Seasonal Preparedness Guide

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Chronic condition optimization

Chronic conditions like asthma, COPD, and heart failure often worsen during respiratory season. Proactive management—including timely assessment, individualized action plans and appropriate education for people living with these conditions— can help reduce complications, improve outcomes and support stability during high-risk periods. 

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Asthma and COPD

Key messages1–5

  • Minimize exposure to known triggers and optimize daily therapy.
  • Encourage vaccination and good hygiene to prevent respiratory infections.
  • Support self-management with a personalized action plan and ensure medication readiness.

COPD and asthma are chronic respiratory diseases that can worsen during respiratory season due to cold air, viral infections and other environmental triggers.

Both conditions are associated with significant morbidity during respiratory season, but with proper management, most exacerbations are preventable.

Risk stratification
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Risk stratification

COPD5,8–10
  • The risk of acute exacerbation can be assessed by:
    • History of past acute exacerbations of COPD (i.e., timing, frequency, severity and hospitalizations).
    • Severe and worsening airflow obstruction (based on spirometry results).
    • Presence of chronic bronchitis.
  • Low risk of exacerbation:  ≤1 moderate exacerbation in the past year and did not require ER visit or hospitalization.
  • High risk of exacerbation:  ≥ 2 moderate or ≥1 severe exacerbation in the last year, requiring hospital admission or ED visit.
Asthma 4,6
  • Mild exacerbation: an increase in asthma symptoms from baseline that does not require systemic steroids, an emergency department visit, or a hospitalization. Differentiating this from chronic poorly controlled asthma may only occur retrospectively.
  • Severe exacerbation: an exacerbation requiring any of the following:
    • Systemic steroids
    • Emergency department visit
    • Hospitalization
  • Higher risk of exacerbation:
    • History of severe exacerbation requiring systemic steroids, ED visit and/or hospitalization
    • Poorly controlled asthma
    • SABA overuse (>2 inhalers/year)
    • Current smoker or vape use

Management optimization for respiratory season

Annual review & risk assessment4,6,11,12
  • Conduct an annual assessment (or more frequent if control is poor or after a recent exacerbation) to prepare for respiratory season:
    • Evaluate symptom control, lung function (spirometry as needed) and history of exacerbations.
    • Review medication adherence, inhaler technique and trigger exposures.
    • Identify comorbidities impacting control (e.g., GERD, OSA, depression).
    • Identify impact of social determinants on accessing supports (e.g., education, employment, housing, income, geographic location, transportation, access to care).
Prevent respiratory infections1,3,5,12
  • Immunizations:
    • Annual influenza (OHIP covered)
    • SARS-CoV-2 (OHIP covered)
    • Pneumococcal – consult current recommendations
    • RSV prevention product (OHIP covered for high-risk individuals 60+ and may be purchased for others 60+)
    • TD (booster) – every 10 years (COPD-specific)
    • Shingles (OHIP covered for those between 65-70 years old) (COPD-specific)
  • Hygiene and exposure reduction:
    • Handwashing and hand sanitizers
    • Avoid face touching
    • Avoid close contact with sick individuals
    • Clean and disinfect surfaces (caution around cleaning agents that can trigger asthma symptoms)
    • Masking in crowded indoor spaces; encourage in cold, windy or high-pollen conditions to help manage allergies.
  • Encourage smoking cessation.
  • Refer to pulmonary rehabilitation if indicated for individuals living with COPD with high symptom burden and risk of exacerbation. See the Lung Health foundation virtual Fitness for Breath classes and exercise videos for more information.
Manage triggers
  • Ensure individuals are prepared and understand common seasonal triggers and environmental control strategies.
Season
Triggers
Strategies

Summer12–16 

  • Environmental triggers: pollen, pet dander, dust mites, mould, smog, humidity 
  • Heat 
  • Smoke: cigarette, cigar, fireplace, wood burning stove or campfire 
  • Overexertion 
  • Check the Pollen Count and local Air Quality Health Index before going outside. Discuss what these numbers mean and how they can make symptoms worse.
  • Schedule physical activity during cooler parts of the day (e.g., morning or evening) and indoors when possible. 
  • Avoid scented products and smoke. 
  • Take breaks when overexerted. 
  • Stay hydrated.
  • Use AC and keep windows closed to minimize exposure to allergens. For more information for OW and ODSP individuals see: https://link.cep.health/sphtml25

Respiratory season1,3,14,15

  • Environmental triggers: cold air (wear mask/scarf), viral infections (see prevent respiratory infections section).
  • Holiday-specific exposures: real trees may carry mould or dust.
  • Allergen and irritant reduction. 
  • Consider Air Quality Health Index before going outside
  • Rinse trees or opt for artificial trees. Clean stored decorations before use. 
  • Improve air filtration (provide recommendations), avoid scented products and smoke, minimize dust/mould. 
  • Ensure individuals are up to date with immunizations. See prevent respiratory infections for more information. 

Self-management and action plans5-7,11,12

Provide/refresh individualized action plans, including strategies for control (e.g., adherence, environmental considerations, trigger management), when to seek urgent care (worsening symptoms), medication management/adjustments, etc. Hospitalization may act as a natural trigger to initiate discussions with patients and their families on advanced care planning. 

