According to the Food and Drug Administration (FDA), GlaxoSmithKline (GSK) is discontinuing production of Flovent HFA (fluticasone propionate) and Flovent Diskus. Flovent HFA and Flovent Diskus are inhaled corticosteroid medicines used as a controller medicine to treat asthma.

GSK notified the FDA of this decision on June 2, 2023. The last date the product will be available for ordering is Dec. 31, 2023. GSK believes a supply of these products will be gone by early 2024.

A concerning and dangerous trend is circulating on social media channels like Facebook, Twitter, and TikTok. People are breathing in hydrogen peroxide through nebulizers to try to prevent or treat COVID-19.

DO NOT put hydrogen peroxide into your nebulizer and breathe it in. This is dangerous!

It is not a way to prevent nor treat COVID-19. Visit aafa.org/covid19 for information about asthma, allergies, and COVID-19.

Hydrogen peroxide can be used as a cleaner and stain remover, and can cause tissue damage if you swallow it or breathe it in. According to the Agency for Toxic Substances and Disease Registry:

"Hydrogen peroxide can be toxic if ingested, inhaled, or by contact with the skin or eyes. Inhalation of household strength hydrogen peroxide (3%) can cause respiratory irritation. Exposure to household strength hydrogen. peroxide can cause mild ocular irritation. Inhalation of vapors from concentrated (higher than 10%) solutions may result in severe pulmonary irritation."

A nebulizer is a “breathing machine” used to treat asthma. It turns liquid asthma medicine into a mist. You then breathe in the medicine through a mask or mouthpiece.

Only use asthma medicine prescribed by your doctor in your nebulizer. Other chemicals can be harmful to your lungs.

In December 2019, a new coronavirus named SARS-CoV-2 started spreading and triggered a pandemic (worldwide outbreak). This coronavirus causes an illness known as COVID-19.

The coronavirus spreads through close contact from person to person. A person with the virus can spread it to others by talking, coughing, sneezing, singing, or breathing. The virus will be in large or small droplets that are exhaled from the mouth or nose out into the air.

If you are within 6 feet (2 meters) of someone who is ill with COVID-19, you may be at greatest risk for becoming infected. But it may be possible to catch the virus even if you are more than 6 feet away from an infected person because very small droplets can spread in the air. If someone who is sick coughs on or near your face, you may get infected. People may be infected with the coronavirus and not show any symptoms. They may spread the virus without knowing it. The virus may also spread through direct contact with a person who has COVID-19.

What Are the Symptoms of COVID-19?

According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), COVID-19 symptoms can include:

• Fever
• Chills
• Cough
• Shortness of breath or trouble breathing
• Feeling tired and weak
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Stuffy or runny nose
• Nausea or vomiting
• Diarrhea
  
  

If you or someone you know has these emergency warning signs, call 911 or go to the emergency room immediately:

• Trouble breathing or shortness of breath
• Pain or pressure in the chest that doesn’t go away
• Newly confused
• Can’t wake up or stay awake
• Cyanosis which is tissue color changes on mucus membranes (like tongue, lips, and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
  
  

According to the CDC, this list may not include all symptoms. If you have any symptoms that are severe or concerning, call your doctor.

The CDC warns that symptoms may appear two to 14 days after coming in contact with the virus.

How Can I Tell the Difference Between Asthma, COVID-19, the Flu, a Cold, or Seasonal Allergies?

Some symptoms are similar between these respiratory illnesses. Respiratory illnesses may worsen asthma, so it’s important to keep taking your asthma medicines. If you have a fever and a cough, call your doctor. If you have seasonal allergies, there are things you can do to treat them at home. If your allergy symptoms are hard to control, make an appointment with an allergist.

This chart can help you figure out if you may be feeling symptoms of asthma, allergies, or a respiratory illness like COVID-19, the flu, or a cold:

Click to see larger image (English)

Click to see larger image (Spanish)

Are People With Asthma at Risk of Severe Illness From COVID-19?

Many studies show that having asthma does not put you at a greater risk of getting COVID-19 or having severe COVID-19.^1,2,3 A study published in “The Journal of Allergy and Clinical Immunology: In Practice” (JACI: In Practice) found that people with well-controlled asthma have less severe COVID-19 outcomes than people with uncontrolled asthma.⁴

The CDC continues to list moderate-to-severe asthma as a chronic lung disease that can make you more likely to have severe illness from COVID-19.

No matter what, it is important to keep your asthma well-controlled. If your asthma is not under control, you are at a greater risk in general of having an asthma episode or attack, going to the emergency room, staying in the hospital, or even death. If you feel like your asthma is not well-controlled, talk with your doctor as soon as possible.

Even though people with asthma are not at the highest risk for COVID-19, it is still important to keep your asthma under control. Common medicines you may take for asthma and allergies do not increase your risk of getting COVID-19. They will help you keep your asthma under control. You are at greater risk for having an asthma attack if you stop taking your medicines. Take your medicines at the first sign of symptoms as listed on your asthma action plan. Continue to take these medicines as prescribed:

• Quick-relief medicine (such as albuterol)
• Inhaled corticosteroids (controller medicines)
• Oral corticosteroids (such as prednisone)
• Biologics
• Antihistamines (allergy medicine)
• Proton pump inhibitors for acid reflux
• Nasal allergy sprays
• Allergy shots
  
  

If you have any questions about asthma medicines and COVID-19, talk with your doctor.

If you need to take quick-relief medicine (such as albuterol) for an asthma episode, use an inhaler (with a spacer if directed by your doctor) if possible. Using a nebulizer can increase the risk of sending virus particles in the air if you are sick. But if you have a nebulizer and solution, it is OK to use it to treat an asthma episode. When using a nebulizer, limit the number of people in the room or use it in a room by yourself.

How Can I Avoid Getting COVID-19 (And Other Respiratory Infections)?

The following steps will help you avoid COVID-19, the flu, and other respiratory infections:

1. Get your vaccines.

Vaccines can help protect you, your loved ones, older adults near you, teachers, and essential workers from getting a respiratory infection. They can also cut down your symptom severity if you do get sick. Vaccines reduce the burden on our health care system by reducing the number of people who get COVID-19 or the flu.

Everyone who is 6 months and older can get a COVID-19 vaccine for free with no out-of-pocket costs in the United States. There are currently four vaccines available: Pfizer, Moderna, Johnson & Johnson (J&J), and Novavax.

Visit vaccines.gov to find out where you can get the COVID-19 vaccine near you. Most people can get the COVID-19 vaccine with no issues. Allergic and adverse reactions are rare.

The flu vaccine is recommended for everyone age 6 months and older with rare exceptions.

It is safe to get both the COVID-19 vaccine and the flu vaccine at the same time.

2. Wear a mask.

Face masks can help reduce the spread of the coronavirus. They can benefit people who are vaccinated and unvaccinated alike. Some people may have COVID-19 and not show symptoms for a few days, while some may not have any symptoms at all. And some vaccinated people have gotten breakthrough infections, which have usually been mild.

Wear a mask that fits snugly on your face, and covers your nose, mouth, and beard completely. Wear a mask when you leave your home, if you are caring for someone at home who is sick, and if you have been exposed to someone with COVID-19. People with asthma should be able to wear face masks.

Face masks offer other benefits as well. They can reduce your exposure to pollen, air pollution, and other respiratory infections like the flu.

3. Keep a physical distance from people outside your household.

In general, the more closely you interact with other people and the longer that interaction, the higher the risk of coronavirus or flu spread. Try to stay home when possible when these illnesses are spreading in your community. Avoid large crowds of people, especially in indoor locations. When in public, keep at least 6 feet apart. Stay away from people who are sick or have been in contact with someone who is sick. Even when you’re at home with family, don’t share makeup, food, dishes, or eating utensils.

Postpone any unnecessary travel during the COVID-19 pandemic. See the CDC’s guidelines on how to protect yourself at specific locations and in certain situations, such as shops, public places, gatherings, and more.

4. Wash your hands properly and often.

Use soap and warm water to wash your hands for 20 to 30 seconds. Always wash your hands before and after eating and after coughing or sneezing. Don’t touch your eyes, nose, or mouth.

If you don’t have access to running water, use an alcohol-based hand sanitizer that is at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol).

5. Make sure your indoor spaces are well-ventilated and have good indoor air quality.

If you are staying indoors more because of COVID-19, be mindful of the quality of your indoor air. The air inside our homes can often be more polluted than the air outside. Unhealthy indoor air can be full of asthma triggers and allergens that can cause symptoms and make your asthma harder to control. Take steps to improve and maintain healthy indoor air quality.

Air circulation is important too. Keep your indoor spaces well-ventilated by opening windows or doors, using fans, running air cleaners, or using proper air filters in your HVAC system.

Current evidence shows the risk of the coronavirus spreading is much lower outdoors than indoors. Good ventilation in your indoor environment may help reduce the spread of the coronavirus. It may also affect the risk of transmission (how fast it spreads).

On days when pollen is low and air quality is good, open your windows to let in fresh air. Run your HVAC system as much as possible (especially when windows are closed). Use high efficiency air filters in your HVAC system and replace them at least every three months.

6. Take care of your health.

Take your asthma control medicines as directed to keep your airways open. Eat well and get enough sleep.

Pollen (such as grass or ragweed pollen) may impact people across the U.S. too. Seasonal allergies can affect people with allergic asthma. If pollen allergies trigger asthma symptoms for you, be sure to follow your allergy treatment plan to keep your allergies under control to prevent asthma episodes or attacks.

