The Woolcock Institute of Medical Research

As the transition from summer to autumn begins, many people with asthma experience a predictable worsening of symptoms. Cooler temperatures, changing humidity and increased circulation of respiratory viruses all contribute to a seasonal rise in asthma flare-ups. For clinicians, autumn marks a critical window for prevention. For people living with asthma, it is the most important time of year to ensure management is optimised.

Cold air is a well-established trigger for bronchoconstriction. When inhaled, cool, dry air irritates the airway epithelium, increasing inflammation and airway hyper-responsiveness. Rapid shifts between warm indoor environments and cold outdoor air further stress already sensitive airways. Autumn also brings fluctuating humidity, which can destabilise airway function and increase exposure to allergens such as mould spores and dust mites. At the same time, respiratory viral infections become more common, remaining one of the leading causes of asthma exacerbations across all age groups.

Asthma symptoms are also more likely to worsen at night, particularly during the colder months. Nocturnal asthma reflects circadian changes in airway tone, cortisol secretion, and inflammatory activity. Night-time coughing, wheeze or breathlessness is not just disruptive to sleep—it is a recognised marker of poor asthma control and increased exacerbation risk.

A Puff Is Not Enough

In recent years, international asthma management has shifted significantly in response to growing evidence about preventable risk. The Global Initiative for Asthma (GINA) guidelines stress the importance of preventer medication reflecting clear data that short-acting beta-agonists (SABAs), the common “blue puffer,” does not address underlying airway inflammation and is associated with higher rates of severe exacerbations, hospitalisations and asthma-related deaths.

That means early and consistent anti-inflammatory treatment, even in people with mild or intermittent symptoms. Preventive inhaled corticosteroid–based therapy—often in combination with a fast-acting bronchodilator—is now central to modern asthma care. This prevention-focused approach aims to reduce airway inflammation before symptoms escalate.

Management, Not Managing

For people who have “managed” their asthma for years using only a blue reliever, autumn is an important moment for reassessment. Increased reliever use, night-time symptoms, exercise limitation, or seasonal flare-ups are all signs that current management may no longer be adequate. An effective asthma management plan should be tailored, documented and reviewed regularly. It should include the correct preventer therapy, inhaler technique assessment, trigger identification and a clear action plan for worsening symptoms or viral illness.

A review by a respiratory specialist allows for detailed assessment of asthma phenotype, lung function, symptom patterns and exacerbation history, ensuring treatment aligns with current evidence-based guidelines.

If you have asthma, autumn is not the time to wait and see. If you rely on a blue puffer, experience night-time symptoms or have a history of winter flare-ups, now is the time to act. Proactive, preventive care before winter begins can significantly reduce flare-ups and improve long-term asthma control.

Find out more

• Our Respiratory Specialists
• Asthma