Ensure medication readiness (30-day supply), and correct use of inhalers.

Encourage individuals to carry relievers at all times (e.g., at home and at work) and regularly check dose counter.

Referrals

Consider referral to specialized care for:4,6,7,17

Specialized care may include respirologists, allergists, Certified Respiratory Educator (CRE), Certified Asthma Educator (CAE) or other trained professionals.6,7 

Patient resources

Patient resources

Asthma

COPD

Heart failure

Key messages

  • Support self-management in different seasons with a personalized action plan.
  • Support management of any comorbidities that may be impacted by seasonal changes, such as COPD.
  • Encourage Immunization as part of seasonal activities in the person’s individualized care plan.

Heart Failure is a clinical condition where the heart is unable to pump enough blood to meet the demands of the body. The condition is complex, progressive and ultimately fatal. Heart Failure is often found alongside other conditions, with 37% of Ontarians experiencing four or more co-occurring chronic conditions. Seasonal weather such as extreme heat, may impact people with cardiovascular disease such as heart failure. While there is still more research needed on the ways in which the heat impacts cardiovascular disease and to what extent, it is important to consider this risk to cardiovascular health.18,19

Symptoms and Severity

Heart Failure’s hallmark symptoms include shortness of breath, fatigue and ankle swelling. There are different categories of people living with Heart Failure which include18,20,21:

The NYHA classification also describes degrees of symptom severity among people living with Heart Failure (PWHF). For more information, see CEP’s Heart Failure tool.

Seasonal preparedness for HF patients12,18

Review care plans
  • Review a person with Heart Failure’s at least every 6 months.
  • Consider timing follow-up appointments just before high-risk times of the year.
  • Consider the way seasonal changes may impact management of their condition and ensure the PWHF and their care partners are knowledgeable about seasonal changes to their care plan.
Prevent exacerbating illnesses
  • Relevant immunizations available in Ontario include:
    • Annual influenza (OHIP covered)
    • SARS-CoV-2 (OHIP covered)
    • Pneumococcal – consult current recommendations
    • RSV prevention product (OHIP covered for high-risk individuals 60+ and may be purchased for others 60+)
    • Shingrix (OHIP covered for seniors 65-70 who have not had a Zostavax® II vaccine) 
Be aware of worsening heart failure
  • Ensure the PWHF is aware of warning signs of worsening heart failure, has a plan for monitoring their symptoms and knows when to take action.
  • When gradual, worsening symptoms are reported, they should be assessed by a clinician and have their medications adjusted (as needed) within 48 hours.
  • For information on coordination of care and referrals see CEP’s Heart Failure tool or seek support from the Best Care program.
Season
Triggers
Strategies

Summer12,18,19,22

  • Heat and increased exertion (e.g., outdoor activities).
  • Dehydration, electrolyte imbalance, and related medication effects. 
  • Increased sodium intake (e.g., summer BBQs, etc.)  
  • Seasonal exacerbation of comorbid conditions.
  • Discuss safe exercise practices and if modifications need to be made during a heat wave. If unsure about safely meeting the physical activity goals, consider consulting a physiotherapist or kinesiologist. 
  • Counsel the person with heart failure about appropriate hydration during hotter than usual times. Be aware that the evidence base to support fluid restriction is limited, and severely limiting intake may have adverse consequences.
  • Consider any changes needed to prescribed diuretic medication.
  • Encourage the PWHF to monitor weight and symptoms daily to detect early signs of worsening heart failure. 
  • Monitor the individual’s dry weight and volume status. 
  • Counsel on appropriate diet and sodium intake. 
  • Discuss and share resources on self-management strategies for the season.
  • Discuss management of co-occurring conditions, such as COPD in summer.

Winter12,18,23,24

  • Cold weather and increased exertion (e.g., snow removal, walking through heavy snow).
  • Reduced physical activity.  
  • Seasonal illnesses, such as respiratory viruses (possible increased risk of worsening heart failure).  
  • Risk of weather impacts, social isolation and travel considerations. 
  • Increased sodium intake (holiday events, etc.).  
  • Seasonal exacerbation of comorbid conditions.
  • Advise keeping warm and wearing appropriate layers of clothing.
  • Discuss safe exercise practices and if modifications need to be made during cold weather. If unsure about safely meeting the physical activity goals, consider consulting a physiotherapist or kinesiologist. 
  • Encourage the PWHF to obtain annual immunizations.
  • Encourage the PWHF to monitor weight and symptoms daily to detect early signs of worsening heart failure.  
  • Encourage the PWHF to maintain a supply of their prescribed medication in case of winter weather and difficulty with travel. 
  • Counsel on appropriate diet and sodium intake.  
  • Discuss and share resources on self-management strategies for the season.
  • Discuss management of co-occurring conditions such as COPD in winter.

Patient resources

Practice management during respiratory season (coming this fall)

Seasonal and respiratory immunizations (coming this fall)

Seasonal illness testing and management (coming this winter)

IPAC recommendations (coming this winter)

References New