Traditionally, asthma exacerbation is very common during September in India, especially in the southern part of the country, with Bengaluru being one of the most affected cities. The pollen count, the hay, and the mold count all increase exponentially, coupled with the drastic changes in the humidity that affect the pH level of the airways.?
Apart from these, there are other factors that contribute to asthma exacerbation during the winter months. People tend to spend much of the time indoors during winter, which adds to larger exposure to dust mites and itch mites, both of which are known to trigger asthma attacks. Wearing warm clothing, especially fur clothing also can add to the burden of asthma exacerbations by trapping allergens and triggering an allergic reaction.?
This year, such an annual challenge is being made more complicated by the very high prevalence of respiratory syncytial virus, H1N1 influenza virus family, adenovirus, and to some extent human metapneumovirus. Some of the viruses render the lung cells refractory to the commonly used asthma medications. In essence, viral infection not only contributes to asthma and the infective scenario but also makes it difficult to manage during winter.?
?A non-asthma person commonly suffers from a cough that lasts for one to two days followed by constitutional symptoms such as temporary loss of appetite and runny nose, cough, etc. However, in an asthma patient, in addition to the above, the symptoms can be more severe. There will be an increased need for inhalers, and along with that, a lack of relief with bronchoconstriction. This propels them to take more medications.
In regards to the above exacerbation, the other commonly asked question is whether we should use air purifiers. Air purifiers or double-edged swords are capable of trapping particulate matter of a particular size depending upon the machine, but the exhaled gases do have the potential to damage the ozone. So in a way, they are not environmentally friendly. The other issue that has not been paid much attention to is the inappropriate use of mosquito mats and room heaters during winter months. This can change the entire humidity and composition of the room air, making it very unfriendly for the airway interior. Also, during winter months, domestic pets tend to spend more time within the house which may increase especially if the dogs are shedders and cats are quite allergy-inducing in their nature.
During the winter months, individuals with asthma and respiratory issues need to be extra cautious to avoid exacerbations of their symptoms. To do so, it is important to follow a simple strategy which includes avoiding using fur clothing and clothes that have a lot of wool material as they can trigger allergic reactions. Secondly, indoor air pollution can be a common trigger for asthmatics, so ensure that indoor pollution is reduced to a minimum. Visit your regular health provider and get a flu vaccination if it is appropriate. You should also consult with your general practitioner, internal medicine physician, or pulmonologist and get a baseline spirometry test done which is a simple test that measures lung function - how much air you can breathe in and out of your lungs. This helps to make sure the treatment you are receiving is appropriate as it may require to be enhanced during these months. During winters, naphthalene balls are used in virtually every household to ensure that the clothes are well protected. This has the potential to exacerbate asthma, and hence care should be taken in making sure to not use naphthalene balls in households with asthma.
Inhalers are very safe to use to manage asthma and the fear of steroids is also unfounded. The right use of inhalers and hand-mouth coordination ¨C both are equally very important to keep respiratory issues at bay. This technique needs to be looked into by your provider or an educator nurse if available at your medical center. They can help you learn the proper technique for using your inhaler and ensure you are getting the most benefit from your medication.?
Last but not least, your healthcare provider needs to have a consorted action plan to tide over any ups and downs in the wheezing scenario. There is also a need for a consorted plan by the government, non-governmental organizations (NGOs), regulatory authorities, physicians, and pulmonologists to work together to ensure that cities are greener and harmful pollutants such as scrubs and parthenium are eliminated. Stagnant water bodies should be cleared along with unclogging drainage systems across the roads. A sense of urgency is required in these matters to prevent exacerbations in the coming years. This year, in addition to weather changes, the increased viral infections and asthma exacerbations are further complicated by cyclonic storms and heavy rainfalls.
About the author: Dr. Satyanarayana Mysore is the HOD and Consultant - Pulmonology, Lung Transplant Physician, Manipal Hospital Old Airport Road. All views/opinions expressed in the article are of the author.?