We haven’t had much of a winter in the Midwest, but the air is still dry enough to cause “winter” asthma. Today I would like to discuss how clinicians can provide evidence-based care for their patients with asthma by advising them on how to control asthma during the cold winter months. Today’s discussion is based on the National Asthma Education and Prevention Program’s Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
- Extreme temperature changes during the winter can wreak havoc on patients with asthma. Inhaling cold air, especially during physical exertion, can cause drying of the airway and bronchospasm in patients with asthma.
- This can result in dangerous episodes of coughing and shortness of breath. Often symptoms occur minutes after exposure.
Patients may recognize that coughing and shortness of breath are a result of exposure to cold air. However, they may not understand that there are ways for them to reduce these adverse reactions to the cold.
Educate your patients about ways to deal with their asthma in cold weather.
- Teach your patients to shield themselves from the cold air with a scarf, turtleneck, or jacket collar. Covering one’s mouth (and nose when possible) with a scarf will help to warm the inhaled air. Warming up before exercise and cooling down for at least 10 minutes after heavy exercise by walking or stretching can also help.
- Every use one of these for outdoor activity when it’s cold?
Most important, as their physician, explain the proper use of medication. All patients with persistent asthma (patients having any asthma-related nighttime awakenings or having daytime symptoms more than twice a week) should be on a controller medication, usually an inhaled corticosteroid. These should be taken daily, not just as needed.
The controller medication can be supplemented by the use of a short-acting beta-2 agonist inhaler before any outdoor activity in cold weather. It is better, however, to control the underlying airway inflammation and reactivity with a controller medication.
And remember: This is the time of year to give your patients a flu shot. It’s not too late even in March. People with asthma are more likely to have serious health problems from getting the flu, yet most people with asthma don’t receive a flu shot every year. Flu vaccine is the first and most important step they can take to protect themselves from the flu.
Finally, the goal of good asthma care is for your patients to be able to enjoy life with as few symptoms as possible. Partnering with your patients through scheduled follow-up care can achieve that goal. Schedule regular follow-up visits. Assess control at each visit, beginning with a standardized questionnaire. Review the patient’s written Asthma Action Plan at each visit. Ask about asthma triggers and help your patients reduce or eliminate them. Review medications and be sure your patients understand how and when to use them.