Wheezing in a Winter Wonderland

Q: In the wintertime, I often get an asthma attack when it's cold and when I exercise. Why do my lungs respond to cold weather with an asthma attack? How can I be active outdoors without suffering from an attack?

A: Sounds like you may have two breathing concerns: cold air-induced bronchospasm and exercise-induced asthma (EIA). While the specific reason why winter air triggers asthma symptoms in certain individuals is not proven, it is thought the cold and dry air irritates the airways, resulting in a constriction and narrowing of the very passages that allow airflow into your lungs. Adding exercise to this impairment further strains the ability to breathe normally in those affected by exercise-induced asthma, leading to more airway spasm. Fortunately, the proper preventive measures and a personalized asthma action plan can greatly increase your ability to enjoy your winter outdoor activities.

Asthma is a condition that causes the airways in the lungs (bronchi) to become narrow due to spasm and inflammation. This results in hyper-reactive airways that tighten up when exposed to certain triggers (exercise, cold/dry air, pollutants, stress, others), as well as a further blockage due to an increased production of thick mucous. As a result, less air is able to get into the lungs and breathing is impaired. Common symptoms include:

• Coughing, especially during or right after exercise or exposure to cold
• Wheezing, which is like a whistling noise when you breathe
• Chest tightness and an inability to take a deep breathe
• Chest congestion
• Shortness of breath
• Limited exercise endurance

In situations such as yours, the cold winter air often triggers asthma flares within five to 15 minutes after outdoor exercise has begun. At the very least these symptoms are bothersome, but at their extreme worst they can lead to severe breathing problems and even death. That being said, please know there are many measures you can take to prevent, or at the very least, greatly decrease the amount of asthma flare-ups you experience during this winter exercise season. These include but aren’t limited to:

• Consulting a doctor very experienced in the diagnosis and management of asthma. Family doctors, allergist/immunologists, sports medicine, internists and pulmonary specialists may all be well-trained in this area. For asthma types such as yours, you may be prescribed several classes of medication, including one to prevent or control the inflammation of your airways, as well as one to quickly halt the symptoms once they occur.
• Taking your asthma medications as directed. When used properly they can prevent many attacks from occurring.
• Always carrying your rescue medications (albuterol, others) in case of an unexpected asthma attack.
• Warming up indoors for 30 minutes prior to any cold weather outdoor activity. This may decrease the chances of exercise-induced airway narrowing for several hours.
• Minimizing outdoor exercising along busy roads or in areas where outdoor pollution can further irritate your symptoms.
• Exercising indoors if possible. If exercising outdoors, please use a scarf to cover your nose and mouth so that the air entering your nose and mouth remains warm and moist and doesn’t cause the airways to spasm. There are also specially designed heat exchanger masks that warm up the cold air (available in some sporting goods or medical supply stores) and may decrease the risk of asthma triggered by cold air.
• Avoid using wood stoves or wood fireplaces, as particles given off can irritate the airways and lead to even more cold weather airway sensitivity.
• Taking a preventive dose of asthma medication (albuterol, others) 30 minutes before exercising or going outdoors.
• Quitting smoking. These products are bad for everyone, especially those affected by asthma.

It is also important to speak with your physician regarding the influenza vaccine. As long as you are medically able to receive it, the flu shot may help to reduce your asthma flares during the winter flu season.  Lastly, with a little work and dedication (remembering to take your medications), regular health check-ups, and the ability to recognize and treat the early symptoms before they get out of hand, this winter season will be yours to enjoy.

Find More on MSN Health & Fitness:

• Do You Get Asthma Attacks When It's Cold Outside?
• Breathing Lessons: Rowing Across the Atlantic with Asthma
• Reducing Asthma Triggers in Your Home
• Adults Have Asthma Too
• MSN Health Centers: Asthma

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)