Breathe Easily: Winter Asthma Advice

People with asthma need extra TLC during cold and flu season. WebMD goes to the experts for advice on staying healthy all winter long.

From the WebMD Archives

As winter weather rolls in, so do colds and flu. But for those with asthma, it can be an especially stressful time of year because even a simple cold virus can trigger a major asthma event.

"In asthma, the lungs are already irritable and more reactive. So any virus that impacts the lungs has a propensity for creating more problems, including bringing on an asthma event faster and easier than many people realize," says Jonathan Field, MD, director of the Allergy and Asthma Clinic at NYU Medical Center/Bellevue Hospital in New York City.

And that, experts tell WebMD, is more likely to happen during the fall and winter months. In one study published in the Journal of Allergy and Clinical Immunology in 2005, researchers identified what they came to call the "September epidemic," an upswing in the number of children admitted to emergency rooms for the treatment of acute asthma symptoms in the fall months.

The study concluded that one reason behind the increase was the start of the school season -- and a greater exposure to cold and flu viruses.

While you or your child may not be able to avoid these exposures, there are ways to stay safe and healthy. Among the most important: Take control of your winter asthma symptoms before other problems occur.

This simple tenet is so important that in new guidelines set down by the National Heart, Lung and Blood Institute (NHLBI) in August 2007, doctors put special emphasis on the need to encourage better day-to-day symptom control.

"Asthma affects over 22 million Americans, including 6.5 million children, but there is one truth: Asthma control is achievable for nearly every patient ... As health care providers, we should accept nothing less," NHLBI Director Elizabeth G. Nabel, MD, said when the new guidelines were introduced.

A good way to gain control is to become more vigilant about taking your regular asthma medications.

"This is especially [important] in patients who have been noncompliant with their asthma regimens in the past," says Len Horovitz, MD, a pulmonary specialist at Lenox Hill Hospital in New York City.


Because many patients feel better in warm weather, by the time fall and winter roll around they may see less of a need to take the drugs designed to control their asthma symptoms. But this, says Field, is a huge mistake.

"If there is any time of the year to be more compliant about your medication, it's certainly the start of the winter season," he says.

The new NHLBI report recommends the use of daily inhaled corticosteroid medications to prevent problems in young children during cold and flu season.

Your Winter Asthma Action Plan

Another way to avoid problems -- during the winter or anytime -- is to create and stick to an asthma action plan. This is an organized system of care that can help you triage your symptoms in the event a problem does occur.

According to the American Lung Association, your plan should include not only a list of the asthma triggers you need to avoid, but also the specific symptoms you need to be on the lookout for, such as coughing, wheezing, or shortness of breath.

The plan should also list your regular medications, the symptoms they control, and most important, what to do and what to take in the event of an asthma emergency.

"You should always have on hand one or more fast-acting medications, drugs you know you can take for immediate relief," says Field.

You should also make a habit of using your peak flow meter. This is a device designed to monitor how well your asthma is doing. It measures your ability to forcefully expel air from the lungs, and experts say using one regularly can help you head off a potential crisis regardless of the season.

"By remaining aware of your peak flow meter readings on a regular basis, you will know when you are headed for trouble before you get there. And that means your doctor can prescribe additional medications, such as steroids, to offset any major asthma events before a cold or flu has a chance to take hold," says Susan Zafarlotfi, PhD, clinical director of the Breath and Lung Institute, Hackensack University Medical Center in New Jersey.


The American Lung Association also advises patients to classify their peak flow meter readings and their symptoms into three zones -- and use them as a guide to determine how well your asthma is under control.

The three zones are:

  • Green Zone: Peak flow reading of 80%-100% of your usual "personal best" peak flow reading. The green zone indicates good asthma control.
  • Yellow Zone: Peak flow reading of 50%-80% of your usual peak flow reading. This indicates that your asthma control is not optimal. You may or may not notice symptoms such as cough or wheezing. Your asthma needs to be addressed according to the asthma action plan set up by you and your doctor.
  • Red Zone: Peak flow reading of less than 50% of your usual reading. This indicates poor asthma control needing rescue medications. Make sure to follow your asthma plan regarding use of rescue drugs and seeking medical attention.

