The Relationship Between Colds and Asthma

Colds and asthma are both characterized by inflammation of the airways, and they have something of a complicated, two-way-street effect on the lungs. Even if asthma is well-controlled with daily medications, a cold can trigger an attack in some people. On the flip side, asthma can increase your vulnerability to colds and other respiratory tract infections.

When a cold triggers an asthma attack, it is typically referred to as viral-induced asthma. Having a cold and asthma together can make asthma symptoms harder to control or turn an otherwise mild respiratory infection into a serious medical event.

It is important that people living with asthma take precautions to avoid colds and to adhere to daily medications that reduce airway hyperresponsiveness and control asthma symptoms.

Viral-induced asthma is common, affecting roughly 85% of children and 50% of adults with asthma. It is not the same as cold-induced asthma, in which an attack is triggered by inhaling cold air.

Susceptibility to Colds

Poorly controlled asthma can damage the lining of the airways by exposing them to persistently high levels of inflammation. Over time, this progressive remodeling can cause the airways to thicken and lose their flexibility while increasing their susceptibility to respiratory infections.

Scientists are not entirely sure why this is, but some contend that the remodeling of airways blunts the local immune response. Research suggests that damaged epithelial cells lining the airways are less able to produce interferon-beta (IF-β), a type of inflammatory compound called a cytokine that exerts strong antiviral activity.

Others believe that asthma, a disease characterized by an abnormal immune response, simply affects how the immune system responds to certain viral infections. Genetics may also play a part.

But while managing asthma with medication can help temper inflammation that can increase your susceptibility to colds, certain medications that can help control asthma—like inhaled steroids—can suppress the immune system. And if you get sick, this can increase the risk of a secondary pneumonia infection.

Inflammation and Your Lungs

The common cold is caused by any one of over 200 viral strains, the most common of which are rhinoviruses, followed by coronaviruses, influenza viruses, adenoviruses, and respiratory syncytial virus (RSV).

When a respiratory infection occurs, the immune system responds by releasing cytokines that draw defensive white blood cells to the site of the infection. (This includes a type of white blood cell known as an eosinophil commonly seen with allergic asthma.)

Many of these cytokines—most especially interleukin types 4, 5, 9, 10, 11, and 13—are responsible for triggering airway hyperresponsiveness and bronchoconstriction in people with asthma. In essence, the inflammation caused by a cold can "spill over" to the lower respiratory tract and instigate an attack.

Research also suggests that antigens on certain respiratory viruses can trigger an allergic response in people with asthma. Antigens are the proteins of the surface of cells that the immune system reacts to. In some cases, the antigen will spur allergic inflammation that only adds to the burden of viral inflammation.

Although viral-induced asthma has long been considered separate from allergic asthma, evidence suggests that viral-induced asthma can affect people with allergic and non-allergic forms of the disease, including exercise-induced asthma and eosinophilic asthma.

This dual source of inflammation may explain why certain people are more prone to viral-induced asthma than others.

Colds, even recurrent colds, do not "cause" asthma. With that said, children under 2 who experience a severe respiratory infection are more likely to develop asthma than those who do not.

Symptoms of Viral-Induced Asthma

Given that colds affect every part of the upper respiratory tract from the nasal passages to the larynx (voice box), and asthma affects every part of the lower respiratory tract from the larynx to the lungs, the symptoms of each are relatively distinctive and easy to differentiate when one of the conditions occurs on its own.

While there is some overlap—such as with cough and breathing difficulties—cold symptoms are generally centered around the nose and throat, while asthma symptoms come more from the chest.

  Common Cold  Asthma Attacks
Breathing problems Common, usually mild with nasal and sinus congestion Common, usually severe with shortness of breath, wheezing, and difficulty breathing
Cough Common, sometimes with phlegm Common, often dry (hacking) but occasionally wet (with phlegm)
Nasal problems Common, including runny nose, sneezing, post-nasal drip, and congestion No
Throat pain Common, usually with mild sore throat Common, including throat tightness, hoarseness, or irritation 
Fever Common, usually mild Uncommon
Headache Common Uncommon
Body aches Common, usually mild muscle and joint aches No
Chest pain Occasional, mostly due to prolonged coughing Common, including chest pain and tightness

The same may not be said if a cold and asthma co-occur. With viral-induced asthma, the symptoms of a cold typically precede an asthma attack and eventually involve both the upper and lower respiratory tract.

What this means is that that the sneezing, coughing, headache, and nasal congestion characteristic of a cold will be followed by the wheezing, shortness of breath, and chest pain characteristic of asthma. And if a cold develops rapidly, the cascade of symptoms may occur all at once.

With viral-induced asthma, there may also be symptoms less commonly seen with either disease, including high fever and chills. This typically happens if there is a secondary infection of the lungs, including bacterial pneumonia.

Diagnosis

The overlap of symptoms in people with viral-induced asthma can make diagnosis difficult. While classic cold symptoms are easily recognized by doctors, the co-occurrence of wheezing, shortness of breath, and chest pains can often suggest other diseases, including severe bronchitis or pneumonia.

The diagnosis of viral-induced asthma requires a thorough review of your symptoms and medical history along with a physical exam and other diagnostic tests.

