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November 2009
Asthma in Winter
Dr Raja Dhar
Asthmatics are unable to draw in air, or breathe out, during a bout of asthma. The disease compromises the quality of life of about a 100 million people worldwide, who without optimal management of the condition, can even die.

Escalation of Asthma in Winter

Asthma is usually the culmination and combination of three individual but inter-connected conditions:
  • The airways become tight and swollen up from inside
  • The muscles go into a spasm or involuntary contraction
  • There is secretion of sticky mucus in the lungs

All these make the airway narrow and movement of air difficult. The reasons of escalation of asthma during winter lies in a number of factors, which may be variable from patient to patient.
  1. Effect of seasonal change: Thedrop in environmental temperature causes stress that is too much to handle for the sensitive airway of an asthmatic.
  2. The smog effect: Winter air is relatively heavier and sluggish due to low temperature. This heavy atmosphere results in lingering of the smoke and dust (which hangs heavy at lower level of the troposphere - the lowest level of atmosphere). When breathed in, this smog causes havoc in the airway of asthmatics.
  3. Pollen problems: The tiny pollen released in the air maybe a prominent source of asthma attack.
  4. Increase in infection: Winter brings in episodes of cold and cough, flu and fever. The upper respiratory infections manifesting like runny nose, sore throat etc may be quick to migrate to the lower respiratory tract, triggering an episode of difficult breathing.
Treatment Time
If you or anyone you know has asthma, make sure to visit the chest specialist before the winter sets in. In most instances, the doctor will adjust the medication so that the asthmatic is well protected for the season. Remember, the increased medication dose is to prevent those nasty asthma attacks, emergency visits, hospital admissions and help you breathe easier. Follow the prescription dutifully.

The Medicines
Preventive medicines (mostly inhaled corticosteroids) are to be used regularly to bring down the airway inflammation and improve the lung function. They have to be taken every day, even if there are no symptoms.

Reliever medicines are to be used on a need basis. If the asthma is triggered by certain allergies, you could be asked to take additional anti-allergic medicines. If the airway inflammation is severe and not adequately responding to inhaled steroids, your doctor might prescribe short (seven days) course of oral steroids (powerful medicines that reduce inflammation). These short courses are absolutely safe and cause no long-term side effects like osteoporosis. In rare cases where long term oral steroid is needed, the doctor will prescribe medicines like calcium supplements and immunity boosters to prevent possible adverse effects.

Home Monitoring
Peak Flowmetry is the simplest way of monitoring asthma at home. It is the measurement of the amount of air one can breathe out forcefully (Peak Flow) and rapidly through a simple handheld device called Peak Flow Meter (PFM). A steady or sudden fall or wide fluctuation in the reading indicates poor control or impending asthma attack long before any symptoms are experienced. This gives time to adjust the treatment to achieve better control and prevent the attack. For accurate results, it should be done regularly at the same time every day. The Current Peak Flow chart should always be taken to the doctor during consultation.

7 Red Signals

If one or more of the symptoms mentioned below is seen, the patient needs to be rushed to a well-equipped Emergency with back-up support of an Intensive Care Unit
  1. Inability to speak a complete sentence due to severe breathing trouble>
  2. Uncontrolled cough and wheezing that can be heard without a stethoscope
  3. Inability to lie down due to breathing difficulty>
  4. Lips and nails turning blue, hands and feet turning cold
  5. Extreme agitation
  6. Pulling in of the chest wall while breathing (chest retraction)
  7. Being confused or drowsy (due to high levels of carbon dioxide in the blood)

Once inside the Emergency, the patient will need oxygen, intravenous administration of steroids and other medicines to ease the breath. Close monitoring of the heart rate, oxygen level and other parameters will be done. In rare cases, mechanical ventilation may be needed. In most instances, the patient will need a hospital admission for a few days for better management and will be discharged when he/she is stable. But in most cases, these can be prevented by a good control of asthma at home.

Tips to Breathe Easy
  1. Take prescribed medicines without fail. For any concern regarding dose or side effects, consult your doctor but never stop or alter the dosage on your own.
  2. Clean the breathing equipments like your inhaler (the plastic jacket and cap) and spacer at least once a week with very gentle soap and running water. Do not wipe the spacer with cloth but leave it to dry on its own.
  3. Avoid any item that triggers an asthma attack.
  4. Dress appropriately before heading out for a morning walk. Avoid exposure to the cold air, which might trigger an attack.
  5. Winter is synonymous to heavy feasting. It is better to take an early dinner and have a light stroll before going to bed. It aids in digestion.
  6. Almost 40 percent asthmatics have reflux problems. In case of symptoms like sour or bitter taste in the mouth, burning sensation in the chest or increase in cough after meals, consult with your doctor for proper treatment.
  7. Take reliever inhaler, as advised by the doctor, before unavoidable exposure to triggers like smoke. It is better to use a mask, if you can.
  8. Do not stop regular exercise. In extreme cold weather, it may be done indoors.
  9. While going out for vacations, carry all your medicines, preferably with extra supplies.
  10. Carry an emergency card having details of your condition, current treatment, allergens, and contact number of your physician. It can be life saving. Be sure to consult your doctor before making travel plans.
  11. In case of any symptoms indicating worsening of asthma or even a general feeling of being unwell, take an early appointment with your doctor. Remember, a stitch in time saves nine.
Dr. Raja Dhar is Consultant Respiratory Physician at Apollo Gleneagles Hospitals, Kolkata

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