Transcription:
Tips for Managing Your Asthma in Cold Weather

Amanda Wilde (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.

This podcast is sponsored by UM Capital Region Health, the largest healthcare provider in Prince George's County; dedicated to enhancing the health and wellness of the community by providing high quality accessible patient care. UM Capital Region Health, changing up health care in Prince George's County.

Today, we'll talk about managing asthma in cold weather with Dr. Sunil Swami, Pulmonologist at UM Capital Region Health. I'm Amanda Wilde. Doctor, great to have you here. First, is it true that cold weather triggers asthmatic flare ups?

Sunil Swami, MD (Guest): This is true. Asthma has many triggers depending on the type of asthma that you do have. What asthma is, is a chronic lung condition that affects the airways and a hallmark feature of asthma is inflammation within the airways that narrows the bronchial tubes over time. And this leads to airflow obstruction, which can lead to air trapping in the chest, which causes a sensation of being short of breath.

Another feature of asthma is bronchial spasm. So, the large and medium size airways will spasm in response to a trigger. And this can cause acute symptoms like cough, wheezing, chest tightness, or shortness of breath. So, cold weather is one trigger that can cause these symptoms and have a person to have an asthma flare up.

Host: So, what kind of precautions can someone take who has asthma in the winter?

Dr. Swami: So, in the winter time, generally we ask our asthmatics to adhere to their controller medication. And the guidelines for asthma have changed recently. Before we used to prescribe something called a bronchodilator or albuterol on an as needed basis for mild asthma. Now those guidelines have changed and we started to add on inhaled corticosteroids, on an as needed basis as well. So whenever an asthmatic has symptoms, we ask them to use the steroid inhaler as well. And this is to control the inflammation within the airways. So, all of my asthmatics during the winter time, I'd tell them to take their controller medication and albuterol prior to going outside or prior to exercise. And another thing that people can do is to cover their face with a cloth, preferably a hypoallergenic cloth that doesn't have a lot of fibers that could also trigger their asthma. And this helps as well.

Host: You mentioned exercise, what types of exercises are best in the winter months for someone with asthma?

Dr. Swami: So, exercise in general, is good for asthmatics, regular exercise. The catch is that sometimes exercise can trigger asthma and there's something called exercise induced asthma. But this can be mitigated by taking your controller therapy on a regular basis. And taking your as needed inhaler or albuterol prior to exercise. We've looked at studies with deep breathing exercises, such as yoga, and this has proven to help control asthma symptoms.

Host: So, do we do those deep breathing exercises before, during or after other forms of exercise or, all three?

Dr. Swami: Right. No, so the deep breathing exercises, if you do them on a routine basis have been shown to control asthma symptoms. You don't necessarily have to do them prior to your regular exercise regimen. But one problem in the winter time is that a lot of people have to exercise indoors. And a lot of the time people have allergic asthma and the main cause of allergic asthma indoors is dust mites, sometimes pets, if you have a pet, cockroaches, if you have those, and other allergens that can be living in your carpet. So, wherever you're exercising indoors, you have to make sure that that area is clean.

Host: Did you say cockroaches?

Dr. Swami: I did. So, sometimes it's one of the major allergens within the household. Sometimes you can't see them and their excrement, which was pretty gross, can trigger asthma, but dust mites are very prevalent. And they're something that you can't see and dust mites tend to thrive in humid areas. So, if you have a humidifier, we generally recommend against that with our asthmatics, because dust mites tend to survive in humid areas and they survive with the moisture in the air. And if you have a humidifier near you, especially where you sleep, you're kind of propagating these dust mites to survive, and these are a major allergen that can trigger asthma.

Host: So, don't use humidifiers. That's not good. It may even help facilitate a flare up, it sounds like.

Dr. Swami: That's correct. You know, and for two reasons. So, one reason is it helps dust mites thrive. The other reason they're very hard to keep clean and they tend to develop mold inside of it. So, once even a little bit of mold develops inside of a humidifier, that can propagate an asthma flare up.

You may think you've cleaned it out, but it always comes back. So, those are the two main reasons we advise against humidifiers, especially where you sleep. In your AC unit, we generally advise to keep the humidity less than 50%. If it's between 35 and 50%, the less chance of these things happening.

Host: So, in terms of managing your personal environment, those are some things you can do. Are there any other climactic conditions that could make someone with asthma, more prone to symptoms or flare ups?

Dr. Swami: Sure. So, basically any type of severe weather, so very cold weather can flare up your asthma and very hot and humid weather can flare up your asthma. So, it's even mentioned in the literature of thunderstorms and that has to do with humidity as well. And these things can trigger the airways to go into bronchospasm.

But generally if you manage the asthma with your controller therapy and the patient adheres to their controller therapy, these things tend not to happen, but I do advise during severe weather, whether it be very hot or very cold, to try to avoid going outside during those times. But to definitely take your controller therapy, if you have to.

Host: So, those are some good preventative measures. Any other tips for managing a lifelong condition like asthma, whether it's cold weather or otherwise triggered?

Dr. Swami: It really depends on what the trigger for asthma and allergic asthma is the predominant type of asthma. And in the DC Metro area, we have a lot of plant life. So, it's hard to get away from that. So, we use inhaled steroids and in conjunction with antihistamines and nasal steroids to control asthma in these patients. But in general, a healthy diet, lots of fruits and vegetables. Vitamin D is also associated with more control of asthma, if your vitamin D levels are adequate, and plenty of exercise, but with exercise that catches you have stay on your regimen and pre-medicate prior to exercise.

Host: Are there any other takeaways you'd like to share with our audience?

Dr. Swami: Just follow up with your pulmonologist frequently. Asthma is a variable disease, it can change over time. Sometimes it can present just as classically wheezing or shortness of breath and then it can change the course and just manifest as a cough. So, it's important to know what your triggers are.

And it's important to know when to use your rescue inhaler and you need close follow up with the pulmonologist to assess your lung function. I had a state trooper one time, who's very fit, probably 6' 4" 250 pounds, was a state trooper for about 20 years and came in. To me, he was very short of breath, all of a sudden, lifelong non-smoker and he had never thought that he had asthma. And then we did lung function testing on him and we looked at it and it looked like his lungs, of a person who had been smoking a pack a day for 30 years.

And what had happened was he had had asthma. He had allergic rhinitis, ever since early adulthood and just really ignored his symptoms. And his main symptom was cough so he would be coughing intermittently, more so during the spring and fall, but just was very busy and ignored his symptoms until he had so much airway inflammation and obstruction that he really felt short of breath.

So, the takeaway from that is don't ignore your symptoms. If you have a cough lasting more than six to eight weeks, please get checked out. And see what the reason is for that cough. But we got him on therapy and he was able to get back to his normal life and continue working with no problem.

Host: Yeah. And these days a cough is something everyone's paying attention to.

Dr. Swami: Correct. Yes. A lingering cough can sometimes be a more serious matter. If it's longer than six to eight weeks, it should be worked up.

Host: So that's a good preventative measure too, is just, if you find something that's not right, follow up on that and don't ignore it. Also know our triggers. Do deep breathing, reduce allergens. Don't use the humidifier, avoid inflammation, have a healthy diet, take vitamin D, exercise and don't hesitate to stay in close touch with your pulmonologist.

Dr. Swami: That's correct. That sounds good to me.

Host: And thanks for the tips. It's definitely sure to make winter and other seasons go more smoothly. And that's what it's all about. Thank you Doctor for your time.

Dr. Swami: Thank you. Thank you for having me.

Host: Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.