Diagnostic Work-Up

Diagnosing viral-induced asthma typically requires some detective work. As part of the diagnostic work-up, the doctor will want to know:

  • Preceding and current symptoms
  • The progression of symptoms (i.e., which came first)
  • Your history of respiratory infections
  • Your family history of chronic respiratory illnesses
  • Any chronic illnesses you have (such as COPD or congestive heart failure)
  • Your smoking history

Your doctor may also take the time of year into consideration. For example, respiratory infections occurring in early fall are more likely due to a rhinovirus, while those occurring in winter are more likely due to influenza or RSV. These factors, along with age, can make a difference in how your condition is treated.

A physical exam would include an evaluation of breathing sounds (including crackles, rales, vibrations, or wheezing), abnormalities of which can point the doctor in the direction of the likely cause. With asthma, wheezing is considered one of the defining features of the disease. Any accompanying sounds may suggest which type of virus is involved.

Lab and Imaging Tests

If the symptoms are severe and abnormal breathing sounds are detected, your doctor may order blood tests to investigate whether viral pneumonia, RSV, or influenza is involved. (Blood tests for rhinovirus or adenovirus are also available, but are less commonly used because there are no direct treatments for either.)

If a bacterial infection is suspected, a throat swab or sputum culture may be performed.

The doctor may also order a chest X-ray or a computed tomography (CT) scan to check if there is evidence of pneumonia or other lung abnormalities.

In emergency situations, pulse oximetry or an arterial blood gas (ABG) test will be used to see if blood oxygen levels are low. Other pulmonary function tests (PFTs) may be performed to evaluate how well your lungs are functioning during and after an acute attack.

Allergen testing may be useful in diagnosing allergic asthma, but it does not necessarily exclude viral-induced asthma as a cause.

Even if a respiratory virus cannot be identified, the co-occurrence of a respiratory infection with a reduced forced expiratory volume (FEV1) of 20% or more is strongly suggestive of viral-induced asthma, particularly in people with well-controlled disease.

Given that viral-induced asthma is as common as it is, findings like these will often warrant treatment even if the viral culprit is not identified.

Treatment

Because cytokines induced by a virus are produced independently of those induced by asthma, asthma medications will never fully prevent or relieve asthma symptoms induced by a cold.

Until the trigger (in this case, the cold) is fully resolved, breathing difficulties may persist as inflammation from the upper respiratory tract "fuels" inflammation in the lower respiratory tract, and vice versa.

This is especially true when eosinophils are produced in excess. This can lead to a condition known as eosinophilia in which the accumulation of eosinophils causes inflammatory damage to the airways. It is this sort of damage that can increase the risk of severe illness, including pneumonia, in people with viral-induced asthma.

Medications

If a cold is a trigger for an attack, the resolution of the infection (which usually happens within two weeks) will usually improve breathing problems as well.

Still, the standard treatment of a cold or flu should be accompanied by the appropriate use of asthma medications. This may include the increased use of a short-acting beta-agonist (also known as a rescue inhaler).

Cold Treatment
  • Symptoms may be managed with decongestants, cough formula, antihistamine, and nonsteroidal anti-inflammatory drugs.

  • Nasal washing may help clear mucus build-up.

  • Flu may be shortened with the early use of antiviral drugs like Tamiflu (oseltamivir) and plenty of bed rest.

Asthma Treatment

According to the National Heart, Lung, and Blood Institute, a short-acting beta-agonist like albuterol can be used every four to six hours during a cold to reduce the risk of an asthma attack.

Using rescue inhalers for more than six hours should be avoided unless your doctor tells you otherwise. If asthma symptoms require you to use rescue inhalers more frequently than every six hours, you probably need to step up your asthma treatment. Speak to your doctor.

One of the areas in which treatments can vary is in the use of antihistamines. Though antihistamines can provide relief of nasal congestion caused by a cold, they tend to be less useful in treating viral-induced asthma as they have no real effect on the virus itself.

If you have a history of severe viral-induced asthma, speak with your doctor about taking oral corticosteroids at the start of a cold. There is some evidence that they can help, especially people who required emergency care or hospitalization after a severe attack.

Prevention

Clearly, one of the best ways to avoid viral-induced asthma attacks is to avoid colds. This is often easier said than done, particularly during cold and flu season or in families with young children. Cold viruses are easily passed by sneezing and cough or by touching surfaces contaminated with germs.

The Centers for Disease Control and Prevention (CDC) recommends the following measures to avoid getting a cold:

  • Avoid people who are sick.
  • Wash your hands frequently with soap and water for at least 20 seconds.
  • Avoid touching your face, nose, or mouth with unwashed hands.
  • Disinfect frequently touched surfaces and items, including counters and toys.

To further reduce the risk of viral-induced asthma, adhere to your daily asthma medications, taking them as prescribed and on schedule. If you have a history of severe viral-induced attacks, ask your doctor if a short course of oral corticosteroids is reasonable.

You should also avoid secondhand smoke and other asthma triggers until the cold is fully resolved. If you are a smoker and cannot quit, ask your doctor about smoking cessation aids (including nicotine patches and oral medications) to help you stop.

There are currently no vaccines to prevent a cold, but annual flu shots can help reduce your risk of influenza and, with it, the risk of an asthma attack.

A Word From Verywell

If you find that a cold or flu triggers an asthma attack, let your doctor know. This occurs more frequently than many people think and may indicate the need for more aggressive asthma treatment, especially if you are prone to respiratory infections.

You should also speak with your doctor if you use your rescue inhaler more than twice weekly. Using an inhaler this often is a sign of poorly controlled disease, which places you at an increased risk of a viral-induced attack. By finding the right combination of controller medications, you may significantly reduce your risk.

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