroid and antibiotic pack at home if you are prone to chest infections. In the acute stage, if your inhalers are not working and you are still short of breath or wheezy, do not wait - seek medical help immediately."

The winter months may not be your favourite time of year if you have asthma. However, with the right asthma action plan in place, you have every chance of keeping symptoms at bay as the temperature plummets.

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