If you stopped seeing your allergist or getting allergy shots (immunotherapy) during the COVID-19 pandemic, consider making an appointment soon. Keeping up with your regular allergist visits is an important part of keeping your asthma controlled.

The most important thing you can do is to keep your asthma under control. If your asthma is not under control, call your doctor right away.

In general, tracking your symptoms and following your asthma action plan are key to managing your asthma. Some people use peak flow meters to monitor their airways. Monitoring your blood oxygen levels with a pulse oximeter (or “pulse ox”) is not a recommended part of home management of asthma. Many pulse oximeters you can buy for home use are not as accurate as medical grade devices.

It is important to remember that the symptoms you feel should always come before pulse ox and peak flow numbers. But if your peak flow numbers are down and you don’t have symptoms, follow your asthma action plan and contact your doctor.

There are no data demonstrating that monitoring your pulse ox through an oximeter or smartphone app will help manage your asthma. As always, talk with your doctor about the best ways to monitor your symptoms and asthma control.⁶

If I Think I Have COVID-19, What Should I Do?

If you start having symptoms of COVID-19, get tested or take an at-home test. If you have mild symptoms and are not at high risk for having more severe COVID-19, you do not need to call your doctor. Call your local health department within 24 hours to let them know so they accurately report local cases.

If you are at high risk for severe COVID-19, call your doctor within 24 hours if you test positive. They may want to you to take the medicine Paxlovid.

Many pharmacies have various testing options (including at-home or drive-thru tests). The United States Postal Services is providing free at-home COVID-19 tests. U.S. households can get eight rapid antigen COVID-19 tests for free. To receive them, you’ll need to complete an online form. Please note: You will not need to enter any credit or debit card details to place the order.

Some doctors may offer telehealth (video or virtual appointments). If that is an option, ask your insurance company if telehealth is covered under your plan. And if you have Medicare, you might be able to have a virtual visit with your doctor. The government expanded the coverage of telehealth services during the COVID-19 pandemic.

Stay home and isolate from family members so you don’t spread the coronavirus to other people.

Medical Review, July 2022 by Mitchell Grayson, MD

References
1. Chhiba, K.D., Patel, G.B., Vu, T.H.T, Chen, M.M., Guo, A., Kudlaty, E., Mai, Q., Yeh, C., Muhammad, L.N., Harris, K.E., Bochner, B.S., Grammar, L.C., Greenberger, P.A., Kalhan, R., Kuang, F.L., Saltoun, C.A., Schleimer, R.P., Stevens, W.W., & Peters, A.T. (2020). Prevalence and characterization of asthma in hospitalized and non-hospitalized patients with COVID-19, Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.06.010.
2. Butler, M. W., O’Reilly, A., Dunican, E. M., Mallon, P., Feeney, E. R., Keane, M. P., & McCarthy, C. (2020). Prevalence of comorbid asthma in COVID-19 patients. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.04.061
3. Lieberman-Cribbin, W., Rapp, J., Alpert, N., Tuminello, S., & Taioli, E. (2020). The Impact of Asthma on Mortality in Patients With COVID-19. Chest. https://doi.org/10.1016/j.chest.2020.0air pol.575
4. Huang, B. Z., Chen, Z., Sidell, M. A., Eckel, S. P., Martinez, M. P., Lurmann, F., Thomas, D. C., Gilliland, F. D., & Xiang, A. H. (2021). Asthma disease Status, COPD, and COVID-19 severity in a large Multiethnic POPULATION. The Journal of Allergy and Clinical Immunology: In Practice. https://doi.org/10.1016/j.jaip.2021.07.030
5. Kampf, G., Todt, D., Pfaender, S., & Steinmann, E. (2020). Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection, 104(3), 246–251. doi: 10.1016/j.jhin.2020.01.022
6. Heneghan, C. (2018, January 30). Self-management of asthma – is there an app or pulse oximeter for that? Retrieved from https://blogs.bmj.com/bmjebmsp...-app-pulse-oximeter/

To understand asthma, a chronic disease that causes your airways to become inflamed, it helps to first know how your airways work.

Watch on YouTube

How Do Normal Airways Work?

When we breathe in, air moves through our airways – from our nose or mouth, down a large hollow tube in the front of the neck called a windpipe or trachea – and into our lungs.

The trachea divides into two tubes called bronchial [bron-KEE-uhl] tubes in the lungs. They look like upside-down trees. As the bronchial tubes pass through the lungs, they divide into smaller air passages called bronchioles [bron-KEE-ohlz]. At the end of each bronchiole are tiny air sacs that fill up with air, like tiny balloons, each time we breathe in. These are called alveoli [al-VEE-uh-lahy].

Air comes into our lungs each time we breathe in. This air has oxygen in it. Oxygen has a special job. It helps feed, or give energy to, all parts of our body so we can walk, talk, eat and exercise.

How Do Your Airways Work When You Have Asthma?

When you have asthma, your airways aren't able to function as well as they should.

Common asthma symptoms are:

• Coughing
• Shortness of breath
• Wheezing
• Chest tightness
  
  

Asthma causes inflammation, or swelling, in the lungs. It can also cause squeezing, called bronchoconstriction [bron-KOH-con-STRICK-shun], and extra sensitive or twitchy airways.

When something bothers your airways, you have trouble breathing. This is called an asthma attack or episode. It gets harder to breathe because the tiny muscles around your airways squeeze tightly and they have swelling inside.

Your airways will make more mucus inside your airways, which makes it even harder to breathe. These changes in your airways can cause coughing and wheezing.

There is no cure for asthma. But you can take steps to manage it. If you have asthma, it's important to see an asthma specialist, like an allergist or pulmonologist, to come up with the right asthma treatment plan. Medicines and avoiding asthma triggers can help reduce swelling and relax tight muscles in your airways.

Did you know there are different types of asthma? One type you may not have heard of is called eosinophilic [EE-oh-sin-oh-FILL-ick] asthma. It is sometimes called e-asthma or eos asthma for short. It is a type of asthma that has increased inflammatory cells called eosinophils [EE-oh-sin-oh-FILLS] in the airway. An estimated 25 million people in the United States have a diagnosis of asthma and about 10% of them have poorly controlled, severe asthma. Many of these patients could have e-asthma.   

What Is Eosinophilic Asthma?

Eosinophilic asthma is a type of asthma that is caused by high levels of white blood cells called eosinophils in the airways of the lungs. The purpose of these white blood cells is to help you fight infections. Sometimes these immune cells are over-reactive and cause inflammation in the body, including in the lungs. People who have high levels of eosinophils can have swelling in the airways which can lead to asthma symptoms.

Eosinophilic asthma is a type of severe asthma. It usually starts in adulthood and may not respond to treatment with a common asthma medicine called a corticosteroid. In addition, this type of asthma can be associated with increased allergies.

If you have eosinophilic asthma, you can have allergic or non-allergic asthma triggers. Other types of asthma, such as allergic asthma, are more often triggered by specific allergens such as animal dander, mold spores, dust mites, and environmental allergens in the air.

How Do You Treat Eosinophilic Asthma?

Your doctor may do several tests to confirm your type of asthma. This may include checking your mucus or saliva for eosinophils, checking your blood eosinophil count, or doing a test that checks your breath for a nitric oxide gas. Your doctor will also ask you about your current and past symptoms, as well as any current and/or history of allergies If your doctor diagnoses you with e-asthma, understanding this unique type of asthma is important to help you manage symptoms and have better quality of life.

Current management of e-asthma begins with standard guideline-based therapy. For example, most people with asthma are prescribed two medicines:

• A controller medicine that treats airway swelling – usually an inhaled corticosteroid
• A quick-relief medicine to help relieve symptoms when they occur by relaxing bronchospasms [brahn-ko-spaz-uhmz] – when muscles tighten and squeeze around the airways
  
  

Depending on how often and how severe your symptoms are, you may take these medicines every day or as needed. Your health care provider should develop a clear, written, and understandable action plan for effective management of asthma symptoms.

For some people with e-asthma, the common controller medicines may not work well enough on their own to control asthma symptoms. Once your doctor looks at your tests, medical history, and current symptoms, the next step is making a plan for your treatment. Shared-decision making can be undertaken with your health care provider to see if you need to add a targeted therapy. This type of asthma treatment is known as a biologic, or monoclonal antibody therapy.

Biologics target specific cells (pathways that are part of your immune system) to block swelling and reduce symptoms. You get these therapies as a shot or by IV every few weeks or two months, depending on the treatment.

Current biologic options for e-asthma include:

• Omalizumab
• Benralizumab
• Dupilumab
• Mepolizumab
• Reslizumab
• Tezepelumab-ekko
  
  

How Does Eosinophilic Asthma Affect Quality of Life?

If you have uncontrolled asthma, no matter the type, you are at higher risk for emergency room visits, hospital stays, or death. If you have severe asthma, you may have symptoms every day and go to the emergency room more often than people with well-controlled asthma. Severe asthma can limit your ability to do even simple tasks, can be debilitating, and can decrease your overall quality of life. Identification of severe subtypes of asthma (like e-asthma) may be very important for treatment of your uncontrolled asthma.

A study by the Asthma and Allergy Foundation of America (AAFA) in 2017 found that people with severe, uncontrolled asthma have greater emotional, social, and financial burden of disease. But not all people with severe, uncontrolled asthma are aware of what type of asthma they may have or that biologic treatments exist that may control their asthma better and improve their quality of life. This is an issue that you should be aware of and discuss with your health care provider.

