Welcome to another edition of DocSmo.com. Thank you for joining me today I’m your host Dr. Paul Smolen; by day I’m a board-certified pediatrician practicing general pediatrics in Charlotte North Carolina for the past 32 years but by night I’m DocSmo, the blogger. I’m recording this pedcast in December and it’s respiratory season here in Charlotte, a time of year when a lot of kids come to the doctor with deep chest coughs. They usually have bronchitis; that is a really bad cough with lungs that sound clear and no fever. This condition is almost always caused by either a viral infection or allergy or both. Part of my advice to children with bronchitis about getting well is to give them the same advice that their grandmother’s would give them… STAY OUT OUT COLD AIR UNTIL YOUR COUGH IS GONE, I think it’s important that these kids not expose themselves to extremes of cold weather and in today’s podcast I’m going to try explain to you why I think this is good advice. Long time listeners of my blog will know that I have a very healthy respect for the advice that grandma’s passed down from generation to generation, hence the Doc’s Pearl; “Grandma didn’t waste her time recommending things that weren’t important.”
So let’s get started talking about respiratory irritants, specifically cold air.
Now to get into a discussion about why cold air is an irritant to your child’s airways, we need to take a little trip down science lane. I love science lane. You remember from your high school and middle school science classes that air is mostly composed of nitrogen gas and a water. There’s actually a lot water in air. We all intuitively know that because when we go outside on a cold day and exhale, the warm air from our lungs immediately turns into rain as it cools down to the cold outside temperature. We can see that happen. Remember cold air can’t hold as much water as warm air can. As the air cools down leaving your child’s lungs, it literally has the water squeezed out of it. That’s one of the reasons your child’s nose runs when they go out in the cold air. It is literally raining in your child’s nose when they are outside on a cold day. You can see that the cold air itself is causing a “weather event” in your child’s nose and lungs when they are outside for very long on a nippy day.
Additionally as the outside air dries out from being cooled, this lower humidity cool air cools the surface of your child’s airways which can be very irritating to some children’s noses and bronchioles. You’ve probably heard about exercise asthma. Well this phenomenon occurs mainly because breathing large amounts of cool or cold air bathes the lining cells of your child’s airway and in some children, this triggers an asthma attack. You can see that in some children, very cold air in large quantities is just not good for their airways especially when they’re sick. When they are sick, those delicate cells that line their nose and bronchioles have already been damaged by some respiratory virus and now here comes another irritant, dry, cold air. This is why grandma was so upset when her children went out to play for a long time on a very cold day. She knew that this was just going to add to their troubles. And sometimes there was so much trouble added, that the child could not cough up a all their chest mucous, maybe with a little bronchospasm to boot, and before you know it they have…” pneumonia”, which is exactly what grandma feared the most, and she was right in saying that cold weather can cause pneumonia. Remember that it wasn’t that long ago, before we had penicillin, pneumonia frequently meant death even in young healthy children and adults. That’s why grandmas, even today, get such a pained expression on their face when a doctor mentions the word pneumonia. They remember what pneumonia could do to a child. Fortunately in the modern era this rarely occurs.
So here’s some good advice that I give my patients who have bronchitis or even upper respiratory illness, when they come in to be examined and treated. I think it’s fine for a child to be outdoors playing in cold weather when they’re well but when they have a deep bronchial-based cough, I ask them to stay out of cold air exercising until there cough has cleared. For me, too cold is below 60 degrees Farenheit. Since Johnny is already suffering from one respiratory irritant, probably a virus, I don’t think they need to have others like cold dry air adding to their problems. We don’t want him to suffer the perfect storm of bronchial irritants and come down with pneumonia, as Grandma feared do we? Of course, as soon as his or her cough is gone, it’s back outside full tilt.
In my mind, I think there is good science behind grandma’s recommendation to stay at a cold air with really bad cough. As I have said, I give this advice to my patients to this day and I think it’s good advice. So now, if your coughing child is giving you a hard time about not letting them outside on really cold day to play, I think maybe you can explain to them why you feel this way. Kids are amazingly logical when you take a few minutes to explain things to the. Here’s another DocSmo pearl to remember; When you treat your children like adults, one day they are likely to act like one!
Thanks for tuning in today. I hope I added to your parenting knowledge base. Portable, practical, pediatrics is always our goal here at the DocSmo blog. If you enjoy this educational format, take a moment to write a review on iTunes or leave a comment at my blog, www.docsmo.com. and maybe subscribe and be weekly listener. My staff has made it very easy to send podcasts to friends and family so take advantage of that feature, won’t you. This is Dr. Paul Smolen broadcasting from studio 1E, that’s the first child’s bedroom on the east side of my house… Reminding you that when the temperature takes a dip, don’t forget DocSmo’s tip… Keep those little coughing babes in a nice warm place, won’t you? Until next time.