Cold-Induced Asthma, How Can You Manage It?

Individuals all over the world commonly experience chronic diseases like Allergic Rhinitis and Cold-induced Asthma. Studies and data collected over the years show Asthma affects at least 4.3% of the global population. The percentage continues to grow in developed countries. (1) However, you can manage cold-induced Asthma using a step-wise approach which includes both conservative and pharmacological methods, which will be discussed in detail below. (2)

What is Cold-Induced Asthma?

Asthma is a chronic condition affecting the respiratory airways. It involves the narrowing and inflammation of the airways, which causes symptoms like wheezing, cough and shortness of breath. Some individuals may also experience symptoms like atopy, Eczema and hayfever Eczema. (3) There are many triggering factors for exacerbation of Asthma, one of which is most commonly investigated is Cold Induced Asthma. Studies on this subject matter show that you are more likely to experience Asthmatic symptoms and complications in cold temperatures. (4)

What Causes Cold-Induced Asthma?

Airway Dryness Causing Cold-Induced Asthma  

As mentioned earlier, individuals living in colder environments are more likely to experience Asthma as compared to those living in warmer temperatures. This phenomenon is also known as Cold-induced Asthma. When the cold air comes into contact without respiratory airways, it not only causes them to cool up but also promotes their drying out. You may see the immediate effects of this in the form of congestion of the airways, rhinorrhea and sneezing. These symptoms may be even greater in individuals diagnosed with Asthma and Rhinitis compared to healthy individuals. (5)

Activation Of Nasal Responses Causing Cold Induced Asthma

Moreover, another factor, which has been highly studied in previous years, is the activation of nasal responses when exposed to cold temperatures. When an individual gets exposed to cold air, their nasal sensory nerve gets activated and produces mast cells. ⁷ The production of mast cells promotes inflammatory markers in the sputum and decreases respiratory functions. The cold air is also proposed to cause permanent damage to the airway epithelium and changes the structure and function of the airways as well. (6)

How Is Cold-Induced Asthma Diagnosed?

The doctor will start by taking a history of the individuals presenting with symptoms of cold-induced Asthma. The patient will often report a history of unexplained coughing or wheezing, which gets worse when they expose themselves to a cold. These symptoms are often much worse at night. The patients may also report other signs and symptoms like the appearance of Eczema on various areas of their body or hay fever along with cold-induced Asthma. After taking the history, the doctor will go ahead and perform a thorough physical examination. This will help them determine if the patient was experiencing an acute exacerbation of their cold-induced Asthma. 

Acute Exacerbation Of Cold Induced Asthma

If the patient is currently experiencing an acute exacerbation of cold-induced Asthma, they will present with common signs like fine tremors in the hands and a fast heart rate. Salbutamol use is one of the proposed reasons for the fine tremors experienced by the patients. In addition, due to shortness of breath, the patients will also be sitting forwards, as this allows the airways to open up. 

What Are The Stages Of Cold-Induced Asthma?

There are two main forms of Asthma known Acute Asthma and Chronic Asthma. The stages of Acute Asthma include acute severe Asthma, life-threatening Asthma and neat fatal Asthma. On the other hand, there are four main stages of the chronic forms of Asthma, based on their severity. These stages include intermittent Asthma, mild persistent Asthma, moderate Asthma and severe chronic Asthma. 

Management Of Cold-Induced Asthma

Two primary types of management of Cold Induced Asthma include conservative management and medical management. 

Conservative Management Of Cold Induced Asthma

The conservative measures that may be taken for the management of cold-induced Asthma include asking the patient to relax and move away from the triggering factor. For Cold-induced Asthma, the triggering factor is usually cold wind. Hence the individual will benefit by avoiding direct exposure to the cold wind by keeping their always covered. They may also benefit by increasing exposure to warm and humid environments. This may include taking steam or using a hair humidifier in their room. (7) (8) A newer technique introduced to achieve this more effectively is known as Bronchial Thermoplasty. Bronchial Thermoplasty helps deliver warmth to the walls of the airways and, by doing so, keeps them open and prevents their narrowing. (9)

Medical Management Of Cold Induced Asthma

The medications which help relieve the symptoms of cold-induced Asthma include bronchodilators and anti-inflammatory drugs. The commonly used bronchodilators for this purpose include Beta 2 Agonists like Salbutamol and Muscarinic antagonists like Ipratropium Bromide. On the other hand, the inhaled anti-inflammatory agents which are effective at relieving the symptoms of Asthma include inhaled steroids like Beclometasone. 