If you have asthma, talk with your doctors specifically about how asthma negatively affects your day-to-day life. Let them know what you hope to achieve with treatment. Ask them if you are a potential candidate for biologic asthma treatments.

We also encourage health care professionals to work closely with their patients to understand the many ways severe asthma is affecting quality of life. Together, people with asthma and their support teams can develop a shared understanding of asthma management and treatment goals.

Medical Review: May 2022 by John M. James, MD

Birch trees are known for their tall, thin trunks and white bark. But did you know they trigger a lot of allergy symptoms for much of the population each spring? These allergy symptoms can range from nasal symptoms, like sneezing and a stuffy nose, to the lesser-known oral allergy syndrome (OAS).

What Is OAS?

If you have a pollen allergy, you could have OAS. It is a mild form of food allergy.¹ With OAS, your mouth and throat may itch or tingle right after you eat certain raw fruits, vegetables, seeds or nuts. You might even get hives where the food touched your skin or swelling of your mouth, lips, tongue and throat. Many people with OAS can eat the foods that cause reactions if they are cooked or if the skin is removed.

It might seem strange that you would react to some foods because of an airborne tree pollen. This happens when your immune system gets confused. The pollen is similar to the proteins in some foods, so your body can’t tell the difference. So if you are allergic to birch pollen, your body might think it’s invading your body when you eat an apple. This is called cross-reactivity.

What’s the Difference Between OAS and Anaphylaxis?

The symptoms of OAS sound similar to anaphylaxis. So how do you know the difference?

Anaphylaxis (anna-fih-LACK-sis) is a severe reaction that comes on quickly and usually affects more than one organ system (part of the body), such as the skin or mouth, the lungs, the heart and the gut. It requires epinephrine and immediate medical attention. Some symptoms include:

• Skin rashes, itching or hives
• Swelling of the lips, tongue or throat
• Shortness of breath, trouble breathing or wheezing (whistling sound during breathing)
• Dizziness and/or fainting
• Stomach pain, bloating, vomiting or diarrhea
• Uterine cramps
• Feeling like something awful is about to happen
  
  

OAS is milder and often only affects the mouth. It can come on immediately when eating the offending food and go away quickly after eating the food.

But call your doctor if your OAS:

• Gets worse
• Happens when you eat nuts or cooked fruits and vegetables
• Trigger any of the above symptoms of anaphylaxis
  
  

What Foods Could I React to If I Have a Birch Pollen Allergy?

If you are allergic to birch pollen, there are several foods you could react to. But you may not react to every food on the list. Here are foods that cross-react with a birch pollen allergy:

• Almond
• Apple
• Apricot
• Carrot
• Celery
• Cherry
• Hazelnut
• Kiwi
• Parsley
• Peach
• Peanut
• Pear
• Plum
• Soybean
  
  

If you do not have symptoms when eating birch-related fruits and vegetables, you may continue to eat them as tolerated. If you have severe OAS symptoms, you should discuss this with an allergist. You’ll want to avoid eating the foods that trigger them, especially when birch pollen is high. Birch trees release their pollen between January to April, depending on where they grow. And birch trees grow throughout most of the United States, so they are hard to avoid.

If you have a reaction to almonds, hazelnuts or peanuts, you might have more serious symptoms. These nuts can cause anaphylaxis, a serious, life-threatening reaction. If you have symptoms when eating these nuts, talk to your doctor right away.

Birch trees are not the only plants that can trigger OAS. If you have symptoms of OAS, your doctor can perform tests to diagnose your pollen allergies so OAS won’t leave you guessing.

Medical Review February 2018.

References
1. Oral allergy syndrome (OAS) | AAAAI. (n.d.). Retrieved March 1, 2017, fromhttps://www.aaaai.org/conditio...ergies-can-be-relate;

Springtime pollen allergies are in full swing. With every cough or sniffle, you may wonder if it’s asthma or allergies, the flu, the common cold, or even COVID-19. But how can you tell the difference?

The Asthma and Allergy Foundation of America (AAFA) created a respiratory symptoms chart to help you recognize the similarities and differences between these conditions.

Click to see larger image (English)

Click to see larger image (Spanish)

Asthma Symptoms

Asthma is a chronic disease that causes your airways to be inflamed. The best way to manage it is to take your asthma medicines, avoid your triggers, and treat asthma symptoms as soon as they occur.

Common symptoms of asthma include:

• Shortness of breath
• Cough
• Chest tightness or pain
• Wheeze (a whistling sound when you breathe)
• Waking at night due to asthma symptoms
• A drop in your peak flow meter reading (if you use one)
  
  

Symptoms can come on gradually, or they can come on suddenly.

What to Do If You Have Asthma Symptoms

At the first sign of asthma symptoms, take your quick-relief (sometimes called “rescue”) medicine. Follow the Yellow/Caution Zone on your Asthma Action Plan. The earlier you treat asthma symptoms, the better your chances are of not having an asthma emergency.

Asthma can be life-threatening, so it’s important to know the signs of an asthma emergency and to keep your quick-relief inhaler with you at all times.

Red/Danger Zone symptoms are a medical emergency. Take your quick-relief medicines right away as directed on your Asthma Action Plan and then get immediate medical attention. Call 911 or go directly to the emergency room if you have these asthma symptoms:

• Asthma is getting worse quickly
• Asthma quick-relief (rescue) medicines are not helping
• Chest tightness or pain
• Severe shortness of breath
• Breathing is faster or slower than normal
• Breathing may be hard or shallow
• Trouble walking or talking due to shortness of breath
• Chest retractions (skin sucks in between or around the neck, chest plate, and/or rib bones when inhaling; this is rare in adults)
• Ribs or stomach moving in and out deeply and rapidly
• Expanded chest that does not deflate when you exhale
• Shoulders hunched over (“posturing”)
• Cyanosis, a tissue color change on mucus membranes (tongue, lips, and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
  
  

COVID-19 Symptoms

The coronavirus that causes COVID-19 is a respiratory virus that started spreading worldwide in December 2019. According to the CDC, COVID-19 symptoms can include:

• Fever
• Chills
• Cough
• Shortness of breath or trouble breathing
• Feeling tired and weak
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Stuffy or runny nose
• Diarrhea
• Nausea or vomiting
  
  

This list may not include all of the symptoms. As new variants of the coronavirus appear, the information about symptoms may change.

People age 5 and older can get a COVID-19 vaccine.

What to Do If You Have COVID-19 Symptoms

If you have any of these symptoms or if you have been exposed to someone who has COVID-19, take an at-home test or contact your doctor right away. Avoid contact with others unless absolutely necessary. Call before you go to your doctor’s office and ask for instructions. Your doctor may have a special process for you to follow so you don’t risk spreading it to other patients and staff. They may have you get tested elsewhere for COVID-19 and will give you further instruction.

If you have these severe symptoms, call 911 or go to the emergency room right away:

• Trouble breathing or shortness of breath
• Pain or pressure in the chest that doesn’t go away
• Newly confused
• Can’t wake up or stay awake
• Cyanosis which is tissue color changes on mucus membranes (like tongue, lips, and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
  
  

If you have to leave home for treatment, wear a face mask to prevent spreading the virus. Isolate yourself from people you live with and wear a face mask around them even at home. Clean and sanitize surfaces that are touched often like doorknobs, light switches, and cell phones.

Flu (Influenza) Symptoms

The flu is a contagious respiratory illness caused by influenza viruses. Symptoms can start suddenly and can cause mild to severe illness. It can also cause death in severe cases. Common flu symptoms include:

• Fever (often very high, 101 or above)
• Headache
• Extreme tiredness
• Chills
• Constant cough
• Sore throat
• Runny or stuffy nose
• Body aches in bones and/or muscles
• Diarrhea and vomiting (more common in children)
  
  

Thankfully, a flu vaccine is available. To reduce your chances of getting and spreading the flu, get the flu vaccine every year. The CDC recommends that people ages 6 months and older get the flu vaccine. Even if you catch a strain of flu that isn’t covered by the current year’s vaccine, getting vaccinated can make your illness less severe and lower your chance of being hospitalized.

People with asthma, as well as senior adults and people with other pre-existing conditions, are at high risk from complications from the flu.

It is important to get the flu vaccine every year. You can get the flu and COVID-19 at the same time. This increases your chance of becoming very ill. The flu vaccine also protects high-risk people you know and come in contact with, like essential workers, teachers, family and friends, pregnant women, children, and senior adults.

What to Do If You Have Flu Symptoms

If you have flu symptoms or are exposed to someone with the flu, contact your doctor right away. There are anti-viral treatments for the flu that can reduce symptoms. But you have to take them within two days of getting sick.

Like COVID-19, call your doctor before walking into their office if you have symptoms or have been exposed to the flu.

If you start having flu symptoms and have trouble breathing, start following the Yellow/Caution Zone on your Asthma Action Plan.

Cold Symptoms

The common cold is usually mild compared to the flu and COVID-19. But even a mild cold can trigger asthma symptoms, so if you catch a cold, you want to take it seriously.

Common symptoms of a cold include:

• Mild cough
• Sneezing
• Runny or stuffy nose
• Sore throat
• A short fever
• Aches and pains
  
  

What to Do If You Have Cold and Other Respiratory Symptoms

If you start having trouble breathing when sick with a cold, start following the Yellow/Caution Zone on your Asthma Action Plan. Contact your doctor if symptoms do not improve. And get immediate medical help for emergency asthma symptoms.

