Winter's impact on chronic conditions

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This summer’s sweltering temperatures provisionally make 2026 the UK’s hottest year since records began back in 1884. Interim figures from the UK Health Security Agency suggest that the heatwaves in May and June caused 2,877 excess deaths in England.

Despite the focus on global warming, excess winter deaths in England and Wales reached 25,832 in 2024–25 – a marked decline from the 106,400 recorded when records began in 1950–51. Nevertheless, deaths during winter 2024–25 were 15% higher than in the non-winter months.

The three cold snaps that winter (at least two consecutive days when the average daily mean temperature was below 2°C) were associated with an estimated 2,544 deaths in England, according to Government statistics – similar to the number attributed to this year’s heatwaves.

Pharmacists should advise people with suspected hypothermia – a body temperature below 35°C – to attend A&E or call 999.

Cold weather also triggers or exacerbates many other diseases, as the examples in this article show. So how can community pharmacy teams help people cope better with the cold?

COPD and asthma

Each year, as inevitably as prices going up at Christmas, my asthma worsens during the winter. I’m not alone. In a UK survey, seven in 10 people told Asthma + Lung UK that cold air exacerbated their lung condition.

According to the charity, winter can exacerbate asthma and chronic obstructive pulmonary disease (COPD) in several ways. Cold air can cause bronchoconstriction, increase mucus production and irritate the airways, worsening wheeze, cough and breathlessness.

Lower temperatures may also weaken immune defences, while spending more time indoors allows respiratory infections to spread more readily.

“Community pharmacists are ideally placed to make high-value evidence-based interventions that improve the health and wellbeing of people with COPD and asthma,” says the Guy’s and St Thomas’ NHS Foundation Trust (GSTT) Pharmacy Airways Team – particularly in the colder winter months.

For example, community pharmacists can optimise medicines use, which “encompasses ensuring that the patient is prescribed and adherent to appropriate therapy, has satisfactory inhaler technique and reinforcing the need to attend, or in some areas deliver, annual respiratory reviews,” the GSTT team points out.

They also stress that community pharmacists should “encourage and administer vaccinations to combat the respiratory viruses – including flu, Covid-19 and rhinovirus – that circulate more widely during the winter and commonly trigger asthma and COPD exacerbations.”

GSTT also suggests that community pharmacists should always help tackle tobacco dependence and signpost people to financial support, including NHS prescription prepayment certificates and help with heating costs. Pharmacists can remind patients to stay hydrated, loosely cover their mouth and nose in cold weather and remain active within their limits.

Eczema and psoriasis

“Winter weather can be particularly challenging for people living with eczema or psoriasis,” remarks William Price on behalf of the British Association of Dermatologists. Indeed, Google searches for atopic dermatitis peak between January and May across 42 countries in the northern hemisphere.

“Cold temperatures, in combination with windy conditions, can strip the skin of moisture, leaving it drier and potentially worsening symptoms. Alongside any prescribed medication, it is important to keep the skin well moisturised. Emollients can be used in both the usual leave-on manner and as soap substitutes to help prevent dry skin,” he advises.

Importantly, pharmacists “can provide valuable, life-saving safety advice” about emollient flammability, adds Price, who is also lead dermatology pharmacist at East Lancashire Hospitals NHS Trust. “When it is cold outside, there is greater potential for fire hazards indoors from sources such as fireplaces and space heaters.”

“The National Fire Chiefs Council has great resources on this online, developed in conjunction with the MHRA,” he says (see Resources). “Patients should avoid being lulled into a false sense of security by using ‘non-paraffin-based’ emollients. These present a similar fire hazard to paraffin-containing products.”

Once again, pharmacists should encourage vaccination. “Many systemic treatments for moderate to severe eczema and psoriasis are immunosuppressive or immunomodulatory. Pharmacists are perfectly placed to remind patients of the availability of vaccine programmes such as those for flu, pneumonia and Covid,” says Price.

“People with eczema and psoriasis should try to minimise environmental triggers by keeping their home at a comfortable, consistent temperature and avoiding overheating,” he suggests. “Moving between cold outdoor temperatures and warm indoor environments can dry out the skin, increasing itching and potentially triggering inflammation.”

Dressing in layers makes it easier to adjust clothing to suit changes in temperature. Patients should try to avoid wearing rough fabrics such as wool directly against the skin, as this can cause irritation. “Keeping limbs and the scalp covered in windy weather can reduce the drying effect of airflow,” he adds.

Diabetes

Several factors make winter potentially difficult for people with diabetes. Responses to cold can be impaired – people may be less likely to shiver – while autonomic neuropathy can impair vasoconstriction and predispose to hypothermia. In cold weather, brown adipose tissue metabolises lipids, stimulates the sympathetic nervous system and increases glucose uptake by skeletal muscle, so improving insulin sensitivity.

People with diabetes tend to be obese or overweight but typically have less brown adipose tissue than people without diabetes. This may reduce their ability to generate heat in colder temperatures. They may also be less active and increase their calorie intake on cold days, undermining glycaemic control.

