Asthma in Winter: A South African Guide for Adults and Children

Winter is the hardest season for anyone living with asthma. The cold, dry air of a George winter, combined with the coughs and colds that circulate from May onwards, can turn well-managed asthma into something that disrupts sleep, limits activity, and occasionally lands a person in casualty. This is true for adults and children alike.

Asthma is the most common chronic illness in South African children, and its prevalence is rising: in some South African cities, close to one in five teenagers now has asthma symptoms. More sobering, South Africa has one of the highest asthma death rates in the world among young people, and most of those deaths are considered preventable with better day-to-day control. Winter, when triggers cluster, is when that gap between controlled and uncontrolled asthma matters most.

This article explains what winter does to the airways, how to tell when your asthma is no longer well controlled, why your inhaler technique matters more than most people realise, and the warning signs that mean you should see a doctor or go to casualty. It is not a substitute for a consultation. Asthma treatment is personal, and the right plan for you or your child is something we work out together. What follows is the background that helps you recognise trouble early and know when to act.

What winter does to asthma

Two things drive most winter asthma flare-ups: cold air and viral infections. They work in different ways, and in winter they often arrive together.

Cold, dry air irritates the lining of the airways directly. Research has shown that low temperatures weaken the protective barrier of the cells lining the bronchial tubes, making the airways more permeable, more inflamed, and more twitchy. That twitchiness, what doctors call bronchial hyperresponsiveness, is why a walk to the car on a cold George morning can set off coughing and chest tightness in someone whose asthma was quiet all summer. People with asthma report substantially more cold-weather breathing difficulty than people without it, and the effect is real, not imagined.

Viral infections are the bigger driver. Common respiratory viruses, the rhinovirus chief among them, are responsible for the large majority of asthma attacks in both children and adults, and they peak in the colder months. There is a specific reason asthmatic airways suffer more from these infections: the airway lining in a person with asthma produces a weaker antiviral response, which means the virus is cleared more slowly and the inflammation it causes runs deeper and lasts longer. A cold that gives most people a few sniffly days can give a person with asthma a fortnight of poor control. This is also why flu and other respiratory infections matter so much for asthma, and why staying up to date with vaccination is worth discussing with your GP. The flu vaccine is one of the simplest ways to reduce winter flare-ups, and we offer it at the practice to everyone, billed to the preventive benefit on most medical schemes or at a cash price of R200 for private patients. You can read more in our guides to the 2026 flu season and catch-up vaccines and new shots.

The practical message is simple: in winter, the things that worsen asthma are more common and more potent. That makes it the season to pay closer attention, not less.

How to recognise poorly controlled asthma

Many people live with worse asthma control than they realise, because symptoms creep up slowly and they adjust their lives around them. The international standard for judging control, used by doctors worldwide, looks at four simple questions covering the past four weeks. Your asthma is well controlled only if you can answer no to all four.

In the last four weeks, have you had:

• Daytime asthma symptoms more than twice a week
• Any night waking caused by asthma
• A need to use your reliever inhaler for symptoms more than twice a week, not counting use before exercise
• Any limit on your usual activities because of asthma

None of these means your asthma is well controlled. One or two means it is only partly controlled. Three or four means it is uncontrolled, and that is a signal to be seen.

There is one number worth knowing on its own: how often you reach for your blue reliever inhaler. Needing it more than twice a week for symptoms is a sign that the underlying inflammation is not being managed well. Getting through three or more reliever canisters in a year, which works out to roughly two puffs a day, is associated with a higher risk of severe attacks. If you are buying reliever inhalers often, that is not a sign your asthma is mild and easily handled; it is the opposite, and it is worth a conversation with your doctor.

Tools like the Asthma Control Test, a short questionnaire, can help put a number to your control, and we can work through one with you in a consultation.

