The change of seasons could influence your patients’ respiratory health, and they may be sharing information during your discussions about how they are feeling. To explain the impact of changing seasons on their respiratory health, and how to mitigate the effects of such triggers, here are some guidelines and directives that could help.

Irritants and antigens. With the transition from summer to fall, for instance, certain irritants and antigens, such as pollens from weeds and mold from decaying vegetation, increase in concentration, said Colin Swenson, MD, a pulmonologist and associate professor of medicine at Emory University School of Medicine in Atlanta.

“In sensitized individuals, particularly those with atopic asthma and other forms of reactive airway diseases, these antigens cause histamine release and bronchospasm, resulting in chest tightness, wheezing, and dyspnea, as well as upper airway responses such as rhinitis, postnasal drainage, and cough,” said Swenson.

He said it’s important to identify the factors that contribute to disease severity in order to limit exposure and therefore flare-ups.

Temperature shifts. Research reveals how change in seasons also results in changes in temperature and humidity, both of which can affect respiratory health.

“For instance, high heat and humidity levels in summer are associated with increases in pulmonary exacerbations in people with obstructive lung diseases such as COPD [chronic obstructive pulmonary disease] and bronchiectasis,” said Swenson. “Likewise, the cold dry air is often associated with asthma exacerbations in winter.”

Sharing Guidance With Patients Regarding Specific Conditions

Swenson summarized messaging suggestions to explain how seasonal changes affect respiratory health: 

Respiratory tract infections. The fall and winter months are respiratory virus seasons, and these viruses can cause significant morbidity and mortality in patients living with chronic lung disease and may also set the stage for secondary bacterial pneumonias that further negatively affect health outcomes.

Chronic bronchitis. A number of seasonal changes can affect patients living with chronic bronchitis. “Respiratory tract infections during the fall and winter months disproportionately impact people with chronic bronchitis,” he said. “The spring and early summer months bring an increase in pollen and atmospheric particulate matter, which can trigger exacerbations of bronchitis. The heat and humidity of summer cause an increase in dyspnea in many patients living with chronic bronchitis.”

Allergic rhinitis. Viral infections, pollen, smoke, and chemicals are known to trigger exacerbations of underlying chronic rhinitis. In many patients with allergic rhinitis, these triggers can cause year-round symptoms.

Sinusitis. Like allergic rhinitis, sinusitis may exacerbate due to factors like viral infections during winter or pollen during spring and summer. “Typically, irritants, infections, and/or antigens lead to increased mucus production, the drainage of which may be impaired in chronic sinus disease. This, in turn, can lead to bacterial infection of the retained secretions,” Swenson said.

Asthma. It’s common for patients with asthma to experience symptomatic worsening during certain times of the year. “Classically, the winter and spring months are the most severe, correlating with colder, dryer air and increased pollen counts, respectively,” said Swenson.

COPD. Like asthma, patients with COPD may also experience increased symptom burden during certain times of the year. Patients may be at a risk for complications from respiratory viruses during the winter months and may also have underlying atopy that results in symptomatic worsening during the spring pollen season, he said. “Many patients with COPD become more symptomatic during the hot, humid summer months.”

How Can Patients Better Manage Their Respiratory Diseases When the Seasons Shift

As a primary care doctor, you play a pivotal role assisting your patients with guidance and understanding about the intersection of seasonal changes and respiratory diseases. Your directives can help them ease the severity of their symptoms.

Here are some suggestions to consider giving your patients:

• Rethink outdoor exercise. For patients with asthma, this may mean avoiding outdoor exercise during the cold winter months and high pollen counts of the spring, according to Harvard Health. Also, patients living with COPD, choosing indoor exercise in a climate-controlled environment during the summer months may improve dyspnea scores, said Swenson.
• Stay up to date with vaccinations. All patients with respiratory diseases should receive their routine vaccinations each fall and be educated on the importance of limiting sick contacts and exposures to factors known to exacerbate their symptoms, Swenson said.
• Recognize triggers. This measure can help with managing flare-ups. “I recommend that patients observe and document suspected or known triggers,” said Geeta Patel, MD, an allergy and immunology physician at Perelman School of Medicine at the University of Pennsylvania (Penn Medicine) in Philadelphia and Radnor, Pennsylvania. “When they realize what triggers them, they can act to prevent exposure to their triggers or talk to their doctors about escalating medications and treatment when required.” For example, she said, patients with asthma triggered by cold temperatures might benefit from maintenance asthma medications in the winter. “Once a patient and physician identify triggers, tailor avoidance measures based on the condition and the trigger,” said Patel. “For example, advise that patients monitor weather and air quality reports. When poor air quality alerts are in effect, advise staying indoors and closing windows.”
• Take indoor precautions. Patients can turn to HEPA filters, which Patel said can improve indoor air quality and reduce indoor allergens such as pets, as well as any outdoor exposures that make their way inside. Suggest your at-risk patients keep four-legged friends out of the bedroom. “Keeping pets out of the bedroom can make a big difference for pet allergic patients who are spending more time indoors due to outdoor conditions,” Patel said. “Pets can also bring in outdoor pollen which can worsen allergies.”
• Raise precautions for the most vulnerable. For vulnerable populations and patients with underlying respiratory conditions, Patel recommends advising general infection prevention strategies such as avoiding known sick contacts, practicing hand hygiene during seasons with increased viral illnesses circulating, and masking during COVID waves or when the patient is around large groups indoors.