The Winter of Our Discontent: Part II

“Winter is the time for comfort, for good food and warmth, for the touch of a friendly hand and for a talk beside the fire: it is the time for home. It is no season in which to wander the world as if one were the wind blowing aimlessly along the streets without a place to rest, without food, and without time meaning anything to one, just as time means nothing to the wind.” -- Edith Sitwell

It was Christmas Eve, very late; in fact, nearly midnight. Hours after all the merrymaking, everything was quiet and my little boy was asleep. I went out onto the porch to see the stars and hear the silence. This was my favorite part of Christmas; being outside with the peace and the solitude. Feeling like the whole Earth was looking forward to a Grand Event.

Living in a very rural area in the countryside, looking up at the skies is an amazing experience. You can see the whole and the breadth of the heavens. The stars are everywhere. The moon is bright and familiar. You can see the Milky Way. You can see the universe.

The winter night was still, with only a slight breeze or a rustle of leaves. I sat on the porch, the only light coming from the snow shining silver from the moonlight. I got lost in reverie, thinking about all that's right in the world.

“Get back inside. You'll catch your death of cold!” my husband had opened the door, his words and the foyer's bright light interrupting my interlude. Sighing because he was right, I gave one last glance to the sky and went inside to its warmth.

He withers all in silence, and in his hand
Unclothes the earth and freezes up frail life.
~William Blake (1757-1827), "To Winter"

Have you ever wondered if the cold of winter does in fact make you sick? Do you seem to feel worse during cold months? Go to the doctor more often in January and February? Sleep more, have shortness of breath and increased mucus?

No, you're not crazy and it's not an old wives tale.

Take, for instance, this online article from The International Journal of Chronic Obstructive Pulmonary Disease, 2014; 9: 1101–1110. Published online 2014 Oct 6. doi: 10.2147/COPD.S54475.

“The Causes and Consequences of Seasonal Variation in COPD Exacerbations,”
Gavin C. Donaldson and Jadwiga A. Wedzicha

It is here in its entirety.

To sum up, the article collected the results from several studies of COPD patients and outlined the results to determine whether people in the studies experienced fewer, the same amount, or more exacerbations during the winter versus other seasons of the year.

The studies included a global study from 2001 to 2005 (The TORCH Study) collecting data from 6,112 COPD patients around the world 40 – 80 years old with a history of smoking. Part of the study tested whether participants had more exacerbations (which they defined as episodes where antibiotics and/or corticosteroids were needed or an event that needed hospitalization.) Another study cited was the POET-COPD (Prevention Of Exacerbations with Tiotropium in COPD) which followed 7,376 patients for nearly two years. It also measured treatment and hospitalization to test if the rate of COPD exacerbations were affected by the season. There were three more lesser single studies explored in the article as well.

The results are fascinating.

Exacerbations were definitely at a higher rate during winter months globally, with the exception being those who lived in a tropical climate. The TORCH Study showed a 71% increase of exacerbations in winter, with 9% of patients having exacerbations in winter versus 5% in summer and the POET Study showed an 116% increase with 7.63% of patients having exacerbations in winter versus 3.53% in summer. There smaller studies, such as one in the UK between 1995 and 2009 with 307 patients showed increases as well.

But why?

According to the article, the reasons are “complex and interrelated” and need more research for definitive answers. There is a possible relation between colder temperatures and increased respiratory problems, with studies being conflicting. Regardless of what the studies say, I know that, personally, cold air makes it harder for me to breathe, and I end up short of breath much more often. You may find the same thing. It can also be more difficult for me to move from warm temperatures to cold temperatures and vice versa, going from my house to the outdoors and back.

Also, “flu season” is a reality. The article stated that Influenza A, RSV (Respiratory syncytial virus), and Mycoplasma pneumoniae (a type of bacterial pneumonia) most often happen in winter months. I know my doctor's office is usually much busier during that time of year than any of the other. These illnesses can really impact those of us with COPD in a bad way, as you may have experienced.

“Conscious breathing is my anchor.” – Thich Nhat Hanh

What can we do about it?

The good news is that there are a few things we can do to decrease our chances of getting in an exacerbation.

• Some people swear by scarves or face/breath warmers during the winter. These are said to help warm the air before it gets to your nose and thus your respiratory system. You can find them at your local store or online.
• Talk to your doctor about getting a flu shot and/or a pneumonia shot. I get both of these every year, as my physician agreed they were the right thing for me to do. I have had great success. Now if only there were a shot for the common cold!

John Walsh, the founder of the COPD Foundation, also has tips in his article “8 Way to Manage COPD in Winter.”

• Some things you can do are just common sense: Stay away from sick people, wash your hands, and avoid smoke and irritants. I do these things all year round and you may already do them too. Make sure to take all of your medicine as prescribed, as well.
• He also recommends that you know your Alpha-1 Antitrypsin status since it requires specific treatment. His further suggestions include cleaning humidifiers every other day to prevent mold and drinking plenty of water, “especially if you have a respiratory infection.”
• I highly recommend doing your own research and talking to your doctor to determine what kind of respiratory problems you experience in winter and what steps you need to take to avoid them.

And remember:
“No winter lasts forever; no spring skips its turn.” -- Hal Borland

For Part I in this series, click here.