Episode 92: Cold Weather’s Effect on the Cardiopulmonary System

As the temperature drops across the country it is important to understand the impact the cold air will have on the cardiopulmonary system.  Similar to pipes in a house, the cold affects both the pipes in the lungs and body in the same way, constriction.  Although these changes occur in healthy individuals,  they have more profound impact on those with heart and lung conditions.

Join me as we discuss these changes, and some tips to help combat them.

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Chapters

• 0:04 Cold Weather's Effect on Cardiopulmonary System
• 17:41 Winter Weather Health Risks

Transcript

Rachele Burriesci: 0:04

Welcome to Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci, physical therapist and board-certified cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences. The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation. Thanks for joining me today, and let's get after it.

Rachele Burriesci: 0:36

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Rachele Burriesci: 1:29

All right, we're a second week into January of 2025. It's Friday the 10th and it's been a wild week. Beginning of the week started with a pretty aggressive blizzard here in Kansas City. I think we actually made national news. You know it wasn't the most record-breaking amount of snow, so to speak, but it was kind of how it all was laid out. So we ended up with a ice storm on Saturday which pretty much laid the foundation for really crappy road conditions, and then Sunday, pretty much for the entirety of the day, was just a constant drop of about 12 to 15 inches and 30 to 40 mile an hour winds. So Nikki and I were both supposed to work on Sunday. We did everything to sort of prep to get there, because that is the expectation in healthcare. I actually worked on Saturday, drove home in the ice storm it was already really crummy out but made it safely. So we stayed at my mother-in-law's house to be half the distance to get to the hospital. She's about like 10, 12 minutes away in good weather conditions.

Rachele Burriesci: 2:50

And you know, sunday morning came around. It was not looking good. We tried, we literally we tried. You know the Ford Explorer did great, did better than I expected with the snow and the ice handling, but the visibility was literally shit, so couldn't see an inch in front of the car, and that was the point where we both looked at each other and said this isn't worth it. Right, at what point is your safety more important?

Rachele Burriesci: 3:22

So figuring out how to turn around was its own little beast, because the road that we're on had a big ditch down the middle and Nicki was literally holding the phone. We learned this hack on Instagram. It does work a little bit. If you hold the phone on camera mode up to the windshield, it can see better than the actual condition. So she was literally my eyes while I was trying to actually see the road. We made it I don't know five, maybe a little more, five to eight miles away from the house, and we giddy-dupped and turned around and that was it.

Rachele Burriesci: 4:00

But it's been pretty crappy conditions all week. Literally Monday morning was no better. So as I was cleaning up the driveway for the third time and getting the cars de-iced, we're getting weather alerts, emergency alerts, to stay off the road out in. That Felt a little bit better when we were together and kind of navigating it together, but it's just been one of those like weird weeks here. So I don't know, I've must have shoveled and snowblowed, I don't know if that's snowblowered snowblowed. I can't even tell you how many driveways, how many neighbors the end of our street, because we weren't plowed for a day and a half. You know it's an inconvenience. We were lucky in the sense that we made good decisions. We made it to and from safely, but the roads, the highways, are actually closed. For three to four days, literally all of the highways in Kansas got shut down. People were sliding off of roads into ditches they couldn't get past. Fire trucks are sliding out. So craziness there.

Rachele Burriesci: 5:16

Literally kept trying to sit down to do this podcast, because I'm literally in this environment that I'm going to be talking about today, which is cold weather, and I'll talk about snow shoveling on the next episode, because I think it's just too much to pack in together and there's just so many other things going on in the country and it's sometimes really hard to sit down and record these podcasts when there's just so much more heaviness outside of this California. I have a lot of friends out that way. All are safe at this point. But just craziness, right? Just a really crazy way to start 2025. And here we are.

Rachele Burriesci: 6:06

So what I wanted to talk about today is actually the effect of cold weather on the cardiopulmonary system. This is something that we talked quite a bit about in pulmonary rehab. It's a time of year where our patients with heart and lung disease tend to get hospitalized for a number of different reasons, and actually it's the number one time for increased mortality and morbidity in patients with pulmonary and heart disease. So the question is like what is the actual effect of cold weather on the lungs and the heart? And so there are a number of things that happen within our lung tissue, our airways and then even further into vessels that really can play a big impact. So, from a pulmonary perspective, a lot of the studies that are actually done to sort of prove these conditions are done on healthy people. Actually just read a study where they had a controlled environment I think it was negative 15 degrees Celsius, which translates to about five degrees Fahrenheit, and they had basically a cold chamber and they had the people in there at rest and they had them perform a warmup and then two sprints at moderate to vigorous intensity and then a cool down, and they essentially were looking at different factors and they essentially were looking at different factors. And in the healthy individuals, at both rest and with exercise, they saw increased bronchoconstriction. They had a decrease in FEV1 during exercise. They even showed increased inflammatory markers, which was more significant with exercise than rest but still was apparent with rest.

