If you have chronic pulmonary obstructive disease (COPD), you might have noticed that your breathing often gets difficult when you go out into cold weather. This is no coincidence. There is evidence that cold weather affects the respiratory system in numerous ways, and people with respiratory illnesses such as COPD and asthma are more likely to be affected.
In this blog post, we will discuss the normal environment of your lungs and upper airways, how cold weather affects your lungs, and how to prepare yourself to prevent weather-induced COPD exacerbations or infections.
The Normal Environment of Your Lungs and Upper Airways
The upper and lower airways have several important functions to protect your lungs:
- Filtering out foreign particles
- Heating the air you breathe
- Humidifying the air you breathe
- Protecting the lower airways from infection
These functions occur at varying points starting from your mouth and nose down to the lower airways of your lungs. Under normal conditions, our airways are warm and moist to keep 3 critical processes running smoothly: the cough mechanism, the sneeze mechanism, and the mucociliary escalator.
The upper airways use both the cough and sneeze mechanisms to clear out particles and microorganisms from your mouth, nose, and throat. Collectively known as mucous membranes, when your mouth, nose, and throat are adequately hydrated, your cough and sneeze mechanisms clear out these foreign particles by collecting them in mucus and expelling them outward. Your nasal passages also have strands of hair that act as a collective filter for larger particles, thus preventing foreign particles from being inhaled.
The mucociliary escalator is a physiological function of your lungs that moves foreign particles upwards and out of the lower airways. Your body keeps this process intact when you are adequately hydrated enough to maintain the thin layer of mucus that lines the inside of your lungs (which traps foreign particles) and when the cilia (or small hair-like strands) have adequate warmth to freely push the mucus upwards and out of your lungs to be expelled.
These processes are critical for providing ongoing protection against inhaling foreign and potentially infectious particles. However, when cold weather hits, these processes are in danger of failing.
The Danger of Cold Air for People With COPD
While it might seem harmless to go out in cold weather if you just wear an extra set of clothing, there is established evidence that shows people with COPD are significantly more at risk for exacerbations and infections when exposed to cold weather.
One 6-year study by P. Marno et al. (2006) showed that if cold weather lasted for a week or more, there was a subsequent increase in hospital admissions for COPD patients. A later 10-year study in 2013 confirmed these findings, showing that cold stress increased COPD exacerbation rates. Another study in 2017 found that even cold temperatures indoors (64 degrees Fahrenheit or lower) can adversely affect COPD patients.
The obvious question is this: .How does cold air affect the lungs of COPD patients to put them more at risk for exacerbations and infections? There are several causes at play here.
First, as cold air gets deeper into the lungs, the coldness adversely affects the mucociliary escalator. As mentioned earlier, the mucociliary escalator needs to be warm and moist to function appropriately. However, when cold air is inhaled long enough to get into the lower airways, this dries out the mucus layers of the lungs and stops the cilia (or hair-like strands) from moving foreign particles out of the lungs. Without this critical process in place, your lungs have lost an important defense mechanism against infection. If foreign particles and microorganisms are allowed to enter the lungs unimpeded, that could turn into an infection. Infection risk further increases if you live near water, since viruses and bacteria can be sprayed into the air, stay airborne, and travel great distances by wind.
Second, breathing in cold air effectively dries out the mucous membranes in the nose, which causes inflammation and nasal blockage. The nose is capable of secreting a lot of mucus to stop foreign particles, but when it is dried out by cold air, the mucus thickens and makes it harder to breathe through your nose.
Finally, cold air can trigger reflex bronchoconstriction, which is the inflammation and constriction of your upper and lower airways in response to the cold air. When this happens, you might feel like you suddenly cannot catch your breath after being in the cold for a few minutes or more.
Now that we have covered the normal environment of your lungs and how dry, cold air can negatively affect your lungs, let us now discuss ways to prepare yourself if you must go out into the cold.
