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Running in the Cold

Original Editor - Kapil Narale

Top Contributors - Kapil Narale, Khloud Shreif, Vidya Acharya and Lucinda hampton  

Introduction

It can be agreed that running in the cold Wintery weather is more strenuous for the respiratory system. Inhaling cold air results in poor effects on the lungs of people with respiratory conditions, especially asthma. [1]

It is seen that under normal conditions, breathing through the nose takes account for the effects of cold air, and therefore at rest and with light exercise the facial skin and nasal mucosa, but not the lower airways, may experience cold air related respiratory symptoms. (ref?)

For normal individuals, exercising in the cold has an insignificant effect on the airways. In individuals with asthma, however, bronchoconstriction ma result, and there may be worsening of airway obstruction in those with obstructive pulmonary disease (OPD). [2][3][4] Running in the Wintery weather has ben shown to cause airway hyperresponsiveness, asthma, and chronic cough, as a result of the cold air. [5] [6] [7] [8] [9]It has been shown that the Winter activities caused airway remodeling and due to the repeated cold air exposure and from hyperventilation damage to the bronchi and bronchioles. [10] [11]

With cold air outdoors, other weather related factors such as humidity, visibility, cloud cover, air pressure, wind speed and others, need to be considered, when investigating factors that may cause respiratory symptoms or impairments. [12]


It is interesting to note that the cold climate doesn't seem to be a public precautionary concern. [1]

Physiology

With the inhalation of cold air there are changes in the ASL, mucosa, smooth muscles, and blood vessels. Under normal conditions, alveolar air is at a temperature of 37oC. Alveolar gas is completely saturated with water vapour, humidified and heated by the organs of the upper respiratory tract walls [13]. These walls help with gas exchange, and consists of a large surface area in contact with the external space. They must provide sufficient protection from dehydration and cooling.

With the inhalation of cold air there is activation of the epithelium to generate proinflammatory substances. The disturbance helps determine the activation of exposed peripheral nerves. The parasympathetic and sympathetic nerves regulate the vasomotor control in the airways. The release of neuropeptides, including Substance P and Calcitonin Gene Related Peptide (CGRP) [14], can cause a forceful vasodilation. Vasodilatation of bronchial vessels causes thickening of the mucus in the airways, and thus promotes hyperventilation. This can also help facilitate bronchial sensitivity which can cause asthma attacks.

The bronchorestriction caused in the cold air is associated with an increased fluid osmolarity with an increased breathing rate. However, heat loss, or warming of the airways subsequent to physical activity, may be a determinant of this response. [15] The number of granulocytes and macrophages in the lower airways can be increased with the exposure to cold air. [16] In addition, the impairment of respiratory mucociliary function, caused by the cold air, can prevent the removal of pollutants. [17]

Mechanisms of Cold Air Effects in Athletes

The respiratory system may be particularly affected with runners or athletes in the cold air. Since cold air is being inhaled, it needs to be conditioned and warmed before it can be delivered for the phases of gas exchange. This comes with the cost of loss of heat and water. It is seen that there is a shift from nose breathing to nose and mouth breathing when the VO2 is greater than 30L/min. [18] When this is the case, respiratory symptoms may occur in the nasal mucosa, pharynx, larynx, and lower airways. [19]

During physical activity, nasal breathing shifts to mouth breathing when the minute ventilation is above 40L/min. In this case, the intrathoracic airways are involved in the conditioning of the cold air. [20]

Simultaneous drying and cooling of the airways generally occur in endurance athletes who would have a higher VO2. Respiratory symptoms and airways hypersensitivity are common in skiers, swimmers, and long-distance runners.