Rachele Burriesci: 8:03

So when you're breathing in cold air we can literally have constriction of the large airways, the upper airways, and that's going to create resistance in basically the rest of the tubes. It's going to create resistance for breathing, create shortness of breath. This is more apparent in people who have lung disease, but it still occurs in patients that are healthy. So asthma is a really big one that can be affected by cold weather, where they already have these hyperreactive lungs that are prone to bronchoconstriction and these events or triggers and cold air can be one of those triggers. The other thing is that in the cold the air tends to be dry, less humidified, and that dry air is very irritating to the lung tissue itself, which can trigger an increased inflammatory response. So increased inflammatory mediators basically create this environment of increased hyperreactivity in the lungs, just more susceptible to being reactive.

Rachele Burriesci: 9:14

And the other big piece is pulmonary vasoconstriction. So we also have vessels in our lungs and those vessels constrict. So very similar to pipes in a house, when you have something that is like cold weather think constricting pipes, tight tubes and so anytime you have tight tubes you're going to have increased resistance within the airways In the lungs. The lungs are supposed to be a low resistance system and if we're breathing in cold air and we're causing pulmonary vasoconstriction, we're increasing the resistance in the lungs. And when we increase the resistance in the lungs, well that's then going to have an effect on the right side of the heart. This is kind of the overall concept of pulmonary arterial hypertension, where your lung pressure is now affecting the right ventricle and we have this backwards effect.

Rachele Burriesci: 10:08

The other piece before I move on is dehydration. So we do really have to consider dehydration, even in cold weather. So when we increase our minute ventilation, that is going to dry out our airways quicker. And also dehydration from a whole perspective, a whole body perspective. We have decreased thirst in cold weather. So if you are in winter sports and you have to be exercising outdoors, it's very important to hydrate pre, during and post activity, even though it might not feel obvious, right, because you're not feeling thirsty. So that's a really important thing Now, even if you're not performing winter sports and you have to do some sort of outdoor activity and it's cold outside, this is something to consider. For instance, this week I must have shoveled for 10 hours a day for two or three days out of the week. That is a lot of consistent activity and when you're cold you're typically not having that thirst effect. So you have to stop, take breaks and make sure that you're hydrating throughout.

Rachele Burriesci: 11:20

So from a cold air lungs perspective, we're going to cause bronchoconstriction, which is going to increase resistance of the lungs. We're going to cause pulmonary vasoconstriction, which is going to increase the pressure of the lungs, increase resistance overall, creating a backwards effect on the right ventricle. We can cause increased irritation of the lung tissue, increased resistance overall, creating a backwards effect on the right ventricle. We can cause increased irritation of the lung tissue due to the dry air and increase in inflammatory mediators, which basically create this hyperreactive environment. Big picture we have a decrease FEV1 as well. We have dehydration within the lungs from that increase in ventilation and if we are going to be outside, we need to consider certain things to sort of protect us.

Rachele Burriesci: 12:07

So number one is breathing in through the nose. The nose is more effective in warming and humidifying air, which is very important when we're taking in cold air into a warm system. So the nose sort of absorbs that dryness, tries to humidify it. Try to warm it before it goes into your lungs. If you're mouth breathing, you're losing some of that warming and humidification Big piece. This is a big concept in pulmonary rehab. It's something that I have done since I was a little kid Always cover your nose and mouth with a scarf or a face mask, whatever is comfortable for you. That alone will help warm and humidify the air. So it's less what's that word? Less stark, going from that cold air to warm lungs. In pulmonary rehab we taught once the temperature was under 30 degrees it's time to cover your nose and mouth. So something to consider just in general, especially now as the weather is dropping pretty much across the country and if you're going to be outside doing these types of activities, cover your mouth, breathe in through your nose. It's the little things that will help overall.

