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Asthma in winter: triggers, inhaler use and when to seek care

Why asthma often gets worse in Bangladesh's winter, how to use an inhaler properly, the warning signs of a serious attack, and which doctor to see.

Asthma in winter: triggers, inhaler use and when to seek care

Many people with asthma find their symptoms get worse in the cooler, drier winter months in Bangladesh. Coughing at night can become more common, and some people need their reliever inhaler more often. This guide explains why winter can be hard for people with asthma, how to use an inhaler properly, and when breathing trouble needs urgent care.

What is asthma?

Asthma is a long-term lung condition that affects both children and adults. The World Health Organization (WHO) says that the small airways in the lungs (the tubes that carry air in) become inflamed, meaning swollen and irritated, and narrowed. This makes breathing harder.

Common symptoms include:

  • coughing, which may be worse at night and early in the morning
  • wheezing, a whistling sound when you breathe
  • shortness of breath
  • a tight feeling in the chest

Asthma cannot be cured. But WHO says inhaled medicine can control the symptoms and let people with asthma live a normal, active life.

A research paper published in BMJ Open in December 2023 said that about 7% of people in Bangladesh had asthma between 1999 and 2010. It also said that up-to-date national figures are limited. Worldwide, WHO estimates that asthma affected about 363 million people in 2023 and caused 442,000 deaths. WHO also says that most asthma deaths happen in low- and lower-middle-income countries, where asthma is often not diagnosed or not treated well enough.

Why asthma often gets worse in winter

Each person’s asthma has its own triggers, the things that set off symptoms. Several common triggers are more of a problem in the Bangladeshi winter.

Cold, dry air

The US Centers for Disease Control and Prevention (CDC) lists cold, dry air as an asthma trigger.

Air pollution

The CDC says air pollution can trigger an asthma attack. In Dhaka, the air is much dirtier in winter than in the monsoon. A study published in 2020 measured fine dust particles (called PM2.5, which are small enough to go deep into the lungs). It found average levels of about 178 micrograms per cubic metre in winter, compared with about 30 in the monsoon. That is roughly six times higher. The study found that burning fossil fuels and burning plant material both add to winter pollution. A later study of measurements taken in Dhaka from 2016 to 2021 also found the highest levels in winter and the lowest in the monsoon.

Colds and flu

Winter brings more coughs, colds and flu. The CDC lists infections such as flu, colds and RSV (a common chest virus) as asthma triggers. The NHS (the UK’s National Health Service) says viruses such as flu can make asthma symptoms worse.

Smoke and dust indoors

In cold weather, people keep windows closed and spend more time indoors, so smoke and dust can build up inside. The CDC says that second-hand smoke (smoke from someone else’s cigarette) and mould can trigger an asthma attack. NHS advice also lists dust mites (tiny creatures that live in house dust) as a common trigger.

Practical ways to protect yourself this winter

  • Always keep your inhaler with you, as the NHS advises. That includes when you travel or go to school or work.
  • Use your inhalers the way your doctor told you.
  • Watch the air quality. The CDC advises checking air quality forecasts. The NHS advises trying to avoid your triggers, such as air pollution and smoke.
  • Keep smoke out of the home. Do not allow smoking indoors. If you smoke, the NHS advises getting help to quit.
  • Ask your doctor about the flu vaccine. The NHS advises people with asthma to have vaccines such as the flu vaccine, because viruses such as flu can make asthma worse.
  • Check with a doctor or pharmacist before taking other medicines. The NHS warns that some common painkillers and some heart and blood pressure medicines can trigger asthma in some people.

Using your inhaler properly

Inhalers are the main treatment for asthma. Reliever inhalers (usually blue) open the airways when symptoms start. Many people are also prescribed a preventer inhaler to use regularly. Your doctor will decide which inhalers you need and how to use them. Do not change or stop any inhaler without talking to your doctor first.

The US National Library of Medicine (MedlinePlus) says many people do not use their inhaler in the best way. It gives these general steps for a spray inhaler (called a metered-dose inhaler) used with a spacer. A spacer is a plastic tube that fits onto the inhaler. It holds the medicine so it is easier to breathe in, and it helps more medicine reach your airways.