Exposure to cold makes chronic bronchitis worse, and causes Raynaud's phenomenon of the lungs. This involves vasoconstriction of the pulmonary arteries and a reduction in pulmonary volume in individuals with primary Raynaud's phenomenon. In addition to that, inhaling very cold air can cause acute pulmonary oedema or frozen lungs. [13] It is also seen that inhalation of cold air causes vasodilation, and this increases blood flow to the central airways. [21] Individuals who repeatedly have a higher breathing rate in very cold air, recurrences of critical differences in bronchial blood flow can cause changes in walls of bronchial and pulmonary arteries. This would lead to a quicker impairment of lung function and an increased thickness of the pulmonary artery walls, which is known as Eskimo lung. [21]

Cold Air and Air Pollution

Air pollution, such as various chemicals and gases in the air can cause respiratory difficulties. [22] [23]It was found that cold temperature along with concentrations of black smoke can increase risks of respiratory complications. [24]

Cold Air from Air Conditioning

Cold air that is produced from air conditioning also is a major public health concern. Exposing the airways to cool air, and having drastic temperature changes from the outdoor environment can cause respiratory issues. In this case, air quality can also be altered. Diagnosed discomfort from respiratory conditions can be made worse with the use of air conditioning. Cold and infections from the cold air can cause bronchial inflammation. This can also be caused by air pollution. [1]

Hyperventilation can also cause airway damage due to the cold. With hyperventilation, there is increased cooling due to the higher airflow in the airways. [1] Breathing 20oC air at 15L/min will decrease the tracheal temperature to 34oC, while breathing the same air at 100L/min will decrease the temperature to 31oC. This difference in breathing and the internal temperature has the same effects as inhaling cold air. [25]

There is a thin liquid lining along the airways, called Airway Surface Fluid (ASL). Rapidly Breathing in the cold air may cause the ASL to evaporate quicker than it can be restored [26] [27]. This causes drying and hypertonicity of the ASL. It is noted that the water content of almost freezing air is close to 0oC, thus the effect of cold air on the airways is cooling and drying [28][19][18].

