Behind the whiteboard | Shortness of breath

In our beautiful country of Aotearoa New Zealand, the winter months can bring with them some sights that take your breath away. On a recent trip to Tekapo and Aoraki Mt Cook, with crisp winter mornings and late autumn colour, I got to experience some of this breathtaking scenery.

Unfortunately, as we head into the winter months, there are also less pleasant things that can take our breath away. A selection of respiratory bugs and nasties come out to play as we hunker down around the fireplace or venture out into the cold. So let’s take a look at asthma and allergens, bugs and bubs, chest pain and chills…

Using a well-known first aid approach, we’ll explore the A, B, Cs of common winter ailments. There is a reason that the first things we check in a medical emergency are Airway, Breathing and Circulation; it is because failure of these things can be life-threatening, and also the remedies are often quite simple. Our hearts and lungs work tirelessly to send oxygen to our brains and other organs via the bloodstream 24/7, 365 days a year throughout our entire lifetime. But sometimes other factors interfere, and our hearts and lungs can get tired after all.

It is postulated that winter weather promotes transmission of infection between people for two main reasons: we are more likely to spend longer periods of time indoors with others who are already sick, and our defences are lowered by breathing in cold air and having to work harder to keep our bodies warm.

We cannot “catch a chill,” but we can catch a cold, which is caused by a virus spread from one person to another.

The vast majority of winter infections are due to viruses, which do not respond to antibiotics. Viruses can also make other chronic illnesses, such as asthma and COPD (Chronic Obstructive Pulmonary Disease), worse.

Asthma is a long-term condition that involves both inflammation and spasm of the lower airways. It is often triggered by things such as allergies, viral infections, stress, exercise, mould, smoke, fumes, and cold air. With increased smog and air pollution, increased prevalence of viral infections and colder weather, poorly insulated and mouldy homes, asthma may become worse in winter. The same applies to COPD - a combination of bronchitis (inflamed airways) and emphysema (damage to the air sacs in the lungs). Inhalers for asthma and COPD include preventers and relievers. Preventers are working to reduce the inflammation and improve your health for next month, so it is important to use these regularly, as prescribed by your doctor, before the winter illnesses and triggers set in.

Infants under 12 months of age can be prone to bronchiolitis - inflammation of the small airways in the lungs, most commonly caused by RSV (respiratory syncytial virus), which occasionally results in needing hospitalisation for supportive care if breathing difficulties lead to not getting enough oxygen or having difficulty feeding.

Croup is another common childhood illness, most commonly caused by viruses and usually affecting children aged 6 months to 3 years. It causes swelling in the upper airway, which results in a classic barking cough. Keeping infants and children calm, comfortable, and hydrated are mainstays of supportive care for these infections.

Issues with circulation can also present with shortness of breath. Anaemia, where low red blood cell count means the blood carries less oxygen than it should, is one cause. People with heart failure, angina, heart attack or anaemia can experience breathing difficulties with or without chest discomfort, which are often made worse by cold weather and cold homes."

According to the British Heart Foundation, cold weather causes your heart rate and blood pressure to go up, making your heart work harder to pump blood around your body.

This extra strain on your heart can lead to worsening of heart failure and increased risk of heart attack. Keeping your main living areas comfortably warm and layering warm clothes when you go outside can help to prevent worsening of heart-related symptoms.

Fortunately, first aid for people with breathing difficulties is similar for all these conditions.

Signs to watch for:

• Breathing fast at rest

• Unable to say more than a few words at a time

• Noisy breathing - wheezing or grunting

• Using extra muscles around the chest and neck to breathe

• Blue or grey discolouration around the lips or finger tips

• Agitation, drowsiness or confusion

• Increased use of reliever inhalers or angina medication

In babies also look for:

• Sucking in between each rib or below ribcage

• Flaring of nostrils

• Decreased feeding

Help is available through Plunket line, Healthline, Urgent Care, your GP, or the ambulance service if unsure of severity.

kidshealth.org.nz has excellent videos and advice about babies and children with breathing difficulties.

People with asthma or COPD may have an individual action plan - support them to follow it.

First Aid – based on the Asthma and Respiratory Foundation NZ guidelines, but also relevant to many other causes of breathing difficulty

• Assess the severity of the breathing difficulty - mild, moderate, severe

Call 111 if severe or if the person is frightened

Be prepared to start CPR if the person stops breathing

• Sit the patient upright in a position that they find most comfortable, stay with them and reassure them

Loosen restrictive clothing around the neck and chest

• Treat - Help them administer their own medication if they have a known medical problem - e.g., EpiPen (adrenaline) if known allergy and exposure to trigger;

Asthma - reliever inhaler - 6 puffs (via spacer if available) one at a time, 6 breaths per puff, every 6 minutes until settling or help arrives;

Angina - nitrolingual spray/GTN 1 puff under tongue every 5 minutes for chest pain - call 111 if ongoing chest pain after 10 minutes

• Help – call ambulance if not improving (or if EpiPen used)

• Monitor - if improving - important to note that breathing may become quieter as the patient becomes more unwell - this requires immediate help

• All OK! If improving and symptom-free, return to normal quiet activity. If symptoms recur, repeat treatment and rest. Seek medical attention

As in most situations requiring first aid, prevention is better than cure. When suffering from one of the many winter lurgies, it is important to rest; keep well hydrated; keep the air around you clean by avoiding irritants such as dust, smoke, fumes; wash your hands with soap and water (no need for antibacterial soaps - they don’t help with viruses and we don’t want to kill off the good bacteria that live on our skin normally); throw away used tissues immediately and stay home to avoid sharing the 'love'. 

Make the most of the life-saving immunisations that are available to our children and us before the winter illnesses start to spread.

Avoid exposure to smoking or vaping.

Keep your home mould-free and warm.

Make sure you start taking your preventative inhalers before the flu season if you have asthma or COPD, and ensure that you have a stock of your reliever medication.

So, as we throw another log on the ultra-low-emission burner and wrap up warm to head out for our winter adventures, let’s prepare to have our breath taken away by the scenery and not the sniffles.

A big thanks to Claire for this super informative post, Claire is our newest team member after recently retiring from emergency medicine. Great things to look out for, I (gail) learnt a lot too. You can catch up on the other team members posts in this series too. If you missed last week's update from Jodie? Read Behind the whiteboard | Cold exposure and hypothermia safety. Next week we will be hearing from Nick, with some first aid advice around sports injuries.

This article is intended for general information purposes only and does not constitute medical advice. The first aid guidance included is based on New Zealand Resuscitation guidelines and Asthma and Respiratory Foundation NZ guidelines and is not a substitute for formal first aid training. If you are concerned about your health or the health of someone in your care, please seek advice from a qualified health professional. In an emergency, call 111.