Winter and lung health: Managing respiratory challenges during the cold months

The poor air quality in India during the winter months, due lower temperature, pollution and viral infections, is a major threat to lung health. Major Clinical studies elucidate that respiratory issues i.e. asthma and Chronic Obstructive Pulmonary Disease (COPD) tend to flare up in winter, leading to more hospitalizations and an increased risk of mortality.
According to the Central Pollution Control Board (CPCB), India’s winter air quality has been worsening, with cities like Delhi, Lucknow, and Kanpur often ranking among the worst in the country. Temperature inversions in these areas trap pollutants near the ground, which causes a significant increase in respiratory illnesses. Nearly 2 million deaths in India are attributed to air pollution each year, with a large percentage of these deaths being related to respiratory disorders, according to a report from the Indian Council of Medical Research.
Winter seems to worsen the symptoms of asthma and COPD patients. According to the Indian Journal of Chest Diseases and Allied Sciences, researchers found that bronchoconstriction caused by chilled temperature occurs in asthma. During winter, around 40% of asthma patients complained of having greater symptoms, including coughing, wheezing, and shortness of breath. In addition, patients with COPD suffer more frequent flare-ups. Airways become even more constricted by the cold and dry conditions, leading to higher chances of infections. Some of the respiratory illnesses include common cold, influenza, and pneumonia, are more prone to occur during winter months.
According to the Indian Ministry of Health and Family Welfare, there are more than 30 percent increases in cases of pneumonia during winter especially amongst old people and those already affected with lung diseases. As put by NCBI, Viral infections during winter could probably bring about more serious problems in parts of the country that record tremendous changes in temperature.

How cold weather affects lung health?

Cold air exerts many bad effects on the respiratory system. Asthma patients and COPD patients suffers from extreme discomfort, increased coughing and wheezing, plus shortness of breath. According to a study published in the All India Institute of Medical Sciences, nearly 30% of asthma patients experience increased flare-ups during winter due to bronchoconstriction caused by cold temperatures.
There is increased incidence of viral infections in winter which can potentially lead to severe bronchitis, pneumonia & related hospitalization. This is especially higher in patients with pre-existing chronic lung conditions and immunosuppression.
Air pollution also worsens in winter, and high levels of particulate matter (PM2.5) continue to cause irritation in the lungs besides aggravating the existing ones. According to a report by Greenpeace India, the particulate matter level in Delhi often crosses the safety limit several times during winter months. This leads to the increase in respiratory hospital admissions. During the winter season, the inhalation of pollutants aggravates asthma, COPD, and other respiratory diseases that may lead to severe complications requiring hospitalization.

Managing respiratory health during winter in India

Although winter presents challenges for lung health, there are several practical measures that individuals can take to protect themselves and manage respiratory symptoms effectively.
1. Layer Up and Protect Your Airways
It is necessary to cover the mouth and nose with a scarf or mask while venturing out into cold weather if one has asthma or COPD. In this manner, it ensures that air is warmed up before it hits the lungs and cannot impact the airways, and the probability of asthma attack would be lesser. Bronchoconstriction can easily be provoked due to Indian winter conditions where temperatures tend to dip low significantly in Delhi and Chandigarh.
Wearing layers of clothes also helps avoid exposure to drastic temperature changes, which can put an additional burden on the respiratory system. It is recommended not to expose oneself to abrupt cold weather, as this will worsen the symptoms.
2. Maintain indoor humidity
Heated systems for many houses in India become operational in the winter and can evaporate moisture in the indoors, which will irritate the airway and intensify respiratory discomfort. A humidifier is really helpful when keeping the moisture indoors between 40 to 60%. The Indian Chest Society indicates that a humidity range of between 40-60% significantly reduces the irritation that comes with respiration as well as inhibits complaints such as dryness of throat and cough.
3. Stay active, but cautiously
Exercise plays a crucial role in keeping our lungs healthy, but it’s important to be cautious with outdoor activities during the winter months. Cold air can exacerbate respiratory symptoms. Therefore, indoor exercises like yoga, walking on a treadmill, or swimming in a pool are great alternatives during this season. A study from the Pune Chest Clinic found that asthma patients experienced reduced airway reactivity and better lung function when they opted for indoor workouts in winter rather than exercising outside in the cold.
If you have to exercise outdoors, try doing it during the warmest part of the day and layer your clothing to prevent changing temperatures.
4. Monitor air quality
Air pollution in cities like Delhi, Mumbai, and Bengaluru tends to be at its worst during the winter months. The World Health Organization reports that more than 90% of India’s population is exposed to polluted air, with PM2.5 and PM10 levels reaching dangerous heights in the colder season. On days with high pollution, individuals with respiratory conditions are advised to limit outdoor activities. Air quality monitoring apps, such as SAFAR (System of Air Quality and Weather Forecasting and Research), provide real-time updates on pollution levels, helping people decide when it’s best to stay indoors.
Installing air purifiers in homes, particularly in areas with severe pollution, can improve indoor air quality. Research from the Indian Institute of Technology (IIT) Delhi indicates that air purifiers can effectively lower indoor pollutant levels, thereby alleviating respiratory issues for sensitive individuals.
5. Work Closely with Your Healthcare Provider
Winter might be a challenging time for individuals suffering from asthma, COPD, or other chronic lung diseases. Regular follow-up with a pulmonologist is essential to monitor the lung function and change treatment plans accordingly. In India, healthcare access varies in different regions; hence, being informed and consulting a doctor at the worst symptoms would be wise.
6. Vaccination
Yearly influenza and pneumococcal vaccinations are especially beneficial for elderly individuals and patients with chronic medical conditions such as lung diseases, diabetes mellitus, and hypertension. Consult your pulmonologist or physician for more information.
Winter season may trigger serious respiratory challenges, especially for patients with asthma, COPD, and other chronic lung conditions. However, by following precautions, vaccination lifestyle modifications, and medical treatments, the lung health can be well managed during winter months. Dressing warmly, maintaining indoor humidity, exercising safely, keeping track of air quality, staying up-to-date with vaccinations, and consulting health care providers will help minimize risks of respiratory exacerbations and help individuals enjoy a healthy active life during winter months.
Dr Rohan Aurangabadwalla, Consultant Pulmonology, Apollo Hospitals Navi Mumbai