How to Prepare Yourself If You Must Go Out into Cold Weather
Here are 9 steps to take to fully prepare yourself if you must go out into the cold:
1. Check the Weather
The first thing to do is to check your local weather report. It is better to know whether you will need warmer clothing before you leave your home rather than finding out too late when it gets colder throughout the day.
2. Stay Indoors
While this might not always be possible, if you have a choice, it would be better to stay indoors as much as possible on cold days to prevent a COPD exacerbation. Check to make sure all of your doors and windows are sealed to avoid cold drafts. Also, if you exercise, it would be best to exercise indoors on cold days.
3. Use This Proper Breathing Technique
Inhaling through your nose and exhaling through your mouth is the best way to warm and humidify cold air before it reaches your lower airways. Using this proper breathing technique with the warmth and moisture of your nose can help you optimize your body’s natural defense mechanisms when going out into the cold.
4. Cover Your Mouth and Nose
Covering your mouth and nose when going out into cold weather can keep the air you breathe warm. However, do not use fabrics that have fibers that easily shed off. Use something like merino wool fiber, which is very breathable but does not have fibers that come loose easily.
5. Keep Your Oxygen Tanks Warm
If you use portable oxygen tanks, make sure to keep them insulated when going out in cold weather, so the tank does not get too cold. A cold tank can make the oxygen inside cooler, which means you will be breathing in colder oxygen.
6. Get Your Vaccines
Preparedness goes beyond the mere moment you step out into the cold. Make sure you always get your flu and pneumonia vaccines as soon as they become available. The immunity protection will give you an extra layer of security for those times when you do need to go out into the cold.
7. Quit Smoking
If you have COPD and are currently smoking, it is highly advisable that you quit. One of the many reasons why smoking is bad for your lungs is that the smoke decreases the function of your mucociliary escalator. So combining smoking with breathing in cold air is a recipe for suppressing your body’s natural protection against infection entirely.
8. Avoid Wood-Burning Fireplaces
If you have a wood-burning fireplace, it is highly advisable not to use it as your primary heat source if you have COPD. The reason is the same as smoking a cigarette: the smoke particulates can enter your lungs and suppress your mucociliary escalator. However, if you enjoy your fireplace too much to let it go, make sure to have your chimney cleaned regularly to prevent a backflow of smoke into your home.
If you have done all of these steps, but still find yourself feeling short of breath in the cold weather, the final step would be to pre-medicate yourself before heading out. Pre-medicating would be taking a prescribed dose of your rescue inhaler before going out into the cold. However, save this step for those times when you know you will be out for a long time. That said, if you still get short of breath in the cold, you can use this step to prevent an exacerbation ahead of time.
While COPD and cold weather are generally not a good combination, it is not impossible to live in a cold area with COPD. With the preparedness checklist above, you should be able to prevent COPD exacerbations related to cold weather and feel more confident during the colder months.
Information on this page is for reference and educational purposes only. For more information about chronic obstructive pulmonary disease (COPD), talk to your doctor or primary care provider.
- Egan’s Fundamentals of Respiratory Care, 9th Edition.
- National Institutes of Health. Cilia and Mucociliary Clearance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378048/
- European Respiratory Review. How different measures of cold weather affect chronic obstructive pulmonary disease (COPD) hospital admissions in London. https://err.ersjournals.com/content/15/101/185.full
- Plos One. The Effect of Cold Temperature on Increased Exacerbation of Chronic Obstructive Pulmonary Disease: A Nationwide Study. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057066
- National Institutes of Health. Colder temperature is associated with increased COPD morbidity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817981/
- Multidisciplinary Journal of Microbial Ecology. Deposition rates of viruses and bacteria above the atmospheric boundary layer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817981/
- Multidisciplinary Journal of Microbial Ecology. Deposition rates of viruses and bacteria above the atmospheric boundary layer. https://www.ncbi.nlm.nih.gov/m/pubmed/6360701/