As India experiences a drop in temperature, a silent medical emergency has begun to occur both in homes and hospitals. We often think of the increase in coughing during the winter months as a nuisance, but this is far from the reality. According to a Global Burden of Disease (GBD) study, over 30 million asthmatics live in India and comprise 13.09% of the world's population of asthma patients, but the most shocking statistic is the death rate. India represents over 42% of the worldwide death toll due to asthma. This difference exposes a key weakness in our ability to care for our lung health. If we add the underlying risk of having asthma, COPD or even sensitive airways with the unique winter triggers such as cold weather, pollution (smog) and a virus, the lungs are under "triple" attack. For someone with asthma, COPD or even sensitive airways winter is not simply a season, it is a major stress test.

To protect your lungs from struggling due to the cold weather you need to understand how and why that happens. This guide will provide you with information on the reasons behind the winter wheezing, what to look for if you develop signs of severe or dangerous lung infections and, expert-recommended treatments for winter coughs.

Key Takeaways: Your Winter Lung Protection Plan

• Cold Dry Air (Cold Air Shock) - Cold and dry air is a direct irritant to your airways in addition to causing a bronchoconstriction or tightening of the air passages. The result is an asthma attack.
• The winter weather creates an inversion layer that traps pollutants (PM2.5) near the surface, which exacerbates lung inflammation.
• The immune response in your nose will decline by as much as 50% in lower temps, increasing your risk of contracting a virus.
• It is important to differentiate between allergic and infectious symptoms (cough with high fever/chest pains).
• To manage your lungs in winter, you should use a humidifier, drink plenty of fluids, and strictly adhere to the medication in your inhaler.

What Causes Constant Cough in Winter?

1.The "Cold Shock" (Bronchoconstriction)

The lungs function best with the presence of humid and warm air. The air in winter is generally dry and cold. Therefore, when winter air is inhaled, especially through the mouth, it has a direct impact on the sensitive tissue lining the airways.

• As a result of this contact with the cold and dry winter air, the airways will react by spasming or constricting in order to protect themselves from the cold/dry air. This condition is referred to as bronchoconstriction.
• For people who suffer from asthma, this is an instant trigger for an asthma flare-up. For people who do not have asthma, bronchoconstriction results in a persistent dry and coughing-like sound because the lungs attempt to clear the irritation.

2.The "Inversion Layer" (The Pollution Trap)

• The ability of hot air to carry away pollution during the summer is due to heat rising. During the winter, however, due to the density and weight of cold air, pollutants such as dust, smoke, and transportation-related emissions (PM2.5) become trapped in a dense layer below where you breathe and continue to stay there.

This results in you inhaling a 'concentrated' mass of hazardous materials which will create a condition characterised by chronic inflammation and the development of the well-known 'pollution cough' and increases your likelihood of suffering from bronchitis.

3.The "Cold Nose" Effect (Lower Immunity)

A fascinating study in The Journal of Allergy and Clinical Immunology found that a temperature drop of just 5°C inside the nose kills nearly 50% of the billions of virus-fighting cells located there.

• The Result: Your physical barrier against viruses is weaker in winter, making you biologically more susceptible to the flu, rhinovirus (common cold), and COVID-19.

Asthma Triggers Winter Brings

The winter season is extremely hazardous for the 30 million Indians who suffer from asthma. Take note of some of the key triggers for asthma:

Winter Triggers of Asthma

• Dry Heat From Indoor Heating: Air from indoor heating (blowers & electric and hot-air heaters) drives moisture out of the air in your home causing dry air to form and therefore dehydrating mucous membranes lining the bronchial tubes, who then become tacky and safer for dessicated viruses.
• Indoor Allergens: The fact that most people spend time indoors during cold weather means that there are many more opportunities to be exposed to indoor allergens (such as dust mites in down bedding, pet dander and mold).
• Bronchoconstriction Due to Exercise: Running/exercising in the winter months can also result, due to how quickly you process oxygen-rich blood, in oral inhalation of large quantities of chilled/dry weather air. In most asthmatics, this is a common trigger.
• Viral Infections: A simple viral respiratory infection is capable of escalating into a serious, life threatening asthma flare (exacerbation) that may require hospitalization.

The Difference between Allergy vs. Infection

Cough syrups and antibiotics are two medications that treat coughing caused by lung infections or allergic/asthmatic reactions. The only way to tell the difference is by looking at the signs and symptoms of either condition.

