Winter can be an especially challenging time for people with asthma, a condition that makes breathing difficult and affects more than 22 million adults in the U.S. Respiratory viruses, like the flu, COVID, RSV, and rhinovirus (the cause of most common colds) increase in colder months, causing inflammation in the lungs and airways. And when we hunker down inside and close the windows, a host of other allergens in the home — triggers like pet dander, house dust, and mold — can worsen ongoing asthma symptoms.

Health Matters asked Dr. Canfield for his insights about the challenges winter poses and tips for controlling asthma symptoms.

“The foundation for a healthy winter season is establishing a routine asthma plan to ensure you know what to do with whatever mother nature has in store,” says Dr. Stephen Canfield, an allergist and immunologist at NewYork-Presbyterian/Columbia University Irving Medical Center. “With a little planning, and good communication with your asthma health care provider, winter and all its potential respiratory challenges doesn’t have to pose a threat.”

Triggers of Asthma in Winter

There are several reasons why winter is particularly challenging for those who suffer from asthma.

• Infection: The biggest trigger in the winter is infection. “Vaccination against the season’s anticipated variants of both influenza and COVID-19 represents one of the most protective steps against severe illness,” says Dr. Cranfield. “The pneumonia vaccine is also highly recommended if you have asthma.”
• Cold, dry air and low humidity: The nose functions to warm and humidify the air we breathe in, so breathing cold air through your mouth rather than through your nose can also cause the airways to cool quickly, potentially resulting in irritability (cough) and bronchospasm (tightening of the airways). Rapid, heavy breathing, such as when you exert yourself while exercising or shoveling snow, can then exacerbate asthma.
• Allergies: “Getting allergy tested and the advice of an allergist on ways to minimize exposure to allergens can be helpful,” says Dr. Cranfield.

How to Prevent Winter Asthma Flare-Ups

To help combat the challenges that asthma sufferers face in the colder temperatures, Dr. Cranfield shared these steps:

• Have an asthma action plan: Partner with your physician to ensure that your asthma is under good control, especially as we head into the colder months. Have an asthma action plan in place so you know how to escalate your treatment regimen right away should you develop more symptoms.
• Bundle up: When you go out on cold, blustery days, consider wrapping a scarf over your nose and mouth to aid in warming and humidifying the air you breathe. A good face mask also works well.
• Winter-proof your home: There are specific things you can do around the house to limit your exposure to allergens, such as avoiding excessive humidifying and ensuring proper ventilation. If you have a dust allergy, be aware of dust allergen “reservoirs” at home: high pile carpets, quilts, throws, comforters, pillows and mattresses. Washing in hot water where possible reduces allergen levels, and encasing in allergen-proof covers (especially mattress and pillows) can be very effective. Also: Reduce clutter! (It accumulates dust.)
• Avoid spreading viruses: In addition to getting vaccinated, follow basic safety measures to lower the risk of transmitting viruses. If you have to cough, cough into the crook of your arm, and ask your friends and colleagues to show you the same respect. What’s more, regularly wash your hands with warm, soapy water or use hand sanitizer. Keep a distance from people who appear to be ill.
• Be cautious with physical exertion: If you have to perform physically demanding tasks outdoors in cold air, consider using your albuterol inhaler 15 minutes prior to going out to minimize any symptoms that may result from exertion in the cold. And if you do regularly exercise outside, try switching to an indoor routine to avoid the harsh cold air entering your airways.

When to Seek Care

Managing asthma with medication and avoiding triggers can go a long way in preventing asthma flare-ups. If you feel like your asthma is out of control, contacting the doctor is a good idea because the symptoms can go from bad to worse.

“It’s important to be able to recognize when your symptoms may be beyond your own management,” says Dr. Cranfield. “In that setting, seek urgent medical attention in accordance with your agreed upon asthma plan.”