Cold and flu season can take a toll on anyone, but for those living with asthma, this time of year can be particularly challenging.
“When people come into the hospital for asthma exacerbation around this time of year, it’s generally in the setting of a viral upper respiratory tract infection or influenza. That tends to be the provoking factor,” according to Dr. Benjamin Seides, a pulmonologist at Northwestern Medicine Regional Medical Group in Winfield, Illinois.
As common as colds and flus are, he says many misunderstandings about how the conditions relate to asthma still exist. Here’s the truth about four common myths that continue to confuse people about asthma and the flu.
People with asthma shouldn’t get the flu shot
Seides says this myth is based on the misconception that the flu vaccine will cause asthma to flare up. However, he says there’s no evidence to support this claim.
Before you know you’re exposed to a cold or flu, the immune system knows and is planning an attack because it doesn’t want that virus to settle in the body.
“If you have asthma, you absolutely need the flu vaccine more than the average person, because people with asthma and other chronic lung disease, such as emphysema, can have a very severe course with influenza that is rather exaggerated relative to someone who has otherwise healthy lungs,” Seides said.
Cheryl Nickerson, a respiratory specialist and clinical product manager at Philips Sleep and Respiratory Care, agrees. She says the only people who shouldn’t get the flu shot are those who’ve had a severe allergic reaction to the shot in the past that was diagnosed by a doctor.
“Some people think they’ve had a reaction to the flu shot, but it was something else that coincided at the same time. Unless a doctor told them specifically that they shouldn’t get it, everyone with asthma should get the flu shot,” Nickerson said.
If you have well-managed asthma, a cold or the flu won’t cause issues
A person who’s properly managing their asthma with medication and other measures won’t experience as severe cold or flu symptoms compared to someone with unmanaged asthma.
However, Nickerson says a cold or flu is what makes someone who has well-managed asthma have an exacerbation. She explains this is due to inflammation.
“Before you know you’re exposed to a cold or flu, the immune system knows and is planning an attack because it doesn’t want that virus to settle in the body. Most people recognize symptoms of cold and flu as watery eyes, runny nose, and coughing and sneezing, but that’s all associated with the stage of the cold and flu that’s called inflammation. Inflammation is just the body trying to keep it from getting deeper into your lungs,” she said.
Even with well-managed asthma, when the immune system recognizes a cold or flu, Nickerson says it creates more inflammatory cells.
“That can trigger a person with well-controlled asthma to develop more asthma symptoms,” she said. Seides adds it’s important to stay on medications even if you’re not feeling any symptoms.
“Sometimes if people have well-controlled asthma, they want to get off their meds, but it’s well controlled because of the medications. If asthma is left untreated, even if it’s quiet, it causes changes in your airways, something called remodeling, which is likely to make you more prone to more severe asthma later, and severe asthma is more resistant to treatment,” he said.
Allergens are the most common cause for increased asthma symptoms
Seides says asthma that’s provoked by certain allergens is a small subset of asthma.
“Asthma is a complex disease with a common thread that has to do with airway hyperactivity and a certain characteristic and appearance on pulmonary function tests, but the kind of asthma that is specifically related to certain allergens is a small subset of that,” he said.
The reason for this misconception comes from a logical place, Nickerson says.
“As an asthma educator, one of the biggest things I talk about with people who have asthma is how to manage triggers, and of course allergens is a big trigger. We talk about eradicating the allergens from the house by removing carpet and stuffed animals and other things that could carry the allergens, but in reality it’s not the allergens that are the number one trigger. The number one trigger is cold and flu viruses,” she said.
She points out that in children, cold and flu viruses trigger 80 percent of asthma exacerbations. “Even if they manage those allergens, they could still come down with asthma exacerbation from cold and flu,” she said.
Children with asthma get more colds than kids without it
All children — with or without asthma — get about the same number of colds per year, Nickerson says.
“Most children have six to eight colds per year, but for children with asthma, when they get a cold it seems to hit them harder and the symptoms are worse. Also, [the cold or virus] may keep the airways reactive, so even if the virus goes away, the child may still be having symptoms, such as coughing,” she said.
How can I avoid asthma exacerbations during cold and flu season?
Seides reiterates that the flu shot is the best defense during this time of year.
“The reason we doctors are so concerned about influenza virus — though it varies from year to year — is because it can cause very severe disease and kills many people every year. We also talk so much about it because we have a vaccine that can either prevent or significantly reduce the severity of imprecation in people,” he said.
While there are other respiratory viruses that can be problematic for people with asthma, he says doctors can only help people manage them symptomatically and supportively.
To best guard yourself against other colds and viruses, Nickerson says to keep the following in mind:
- Wash your hands often.
- Try not to share food and drinks, as well as objects that can harbor germs, such as cellphones.
- If you have asthma, ensure that your nebulizers are clean, properly working, and have been replaced within the last 6 months.