“Cold weather can affect blood sugar levels. People who normally monitor their glucose should be encouraged to check it more often during the winter. People who use insulin may also need to adjust their dose and should keep a close eye on their [blood glucose] readings,” says Douglas Twenefour, head of clinical at Diabetes UK.

“If people use insulin or diabetes technology, they should be reminded that very cold temperatures can affect how they work. Insulin can freeze if it is left in a car overnight, so should always be stored according to the manufacturer’s instructions,” he adds.

Good foot care remains essential. “Even in winter when feet are covered, it is important for people living with diabetes to check their feet every day. Taking a minute to remove shoes and socks, and look for any cuts, blisters or other changes, can help spot problems early,” Twenefour says.

Community pharmacists should encourage people living with diabetes to stay active during the colder months, even if getting outside is less appealing. There are plenty of ways to stay moving at home and regular activity can make a real difference to managing the condition.

Twenefour reiterates the importance of immunising against flu. “Getting a flu vaccination is one of the simplest ways that people living with diabetes can help protect their health over the winter,” he says.

Heart disease

Cold weather makes the heart work harder to keep the body warm as blood vessels narrow to conserve energy and heat.

“People with a heart condition and the elderly are particularly vulnerable in the winter months. The cold can increase the risk of developing blood clots, which could lead to a heart attack or stroke,” says Joanne Whitmore, senior cardiac nurse at the British Heart Foundation.

The cold weather can also worsen symptoms for people living with heart conditions, but there are simple steps everyone can take to stay well.

For instance, pharmacists should advise patients to take their prescribed medicines, stay active, eat a healthy, balanced diet, and look after their mental wellbeing. “People can also get a flu jab and Covid-19 vaccine to help protect against cold weather viruses – and some people may be able to get a pneumococcal vaccine,” Whitmore adds. And if someone has a heart condition and feels unwell, it is important that they are advised to seek advice from a pharmacist, particularly before taking OTC cold and flu remedies.

Staying warm reduces the strain on the heart. “Keeping the home warm, eating regular hot meals and dressing in layers when going outside can help protect health during the winter months,” Whitmore says.

“People with angina can wear a scarf wrapped loosely around their mouth and nose or wear a face mask, so they breathe in warmer air. This can help improve any symptoms they may get in colder weather. But patients should contact a GP or call 999 if symptoms persist or worsen.”

Raynaud’s phenomenon

Raynaud’s phenomenon arises from spasms in the small arteries and arterioles of the extremities, typically triggered by cold, emotions or stress.

It usually affects the fingers but can also involve the toes, ears, nose, lips, nipples and penis.

Reduced blood flow turns the skin white (pallor) or blue (cyanosis). As the vessels dilate and blood flow returns, the skin turns red. Patients may also experience pain, numbness and tingling in their extremities.

Between 80-90% of Raynaud’s cases are not associated with another medical condition (classified as primary Raynaud's phenomenon, previously called Raynaud's disease); most remaining cases arise from connective tissue disorders (classified as secondary Raynaud’s phenomenon, previously called Raynaud’s syndrome). For example, Raynaud’s phenomenon is common in people with scleroderma, an autoimmune condition that produces hard, thickened patches of skin. In some people, the autoimmune reaction targets muscles, bones, internal organs and blood vessels (systemic sclerosis).

Hyperviscosity syndromes, arterial injury, atherosclerosis and certain medicines can also cause or worsen Raynaud’s phenomenon.

“Pharmacists should remind their team that many decongestants work by restricting blood vessels and can trigger Raynaud’s attacks,” advises Jill Will, healthcare specialist, Scleroderma and Raynaud’s UK (SRUK). “Many people may not know this or don’t read the labels.”

A warm drink is often a good way to heat up, she says – yet people with Raynaud’s may not know that caffeine can also be a trigger. “Encouraging people to opt for decaffeinated drinks might help reduce the frequency or severity of attacks and allow more benefit from the warmth of a drink,” she suggests.

Will says that pharmacists should refer people with Raynaud’s phenomenon who have sores on their fingers or toes (digital ulcers) to their GP “to consider alternative medications and screening for connective tissue diseases, such as systemic sclerosis”. The wounds “should be formally assessed and dressed”.

“Raynaud’s symptoms can impact day-to-day life despite following general advice about keeping warm and avoiding triggers. Encouraging people to take pictures of their fingers and toes during attacks and keeping a symptom diary can help prescribers to make a thorough assessment when considering the introduction of medications,” Will says.

Many people with Raynaud’s don’t wish to take medicines but are happy to consider vitamins, minerals or lifestyle changes, she adds. SRUK’s website offers some suggestions.

Will reminds pharmacists to check for contraindications and interactions between complementary and prescribed medications if used. She also suggests that people living with Raynaud’s phenomenon should be vaccinated each winter.

Conclusion

Despite the extent of long-term conditions in this country, common winter wellness themes emerge: encourage adherence to medication, offer practical advice to help people keep warm – and vaccinate, vaccinate, vaccinate. With meteorologists predicting that the largest El Niño since the 19th century is set to disrupt global weather, community pharmacists and their teams can offer plenty of practical advice to support people through winter’s cruel embrace.

Source: www.nhs.uk/conditions/hypothermia