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Cold air and chilly weather can make a lot of people uncomfortable, but this climate presents particular challenges for people with pulmonary artery hypertension (PAH), a type of pulmonary hypertension. With PAH, small blood vessels in the lungs become constricted, limiting blood flow. This rare disease causes high blood pressure in the lungs, which can damage the right side of the heart as it works harder to pump blood into the lungs. Symptoms of PAH, such as shortness of breath and chest pain, can worsen in the cold.
Members of myPHteam have described how when temperatures dip, quality of life can too. “Since I have been diagnosed with PAH, my life is very different now,” a myPHteam member wrote. “The cold is very hard on my breathing.”
Another member said, “I hate the cold because it hurts my lungs when I breathe cold air.”
Cold air can aggravate PAH, and prolonged exposure to the cold may contribute to disease progression. But you can take steps to manage the cold and protect your lungs.
Most PAH cases are idiopathic, meaning the cause of the disease is unknown. Researchers also don’t fully understand how cold weather affects the lungs of people with PAH and other lung diseases such as chronic obstructive pulmonary disease (COPD). One study found that exposure to cold temperatures appeared to increase proinflammatory proteins in the immune system that are linked to disease activity in PAH. Extended exposure to cold weather or high altitude also may increase pressure in the pulmonary artery, which is affected by PAH.
In addition to the possible effects of cold on pulmonary artery pressures, some people with PAH may become short of breath in cold environments simply because breathing cold air is more difficult than breathing warm air.
People with PAH have a high risk of heart failure. There’s no known cure for PAH, but disease progression can be slowed with treatment. Surgery such as a lung transplant or even a heart-lung transplant may be advised in severe cases.
To avoid worsening their condition, people with PAH also need to take precautions to protect their heart and lungs. One important aspect of self-care involves preparing for cold temperatures. The five strategies described below can help you stay warm — or warm up faster — and avoid intensifying symptoms of PAH.
The longer you’re exposed to cold air, the greater likelihood of worsening symptoms. Carefully plan for when you need to be out in the cold, and avoid unnecessary time outside. If you’re venturing out, be sure to wear multiple layers of warm clothing, which help trap heat, along with a good coat, hat, and gloves or mittens. Hand warmers or heat packs inside gloves or mittens can add even more protection.
One myPHteam member wrote, “I love the cold weather, but when I go outside, I wear a hat, gloves, and a good scarf around my neck, mouth and nose.” Another member said, “I have hand warmers for my gloves.”
A face mask in cold weather is also very useful because it holds in the warm air that you’ve breathed out, so not as much cold air enters your lungs. Covering your face with a scarf can also help warm the cold air you breathe.
As many people with PAH know, dry air can also aggravate this condition. Some myPHteam members have recommended a heat and moisture exchange mask, which uses a vent to warm and moisten cold, dry air. “This mask is great. It warms the air and keeps the breathing area dry. I live in Minnesota and can be outside — even when the temperature is below zero,” a member said.
When it’s cold outside, inside heating can cause the air inside to become dry too. You may need to run a humidifier during cold weather to add moisture to indoor air.
Be aware that while staying inside more during cold weather can help protect your health by keeping PAH symptoms in check, viruses also spread more easily in winter — partly because of indoor gatherings. Avoid crowds, particularly during cold weather, when closed windows mean a lack of fresh air.
If you must be in a crowded indoor environment, be sure to wear a surgical or N95 mask. Keep in mind that masks with vents do not protect against the spread of viral infections, such as the common cold, influenza, or COVID-19.
Overexerting yourself in the cold can be especially treacherous if you have PAH. It’s important to avoid strenuous physical activity in cold weather, such as shoveling snow. If possible, make arrangements to have someone help with any outdoor work.
If your pulmonologist has advised you to walk for exercise, take your workout inside when it’s cold out. Instead, you might try to:
“I exercise walking around in the house so many times,” a myPAHmember wrote about how they cope with cold winter temperatures.
Plan winter excursions carefully. If possible, avoid going out into the cold by yourself and risking worsening symptoms that may make it difficult for you to safely get home. This includes going anywhere on foot: “Walking in cold weather makes me short of breath. I have to stop and take deep breaths,” a myPHteam member shared.
Getting stuck in ice or snow and experiencing car trouble or weather-related accidents in cold temperatures can be hazardous for anyone — but they’re especially dangerous for people with PAH. When driving in cold weather, always bring a charged phone and drinking water. During the winter, stock your vehicle with important items, including:
If you use oxygen to manage your blood oxygen levels, always bring an extra cannula (tube) in case you have problems with your current one and need to replace it while out in the cold. One myPHteam member described struggling with a cannula in cold weather: “What I find difficult is using my supplemental oxygen. I have a hard time fitting the cannula and the mask around my ears! Lol.”
It’s hard to completely avoid getting chilled outside in cold weather, so plan ahead to warm up as quickly as possible when you get home. Take steps such as the following:
The sooner you warm up, the better you’ll feel, as a myPHteam member pointed out: “I am now very careful to avoid lengthy exposure to cold air (50 or below). I do recover from the deleterious effects once I get back into a warm environment.”
On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 49,000 members come together to ask questions, give advice, and share their stories with others who understand life with pulmonary hypertension and pulmonary arterial hypertension.
Do your PAH symptoms worsen when temperatures drop? What do you do to help manage PAH in cold weather? Share your advice in the comments below, or start a conversation by posting on your Activities page.
Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.
