Breathing in Winter

By Mary Burns, RN, BS
PERF Executive Vice President

While our friends in Scandinavia were shoveling snow, and friends in the Northeast were struggling with ice storms, we had our own problems here in Southern California: Santa Ana winds with hot, sunny, dry weather in the nineties. You don’t feel sorry for us? Well, I can see why, but the operative word here is dry. The humidly can go as low as 10%. This is a temporary condition, so why should we talk about it in a newsletter that goes around the world? Even if you don’t live in a warm desert climate, you too may be having problems associated with dry air as you heat your homes to escape the cold. Let’s talk about solving some of the problems our patients in Southern California had with the dry air to see if we can help you also. When you turn on your furnaces, you may also turn the inside of your house into a warm, dry environment. Why is that a problem? I’ll bet many of you could answer that. Do you ever get a dry tickle in your throat, causing an irritated cough? Do you sneeze a lot even though you don’t have a cold? Do you get nosebleeds? Dry mucus membranes may cause these symptoms, a warning that your need to increase the humidity in the air. What happens if you don’t? You may become more susceptible to respiratory infections and, a more immediate problem in addition to those already mentioned, find that your sputum becomes thick, and difficult to expectorate, maybe to the point where you feel as if you are choking or can’t get your breath.

Needless to say, you should call your doctor if you are having increased difficulties with your breathing or sputum. But if your physician finds nothing really wrong, what can you do to help yourself? There are various techniques.

Drink more fluids! Take frequent sips during the day. You don’t think you ever perspire and so don’t need as much fluid as other people do? Perhaps, but be aware of something called “insensible perspiration.” That is just a fancy way of saying that in dry air your perspiration evaporates so quickly that you are not aware of it. A better way to evaluate your need for more fluids is to be aware of the color of your urine. It should be very pale yellow. If it is a darker yellow that usually means your urine is concentrated and you need more fluids. Be aware that when you first void after taking a pill that contains a Vitamin B you may have dark yellow urine. Hepatitis and liver disease can also cause dark yellow urine but most of you need not be concerned by that uncommon cause.

How much fluid should you drink a day? While we often hear that 8 glasses should be consumed, remember that this does not hold true if you are on diuretics (water pills) or have a heart problem. Ask your physician for guidance on this. Also, all of your fluid intake doesn’t come from water. When you think about increasing fluids, remember that anything that is a fluid at room temperature is also considered a fluid. That means foods like ice cream and jello. Don’t forget soups, and remember that all fruit (that isn’t dried) contains a lot of fluid. These things can all add up. Alcoholic beverages are considered diuretics, that is, causing a loss of fluids in the body. Drinking extra beer is not a good solution for increasing your fluid intake!

If your sputum is still very thick, even though you have increased your fluid intake, remember that sitting in a steaming bathtub or shower and inhaling that moist air will thin out your secretions. That is why sometimes people who produce large amounts of sputum may feel as if they are choking when they get into a humid atmosphere. The increased moisture in the air makes their sputum expand from the moisture inhaled with the air. While this may be a problem for people with thin sputum, it is exactly what we want to happen if your sputum is too thick to expectorate, to cough up.

Suppose you are too unsteady to get into a tub or shower. What else can you do? Remember those old-fashioned croup tents? You can improvise your own by boiling water in a large pan and inhaling the steam. But be careful. Be sure to turn the handle away from you so that you don’t accidentally spill that boiling water and burn yourself!

Another suggestion is to have a cup of steaming water, tea or coffee. Inhale the steam as you sip from the cup. This works well when you are away from home or up in a plane, where humidity can go as low as 4%. Tea and coffee also contain theophylline-like ingredients that may help open your airways. After inhaling the steam for 10 minutes or so, you might also consider postural drainage and percussion an hour before you go to bed. Usually, we only recommend postural drainage for folks producing large amounts of sputum, such as ½ cup or more a day. However, if you wake up coughing in the middle of the night with sputum, postural drainage might help clear your airways before going to bed and help you sleep better.

Postural drainage means lying down on your belly and, with the aid of pillows under your hips or waist, tilting down your upper body (and lungs) so that gravity helps get your secretions out. Even being almost flat, as you are at night while sleeping, helps gravity compared to your upright position all day. That is one reason why you may cough up secretions during the night. Try lying on one side or the other for 20 minutes or so as you watch TV. While you then may produce secretions, it may take another 30 minutes or so, which is a good reason for not doing this drainage immediately before going to bed. If you need to cough while still lying down, it is easier to sit up to do so.

Are you on oxygen? Percolating your oxygen through a humidifier bottle, as is done in the hospital, also helps humidify your air. These bottles look much like a Mason jar. In the early days of home oxygen, all oxygen came with a humidifier. However, studies found that patients did not always keep these bottles clean, turning them into a source of infection. Currently, you will get a humidifier bottle if you use 3 or 4 liters of oxygen per minute. If you use less oxygen but suffer from dry air, you may request such a unit from your oxygen supplier. Sometimes these bottles will come as sealed units, replaced by your oxygen company as necessary. In some locations, you will have to assume responsibility for these humidifiers. You will be instructed to keep the bottles three-quarters filled with sterile or distilled water and given cleaning instructions. They probably will give you several bottles so that you can thoroughly clean and rotate the bottles on a regular basis, rather than just continuing to refill them as the water level goes down. Hot soapy water, rinsing thoroughly, and air-drying will work if you don’t have a dishwasher.

Do you have any additional tips for helping other lung-challenged readers survive the winter? Send them in and we will share them with others in the next issue.

Wayne asks, “Why do people with COPD have more trouble breathing with cold weather?” One of the detailed answers is above. The air tends to be drier, or our heating of the air makes it drier. Cold air can also cause bronchospasm (narrowing of the air passages), especially when there is also a strong wind to contend with. You can compensate for this by wearing a ski mask, covering your nose and mouth with a scarf, or turning your back to the wind.

Come out of your car slowly, to compensate for sudden temperature change, which can also cause bronchospasm. That is, open the door for a few seconds before suddenly getting out of the car.

Really cold air can actually freeze the hairs in your nose! Can you imagine what it could do to the fragile tissue in your lungs, which are one-sixtieth the thickness of a cobweb? Be reassured. Your respiratory system has a much more efficient temperature control mechanism than anything that has been designed by man. Whether the air you breathe in is 160 degrees above zero and almost hot enough to fry eggs, or 80 degrees below zero and freezing everything else in sight, from the time this air enters your nose, until the time it enters your lungs, that air has become body temperature! For those of you who are looking for miracles look no further. This is one that leaves me breathless when I consider the wonder of it.