Steps Required For the Medical Management of Cold Induced Asthma

The medical management of cold-induced Asthma may be further divided into five stages based on the severity of the symptoms. (10) These include:

• Stage 1, where the physician prescribes low dose inhaled corticosteroid and formoterol when it is needed.
• Stage 2, where a physician prescribes a daily low dose of corticosteroids along with a short-acting beta two agonist, which is to be taken when needed.
• Stage 3, where a physician prescribes low-dose inhaled corticosteroid and long-acting beta two agonists for daily use. This is given in addition to a short-acting beta two agonist, which should be taken when needed. 
• Stage 4, where a physician prescribes medium-strength inhaled corticosteroid along with long-acting beta two agonists for daily use. These are given along a short-acting beta two agonist, which should be taken only when needed. 
• Stage 5 includes the prescription of a long-acting beta two agonist, and a high dose inhaled corticosteroid for daily use. These drugs are given along with a long-acting anti-muscarinic agent. 

The Bottom Line

Cold-induced Asthma can be a source of great distress and disability for individuals, particularly those living in colder areas. It may not only cause a greater number of sick leaves for school-going children but also cause missed work days for adults – leading to an economic burden on society as a whole. In order to manage this increasing economic burden, health authorities should increase awareness about cold-induced Asthma and how it may be managed by a combination of conservative and pharmacological methods effectively. 

References

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2. Maio, S., Baldacci, S., Carrozzi, L., Pistelli, F., Angino, A., Simoni, M., Sarno, G., Cerrai, S., Martini, F., Fresta, M., Silvi, P., Di Pede, F., Guerriero, M., & Viegi, G. (2016). Respiratory symptoms/diseases prevalence is still increasing: a 25-yr population study. Respiratory medicine, 110, 58–65. https://doi.org/10.1016/j.rmed.2015.11.006
3. Hashmi MF, Tariq M, Cataletto ME. Asthma. [Updated 2022 Feb 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430901/
4. Harju, T., Mäkinen, T., Näyhä, S., Laatikainen, T., Jousilahti, P., & Hassi, J. (2010). Cold-related respiratory symptoms in the general population. The clinical respiratory journal, 4(3), 176–185. https://doi.org/10.1111/j.1752-699X.2009.00172.x
5. Koskela H. O. (2007). Cold air-provoked respiratory symptoms: the mechanisms and management. International journal of circumpolar health, 66(2), 91–100. https://doi.org/10.3402/ijch.v66i2.18237
6. Sue-Chu M. (2012). Winter sports athletes: long-term effects of cold air exposure. British journal of sports medicine, 46(6), 397–401. https://doi.org/10.1136/bjsports-2011-090822
7. Gosens, R., & Gross, N. (2018). The mode of action of anticholinergics in Asthma. The European respiratory journal, 52(4), 1701247. https://doi.org/10.1183/13993003.01247-2017
8. Almadhoun, K., & Sharma, S. (2021). Bronchodilators. In StatPearls. StatPearls Publishing.
9. Nasim, F., & Iyer, V. N. (2018). Bronchial thermoplasty-an update. Annals of thoracic medicine, 13(4), 205–211. https://doi.org/10.4103/atm.ATM_365_17
10. Rajan, S., Gogtay, N. J., Konwar, M., & Thatte, U. M. (2020). The global initiative for asthma guidelines (2019): change in the recommendation for the management of mild Asthma based on the SYGMA-2 trial – A critical appraisal. Lung India : official organ of Indian Chest Society, 37(2), 169–173. https://doi.org/10.4103/lungindia.lungindia_308_19