Allergy or Rhinitis (Nasal) Symptoms

Irritants and allergens can cause inflammation in your nose. This is called rhinitis. When your symptoms coincide with a certain season of the year, it’s commonly called “hay fever” even though it doesn't cause a fever and can be triggered by many different allergens.

Common allergens that can cause rhinitis include animal dander, dust mites, mold, and pollen.

Allergy symptoms can include:

• Itching in the nose and eyes
• Sneezing
• Stuffy nose (congestion)
• Runny nose
• Mucus (phlegm) in the throat (postnasal drip)
  
  

The inflammation (swelling and irritation) in your nose can cause it to produce a fluid called mucus. The mucus may flow out of your nose, as well as down the back of your throat. It can irritate the back of your throat and cause coughing.

Allergies are not contagious, unlike colds, the flu, and the coronavirus. They are caused by a reaction of your immune system.

What to Do If You Have Allergy Symptoms

If you have allergies, the best way to prevent or reduce symptoms is to reduce or avoid contact with the things you are allergic to. Some steps you can take include:

For dust mite allergy:

• Use CERTIFIED asthma & allergy friendly® dust mite-proof covers for pillows, comforters, duvets, mattresses, and box springs.
• Wash your bedding and pillowcases in hot water weekly to reduce allergens.
  
  

For animal dander allergy:

• Keep pets out of the bedroom to reduce pet dander allergen in your bedding.
  
  

For mold allergy:

• Run a fan in your bathroom for 15 to 20 minutes after showering or bathing.
• Fix plumbing leaks in your home.
  
  

For pollen allergy:

• Plan indoor activities on days when pollen counts are high.
• Keep your windows closed during high pollen and mold seasons. When entering your home, leave your shoes at the door.
• Wear sunglasses and a face mask to protect pollen from getting in your eyes, nose, and mouth when outdoors on high pollen days.
  
  

In general:

• Clean your floors weekly with a CERTIFIED asthma & allergy friendly® vacuum.
• Replace the filters on your heating/air conditioning units as recommended by manufacturer.
  
  

If reducing your exposure to allergens isn’t enough, there are several treatments that can help. Treatments can include nasal sprays, antihistamines, decongestants, and immunotherapy (allergy shots). See a board-certified allergist for allergy testing. They can recommend a treatment plan to help you get relief.

Uncontrolled rhinitis can lead to sinusitis, a sinus infection. If you have asthma, rhinitis symptoms can irritate your lungs and cause asthma symptoms. So if you have allergies, it’s important to get treatment to make sure they are well-controlled.

How to Reduce the Spread of the Coronavirus, the Flu, and Other Respiratory Illnesses

What can you do to reduce your chances of getting sick? To stop the spread of the respiratory infections: get vaccinated, wash hands often for at least 20 seconds with soap and water, wear a face mask when COVID cases in your community are high, and increase air flow in your indoor environment.

If you have asthma, keeping your asthma under control can reduce your chances of having a severe asthma episode or attack if you get sick.

If you do get sick, get plenty of rest, drink water, and follow your Asthma Action Plan if you have asthma.

Always contact your doctor about any concerning symptoms, no matter what. And go to the emergency department or call 911 for emergency signs and symptoms.

Did you know pollen might be responsible for your allergic reactions to fruit or vegetables? If your mouth or throat itches when you eat certain fruit or vegetables, you could have oral allergy syndrome (OAS). And you would have a pollen allergy to thank for that.

1. Cross-reactivity is the reason for OAS symptoms. OAS is the result of a confused immune system. The pollen of some trees and grasses are similar to the proteins of certain raw fruits, vegetables, seed or nuts.

2. Birch, alder, ragweed, mugwort, Timothy grass and orchard grass pollen cause most OAS symptoms. These pollens are similar to the proteins of certain raw fruits, vegetables, seed or nuts. If you are allergic to any of these pollens, you may have OAS symptoms.

3. You may be able to eat foods that cause OAS symptoms if you remove their skins and/or cook them. Heat affects the proteins, so you may be able to eat these foods cooked instead of raw. For example, a fresh apple may cause symptoms, but a person with OAS may be able to eat applesauce without symptoms.

4. If you’re allergic to these pollens but don’t have symptoms when eating related foods, you can still eat them. But if you have severe OAS symptoms, avoid those foods and talk to your allergist.

5. Your OAS symptoms may be worse when pollen peaks. For example, birch trees release pollen January through April, depending on where you live. Ragweed pollen season is in the summer and fall. You may notice that your symptoms are worse during the times when the pollen you are allergic to is highest.

6. OAS can be confused with food allergy. It can cause symptoms such as an itchy or tingling mouth, face, tongue or throat. You may also have some mouth and throat swelling or hives where the food touched your skin. Rarely, OAS can trigger anaphylaxis, a severe allergic reaction, so it is important to know if you have OAS or a food allergy and how to treat it.

7. If you have OAS symptoms to nuts, this could actually be signs of anaphylaxis, a serious allergic reaction. If you have any symptoms while eating nuts, see a board-certified allergist as soon as possible. Nuts are more likely to cause a serious allergic reaction which must be treated with epinephrine and immediate medical attention. And if you don’t know if you are having OAS symptoms or anaphylaxis to any foods, talk to your allergist.

Here is a list of some pollens and the foods they may cross-react with. You may not react to every food on the list.

Birch Tree Pollen Cross-Reactions

• Almond
• Apple
• Apricot
• Carrot
• Celery
• Cherry
• Hazelnut
• Kiwi
• Parsley
• Peach
• Peanut
• Pear
• Plum
• Soybean

Alder Tree Pollen Cross-Reactions

• Almond
• Apple
• Celery
• Cherry
• Hazelnut
• Peach
• Pear
• Parsley

Ragweed Pollen Cross-Reactions

• Banana
• Cantaloupe
• Cucumber
• Honeydew
• Watermelon
• White potato
• Zucchini

Mugwort Weed Pollen Cross-Reactions

• Aniseed
• Bell pepper
• Black pepper
• Broccoli
• Cabbage
• Caraway
• Cauliflower
• Chard
• Coriander
• Fennel
• Garlic
• Onion
• Parsley

Timothy and Orchard Grass Pollen Cross-Reactions

• Orange
• Peach
• Tomato
• Watermelon
• White Potato

Ragweed pollen allergy is a major cause of seasonal allergies, also known as “hay fever.” Its light pollen easily spreads far and wide, triggering nasal allergies and allergic asthma in its path.

If you have a ragweed pollen allergy, it helps to know what you are up against. If you live in the U.S., you probably feel the effects of ragweed pollen in the late summer and fall. Here are some things you may not know about ragweed.

Ragweed Season Peaks in Mid-September

Ragweed starts pollinating as early as July in some states, especially states in the South. But for most of the country, it appears in August and peaks in mid-September. Ragweed pollen can stick around as late as November, depending on where you live.

If you are allergic to ragweed, learn when ragweed pollen starts in your location. Talk to a board-certified allergist about ways to prepare for the season before it begins to make it easier to manage your symptoms when the pollen peaks.

Ragweed Grows in 49 States

If you live in Alaska, consider yourself lucky. You live in the only state where ragweed doesn’t grow. Ragweed has even been introduced to Hawaii. Within the 49 states where ragweed grows, there are 17 different types of ragweed.

Track ragweed season where you live. Check sites like AAAAI's National Allergy Bureau to follow pollen readings regularly. This will help you take steps to reduce your exposure to ragweed pollen.

Ragweed pollen peaks in the mornings. Plan your time outside for the afternoon and evenings when possible.

Your Immune System May Mistake Other Plants and Food for Ragweed

There are other plants that are related to ragweed. They may cause allergy symptoms as well. Avoid planting sunflowers, sage, burweed marsh elder, rabbit brush, mugwort, groundsel bush, and eupatorium near your home.

If you have a condition called oral allergy syndrome (OAS), your mouth may itch or tingle when you eat certain foods. This is because the pollen is similar to the proteins in some foods, so your body can’t tell the difference. This is called cross-reactivity.

Food such as cantaloupes, bananas, watermelon, and sunflower seeds may cause symptoms in some people who have a ragweed allergy.

Rarely, OAS can trigger anaphylaxis, a severe allergic reaction, so it is important to know if you have OAS or a food allergy and how to treat it. Some of the symptoms of OAS and anaphylaxis may be similar. If you have symptoms when eating foods, talk with an allergist.

Ragweed Pollen Can Travel Hundreds of Miles

Ragweed pollen is very light, making it easy for the wind to carry it for miles. In fact, it has been found in the ocean as far as 400 miles away from the coast and two miles up in the air.

Don’t let ragweed follow you around. Cover your hair when you go outside or wash it at night to remove pollen. Also have everyone who enters your home leave their shoes at the door.

Immunotherapy May Provide Relief

If you are allergic to ragweed pollen, there are options for treatment. Many of them are available over the counter.

• Nasal corticosteroids – These nasal sprays treat nasal inflammation, reduce symptoms and congestion, and block allergic reactions. They are the most effective for nasal symptoms and have few side effects.
• Antihistamines – They work by reducing your runny nose, sneezing, and itching in your eyes and sinuses. Choose non-drowsy options.
• Decongestants – They shrink swollen nasal passages to help your feel less stuffy. Nose drops and sprays should be taken short term.
• Leukotriene inhibitors – This medicine blocks chemicals your body releases when you have an allergic reaction.
• Cromolyn sodium – This nasal spray blocks chemicals that cause allergy symptoms, like histamine and leukotrienes.
  
