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Asthma’s Winter Warnings

Sarah forgot something when she went sledding last week. It wasn’t her gloves, her hat or her sled. It wasn’t the key to get back in her house. It wasn’t a handkerchief to use when her nose got runny from the cold.

Sarah forgot to puff her asthma medicine from her inhaler. And she forgot to take her inhaler along with her in her parka pocket. After her first run down the hill, Sarah felt fine. But when she pulled her sled back up the steep slope, she began to cough and wheeze.

“Uh-oh,” Sarah said. “I have to go all the way home to get my inhaler!” That was the end of sledding for that day.

Asthma is a lung condition that affects 11.7 million Americans, including 4.1 million children, according to the American Lung Association. People with asthma react to substances in the air, such as smoke, dust or animal fur. Exercise can bring on an asthma attack in someone with sensitive lungs too. And so can breathing cold, dry air.

According to Robert B. Mellins, a professor of pediatrics (children’s medicine) at Columbia University in New York City, asthma is increasing in all groups of people – but especially among the very young and the very old. “It’s disturbing,” he says. Doctors aren’t sure why asthma is on the rise, but Mellins suspects increased indoor as well as outdoor pollution as one cause. Our snug, sealed-up houses, cozy (but dusty) rugs and our furry indoor pets also play a role. “We’ve done lots of things that make life warmer and richer, but not necessarily healthier,” he says.

When someone has an asthma attack, the passageways inside the lungs swell up. The lungs also produce extra mucus, a sticky, wet material that lines the passageways. This combination of swelling and extra mucus makes the airways inside the lungs narrower than they should be. Breathing gets difficult. As the person breathes, the air passing in and out of the lungs makes a whistling sound called wheezing. People with asthma also cough a lot to try to get the extra mucus out of their lungs.

Asthma’s Winter Warnings

Luckily, there are several helpful medicines available. Some are taken as pills, but most are inhaled. Inhaled medicines go straight into the lungs to open clogged airways and slow down the production of mucus. When asthma is recognized and treated, the person who has it can live a normal life – including exercising and going out to play on a cold snowy day.

Most of the time, Sarah’s asthma doesn’t get in the way of her life. She’s careful to use her medicine. On that one snowy day, she forgot. The combination of cold weather and exercise made her lungs start to react. To prevent becoming short of breath, Sarah should have used her medicine in advance. And she should have covered her nose and mouth with a scarf to warm and moisten the air as she inhaled it.

Winter can be a tough time for people who have asthma, because of low temperatures and the cold and flu season, says Jeff Wager, a physician at Children’s Hospital in Denver, where they know a lot about cold weather. “Cold weather, respiratory tract infections, and irritants in indoor air are potential triggers of asthma episodes,” he says.

Mellins explains that breathing in wintry air cools and dries the airways inside the lungs – especially when you breathe through your mouth. But that doesn’t mean kids with asthma should stay indoors all winter. He says doctors work hard to treat kids with asthma so that their lives are as normal as possible. “We think kids should be physically active,” he says. “If it’s a sledding day, it’s best to prevent an incident with medication, and do things other kids would normally be doing in the snow.”

What should Sarah have done when she felt her lungs start to tighten up? “Step one is to come inside where the air is warm,” says Mellins. “Step two is to take the medication that has been prescribed for her.”

Tips for Parents

Robert B. Mellins, MD, a national spokesman for the American Lung Association who teaches at Columbia and heads the pediatric pulmonary division at Columbia Presbyterian Hospital in New York City, says coughing and wheezing reactions to cold air or winter exercise can be early warning signs of asthma. If you or your kids experience these symptoms in cold air, talk to your physician. For more information, contact the American Lung Association at 1-800-LUNG-USA.

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