References

  1. ↑ 1.0 1.1 1.2 1.3 D’Amato M, Molino A, Calabrese G, Cecchi L, Annesi‑Maesano, D’Amato G. The impact of cold on the respiratory tract and its consequences to respiratory health. Clinical Translations in Allergy. (2018:8:20:1-8.
  2. ↑ Millqvist E, Bengtsson U, Bake B. Occurrence of breathing problems induced by cold climate in asthmatics—a questionnaire survey. European Respiratory Journal. 1987:71:444–449.
  3. ↑ Marino C, de Donato F, Michelozzi P, D’Ippoliti D, Katsouyanni K, Analitis A, Biggeri A, Baccini M,Accetta G,,Perucci C.A. Effects of cold weather on hospital admissions: results from 12 European cities within the PHEWE project. Epidemiology. 2009;20:S67–8.
  4. ↑ Driessen J.M, van derPalen J, van Aalderen W.W, de Jongh F.H, Thio R.J. Inspiratory airflow limitation after exercise challenge in cold air in asthmatic children. Respiratory Medicine. 2012:106(10):1362–1368.
  5. ↑ Hyrkas H, Jaakkola M.S, Ikaheimo T.M, Hugg T.T, Jaakkola J.J.K. Asthma and allergic rhinitis increase respiratory symptoms in cold weather among young adults. Respiratory Medicine. 2014:108:63–70.
  6. ↑ Karjalainen E.M, Laitinen A, Sue-Chu M, Altraja A, Bjermer L, Laitinen L.A. Evidence of airway inflammation and remodeling in ski athletes with and without bronchial hyperresponsiveness to methacholine. American Journal of Respiratory & Critical Care Medicine. 2000:161:2086–2091.
  7. ↑ Carlsen K.H. Sports in extreme conditions: the impact of exercise in cold temperatures on asthma and bronchial hyper-responsiveness in athletes. British Journal of Sports Medicine. 2012:46:796–799.
  8. ↑ Turmel J, Poirier P, Bougault V, Blouin E, Belzile M, Boulet L.P. Cardio respiratory screening in elite endurance sports athletes: the Quebec study. Physician and Sportsmedicine. 2012:40:55–65.
  9. ↑ Langdeau J-B, Turcotte H, Thibault G, Boulet L.P. Comparative prevalence of asthma in different groups of athletes: a survey. Canadian Respiratory Journal. 2004:11:402–406.
  10. ↑ Koskela H.O. Cold air-provoked respiratory symptoms: the mechanisms and management. International Journal of Circumpolar Health. 2007:66(2):91–100.
  11. ↑ Bougault V, Turmel J, St-Laurent J, Bertrand M, Boulet P.L. Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes. European Respiratory Journal. 2009:33:740–746.
  12. ↑ World Health Organization and World Meteorological Organization. Global climate change and human health: from science to practice. Atlas of Climate Change and Health. 2012. http://www.who.int/globalchange/ publications/atlas/report/en/index.html (Accessed 20 Oct 2016).
  13. ↑ 13.0 13.1 Regnard J. Cold and the Airways. International Journal of Sports Medicine. 1992:13:S182–S184.
  14. ↑ Matran R. Neural control of airway vasculature: involvement of classical transmitters and neuropeptides. Supplementum: Acta Physiologica Scandals:1990.
  15. ↑ Sue-Chu M. Winter sports athletes: long-term effects of cold air exposure. British Journal in Sports Medicine. 2012:46:397–401.
  16. ↑ Larsson K, Tornling G, Gavhed D, Müller-Suur C, Palmberg L. Inhalation of cold air increases the number of inflammatory cells in the lungs in healthy subjects. European Respiratory Journal. 1998:12:825–830.
  17. ↑ Clary-Meinesz C.F, Cosson J, Huitorel P, Blaive B. Temperature effect on the ciliary beat frequency of human nasal and tracheal ciliated cells. Biology Cellular. 1992:76:335–338.
  18. ↑ 18.0 18.1 Anderson S.D, Togias A.G. Dry air and hyperosmolar challenge in asthma and rhinitis. In: Busse W.W, Holgate S.T, editors. Asthma and Rhinitis. 1st ed. Boston: Blackwell Scientific Publications: 1995. p.1178–1195.
  19. ↑ 19.0 19.1 Sundell J, Levi H. Ventilation rates and health: multidisciplinary review of the scientific literature. Indoor Air. 2011:21(6):442–453.
  20. ↑ McLane ML, Nelson JA, Lenner KA, Hejal R, Kotaru C, Skowronski M, Coreno A, Lane E, McFadden Jr E.R. Integrated response of the upper and lower respiratory tract of asthmatic subjects to frigid air. Journal of Applied Physiology. 2000:88:1043–1050.
  21. ↑ 21.0 21.1 Schaefer O, Eaton R.D, Timmermans F.J, Hildes J.A. Respiratory function impairment and cardiopulmonary consequences in long-term residents of Canadian Arctic. Canadian Medical Association Journal. 1980:123(10):997–1004.
  22. ↑ D’Amato G, Holgate ST, Pawankar R, Ledford D.K, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani C.E, Baker DJ, Bayram H, Bergmann K.C, Boulet L.P, Buters J.T, D’Amato M, Dorsano S, Douwes J, Finlay S.E, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh J.J, Popov T.A, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra- Monge J.J, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organization Journal. 2015:8(1):25.
  23. ↑ https://earthobservatory.nasa.gov/Features/Aerosols/2010/page3.php. Accessed 10 Sept 2015.
  24. ↑ Carder M, McNamee R, Beverland I, Elton R, Van Tongeren M, Cohen G.R, Boyd J, Macnee W, Agius R.M. Interacting effects of particulate pollution and cold temperature on cardiorespiratory mortality in Scotland. Occupational and Environmental Medicine. 2008:65:197–204.
  25. ↑ Koskela H.O. Cold air-provoked respiratory symptoms: the mechanism and management. International Journal of Circumpolar Health. 2007:66(2):91–100.
  26. ↑ Daviskas E, Gonda I, Anderson S.D. Mathematical modeling of heat and water transport in human respiratory tract. Journal of Applied Physiology. 1990:69:362–372.
  27. ↑ Freed A.N, Davis M.S. Hyperventilation with dry air increases airway surface fluid osmolality in canine peripheral airways. American Journal in Respiratory Critical Care & Medicine. 1999:159:1101–1107.
  28. ↑ Cole P, Forsyth R, Haight J.S. Effects of cold air and exercise on nasal patency. Annals of Otology Rhinology, & Laryngology. 1983:92:196–198.
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