  

If over-the-counter allergy medicine doesn’t relieve your allergy symptoms, talk to a board-certified allergist about other treatment options. It is especially important for you to seek treatment if you have allergic asthma and ragweed pollen is a trigger for you.

Many people benefit from immunotherapy. This can come in the form of allergy shots or sublingual immunotherapy (SLIT).

With allergy shots, your doctor gives you injections of allergens in an increasing dose over time. You gradually become less sensitive to that allergen.

With SLIT, you take a small dose of an allergen under your tongue. You also gradually become less sensitive to that allergen. Currently, SLIT is available for ragweed and dust mite allergies.

The American College of Allergy, Asthma & Immunology and the American Academy of Allergy, Asthma & Immunology have tools to help you find a board-certified allergist in your area.

Wearing a Mask and Sunglasses During Ragweed Season May Reduce the Pollen’s Effects

One thing we learned from the COVID-19 pandemic is that masks have multiple benefits. Not only can they help reduce the spread of the coronavirus that causes COVID-19, but they can reduce your exposure to ragweed pollen too. Wearing a mask when outside can prevent pollen particles from entering your nose and lungs, lowering your chance of having symptoms.

Sunglasses can protect your eyes from ragweed pollen too. Pollen can be irritating and may cause watery and itchy eyes. Also consider a hat to keep the pollen out of your hair.

Healthy Indoor Air Quality Can Help You Manage Your Asthma and Allergies Overall

If ragweed pollen season drives you to spend more time indoors, pay attention to your indoor air quality. Indoor air is often more polluted than outside air. Poor indoor air quality can make your asthma and allergies worse. Combine poor indoor air quality with ragweed pollen, and you may be downright miserable.

The following can affect your indoor air quality:

• Allergens, like dust mites, pet dander, cockroaches, and mold
• Scents, chemicals, and volatile organic compounds (VOCs)
• Outdoor air pollution
  
  

Use our interactive Healthy Home Checklist to find where allergens, triggers, and irritants can hide. Then follow the steps to improve your indoor air.

Some products can help you improve and maintain good indoor air. The asthma & allergy friendly® Certification Program helps you find products that have been scientifically tested in labs and meet strict standards. These products have proven that they effectively remove or reduce your exposure to asthma and allergy triggers. Through our program, you’ll find CERTIFIED vacuum cleaners, air filters, bedding, flooring, and more.

Medical Review August 2019. Updated August 2021

In our second post in our “AAFA Explains” series, we look at claims that salt treatment (also known as halotherapy) can improve your asthma.

This blog series looks at complementary and alternative medicine (CAM) aimed at asthma and allergies. The Asthma and Allergy Foundation of America wants to guide you as you decide between choices that may be “likely safe” or “potentially unsafe.”

CAM treatments usually do not go through the same rigorous scientific research as new drugs and medical procedures. As a result, whether or not CAM works (called efficacy) is unproven for most treatments.

Salt therapy – such as salt rooms, caves or lamps - falls into that category.

What is salt therapy?

“Salt rooms” are popping up in the U.S., Australia, the U.K. and elsewhere. These rooms charge you a fee to enter, like a spa. Salt crystals coat the rooms and the air is salt-laden as an attempt to mimic naturally occurring salt caves.

The history of natural salt caves as an asthma remedy is ancient. In Russia and Eastern Europe, people with asthma would descend into salt caves. The belief is that breathing in extremely small salt crystals would help open up the airways and assist with the buildup of mucus.

What does science tell us about salt therapy?

Studies evaluating salt therapy for asthma are few.

One of the largest studies to examine the use of salt caves evaluated the therapy for COPD (chronic obstructive pulmonary disease). COPD is a chronic disease of the lungs caused by smoking.

Researchers reviewed 151 articles about salt therapy. They checked for high-quality studies (randomized controlled trials), like those conducted for prescription medications.

Of the 151 studies, they found just one randomized controlled trial. Researchers reviewed three other studies to include more people. Many people in the studies reported feeling better after undergoing salt therapy. But researchers identified several quality concerns about these four studies.

As a result, researchers were unable to draw any conclusions. Some of the missing or incomplete information included:

• Whether the subjects had COPD or asthma
• What medications the patients took
• How severe their breathing difficulties were at the start of the study
• The long-term effect of the treatment (for example, people were examined only right after treatment)

In some countries, medical societies have warned that salt caves can have negative effects. For example, the salt cave could induce bronchoconstriction in some people.

Another danger is that if you have asthma, you may stop taking your regular medicine. Halotherapy is expensive. Many patients may struggle to afford both prescription medicines and salt therapy. But long-term control medications are needed to help prevent and control asthma symptoms. Take them as your healthcare provider tells you to, even if you feel well.

Is halotherapy safe?

"If your goal is to find a new way to de-stress, salt caves can do the trick. They’re cool, quiet and relaxing," said Maureen George, PhD, RN, AE-C, FAAN, a member of AAFA’s Medical Scientific Council, and an Associate Professor of Nursing at the Columbia University School of Nursing. "If you’re looking for a natural way to treat your asthma, halotherapy is not what you’re looking for. It has not been rigorously studied, despite claims from ‘experts’."

Patients should also know that inhaling concentrated salts (hypertonic saline) has been proven to irritate the airways, causing cough and mucus, which can make asthma worse for some people.

The bottom line:

Halotherapy, or sitting in a salt room, is not likely to make your asthma better. For most asthma patients, halotherapy is “likely safe.” Since you don't know how you will react, AAFA warns that it is best to err on the side of caution and avoid salt rooms.

Key definitions:

Randomized controlled trials: Participants are randomly placed into two groups. One group does not receive any treatment. The other group receives the treatment under consideration. Researchers follow both groups over time. At the end of the study, they compare results.

Efficacy: Whether or not a treatment works, and by how much.

Reference:

Rashleigh R., Smith S.M., Roberts N.J. (2014). A review of halotherapy for chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease.

Medical Review May 2016.

Each year, usually in the fall, you have the chance to change or sign up for health insurance coverage. Here is a review of what you need to know in order to enroll in a plan, whether you are getting insured for the first time, or are switching plans.

What Are Open Enrollment Terms I Need to Know?

When you review your options for health insurance, there are some terms you need to know so you can make the best decision for you and your family.

A health care provider is a person who is trained and licensed to provide health care, such as a doctor or nurse.

Open enrollment refers to the time period when you can add or change your health insurance. Outside of that time frame, you can only make changes if you have a certain change in your circumstances.

A special enrollment period is a time outside the yearly open enrollment period when you can sign up for health insurance through the marketplace. Certain life events will qualify you for this enrollment period, like getting married, having a baby, adopting a child, moving, or losing health coverage.

Your monthly premium is what you pay each month for the cost of your health insurance plan.

There are also costs you pay each time you need care. These are called out-of-pocket costs.

Out-of-pocket pocket costs include the following:

• A deductible is what you pay each year for health care services or medicines before your insurance begins paying.
• Copayments are what you pay to see a health care provider. For example, it may cost $15 to see your primary care doctor and a visit to your asthma specialist might cost $30.
• Coinsurance is the percentage of your your medical expenses you must pay, including medicines, hospital stays, office visits, etc.
• Covered services means what your health plan will pay for. This includes medical treatments and prescription medicine.
  
  

Finally, know which doctors, specialists and other health care providers are in-network or out-of-network.

• In-network means that your health plan has an agreement with that a group of specific providers for your health care. Copayments and other costs  generally cost less if you use in-network providers.
• Out-of-network means there is no agreement between the health insurance company and the provider. Your costs will be higher to see a health care provider out of network.
  
  

For more insurance definitions, see this list of common terms.

Where Can I get Health Insurance?

Millions of people in the United States can get health insurance through their jobs. If your employer does not offer health insurance benefits, you have other options.

You can buy insurance through the Health Insurance Marketplace, created by the Affordable Care Act.

Open enrollment for these plans ends on Dec. 15, 2023 for coverage that starts on Jan. 1, 2024. You can apply until Jan. 15, 2024, for coverage that starts Feb. 1, 2024.

If you don’t act by Jan. 15, 2024, you can’t get coverage for 2024 unless you qualify for a Special Enrollment Period. Some states may have a longer open enrollment period.

When you apply for insurance, you'll find out if you qualify for financial help to pay your monthly premiums.

_{Updated November 2023}

When you have asthma, how you clean your home is an important part of asthma control. You want to reduce or remove allergens and triggers like mold, pests, dust mites, and animal dander. A multi-part cleaning plan will be most effective.

Clean your home regularly to reduce the spread of the coronavirus (SARS-CoV-2) that causes COVID-19 or other respiratory illnesses like influenza (flu). To prevent asthma symptoms, clean and disinfect your home in a way that kills the viruses and is asthma friendly.

Cleaning Can Worsen Indoor Air Quality

When you’re cleaning, you may actually spread asthma triggers or worsen your indoor air quality. Some tools like feather dusters only move dust around, which can spread dust mites and small particles through the air. Some vacuum cleaners can leak air, spitting the particles from your carpet right back into the air.

And then there’s cleaning products. The very solutions that clean can actually cause asthma symptoms. Many cleaning products contain strong scents, chemicals, and volatile organic compounds (VOCs) that can trigger asthma. One study found that regular use of cleaning products was as harmful as smoking several cigarettes a day.¹ Some products may remove some allergens and asthma triggers but can still irritate your lungs.

