I have asthma or RAD (reactive airway disease): cold air is my trigger

Hello, and welcome to Mayo Connect. You are presenting an unusual set of circumstances, but temperature sensitivity with reactive airway disorder (RAD) is quite common.
How long have you had the diagnosis of RAD? Did it begin as an exercise-induced situation? When did the unusual temperature sensitivity begin? What do you do to manage it?

The reason I am asking specifically is that for many years, I had exercise-induced RAD and asthma in high-temperature/high humidity situations. My doc at the time had "never heard of high-temperature RAD" and I'm sure she believed it was psychosomatic. But use of my albuterol rescue inhaler resolved it.

Then my daughters, both of them with mild asthma, began cross country skiing competitively, one had intermittent RAD at very low temperatures (and more severe, persistent asthma), the other NEVER skiied a race without an attack until her 5th year of competing. Curiously, inhalers resolved her attacks, and she reacted less as the season progressed each year.

Now for the interesting part - last year, for the first time in 10 years, I spent the winter in the cold climate of Minnesota. As part of coping with the pandemic, I took my grandsons out to play in the cold every day while their Mom worked from home (daycare was closed.) At first, because none of us was vaccinated, we wore masks full-time, even outdoors. After vaccine, we decided to forego masks, and I began to experience bronchospasm on any day when it was dry or windy - but it went away if I put on my mask!

Is it possible you have been wearing a mask so much, keeping the air to your lungs warm and moist, that a normal 70F, low-humidity day is causing them to perceive cold and to spasm? What happens if you wear a mask outdoor when it is cool?

Curious to hear from you.
Sue

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Hi Sue, I was quite glad to hear from you recently. I have never communicated with someone who had RAD before and also am new to this web site. My situation is unique. I am 79 years old and live in the San Francisco East Bay and during the fires in No. California, over a year ago, I felt so house bound and took a fatal hike, less than one hour, in the hills on a "bad air day." Even though the sun and clouds were in the sky, something told me it was not a good idea! Suddenly with no warning at all..my throat and pulmonary tubes clammed up. Very scary and also I had to walk back to my car. I have had several pulmonary function tests since Sept. 2020, which always show above normal function for my age. I breathe fine at night and mostly during the day with medication. Interesting that I never have coughed or had any wheezing. Except for complications due to cool air last winter and also having a very high pulse rate in the fall last year taking Albuterol with the fires and bad air, etc. even while inside my home, I avoided taking albuterol while having 4 heart tests in December by a cardiologist to confirm that my heart was OK. Also, largely due to Covid, I was unable to get consistent advice and prescription from pulmonologists (and there were many phone calls!) to treat my problems successfully until May this year when I started taking Symbicort 160, recommended by my ENT physician. (Flovent, Anoro, Singular, and other meds did not seem to help with breathing and often seemed to made breathing more difficult and also I really NOT understand the pulmonary tubes and how constriction could cause your airways to re-model, etc.) I should have. Frequently for a period until May, I would suffer a lot from constriction until my pulmonary system returned to normal on its own to avoid using albuterol. Any cool air was a trigger that got worse over winter when it was hard to stay inside the house. As I said before, now I am extremely sensitive to air temps. even at 70 degrees with a breeze and also since getting a new refrigerator in August, the dry air coming out when you open the doors, brings on tickling in my throat..so sensitive, and followed by some pulmonary constriction. I hold my breathe now, scary but I am getting used to it. I am house bound at present with cooler air and it is difficult for me to look back today at some photos taken exactly two year ago today when I was hiking up above Machu Picchu!! Thank you again for inquiring about my situation. I appreciate your interest and concern in my history.

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Have you tried wearing a mask outdoors when the air is cool? It seems to work for me and is much better than feeling housebound!
Sue

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Hello, and welcome to Mayo Connect. You are presenting an unusual set of circumstances, but temperature sensitivity with reactive airway disorder (RAD) is quite common.
How long have you had the diagnosis of RAD? Did it begin as an exercise-induced situation? When did the unusual temperature sensitivity begin? What do you do to manage it?

The reason I am asking specifically is that for many years, I had exercise-induced RAD and asthma in high-temperature/high humidity situations. My doc at the time had "never heard of high-temperature RAD" and I'm sure she believed it was psychosomatic. But use of my albuterol rescue inhaler resolved it.

Then my daughters, both of them with mild asthma, began cross country skiing competitively, one had intermittent RAD at very low temperatures (and more severe, persistent asthma), the other NEVER skiied a race without an attack until her 5th year of competing. Curiously, inhalers resolved her attacks, and she reacted less as the season progressed each year.

Now for the interesting part - last year, for the first time in 10 years, I spent the winter in the cold climate of Minnesota. As part of coping with the pandemic, I took my grandsons out to play in the cold every day while their Mom worked from home (daycare was closed.) At first, because none of us was vaccinated, we wore masks full-time, even outdoors. After vaccine, we decided to forego masks, and I began to experience bronchospasm on any day when it was dry or windy - but it went away if I put on my mask!

Is it possible you have been wearing a mask so much, keeping the air to your lungs warm and moist, that a normal 70F, low-humidity day is causing them to perceive cold and to spasm? What happens if you wear a mask outdoor when it is cool?

Curious to hear from you.
Sue

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Good morning,
It is interesting that your symptoms are triggered by the cold. I feel like my asthma is triggered by the cold - but it took a long time to diagnose it as "asthma". When I first went to my pulmonologist they didn't think I had asthma because while I had low lung volume in one lung my spirometry was normal. However, when I went to do the methacholine challenge it turns out I have severe asthma (which he says is triggered by allergies) but I have stopped going to cold places if I can because it triggers my asthma. I have a nebulizer that I use with asthma medicine at least three times a day if I am in cold weather. Have you tried doing that? Also has your doctor tested you EOS count or done the methacholine challenge test? I used to get sick and bronchitis and cough all the time especially in the cold. I am now much better after we did the testing and found the right combinations of inhalers. Plus if your eosinophils in your blood count are high there are different medicines that might help - at least in my case they did. I don't have RAD to my knowledge but I do know it took us a long time to identify the type of asthma I have which is eosinophilic asthma. I am not really familiar with RAD so not sure if that is helpful but just thought I would share my story in case it helps. Hope you find a solution. I would wake up coughing for years and was sick all the time in cold weather - took until the age of 42 to get officially diagnosed with this. I take spiriva and symbicort. I also do bi-monthly injections of Fasenra which has made a big difference. I had to stop using albuterol because it gave me hand tremors so everyone is different in what works for this. Just sharing my experience in case it helps.

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I hope you live in a warmer place. Any air temp.change causes severe coughing for me. Docs took out my tonsils when I was 4, didn't help. 80 years later, my best med is Fisherman 's Friends cough lozenges. Lots of good menthol without inhaler side effects.

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