Asthma and COPD in Winter and Smog Season: Inhalers Explained

For people living with asthma or COPD, the months from November to February can be the hardest of the year. Cold, dry air, winter viruses and the thick smog that settles over Lahore and much of Punjab all irritate sensitive airways. Many patients find they need their reliever inhaler more often, or end up in hospital with a flare-up.

Understanding your inhalers, and having a plan before the season starts, makes a real difference.

Why winter and smog make breathing harder

• Fine particles (PM2.5) in smog travel deep into the lungs and trigger inflammation and tightening of the airways.
• Cold, dry air can cause the airway muscles to spasm, especially during exercise.
• Viral infections such as colds and flu are a leading cause of asthma and COPD attacks.
• Indoor smoke from heaters, wood fires and cooking adds to the load when windows stay closed.

Relievers and preventers: what is the difference?

Most people with asthma or COPD use more than one inhaler. Knowing which one does what is important:

Reliever (rescue) inhalers

Short-acting bronchodilators such as salbutamol relax the airway muscles within minutes. They are used for sudden symptoms like wheezing or breathlessness. Carry your reliever with you at all times. If you need it more than a few times a week, your condition is not well controlled and you should see your doctor.

Preventer inhalers

Inhaled steroids such as budesonide and fluticasone reduce swelling and sensitivity in the airways over time. They do not give quick relief, but used every day they prevent attacks. Rinse your mouth after using them to avoid a sore throat or thrush.

Long-acting bronchodilators

Medicines such as salmeterol and formoterol keep the airways open for around 12 hours and are combined with a steroid in asthma. In COPD, once-daily options include tiotropium and indacaterol. These are maintenance treatments, not rescue inhalers.

Tablets

Some patients also take tablets such as montelukast, particularly when allergies play a role, or theophylline as an add-on. Your doctor will decide what suits you.

Get the most from your inhaler

Studies show that many people use their inhaler incorrectly, so much of the medicine never reaches the lungs. A few tips:

• Ask your doctor or pharmacist to check your technique, and repeat the check every few months.
• Use a spacer with metered-dose inhalers. It makes timing easier and delivers more medicine to the lungs, especially for children and older adults.
• Breathe out fully before inhaling, then hold your breath for about ten seconds afterwards.
• Check the dose counter or expiry date before the season starts so you never run out.

For severe flare-ups or for people who cannot manage an inhaler, doctors may advise a nebulizer. See our nebulizer buying guide for help choosing one.

Your winter action plan

1. See your doctor before winter to review medicines and get a written asthma or COPD action plan.
2. Take your preventer every day, even when you feel well.
3. Get the flu vaccine, and ask about the pneumococcal vaccine if you have COPD or are over 65.
4. Check the air quality each morning. On high-smog days, limit outdoor activity and keep windows closed.
5. Wear a well-fitting N95 mask outdoors during heavy smog. Cloth masks offer little protection against fine particles.
6. Avoid smoke from cigarettes, heaters and fires indoors.
7. Cover your nose and mouth with a scarf in very cold air.

Signs of a serious attack

Seek emergency help if you notice any of the following:

• Your reliever is not helping, or you need it every few hours
• You are too breathless to speak in full sentences
• Lips or fingertips look blue or grey
• You feel drowsy, confused or exhausted from breathing
• In children: pulling in of the ribs, grunting or flaring nostrils

Frequently asked questions

Can I stop my preventer inhaler when I feel fine?

No. Preventers keep airway inflammation under control. Stopping them often leads to a flare-up a few weeks later, especially in winter. Talk to your doctor before making changes.

Are inhaled steroids safe for children?

At the doses used for asthma, inhaled steroids are considered safe and are far less risky than repeated attacks. Your doctor will use the lowest dose that keeps symptoms controlled.

Does a humidifier help?

A humidifier can ease dry air indoors, but keep it clean to prevent mould, which can itself trigger asthma.

Browse asthma and COPD medicines on Khasmart, with delivery across Pakistan.

This article is for general information and does not replace advice from your doctor. It does not include dosage; always follow your prescription and action plan.