Cleaning Versus Disinfecting Versus Sanitizing

Did you know cleaning products don’t always disinfect, and disinfectants don’t always clean? And what’s the difference between cleaning, disinfecting, and sanitizing?

• Cleaning removes dirt and germs. This can be done simply with soap and water.
• Disinfecting uses chemicals to kill germs. It does not clean or remove the germs.
• Sanitizing reduces the number of germs to a safe level. A surface is considered sanitized when either cleaning and/or disinfecting reduces the germs to safe level according to public health guidelines.
  
  

To properly sanitize a surface, clean first to remove germs, dirt, and residue. Then disinfect to kill remaining germs.

Asthma-Friendly Cleaning Tips

If you have asthma or live with someone with asthma, create a plan on how to clean and sanitize your home. Try these tips to reduce exposure to asthma triggers:

• Use liquid or gel cleaners instead of commercial spray cleaners, and choose unscented products when possible. Wear a face mask and gloves (latex free if you are allergic to latex).
  
  
• Open windows and run fans during cleaning.
  
  
• Change your clothes and take a shower after cleaning.
  
  
• Use a damp cloth to remove dust or use CERTIFIED asthma & allergy friendly® dusting cloths that trap dust particles.
  
  
• Vacuum at least weekly with a CERTIFIED vacuum with HEPA filtration, or use washable throw rugs and wash them in hot water (130 F or hotter) weekly.
  • Some vacuums cause particles from the floor to get into the air. This can trigger asthma symptoms. If possible, have someone without asthma do the vacuuming while people with asthma are not in the room.
    
    
• Wash bedding in hot water weekly.
  
  
• Reduce clutter that tends to collect dust.
  
  
• Run an exhaust fan in your bathroom for 15 to 20 minutes after showering to reduce mold growth.
  
  
• Remove mold at first sight with soap, warm water, and a brush. If the mold doesn’t remove easily with soap and water, a person without asthma can use a bleach solution if there is good air ventilation.
  
  
• Have someone without asthma clean for you, if possible. Wearing a mask while you clean may help reduce your exposure to asthma triggers.

Cleaning to Prevent the Spread of the Coronavirus

The Centers for Disease Control and Prevention (CDC) recommends that you clean regularly to reduce the spread of the new coronavirus. But not every cleaning product will kill the virus.

These cleaning solutions will kill the virus that causes COVID-19 when used properly:

• Undiluted rubbing alcohol (at least 70% ethyl or isopropyl) – Leave on the surface for at least 30 seconds.²
• Hydrogen peroxide 3% concentration – Leave on the surface for 1 minute.³
• Bleach (5 tablespoons or 1/3 cup per gallon of water OR 4 teaspoons per quart of water) with a sodium hypochlorite concentration of 5 to 6% – Leave on the surface for 1 minute.⁴
  
  

Bleach is a common asthma trigger. People with asthma should avoid using bleach or areas where bleach is being used when possible. If you must use bleach:

• Mix it in the right proportion
• Wear a mask and gloves
• Use it in a well-ventilated room
• Don’t mix bleach and ammonia
• Have someone else clean for you, if possible
  
  

Vinegar and essential oils (like tea tree oil) are not EPA-registered disinfectants and will not kill the new coronavirus.

For a list of more cleaners, see the full list of EPA-registered disinfectants for use against COVID-19.

Homemade Cleaners for General Cleaning

Simple soap and warm water can be effective in many cases for general cleaning. But you’ll want to use something else to disinfect (kill germs).

Homemade cleaning recipes using baking soda, vinegar, borax, hydrogen peroxide, or dish soap may be less likely to cause asthma symptoms. Some people who are sensitive to scents prefer to use steam cleaners to clean. (But be careful if steam triggers your asthma.) Some homemade cleaning recipes call for using essential oils, like tea tree oil. But essential oils can actually be an asthma trigger because of their strong scents, and they release VOCs.

The Environmental Protection Agency (EPA) reviews cleaning products to help you choose options that are better for your health and the environment. You can view the EPA’s Safer Choice products list to find options.

References
1. Svanes, Ø, Bertelsen, R. J., Lygre, S. H., Carsin, A. E., Antó, J. M., Forsberg, B.,... Svanes, C. (2018). Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. American Journal of Respiratory and Critical Care Medicine, 197(9), 1157-1163. doi:10.1164/rccm.201706-1311oc
2. Cleaning and Disinfection for Households. (2020, May 27). Retrieved June 22, 2020, from https://www.cdc.gov/coronaviru...ng-disinfection.html3. Chemical Disinfectants. (2016, September 18). Retrieved June 22, 2020, from https://www.cdc.gov/infectionc...ethods/chemical.html4. Cleaning and Disinfection for Households. (2020, May 27). Retrieved June 22, 2020, from https://www.cdc.gov/coronaviru...ng-disinfection.html

Hives, those annoying itchy red bumps, often occur with an allergic reaction or sometimes a viral infection. Or sometimes, they can be more serious when they happen with a severe allergic reaction called anaphylaxis.

Most of the time, you can find what caused them. But what if you can’t?

There is a condition called chronic idiopathic urticaria (ur-ti-KAIR-ee-uh). Simply put, it means hives that stick around for more than six weeks for no known reason. Many people call it CIU. About 1.5 million people in the U.S. have it.

What Is CIU?

Hives caused by an allergic reaction or a viral infection usually go away after a short time.

CIU is different. It can be harder to diagnose. Women are more likely to have CIU than men. Symptoms usually occur between the ages of 20 and 40. For many, the condition typically lasts 1 to 5 years.

Some signs of CIU are:

• Itchy red bumps (hives) anywhere on the body
• Hives that last longer than 6 weeks (maybe even months or years)
• Hives brought on by no known cause
• Unpredictable symptoms that come and go
• Isn’t always relieved by allergy medicines
  
  

No one really knows what causes CIU. They do know that heat, cold, alcohol, exercise, tight clothes and nonsteroidal anti-inflammatory medicines (ibuprofen, aspirin) may make it worse.

CIU is not life threatening. But sudden hives can be one of the symptoms of a severe allergic reaction.

Go to the emergency room or call 911 if:

• Your hives are severe and cover a large area of your body
• You have other symptoms such as difficulty breathing
  
  

What Do I Do If I Think I Have CIU?

If you think you have CIU, see a board-certified allergist or dermatologist. Both types of specialists treat CIU. They will do a physical exam and ask about your medical history. They may also do allergy testing and blood tests, if necessary.

How Is CIU Treated?

Your doctor may try a combination of different medicines to try to relieve CIU. They may first prescribe an allergy medicine called an antihistamine.¹ If that doesn’t work, there are other medicines your doctor may try until they find the ones that work for you.

Treatment may lessen your symptoms but not relieve them completely. Since CIU can be frustrating, support may help you cope as well. Support groups, such as the Asthma and Allergy Foundation of America’s Skin Conditions Support forum, can connect you with others with CIU. Talking to others who understand what you’re going through can be comforting.

Medical Review September 2017.

References
1. Godse, K. V. (2009). CHRONIC URTICARIA AND TREATMENT OPTIONS. Indian Journal of Dermatology, 54(4), 310–312. http://doi.org/10.4103/0019-5154.57603

Face masks are an essential tool in our fight against the coronavirus that causes COVID-19. They also have other benefits for people with asthma and allergies.

Can People With Asthma Wear Face Masks?

Yes, people with asthma can wear face masks.

“For people with mild asthma or well-controlled asthma, it’s probably not going to be an issue,” said Dr. David Stukus, member of the Medical Scientific Council for the Asthma and Allergy Foundation of America (AAFA). “For people who have very severe disease and have frequent exacerbations, ER visits, hospitalizations, require lots of medications and frequent symptoms, it might cause more issues for those folks.”

It’s important to keep your asthma under control. Keep taking your medicines as prescribed. If you are having breathing issues that need your quick-relief inhaler (albuterol) more than two or more times per week, it’s a sign to call your doctor.

If you’re having trouble wearing a mask, try a different fabric, type, or fit. According to the WHO, medical masks, when worn the right way, do not cause you to breathe in more carbon dioxide or reduce your oxygen levels. Other studies back this up as well.¹ And a face mask made of three layers probably won’t fit tightly enough to affect your oxygen either. If your mask is uncomfortable, try a new type of mask.

How Do Face Masks Help Reduce the Spread of the Coronavirus?

The coronavirus that causes COVID-19 is airborne and spreads from person to person. It can spread through droplets from your nose or mouth when you breathe, talk, sing, yell, eat, sneeze, or cough. You are most likely to catch it if you are not fully vaccinated and less than 6 feet (2 meters) away from someone who is infected.

It’s best to wear a mask in public indoor spaces even if you are fully vaccinated. They also recommend universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status.

Masks are effective in reducing the spread of the coronavirus in both vaccinated and unvaccinated people.² Studies have shown many people have COVID-19 and don’t show symptoms. Or they may have the virus a few days before they show symptoms. The purpose of wearing a face mask is to protect you as well as keep you from spreading COVID-19 to other people. This is especially important in public indoor spaces.

Wearing a face mask may also make COVID-19 symptoms less severe if you do get it.³ Several studies show that face masks may reduce the amount of particles of the coronavirus you take in, which can result in milder illness.²

Proper care of your face mask is also important to help you reduce your chances of getting COVID-19. Follow these steps when putting on and removing a face mask:

• Wash your hands or use hand sanitizer before putting on a face mask.
• Avoid touching the face mask while using it.
• If your face mask gets damp, replace it with a clean one.
• Remove the mask by the ear loops or ties, trying to not touch the parts of the mask that touch your face.
• Wash your hands or use hand sanitizer.
• Wash fabric face masks in hot, soapy water right away. Throw away disposable masks immediately.
  
