This blog post was written by Katie Keating, RN, MS, patient advocate

Exacerbations and flare-ups are a part of life for many bronchiectasis and/or NTM patients. A flare-up is when your everyday symptoms worsen; such as on humid or rainy days. Exacerbations, however, last longer and are more serious. They usually happen when a respiratory infection causes inflammation, excessive mucus, fever, increasing cough, shortness of breath, or reduced lung capacity, as noted on pulmonary function tests.

Unlike flare-ups, exacerbations can have permanent effects. Some patients’ conditions may never get back to where they were before the exacerbation. This often is the case following a pseudomonas infection.

As a patient and a nurse, I made light of my exacerbations in the past, just figuring that another round of antibiotics was part of the journey. Little did I realize the impact long-term antibiotics would have on my gastrointestinal and genitourinary tracts. I now take a more proactive approach to prevent any possible infection from invading my body and avoid antibiotics as much as I can.

Winter weather causes an increase in symptoms because cold air is denser, drier, and more difficult to breathe. Airways and nasal passages may be dry, causing inflammation that worsens symptoms, increases mucus production, and increases your risk of illness or infection. In cold weather especially, individuals at risk of infection should try to do everything possible to keep your body strong and prevent acute exacerbations.

The following are seven suggestions to stay strong this winter season.

1) Avoid people who are sick. Public places are full of germs, but caregivers or family members might also be a threat to you. If you must come into contact with people when they are sick, wear a mask or ask them to wear one, preferably a mask with a HEPA-filter. Avoid sharing drinking glasses or utensils, common condiments or other group-food containers. Do not visit hospitals, nursing homes, or sick people.

2) Practice good handwashing techniquesif you are in a public place or come into contact with someone who is sick. Wash your hands in warm, soapy water for a few minutes (Sing the ‘Happy Birthday’ song to make sure you’ve washed long enough) and dry them with a paper towel. Use a paper towel to turn off the running water and to open the exit door. Don’t touch your eyes, nose, or mouth unless you know your hands are clean. Carry antimicrobial hand sanitizer for times when you don’t have access to soap and water.

3) Get your annual flu shot and a periodic pneumonia aaccine(once every five years if you are under 65).

4) Create a healthy home. Avoid smoke from wood-burning stoves and fireplaces and other inside pollutants such as scented candles, perfumes and aerosol cleaning products. Be mindful of dust, pet dander and mold. Here is a resource with some good information in home evaluation: https://www.nationaljewish.org/health-insights/air-pollution-and-healthy-homes/evaluating-a-home

a. Air filters and purifiers can help. Always be conscious of HVAC systems in homes you visit. Do not use humidifiers.

b. For those who do not have elderly, children or guests in their home, raising the thermostat on the water heater from 120° to 145° may reduce exposure to mycobacteria. Adding a water purification system to your home or apartment may also reduce exposure.

5) Button up outside. Since cold weather can make respiratory symptoms worse, breathe through your nose and wear a scarf over your face when you’re outside. This traps the heat and moisture from your breath and warms and humidifies it. When possible, try to breathe through your nose, not your mouth, so the air can further warm and pick up moisture as it travels through your airways to your lungs. Avoid going outside when it is extremely windy or cold.

6) Travel with care. Limit your choice of hotels to “green” hotels and avoid old hotels with dry heat. Use a tissue to push elevator buttons. Take caution on trains and planes, and use a N95 mask as needed. Avoid hot tubs and indoor pools.

7) In general, take care of yourself. Eat a balanced diet. Take probiotics and nutritional supplements as needed. Get enough sleep so you don’t get worn down. Try to keep stress in check. Adhere to your regimen, which likely includes chest/airway clearance every a.m. and p.m.; as long as your doctor has cleared this, you may want to utilize nasal wash when your nose is dry due to dry heat; pulmonary rehabilitation as needed or and or some exercise.

Please remember that the results of many exacerbations may have a negative cumulative effect on your body. When you have bronchiectasis and/or NTM, y the proactive actions you are taking may have an impact on your quality of life.

Take action for health this winter. I am.