Winter is definitely here and many have seen the first joyful snow flurries.

However, for those with asthma, it can be a difficult time. Lots of people find their asthma symptoms get worse over winter because there are more triggers around at this time of year – including chilly weather, colds, mould and chest infections. So, if you’re coughing more, or your chest is tighter at the moment, you’re not alone.

Asthma UK has found that the number of potentially life-threatening asthma attacks in the UK is more that three times higher that previously thought:

• That means every three seconds, someone is having an asthma attack
• Three people a day die from such asthma attacks
• Its figures suggest 10 million such episodes annually, when previous figures suggest around three million attacks annually.

Why the change?

Apparently, previous estimates were based on the amount of medication used, missing cases where patients struggled without an inhaler.

Asthma UK also raised concerns that growing numbers of children and adults are suffering from breathing results as a result of air pollution and of poor management of their condition. And yet, two thirds of asthma cases can be prevented with the right care.

What should you do, especially at this time of year, if you have asthma?

• If you are using your reliever (usually blue) inhaler more than three times a week or waking up at night because of your asthma you should contact your GP
• You should also seek help if your symptoms such as wheezing or a cough are getting worse or interfering with your usual activities
• Those with a preventer inhaler (often brown) should take it daily to help build up protection against asthma attacks
• Keep your inhaler with you at all times and use as instructed
• Wrap a lightweight scarf loosely around your nose and mouth when you go outside or into a cold environment – it warms the air you breathe in so it’s less likely to irritate your airways
• Burning wood gives off fine particles and breathing them in can make the airways inflamed. Getting your chimney swept regularly may help to get more smoke and pollution particles out of the room so they affect your asthma symptoms less
• Dust mites love central heating and can multiply in the winter. Ask your doctor or asthma nurse if they think antihistamines could help
• Mould is more likely to grow indoors during wet weather. If your allergy to mould is triggering asthma symptoms, ask your doctor or nurse about taking antihistamines
• Chest infections are often worse for people with asthma because they cause more inflammation in the lungs. Take your preventer inhaler to help deal with the inflammation
• The flu vaccination is considered your best bet for avoiding the flu. Colds are harder to avoid so taking your preventer inhaler is your easiest option.

What is asthma?

Asthma is a long-term condition that affects your airways, i.e. the tubes that carry air in and out of your lungs. Some believe that someone with asthma has “sensitive” airways that are inflamed and ready to react when they come into contact with something they don't like. When a person with asthma comes into contact with something that irritates their sensitive airways even more (an asthma trigger), it causes their body to react:

• The muscles around the walls of the airways tighten so that the airways become narrower
• The lining of the airways becomes inflamed and starts to swell
• Sticky mucus or phlegm sometimes builds up, which can narrow the airways even more.

These reactions cause the airways to become narrower and irritated - making it difficult to breathe and leading to asthma symptoms, such as chest tightness, wheezing, or coughing. Symptoms can range from mild to severe between different people and at different times in the same person. Each episode of symptoms may last just an hour or so, or persist for days or weeks unless treated. Asthma can be fatal, so if you have any symptoms, see your GP. In a severe attack, call 999 if you have taken reliever treatment (inhalers) and are still struggling to breathe.

What are the symptoms of asthma?

The usual symptoms are:

• Wheezing
• Coughing
• Shortness of breath
• Tightness in the chest.

Not everyone will get all of the symptoms. Some people experience them from time to time, but otherwise live normal lives doing everything they want to do with very few symptoms. Unfortunately, about five percent of people with asthma have what is known as severe asthma, and they require specialist care and support to manage symptoms. Others have asthma symptoms all the time because they're not taking their medicines, or not taking their medicines correctly.

What causes asthma?

People with asthma have sensitive airways that are inflamed and are ready to react to triggers that set off symptoms. Although asthma is complicated, there are two main ways that symptoms can be set off:

• If you have allergic asthma, your symptoms are caused by an allergic reaction when you come into contact with an allergen (a substance that triggers an allergic reaction). Common allergens include pollen, pets and house dust mites
• If you have non-allergic asthma, your symptoms are caused by an irritant you breathe in or another factor, but are not caused by an allergic reaction. Common irritants include cigarette smoke and car exhaust fumes. Common factors that can trigger asthma symptoms include exercise, cold weather, colds and flu.

It is possible that your asthma symptoms can be caused by allergic and non-allergic triggers, which means you can have both allergic and non-allergic asthma. Asthma also tends to run in families, especially when there's also a history of allergies and/or smoking.

What can make asthma symptoms worse?

Things that may trigger asthma symptoms include:

• Infections: particularly colds, coughs and chest infections
• Pollens and moulds: asthma is often worse in the hay fever season
• Exercise: however, sport and exercise are good for you if you have asthma. If necessary, you can use an inhaler before exercise to prevent symptoms from developing. However, exercise-induced asthma often represents undertreated asthma. If it occurs, it may indicate a need to step up your usual preventer treatment
• Certain medicines such as aspirin, ibuprofen and beta-blockers
• Smoking and cigarette fumes
• Other fumes and chemicals
• Certain pillows and mattresses
• Allergies to animals
• House dust mites
• Some foods: this is uncommon
• Emotion: asthma is not due to “nerves”; however, such things as stress, emotional upset, or laughing may trigger symptoms.

How is asthma diagnosed?

Sometimes symptoms are typical and the diagnosis is easily made by a doctor. If there is doubt, some simple tests may be arranged. These include spirometry and a peak flow meter assessment.

What are the treatments for asthma?

For most people with asthma, the symptoms can be prevented most of the time with treatment. This includes inhalers that deliver a small dose of medicine directly to the airways. The dose is enough to treat the airways – patients are usually given a reliever to help when symptoms occur and a preventer to prevent the airways from becoming inflamed. Talk to your GP for more details.

You should also make sure to get your annual flu shot as a flu infection can be much worse for those with asthma.