Signs of Coughing due to Allergic or Asthmatic Reactions:

• Type of Cough- Dry, Hack, Wheeze (sharp and shrill)
• When Does It Occur- Most likely worsening at night, when you first wake up, or if you have been exposed to a cool and/or pungent environment (odors and dust).
• Fever is Absent- You will likely feel more or less like yourself except for the fatigue from having a cough.
• Tickling or Scratchy in the Throat- Usually due to mucus in the back of your throat from an irritated nasal cavity.

Signs of Coughing due to a Pneumonia or Bronchitis Lung Infection:

Signs that You May Have Pneumonia Include:

• When mucus is produced: If you have productive coughs that cause you to lose mucus from your lungs (thick and yellowish-green or rust-colored),
• Fever: You will probably have a fever above 101 degrees Fahrenheit and experience chills or shivering during this time.
• Pain: Pneumonia will usually cause pain in the chest, particularly if you're taking a deep breath or coughing, because of pleurisy.
• Shortness of Breath: Even if you're not exerting yourself, pneumonia will cause you to feel short of breath whenever you're sitting still or attempting simple actions.
• Extreme Fatigue: Pneumonia will make you weary and sore, with flu-like symptoms throughout your body.

Expert-Backed Winter Cough Treatment & Prevention

Treating a winter cough requires a two-pronged approach: soothing the irritation and modifying your environment.

1.Hydration is the No. 1 Expectorant

Dry lungs are irritated lungs.

• The Fix: Drink warm water throughout the day. It thins the mucus, making it easier to cough up, and soothes the raw lining of the throat. Herbal teas with ginger and honey are excellent natural anti-inflammatories.

2.Humidify Your Habitat

Combat the dryness caused by heaters.

• The Fix: Use a cool-mist humidifier in your bedroom to keep humidity levels between

40-50%. If you don't have one, place a bowl of water near the heater. This prevents your airways from drying out while you sleep.

3.The "Scarf Strategy"

Create a personal climate zone.

• The Fix: When you go outside, loosely wrap a scarf over your nose and mouth. This creates a pocket of warm air. By the time the air travels through the scarf, it is warmer and moister before it hits your lungs, preventing the "cold shock" spasm.

4.Master Your Medications (Don't Skip!)

• The Fix: If you have asthma, use your preventer inhaler (corticosteroid) religiously, even if you feel fine. It builds a shield of protection against inflammation. Keep your reliever inhaler with you at all times.

5.Steam Inhalation

• The Fix: Inhaling steam (plain or with a drop of eucalyptus oil) for 10-15 minutes helps moisten dry nasal passages and loosen phlegm. Caution: Be careful with hot water to avoid burns.

When to See a Doctor (The Red Flags)

Although some home treatments work well for mild symptoms, any respiratory issues may be able to progress very quickly during the cold months of winter, and therefore, if you experience any of the following, you should contact your physician right away:

• Wheezing and your short-acting bronchodilator has not been effective
• Fever that lasts longer than three days
• Blood in mucous
• Difficulty talking in full sentences due to shortness of breath
• Bluish lips or bluish fingernails/cyanosis

Your Partner in Respiratory Health at SGRH

Your lungs are vital, and in the challenging environment of an Indian winter, they need expert care. The Department of Medicine at Sir Ganga Ram Hospital is a national leader in managing complex airway diseases.

From advanced Pulmonary Function Tests (PFT) to diagnose the severity of asthma, to specialized care for winter bronchitis and pneumonia, our team of experts is equipped to help you breathe freely. We specialize in creating personalized action plans to help you navigate the winter season safely.

Don't let the winter wheeze silence you. Book a consultation with SGRH today.

Frequently Asked Questions (FAQs)

Q1: Is it possible to become addicted to an asthma inhaler?

This is a common belief that is not true and potentially harmful. Asthma inhalers (particularly preventatives) do not have any addictive properties and are a critical form of talk medicinal treatment similar to the role insulin has for people with diabetes. Ceasing the use of asthma preventers during cold months simply because you feel fine, will most likely be the most common contributor of serious asthma attacks.

Q2: Is honey a good treatment for nighttime coughs during the winter months?

Yes, honey is an effective treatment for a cough at bedtime according to multiple studies. Honey was found to be equally effective as one of the common medications used for nighttime cough suppression. Additionally, honey also has some mild antibacterial properties, and, due to its viscosity, coats the back of the throat very well. (Use caution and do not give honey to children younger than 1 year.)

Q3: Why is my nighttime cough getting worse?