How cold air affects asthma

A winter wind whips your face. What do you do? Probably squint and tear up because cold air dries out and irritates the delicate tissue of the eyes. Asthmatics can have a similar reaction in their lungs, one that literally takes their breath away. Cold, dry air irritates hypersensitive lungs that have become inflamed, causing bronchospasm. The muscles around the irritated bronchial tubes constrict and become even more narrow, making it difficult to breathe. An increase of mucus in the lungs also limits breathing, resulting in wheezing, coughing and tightness in the chest.

Dr. Mark Greenwald, vice president of the Asthma Society of Canada, notes that even non-asthmatics can feel their breath catch in a frosty gust on extremely cold, dry days. “That’s what the asthmatic feels, but it’s triggered much easier and by air that’s not as cold.” He reminds, however, that with proper treatment, the asthmatic should be able to do everything the non-asthmatic can. “Be very aggressive with your asthma control,” he says.

What should you do about cold air and asthma?

• You don’t want to stay inside all winter: if you are experiencing symptoms from the cold, speak to your doctor soon about altering your medication plan.
• Wear a scarf loosely over your nose and mouth and breathe through your nose to warm and humidify the air you breathe. (This is easier on asthmatic lungs, reducing the likelihood of irritation.)
• Keep your inhalers close to your body, since warm medication is more easily distributed into the respiratory system.

Exercise and asthma

Greenwald points out that about 20 per cent of the Canadian Olympic team has asthma, and if they can handle strenuous workouts, you can exercise, too! It’s a question again of managing your asthma medication plan.

Be aware that if you have Exercise Induced Asthma (EIA), it can flare during the winter (even if controlled the rest of the year). This is due to the fact that when people exercise, they often breathe through their mouths rather than noses. When the air is cold and not warmed in the nose, that can irritate sensitive lungs. In a 2001 study, British researchers found that 70 per cent of asthma patients had symptoms triggered by a combination of cold air and exercise.

What should you do about exercise and asthma?

• Choose indoor activities like swimming or basketball if you find your symptoms are increasing outdoors.
• Speak to your doctor as soon as possible. He/she may suggest an increased dosage in your controller/preventive medications during the winter, or add a reliever medication to your routine. Then get out and ski or skate.
• Be sure to warm up and cool down slowly with vigorous activity.

Indoor allergens and asthma

Studies in recent years have found that the air quality inside the average home is up to five times worse than that outside. And North Americans spend about 90 per cent of their time indoors during the winter.

Besides increasing exposure to asthma triggers such as chemicals and fumes from cleaning products, a building sealed tightly against the cold also provides an ideal environment for mould and dust mites. Add pet dander or cigarette smoke and asthma problems are compounded.

What should you do about indoor allergens and asthma?

• The best defence is a clean house. Use a HEPA-filtered vacuum on furniture, drapes and floors, and dust with a damp cloth.
• Never let anyone smoke in your home.
• Never let anything smoke in your house either: sorry, no fire in that fireplace.

Cold and Flu – Added Aggravation for Asthma

“Asthmatics are more reactive to colds,” Greenwald says. In a study of students in Denver, published in 2004, researchers found that an upper respiratory infection doubled the likelihood that a child would have a full-blown asthma attack, and quadrupled the chance of a general increase in symptoms. Statistics Canada research shows colds and chest infections are the most common trigger for more than 80 per cent of asthmatics.

What should you do about colds and flu and asthma?

• Prevent colds and viruses by washing your hands frequently and keeping your distance from infected friends and co-workers.
• If you do get sick and your asthma symptoms worsen, ask your doctor about adjusting your medication.
• The good news: though still in early stages of research, British scientists found that a drug developed to treat multiple sclerosis also inhibits the replication of cold virus cells in the lungs of asthmatics. This group usually has a higher rate of replication than non-asthmatics.

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Be In Control of Your Asthma

If your asthma is under control, you should not be experiencing symptoms – even on the coldest days or when exercising vigorously. Yet, about 60 per cent of asthmatics in Canada are not managing their disease well. Greenwald admonishes: “Everybody still relies on emergency treatment, and that’s not the way to go.”

So if you know the cold causes you grief, speak to your doctor, amend your asthma action plan, and breathe easy.

Related:
• 15 ways to clean up your home’s air
• The dangers of third-hand smoke
• 5 plants that clean your home’s air

Sources: Statistics Canada: National Population Health Survey; The Asthma Society of Canada, www.asthma.ca; the Asthma and Allergy Foundation of America, www.aafa.org; the National Jewish Medical and Research Center, www.nationaljewish.org. the American Lung Assocation, www.lungusa.org; the Mayo Clinic, www.mayoclinic.com; and www.kidshealth.org. Facts reviewed by Dr. Mark Greenwald.

First published in Allergic Living magazine. © 2005 Copyright AGW Publishing Inc.

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Since being diagnosed with asthma when he was 4 years old, Brett Favaro has suffered pneumonia and bronchitis, asthma attacks, and been to numerous doctors. Now 22, he still has a nebulizer, a machine that delivers asthma medication in a fine mist through a facemask, in his bedroom.

But if you’re picturing a skinny kid, wheezing on the sidelines, you’ve got the wrong guy. Favaro was a competitive swimmer for 13 years, culminating with a stint as captain of the varsity swim team at Simon Fraser University in Vancouver. He’s also competed in cross-country running, taken tae kwon do lessons, and played basketball. Plus, he’s an avid weightlifter. Favaro says that with the support of his doctor, “I was able to do everything that everyone else did. I just had to be more mindful of my ability to breathe than other people.”

Growing up, Favaro achieved what experts say is possible for all asthmatic kids. “If they have good control, they can be competitive to any level,” says Dr. Brian Lyttle, a pediatric respirologist in London, Ontario. Good control usually means taking a corticosteroid (such as Flovent or Pulmicort) every day to reduce inflammation, minimizing exposure to triggers such as cigarette smoke and allergens, and having a fast-acting reliever puffer on hand in case of an asthma attack.

While exercise is important for everyone, it plays a special role for people who have asthma. “The better shape you’re in, the better your lungs function,” says Dr. Michael Clarfield, a sports medicine specialist and former team physician for the Toronto Maple Leafs. “When you’re getting diminished function from your asthma, the more function you had to start with, the better off you will be.”

Dr. Alan Kaplan, a doctor in Richmond Hill, Ontario who chairs the Family Physician Airways Group of Canada, looks at it this way: “Exercising will teach your muscles to learn to work with what you’ve got. So even if you do have lung impairment, it’s still important to exercise and to teach your muscles to be able to exercise even at lower oxygen levels.”

It’s not that asthmatic kids should ignore their symptoms and push themselves into respiratory distress; rather, with the right combination of medications, and in a supportive environment with minimal triggers, all kids with the disease should be able to reach their athletic goals.

Katherine Smith, 14, a Canadian whose family lives in Phoenix, has certainly not let asthma deter her athletic pursuits. A bout with pneumonia at age 1 left her with diminished lung function, and she also has bad seasonal allergies. When she was about 9 years old, her parents noticed she had difficulty breathing when she ran or played sports at school. “If she had to do anything that required any endurance, all of a sudden she was gasping for air,” says her dad, Doug Smith.

With the right medications and a good attitude, Katherine has thrived. She pitches for a competitive softball team that placed ninth out of 70 teams at last year’s U.S. national championships. “She treats the asthma meds as something ‘I’ve just got to do to prepare,’ ” says Smith, “like going to conditioning class, or to her trainer.”