  1. Take the caps off the inhaler and spacer, and check that nothing is inside the mouthpiece.
  2. Shake the inhaler well, then attach the spacer.
  3. Breathe out gently.
  4. Put the spacer mouthpiece between your teeth and close your lips tightly around it.
  5. Start breathing in slowly through your mouth. Press the inhaler once, and keep breathing in slowly and as deeply as you can.
  6. Take the spacer out of your mouth. Hold your breath for a count of 10 if you can, then breathe out slowly.
  7. If your doctor has told you to take more than one puff, follow their instructions for the timing.
  8. After using your inhaler, rinse your mouth with water and spit it out. Do not swallow the water.

A few more tips:

  • MedlinePlus says almost all children can use a spacer. Ask your doctor which spacer is best for you or your child.
  • WHO says a homemade spacer made from a 500 ml plastic bottle can work as well as a shop-bought one. Ask your doctor or nurse to show you how to make and use one.
  • Dry powder inhalers do not need a spacer. Follow the instructions that come with your inhaler, and check with your doctor if you are unsure.
  • Check the dose counter and get a new inhaler before you run out.
  • Take your inhaler to every appointment so the doctor can check how you use it.

Signs that your asthma is not well controlled

See your doctor if:

  • you need your reliever inhaler more often than usual, or your treatment is not helping
  • asthma wakes you up at night
  • asthma stops you doing your usual activities, such as school or work
  • you have had an asthma attack, even if you now feel better. The NHS advises seeing a doctor on the same day if you did not need hospital treatment, or within 48 hours of leaving hospital.

Ask your doctor for a written asthma action plan. This is a simple plan that tells you what to do when your symptoms change. If your symptoms are getting worse, follow your doctor’s instructions and your action plan.

Warning signs: get urgent medical care

A severe asthma attack can be life-threatening. Go to the nearest hospital emergency department straight away, or call for an ambulance, if you or your child:

  • is so breathless that it is hard to walk or talk
  • is hunched over, struggling to breathe
  • has skin on the chest, between the ribs or at the neck sucking in with each breath
  • has blue or grey lips or fingernails
  • is confused, very drowsy or less responsive than usual
  • does not get better after using the reliever inhaler, or needs it again very soon
  • is getting worse at any point

During an attack, sit up straight, try to stay calm, and use your reliever inhaler as your asthma action plan or doctor has told you. The NHS advises that you should not drive yourself to hospital. Ask someone to take you, or call an ambulance. In hospital, treatment may include oxygen, a nebuliser (a machine that turns medicine into a mist you breathe in), and other medicines that the doctors will decide on.

If you are not sure how serious the symptoms are, you can call the government’s health call centre, Shasthyo Batayon (16263), to speak to a doctor at any time of day or night. If someone is struggling to breathe, do not wait for advice. Go to hospital.

Which doctor should you see?

Situation Type of doctor
First symptoms, or a routine asthma check A general practitioner or a medicine specialist (internal medicine)
Asthma that stays uncontrolled, frequent attacks, or a need for breathing tests A chest specialist (pulmonologist or respiratory medicine specialist)
Children with wheezing or asthma A paediatrician (child specialist), or a paediatric pulmonologist for difficult cases
Strong allergies, or a blocked or runny nose alongside asthma An allergy specialist or an ENT (ear, nose and throat) specialist, usually on your doctor’s advice
Severe breathing difficulty The emergency department of the nearest hospital

You can use the ratings.com.bd directory to find pulmonologists, paediatricians and hospitals near you.

The bottom line

Winter in Bangladesh brings cold, dry air, heavy air pollution and more colds and flu, and all of these can make asthma worse. Always keep your inhaler with you and use your inhalers as your doctor advised. Learn to use your inhaler properly, and avoid smoke where you can. Get help early if your symptoms are getting worse, and treat severe breathlessness as an emergency.

Sources

This article is for general information only. It does not replace advice from a doctor who knows your health history.

Find a doctor

Browse Chest Diseases doctors in Bangladesh on ratings.com.bd, with chamber addresses, visiting hours and appointment numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above and checked automatically against them; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.

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