Article by Arianne Brown
In the United States, an estimated 16 million adults have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Research has indicated that COPD is underdiagnosed, however, and the American Lung Association (ALA) suspects that there may be as many as 24 million American adults living with the disease. While COPD is a condition that affects patients all year long, winter can exacerbate symptoms.
A global study of patients ages 40-80 found that those with COPD had a 70-80% increase in symptoms during the wintertime. The study concluded that apart from individuals living in tropical areas where extreme winter temperatures are not normally experienced, winter exacerbations were a global phenomenon.
While some factors, like air pollution and sickness, may seem intuitive, winter brings with it conditions that can be more difficult to spot, such as poor indoor air quality and lack of physical activity.
According to Dr. Nathan LaCross, who oversees the Environmental Epidemiology Program at the Utah Department of Health, environment plays an important role in COPD symptoms.
“Wintertime can be challenging for people with COPD,” he said. “Cold, dry air can irritate the airways of people with respiratory conditions like COPD, exacerbating symptoms.”
Low humidity, rather than temperature, is the main factor that triggers seasonal exacerbations of COPD. In fact, dry air can trigger symptoms at either extreme. Research by the European Respiratory Review found that that temperature extremes, either below freezing or above 90°F (32°C), are particularly dangerous.
LaCross suggested monitoring weather conditions, and staying indoors on days dipping below freezing temperatures.
Outdoor air quality
Winter exacerbations of COPD are particularly common where air pollution is a factor. Pollutants from things like industrial production, forest and brush fires, garbage burning, and motor vehicle emissions make up a large portion of outdoor pollution that can cause long-term and short-term damage. A recent study found that short-term exposure to air pollutants increases the chances of risk of acute exacerbations significantly, particularly in lower income areas and in developing countries.
In some areas, winter can make matters worse during what’s called a temperature inversion.
“During an inversion, a layer of cold air is held at ground level, which traps air pollutants along with it,” LaCross said. “People with COPD are more sensitive to the harmful effects of breathing in pollution and can experience exacerbations and worsened symptoms.”
LaCross recommended monitoring air quality alongside the daily weather report. Current information on air conditions collected by the US government can be accessed at airnow.gov.
Indoor air quality
Indoor pollutants also cause exacerbations with COPD, particularly pollutants brought by cigarette smoke.
According to the National Institutes of Health (NIH), smoking is the leading cause of COPD, damaging the air sacs, airways, and tissues lining the lungs. Smoking can also trigger winter exacerbations because there is less humidity in the air to move the smoke through the lungs than in the spring and fall.
The first step to reducing smoke-related complications with COPD is to quit smoking.
Other indoor pollution factors include candles and wood burning stoves or fireplaces. Reducing the use of these things in your home can help minimize their impact on your airways.
Cold and flu season
COPD sufferers are often more susceptible to exacerbations in the winter because cold and flu season traditionally goes from December through February. This is because flu viruses are more stable in cold air, and the lower humidity also helps the virus particles remain in the air instead of attaching to water and dropping to the ground.
“Infectious respiratory diseases like the common cold and influenza are more common during winter, and can also cause exacerbations,” LaCross said. “Getting the influenza vaccine every year, maintaining good hand washing practices, and avoiding people with colds or the flu will help prevent complications from infectious disease.”
Not enough exercise
Building cardiovascular and pulmonary strength is extremely important for those suffering from COPD. According to LaCross, although many find it difficult to get regular physical exercise in the winter months due to limited outdoor activity, it is still important to find ways around the winter barrier.
“Exercise is good for health, so it’s important to both stay active as well as know when to make changes,” LaCross said. “If temperatures are low and/or air pollution levels are high, substitute less strenuous activity like walking instead of jogging. Avoiding strenuous activities outdoors, or limiting time outdoors can help reduce exacerbations. It’s also a good idea to spend less time in areas likely to have higher polluted areas, like near busy roads.”
There are many ways to stay physically active indoors, like joining a local gym, keeping exercise equipment like a treadmill and some weights at home, or simply making sure you are taking time throughout the day to get up and move around.
Stress can aggravate winter exacerbations of COPD, and winter can bring on more stress. Research has even suggested that the lower amounts of sunlight could be a cause of depression and mental imbalance.
Whatever the reason or reasons, experts have found that people with COPD have a greater risk for depression, stress, and anxiety. Enlisting the help of family, or learning calming techniques such as pursed-lip breathing, can help COPD patients with anxiety or depression manage their symptoms.
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