COMMENTARY

The Prescription for Wintertime Asthma Control

Elizabeth Herman, MD, MPH

Disclosures

February 13, 2012

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Hello. I am Dr. Elizabeth Herman with CDC's National Asthma Control Program. I am speaking to you as part of the CDC Expert Commentary Series on Medscape.

Today I would like to discuss how clinicians can provide evidence-based care for their patients with asthma by advising them on how to control asthma during the cold winter months. Today's discussion is based on the National Asthma Education and Prevention Program's Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.

Extreme temperature changes during the winter can wreak havoc on patients with asthma. Inhaling cold air, especially during physical exertion, can cause drying of the airway and bronchospasm in patients with asthma. This can result in dangerous episodes of coughing and shortness of breath. Often symptoms occur minutes after exposure.

Your patients may recognize that coughing and shortness of breath are a result of exposure to cold air. However, they may not understand that there are ways for them to reduce these adverse reactions to the cold.

Educate your patients about ways to deal with their asthma in cold weather. Teach your patients to shield themselves from the cold air with a scarf, turtleneck, or jacket collar. Covering one's mouth (and nose when possible) with a scarf will help to warm the inhaled air. Warming up before exercise and cooling down for at least 10 minutes after heavy exercise by walking or stretching can also help.

Most important, as their physician, explain the proper use of medication. All patients with persistent asthma (patients having any asthma-related nighttime awakenings or having daytime symptoms more than twice a week) should be on a controller medication, usually an inhaled corticosteroid. These should be taken daily, not just as needed.

The controller medication can be supplemented by the use of a short-acting beta-2 agonist inhaler before any outdoor activity in cold weather. It is better, however, to control the underlying airway inflammation and reactivity with a controller medication.

And remember: This is the time of year to give your patients a flu shot. People with asthma are more likely to have serious health problems from getting the flu, yet most people with asthma don't receive a flu shot every year. Flu vaccine is the first and most important step they can take to protect themselves from the flu.

Finally, the goal of good asthma care is for your patients to be able to enjoy life with as few symptoms as possible. Partnering with your patients through scheduled follow-up care can achieve that goal. Schedule regular follow-up visits. Assess control at each visit, beginning with a standardized questionnaire. Review the patient's written Asthma Action Plan at each visit. Ask about asthma triggers and help your patients reduce or eliminate them. Review medications and be sure your patients understand how and when to use them.

Web Resources

CDC National Asthma Control Program

CDC Asthma Management and Prevention

National Heart, Lung and Blood Institute - Guidelines for the Diagnosis and Management of Asthma (EPR-3)

National Heart, Lung and Blood Institute - National Asthma Education and Prevention Program

CDC National Center for Environmental Health

EnviroFlash - Air Quality Notifications

Asthma and Allergy Foundation of America

American Lung Association

American Academy of Allergy, Asthma & Immunology

Allergy and Asthma Network/Mothers of Asthmatics, Inc.

American College of Allergy, Asthma & Immunology

American College of Chest Physicians

American Thoracic Society

Dr. Elizabeth Herman currently works for the Air Pollution and Respiratory Health Branch of the National Center for Environmental Health in the Centers for Disease Control and Prevention (CDC). This branch coordinates CDC's National Asthma Control Program. Dr. Herman served as the director of the branch's "Controlling Asthma in American Cities" project from 2005 through its end in 2008. This was a 7-site project to address asthma among inner-city children through community-based interventions. She was editor of a special journal supplement on the Controlling Asthmain American CitiesProject.

Dr. Herman earned her medical degree at the University of Connecticut School of Medicine in 1979. She completed a family practice residency at Duke-Watts Family Medicine Program. Following her residency, Dr. Herman worked as a primary care physician in India. When she returned to the United States, she served as a medical officer and clinical director of the ACL Indian Hospital in New Mexico. She later obtained an MPH degree and completed a preventive medicine residency at the Johns Hopkins School of Hygiene and Public Health. She began her career with CDC in 1998 as a medical officer in the Malaria Branch and joined the Air Pollution and Respiratory Health Branch in 2002.

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