  

What Kind of Face Mask Should I Wear?

There are several types of masks available that can help you reduce the spread of the coronavirus.

N95 and KN95 Masks or Respirators

You may consider wearing an N95 mask or respirator for better protection or if you interact with large numbers of the public or are at increased risk for severe illness. NIOSH-approved N95 respirators labeled “surgical” or “medical” should be prioritized for health care personnel. N95 and KN95 masks should be properly fitted. There are several pharmacies that currently provide free masks (N95 respirators) to the public.

Although respirators may be available in smaller sizes, they are typically designed to be used by adults in workplaces, so they have not been tested for broad use in children.

KN95 masks provide an alternative to N95 respirators and are recommended for non-health-care settings for non-medical use. People who are at increased risk of COVID-19 illness, teachers, staff, and other adults in the indoor school setting may prefer KN95 masks.

Not all KN95 masks meet the similar requirements for N95 masks. Find a reliable source to purchase KN95 masks. Do not use KN95 masks with exhalation valves because they can allow the virus to escape.

Cloth and Disposable Masks

There are many options for cloth face masks. You can buy disposable (surgical) or reusable face masks at many major retail stores or online, or you can make your own. Fabric made from 100% cotton, such as heavy-duty quilt fabric or a knit fabric, can be effective.

If you have a latex allergy, be careful with elastic ear loops. Choose face masks with fabric ear loops or that tie behind your head.

Finding a mask that is comfortable and fits well will provide the best protection. If you feel the need to readjust or pull on your mask, it does not fit well. Consider these following:

• Masks with multiple layers of fabric
• Masks that fit snugly against the sides of your face without any gaps
• Masks that cover your nose, mouth, and chin
• Masks with a metal strip or nose guard to keep air from leaking out
• Mask fitter or brace over a disposable or cloth mask to prevent air leaking out of the sides and top
• Combining one disposable mask underneath a cloth mask (the second mask should push the edges of the inner mask against your face)
• Knotting and tucking ear loops of a three-ply mask (See video below)
• Masks with three layers:

• An outer water-resistant layer (such as polyester or polyester blend)
• A middle layer of non-woven fabric (such as polypropylene
• An inner layer of cotton
  
  

Keep in mind that some businesses or schools may mandate which types of masks are most appropriate in their environment.

Watch on YouTube

Children 2 years and older should wear a mask that is made for children to ensure it is snug without any gaps. Children with a disability that keeps them from safely wearing a mask and children under 2 should not wear masks.

Try different styles and fabrics to see what works for you. To tell if a face mask will be effective, hold your mask up to a light. If you can easily see the light through your mask, it may not provide enough protection. Make sure your face mask blocks the light but still allows you to breathe through it.

Some types of face coverings are not effective at preventing the spread of coronavirus. Bandannas cannot fit tightly enough against your face. If you have a mask with a vent or valve, check the inside of the mask. If you see fabric inside that covers the valve or vent, then the mask is OK to wear. If you see the vent or valve from the inside of the mask, you should not wear the mask because droplets from your mouth and nose can pass through the valve as you exhale.

Do not choose masks that:

• Are made of fabric that makes it hard to breathe, such as vinyl
• Have exhalation valves or vents which allow virus particles to escape, unless the inside of the valve/vent is covered by fabric
  
  

Do not wear two disposable masks at a time or combine a KN95 mask with any other mask.

What Can I Do If My Job Requires Me to Wear a Face Mask?

You may be required to wear a mask as part of your job. Different places may require you to wear a mask. And if your job is located indoors around other people, it is best to wear a mask. If your asthma is not well-controlled and you have trouble breathing while wearing a face mask, what are your options? (Reminder: If your asthma is not well-controlled, talk with your doctor!)

The first step is to try a different mask style – most people with asthma should be able to wear a mask comfortably. Try different types of face masks in different fabrics or styles to find something more breathable. If your job is strenuous, it may feel harder to breathe through a mask.

The second step is to work with your employer. Talk about ways you can work while still helping prevent the spread of COVID-19.

Here are some ways you may be able to work with your employer:

• Ask for time off to get the COVID-19 vaccine and boosters.
• Ask to serve in a role away from the public or other employees.
• Ask if you can work a different shift or from home.
• If you are part of a union, work with your union representative to ask for reasonable accommodations.
• Ask if you can take more frequent breaks if you feel a face mask is affecting your breathing.
• Stay home if you start having asthma or COVID-19 symptoms.
  
  

People with asthma may be covered under the Americans with Disabilities Act (ADA). Under this act, people with disabilities can ask for reasonable accommodations so they can work. If your work requests won’t create a hardship for your employer, you can ask for accommodations.

But the ADA also says if an accommodation could cause harm to other people, then a business does not need to provide the accommodation. If a person with asthma is coughing and not wearing a mask, they might be exposing other people to COVID-19. In this case, the employer could require the person with asthma to stay home or wear a face mask.

If your company requires a face mask, try to find one that works for you. Refer to the mask suggestions above.

Don’t be afraid to talk to your supervisor or human resources representative. They may also have some creative ideas to help you do your job while managing your asthma.

Remember, wearing a face mask is only part of the strategy to prevent the spread of COVID-19. Getting fully vaccinated, physical distancing, improving air ventilation, and washing your hands often can also help protect you and other people from COVID-19.

What Are Other Benefits to Wearing Face Masks?

Pollen can trigger asthma. Wearing a mask can help keep pollen from getting into your nose and lungs. Even though a mask can help prevent symptoms, consider going outside when pollen counts are lower.

Cold weather can trigger asthma. When it’s cold, wearing a face mask can warm and humidify the air you breathe. And masks can reduce your exposure to air pollution.

Masks also can protect you from respiratory infections like the flu, COVID-19, and even the common cold.

Medical Review July 2022 by Mitchell Grayson, MD

References
1. Wearing a mask does not affect oxygen saturation in patients with or without asthma. American Academy of Allergy Asthma & Immunology. (n.d.). Retrieved October 6, 2021, from https://www.aaaai.org/About/News/News/mask.
2. Centers for Disease Control and Prevention. (n.d.). Science Brief: Community use of cloth masks to control the spread of SARS-COV-2. Retrieved October 6, 2021, from https://www.cdc.gov/coronaviru...anchor_1619456988446.
3. Gandhi, M., Beyrer, C., & Goosby, E. (2020). Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer. Journal of general internal medicine, 35(10), 3063–3066. https://doi.org/10.1007/s11606-020-06067-8

It's important to get rid of expired or unused medicines, inhalers, and epinephrine auto-injectors properly. They can be harmful to someone they aren't prescribed for, especially children. Or they could get into the hands of someone who might misuse them. And getting rid of them improperly can cause them to end up in the water supply, affecting humans and wildlife alike. There are several ways you can dispose of your medicines in a way that is safe and better for the environment.

Disposing of Pills and Patches

The U.S. Drug Enforcement Administration (DEA) hosts National Prescription Drug Take Back Day twice a year, usually each April and October. Designated law enforcement agencies across the U.S. will allow you to drop off expired, unused prescription pills and patches so they can be safely disposed.

To find an agency near you that is participating in National Prescription Drug Take Back Day, use the Collection Site Locator.

The agencies will only take pills, tablets, capsules, patches or other solid forms of prescription medicines. They cannot take needles, sharps, inhalers, liquids, or illegal drugs. This includes liquid nebulizer medicine and epinephrine auto-injectors.

Some pharmacy chains, like Walgreens and CVS, have medicines drop boxes in select locations. Check with your pharmacy to find out what types of medicines they will accept.

Disposing of Epinephrine Auto-Injectors

To dispose of epinephrine auto-injectors or needles, visit safeneedledisposal.org. You can search by state to find where you can take these for safe disposal.

Disposing of Inhalers

To dispose of inhalers, the Food and Drug Administration (FDA) recommends that you read "handling instructions on the labeling of inhalers and aerosol products. These products could be dangerous if punctured or thrown into a fire or incinerator. To properly dispose of these products and follow local regulations and laws, contact your trash and recycling facility."

Some Walgreens locations accept inhalers, but this varies by location. Contact your local Walgreens to confirm if they accept inhalers.

Other options for disposal may include the local health department, police or fire department, pharmacies, and trash and recycling facilities. Please contact the facility before visiting. Verify if they accept inhalers, as well as any procedures for disposal.

Disposing of Liquids

Contact your pharmacy for instructions on how to dispose of liquid medicines, like children's antihistamines and nebulizer medicines. Walgreens also accepts liquid medicines.

Disposing of OTC Medicines

Walgreens and CVS will accept over-the-counter (OTC) medicines.

You can also dispose of OTC medicines safely at home if you follow the right steps. According to knowyourotcs.org, follow these steps:

1. Mix medicines with an unpleasant substance, like kitty litter or used coffee grounds. Do not crush tablets or capsules.
2. Place the mix in a container, like a sealed plastic bag.
3. Throw the container in your trash.
   
   

The FDA has more information on how to safely dispose of medicines.

Updated September 2022

Taking your asthma medicine regularly is an important part of controlling your asthma. But do you know how you take your medicine is just as important?

Why Is Correct Asthma Inhaler Use Important?

Incorrect inhaler use can stop your asthma medicines from getting to your lungs.