Particularly during cold and flu season, the American Lung Association recommends that you strive to remain in the green zone and contact your doctor as soon as you begin dropping into the yellow zone.

Asthma and Cold Medicines: What You Should Know

If you do find yourself with a cold or the flu, there is an abundance of over-the-counter medications that can help. But experts advise asthma patients to take some extra precautions and talk to their doctor before deciding what treatment to use. The reason: some over-the-counter medications can be harmful.

"Decongestants, for instance, can cause palpitations when used with bronchodilators [a standard asthma medication], and even anti-inflammatory drugs other than acetaminophen may cause additional asthma symptoms," says Horovitz.

Field adds that you might want to avoid all cold medicines containing pseudoephedrine, a common ingredient in decongestants and multi-symptom products.

"There are some studies to show it may dry out the passages, and though it's still a matter of debate, there is definitely some data showing that this effect may lead to a worsening of asthma symptoms," he says.

Pharmacy professor Nick Popovitch, PhD, agrees. "When you have asthma, you don't want to use anything that could impact air passages in a negative way. You don't want to use any drug that has a drying effect, because hydration is key for controlling symptoms," says Popovitch, a professor of pharmacy administration and a department head at the University of Illinois at Chicago College of Pharmacy.


So what, if anything, can you safely use? Both Field and Popovitch suggest talking to your doctor about local treatment with a nasal spray. Field says if your doctor agrees, you can try either a decongestant nasal spray or a plain saline nasal spray for relief.

Horovitz favors home remedies like a vaporizer or humidifier to hydrate the air and help make breathing easier.

Perhaps most important: All the experts WebMD talked to warn never to depend on any cold or flu medicine to control your asthma symptoms.

"Your regularly scheduled asthma treatments remain the backbone plan for keeping symptoms under control. Think of it as wearing a seatbelt or tying your shoes. And they should not be skipped or missed, regardless of what else you may be doing to treat your cold or flu," Field says.

Winter Asthma Rescue Remedies

Even if you follow all the rules, a cold or flu can still cause asthma symptoms to spin out of control. For this reason, it's essential to be prepared with a rescue emergency kit -- and know how to use it.

"For patients with asthma, the weakest time is usually between 3 and 4 in the morning. So if you have a cold or the flu, it's essential that you keep a rescue inhaler next to your bed and know how to best use it for your symptoms," says Zafarlotfi. The inhaler can contain any number of fast-acting medications that work immediately to open up the airways and make it easier to breathe.

She also advocates talking to your doctor about other types of medications, such as corticosteroids, that can be used in an emergency, and whether or not you need to have those on hand during cold and flu season.

Field also suggests talking to your doctor about using a nebulizer treatment before bedtime. This is a device that changes liquid asthma medication into a fine mist so it can be easily inhaled. If a cough is keeping you up a night, he says a nebulizer treatment before bedtime can open the lungs and help you feel more comfortable.


Finally, experts tell WebMD, you may also find some measure of relief via natural cold and flu remedies, including hot tea with honey, a bowl or two of chicken soup, drinking plenty of fluids (non-alcoholic), and sleeping with your head elevated.

"But regardless of what you do," Field adds, "if you don't see an improvement within 48 hours, if cold symptoms worsen, or if your asthma symptoms are increasing, don't wait -- call your doctor."

WebMD Feature Reviewed by Louise Chang, MD on November 13, 2007


SOURCES: Jonathan Field, MD, director, Allergy and Asthma Clinic, NYU Medical Center/Bellevue Hospital, New York City. Len Horovitz, MD, pulmonary specialist, Lenox Hill Hospital, New York City. Susan Zafarlotfi, PhD, clinical director, The Breath and Lung Institute, Hackensack University Medical Center, New Jersey. Nick Popovitch, PhD, professor, and department head, University of Illinois at Chicago College of Pharmacy. News release, National Heart, Lung and Blood Institute. American Lung Association web site: "Asthma Action Plan." Johnston, N., Journal of Allergy and Clinical Immunology, January 2005; vol 115: pp 132-138. University of Pittsburgh Medical Center web site: "Asthma Treatment Options."

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