Rachele Burriesci: 13:25

From a cardiovascular perspective, same concept Cold creates constriction. So one of the big things that's going to happen is that we're going to have vasoconstriction and we're going to have vasoconstriction throughout the whole system because the body is trying to maintain core temperature. If we have increased vasoconstriction, we're going to have an increase in blood pressure and increase in heart rate. So for the average healthy person you might not feel any different. Maybe you feel a little bit more fatigued with certain activities, but that might be the extent of it. For someone who has heart disease, for someone who has heart failure, this can be very traumatic. We have an increased risk of stroke and heart attack during the season with shoveling, because of these activities. Right, we're in the cold air, we have this systemic vasoconstriction. We're increasing blood pressure, increasing heart rate for prolonged periods of time. You're putting that person at greater risk.

Rachele Burriesci: 14:34

The other piece of the puzzle, with you know the effect of cold is that we have an increase in our sympathetic system. So we have an increase in our sympathetic system. We have increase in catecholamines again, increased blood pressure, increased heart rate. It also triggers the renin-angiotensin-aldosterone system, the RAS system. Now, the RAS system is how the kidneys, who are the friend to the heart, but it's the friend that overhelps Remember me telling the story. Essentially, their role is to increase renin, which eventually leads to conversion of angiotensin to angiotensin 2 and aldosterone. So the adrenal gland is going to produce aldosterone, which is going to basically retain salt and water. So if we have the heart failure picture, we can really exacerbate that whole picture and it releases angiotensin 2, which is a potent vasoconstrictor. So the big picture is we have systemic vasoconstriction from a number of different avenues, which is going to increase blood pressure, increase heart rate, increase pressure on the system. Again, if it's a healthy individual, probably not going to have that much of a response, but in a person who has known heart disease known heart failure maybe already has a is going to really amplify risk.

Rachele Burriesci: 16:03

So really, biggest tip of all is decrease time outdoors while we're in this more severe weather less than 30 degrees Now, pending what state you're in. We lived in Michigan for a while when I was teaching pulmonary rehab. We were in Michigan. When I was teaching pulmonary rehab, we were in Michigan. It's very hard to tell Michiganders to not be outside and cover your mouth as soon as it hits less than 30 degrees, because that is basically from early November into March. We don't adapt as well to cold temperatures. We have only so much room for regulation. So you're going to have systemic effects if you are sustaining your time outdoors.

Rachele Burriesci: 16:53

Biggest tip, then, is if you're going to exercise in the winter months, do it indoors, temp-controlled environment. If you don't have access to a gym, big box stores are a great way to get your steps in. Those stores, typically, are better maintained in the snow anyway, although I was recently disappointed because we made a few trips to Home Depot and Menards and three, four days later we're still having problems. You know problems with our snow removal system here, but that's not everywhere. It's currently just here. So big box stores, walk around, get your steps in that way, versus trying to walk in your neighborhood.

Rachele Burriesci: 17:41

Other piece of the puzzle here, from a physical theory perspective, is falls. Right, we have cardiovascular pulmonary changes, but we also have a risk of falls when we have increased snow, increased ice and all that. Definitely, make sure you're educating your clients, your patients, on being safe in this type of weather. Get help with snow removal. I am young, I am active. I have bit it three times now shoveling. You don't bounce back as good, and as you get older, your increase for fractures is even greater and can be detrimental if we have a hip fracture in our later years.

Rachele Burriesci: 18:19

So cold weather has a huge effect on us, specifically the cardiopulmonary system, we're going to have systemic constriction in both the lungs and the vessels and that's really what creates this increased resistance overall. So if you have lung disease, you're at higher risk for shortness of breath, bronchoconstriction, exacerbation of potentially chronic bronchitis, emphysema. If you're a patient who has asthma, highly recommend exercising indoors, decreasing your time outside, and if you have to be outside, cover your nose, cover your mouth, scarf face mask, what have you and try to always remember to breathe in with your nose, because it's a built-in humidification and warmification center. From the heart perspective, same concept. We have vasoconstriction, systemically, an increase in our sympathetic system, an increase in RAS and essentially we're increasing blood pressure, increasing heart rate on a ready strain system. So we have a lot of heart failure exacerbation, risk for MI, risk for stroke in this population.

Rachele Burriesci: 19:28

So, if you can exercise indoors, decrease your time outside. If you have to be outside, make sure you're covering your nose and mouth and be safe out there. All right, that's all I have for you today. Next week we're going to talk a little bit more about snow shoveling and if we should be doing that and what it means for our cardiovascular system. All right, I hope you all have a wonderful day, stay safe out there and, whatever you have to do, get after it. Thank you.