Why inhaler technique matters more than you think

Here is a fact that surprises most people: studies consistently find that the majority of patients, somewhere between seven and eight in ten, use their inhalers incorrectly. A perfectly good medicine delivers very little benefit if most of it ends up on the back of the throat instead of deep in the lungs. Poor technique is one of the most common and most fixable reasons for poor asthma control.

The errors differ by device. With the familiar pressurised inhalers (the metered-dose "puffers"), the most damaging mistake is poor timing between pressing the canister and breathing in. Others include not shaking the canister, not breathing out fully first, breathing in too fast and shallow rather than slow and deep, and not holding the breath for several seconds afterwards. With dry-powder inhalers, the common problems are not breathing in forcefully enough, and breathing out into the device, which adds moisture and clumps the powder.

A spacer, the plastic chamber that fits onto a puffer, solves much of this. It removes the need for precise timing, gets more medicine into the lungs, and reduces side effects like oral thrush from inhaled steroids. For a child, and for anyone during a flare-up when coordination is harder, a spacer makes a real difference. During a mild to moderate attack, a puffer used with a spacer can work as well as a nebuliser for delivering reliever medicine.

The single most useful thing you can do is bring your inhalers and spacer to your next appointment and show us how you use them. We will watch, correct anything that needs correcting, and you will get more benefit from the medicine you already have. Inhaler technique is also something we can review by telehealth, which suits a quick check without a trip into town.

Asthma in children compared with adults

Childhood asthma is not simply adult asthma in a smaller person. There are differences that matter for recognising trouble.

In young children, especially under five, wheezing is common and does not always mean lifelong asthma. Many preschoolers wheeze only with viral infections and grow out of it. That makes the picture harder to read, and it is one reason a doctor's assessment is valuable rather than assuming the worst or dismissing it.

Children also show distress differently from adults. A child struggling to breathe may go quiet and still rather than complain, may stop feeding or playing, and may visibly suck in at the neck, between the ribs, or under the breastbone as they work to breathe. Because children have a larger body surface relative to their size, the absorption and effects of inhaled medicines are managed carefully, and a spacer, usually with a face mask for the youngest children, is always recommended with a puffer.

For parents, the most important skills are knowing what your child's normal breathing looks like, recognising when they are working harder than usual to breathe, and acting early. If you are unsure whether your child's breathing is normal, it is always reasonable to ask. Our child health service is there for exactly these questions.

When to see a GP, and when to go to casualty

This is the part to read twice. Asthma can deteriorate quickly, particularly in winter, and knowing the difference between "book an appointment" and "go now" can prevent a tragedy.

Go to casualty or call an ambulance immediately if you or your child have any of the following:

• Lips, face, or fingertips turning blue or grey
• Too breathless to speak in full sentences, or a child too breathless to talk, feed, or cry normally
• The reliever inhaler is not helping, or the relief wears off and symptoms return within a couple of hours
• Breathing so hard that the skin sucks in at the neck or between the ribs, or the chest seems to stop moving air
• Drowsiness, confusion, exhaustion, or a child who becomes floppy or unusually quiet
• A sense, in yourself or about your child, that this attack is different and frightening

Do not wait for an online booking, and do not drive yourself if you are severely breathless. In an emergency, call an ambulance or go to your nearest casualty department. Our emergency contacts page lists the numbers to keep on hand.

See a GP soon, within a day or two, if you are not in immediate danger but you notice:

• You are using your reliever more than twice a week
• Asthma is waking you at night
• A cold or chest infection has settled in and your asthma has not returned to normal
• You are cutting back on activities because of your breathing
• You are simply not sure whether your control is good enough

These are the situations where a review changes the course of the winter. Catching loss of control early, before it becomes an attack, is the whole point.

Winter asthma is more manageable than it feels in the middle of a bad week, but it rewards attention. Know your control, get your technique checked, keep your vaccinations current, and act early on the warning signs. If anything in this article matches what you or your child are experiencing, that is a good reason to come and see us.