Inhaler mistakes are more common than you might think. Up to 92% of people with asthma use their devices incorrectly.¹

If your medicine isn’t reaching your lungs, your asthma might be harder to control.

Using your inhaler incorrectly may lead to:^2,3

• More asthma episodes
• More emergency room visits
  
  

Small changes in how you take your asthma medicines may help you breathe better and have better quality of life.

Even if you’ve been using an inhaler for many years, it’s always a good idea to review how you use your inhaler from time to time. This can help you avoid small mistakes. This is especially important when you start taking a new type or brand of inhaler.

What Types of Asthma Devices Are Available?

In order to learn how to take your medicine the right way, it helps to learn about the different types of asthma devices.

Most asthma medicines are inhaled so they can get directly to the lungs. The medicines are put into a device that helps you breathe it in. This may be a handheld inhaler or a machine. These are the types of inhalers that deliver asthma medicine:

• Metered dose inhaler (MDI) – An MDI has a canister that contains the medicine and a propellant to help make the medicine airborne (or aerosol). The canister inserts into a plastic holder with a mouthpiece. You press the canister down to release a puff of medicine into the mouthpiece. You have to time your breath to breathe in the medicine as you press the canister down. These inhalers are sometimes called press-and-breathe inhalers. Before using one, you need to shake this type inhaler. This type of inhaler needs to be primed before using it for the first time or if it hasn’t been used in two weeks. Priming means you spray the medicine into the air away from your face so you can test the spray. MDIs (or press-and-breathe inhalers) deliver the medicine best when used with a spacer or valved holding chamber. A spacer or chamber holds the medicine in the chamber to give you a little bit more time to breathe it in.
  
  
• Breath actuated inhaler – This type of inhaler is not a press-and-breathe inhaler. When you take a fast, deep breath in, it pulls the medicine out of the device and into your lungs.
  
  
• Dry powder inhaler (DPI) – A DPI delivers medicine as a dry powder. It is a type of breath actuated inhaler. It delivers the medicine when you inhale.
  
  
• Soft mist inhaler – A soft mist inhaler delivers medicine in a mist form. You have to prepare a new soft mist inhaler by inserting a cartridge and priming it before you use it.
  
  

How Do You Prime an Asthma Inhaler?

When you open the package of a new inhaler, you may have to prime it. This will depend on the type of inhaler you have. MDIs and soft mist inhalers need to be primed before first use. Check your medicine’s instructions for more information about your device.

Breath actuated inhalers (like a RediHaler™) and DPIs (like an ADVAIR DISKUS) do not need to be primed.

Priming inhalers (MDIs and SMIs) is important because it:

• Mixes the propellant and medicine
• Tests the inhaler for clogs
• Tests that the medicine is inserted into the device correctly
  
  

If an inhaler needs to be primed before first use, the counter will include the extra puffs needed for first priming.

For example, an inhaler with 200 doses will have a counter that says 204. This means the inhaler can be primed four times before the first use as recommended.

Priming an MDI

Most MDIs need to be primed when you first open them. They also need to be primed if you haven’t used the inhaler for two weeks or more.

Priming the inhaler mixes the propellant and medicine. It is important to prime your inhaler to make sure you get the right amount of medicine in your lungs with each puff.

To prime your inhaler:

1. Remove the cap and shake it well for at least 5 seconds (about 10 hard shakes).
2. Spray it into the air and away from your face and other people.
3. Repeat as many times as needed according to the directions on the medicine.

Priming a Soft Mist Inhaler

Soft mist inhalers need to be primed only before the first use and they do not need to be shaken.

The soft mist inhaler comes in two pieces: the cartridge that holds the medicine and the inhaler that delivers the medicine. You must put the cartridge into the inhaler before you can use it.

1. With the cap closed, press the gray safety catch and pull the clear base of the inhaler.
2. Take the narrow end of the cartridge and push it into the inhaler as far as it will go.
3. Push the cartridge down firmly on a hard surface to make sure the cartridge has gone in all the way. (You will still see a small amount of the cartridge even after you push it in all the way.)
4. Put the clear base back into place.
   
   

Do not remove the cartridge or clear base once you have put the inhaler together.

To prime your soft mist inhaler:

1. Hold the inhaler upright with the cap closed.
2. Turn the clear base in the direction of the arrows until you hear a click.
3. Flip the cap open.
4. Point the inhaler down away from your face. Press the release button.
5. Close the cap.
6. Repeat steps 1 through 5 three more times.
   
   

How Do You Use Your Asthma Inhaler?

Once your inhaler is primed, it’s time to check your position. Your posture and position are an important part of making sure your asthma medicines get to your lungs.

Remember these steps to make sure you are in the best position possible when taking your asthma medicine:

• Stand or sit upright, if possible. This is the best position to open up your lungs.
• Face forward with your head upright, not tilted.
• Make sure the inhaler is upright and not tilted. Point the mouthpiece toward the back of your throat.
• If you have a DPI, don’t point it down during or after loading a dose.
• Seal your lips and teeth around the mouthpiece of the inhaler or spacer/chamber with your tongue down.
• Don’t block air vents. Use fingers, not a fist, to hold the inhaler.
  
  

How you inhale when using your asthma devices is important too. Remember these steps as you inhale the medicine:

• Blow air out of your lungs before each dose. This will help you take a deeper breath in when you inhale your medicine.
• Pace yourself as you inhale the asthma medicine. Try not to breathe in too fast or two slow for your device.
• If you have a breath actuated inhaler, make sure you are breathing in with enough force to pull the medicine out of the inhaler.
• Breathe in through your mouth, not your nose.
• Hold your breath for 10 seconds (or as long as you can) once the medicine is in your airways.
• If you cough in the middle of taking your inhaler, you may need to redo your puff.
• Wait 1 minute between doses to help the medicine settle in your lungs. Remember to shake your press-and-breathe MDI inhaler in between doses (not all inhalers need shaking!).
  
  

This video shows you how to use an MDI and ways you can improve your overall inhaler technique so you can make sure your asthma medicine is getting to your lungs where it needs to be.

Watch on YouTube

If you aren’t sure what kind of device you have or how to use it, ask your doctor or nurse to show you how to use it. Also, ask for instructions if you get a new type or brand of inhaler.

It’s also a good idea to review how you use your inhaler with your health care team during regular check-ups. They can help you spot ways to improve so you get as much medicine in your lungs as possible.

What Are Some Common Mistakes People Make When Using an Inhaler?

If you don’t use your inhaler correctly, you may not get the right amount of medicine. That can affect your asthma control.

When you use your inhaler, watch out for these common mistakes:

• Not inserting the canister properly into the device
• Forgetting to prime an inhaler that needs to be primed
• Not shaking the MDI (press-and-breathe) enough to mix the medicine and propellant or forgetting to shake this type of inhaler between each puff
• Forgetting to remove the inhaler cap
• Forgetting to breathe out fully before you take your puff
• Not holding yourself or the inhaler upright
• Not using a spacer/chamber with an MDI
• Not waiting long enough between puffs
  
  

The Asthma and Allergy Foundation of American (AAFA) has resources on how to use MDIs, DPIs, breath actuated inhalers, soft mist inhalers, and nebulizers. Download our FREE handout “How to Correctly Use Your Asthma Devices.”

Download, print, and share

Medical Review: May 2022 by John M. James, MD

References
1. Bonds, R., Asawa, A. and Ghazi, A. (2015). Misuse of Medical Devices: a Persistent Problem in Self-Management of Asthma and Allergic Disease. Annals of Allergy, Asthma & Immunology, 114(1), pp.74-76.e2.
2. Melani, A. S., Bonavia, M., Cilenti, V., Cinti, C., Lodi, M., Martucci, P., Serra, M., Scichilone, N., Sestini, P., Aliani, M., & Neri, M. (2011). Inhaler Mishandling Remains Common in Real Life and Is Associated With Reduced Disease Control. In Respiratory Medicine (Vol. 105, Issue 6, pp. 930–938). Elsevier BV. https://www.resmedjournal.com/...(11)00009-6/fulltext
3. Vanoverschelde, A., Van Der Wel, P., & Lahousse, L. (2019). Poor Inhalation Technique Is a Major Determinant of Acute Exacerbations. In Airway Pharmacology And Treatment. ERS International Congress 2019 abstracts. European Respiratory Society. https://doi.org/10.1183/13993003.congress-2019.pa4236

AAFA’s 2023 Asthma Capitals™ Report Highlights the Most Challenging Places in the U.S. to Live With Asthma

Do you notice more asthma symptoms, or even attacks, during September? If so, you aren’t alone. Each September, asthma attacks and hospital stays increase. This is called Asthma Peak Month (or the September Asthma Epidemic). The third week of September – Asthma Peak Week – is the worst.

To bring awareness to Asthma Peak Month, the Asthma and Allergy Foundation of America (AAFA) has released the 2023 Asthma Capitals™ report. This report analyzes data from the 100 largest cities in the U.S. to identify the most challenging places to live with asthma. Allentown, Pennsylvania, is #1 for 2023.

How Are the 2023 Asthma Capitals Ranked?

Asthma Capitals report ranks each city based on these factors:

• Asthma prevalence (or occurrence)
• Asthma-related emergency room visits
• Asthma-related deaths

The report also highlights risk factors that can affect asthma outcomes:

• Poverty
• Lack of health insurance
• Air pollution
• Pollen counts
• Smoking laws
• Lack of access to asthma specialists

How Can We Improve Asthma Outcomes?

It is AAFA’s goal that the 2023 Asthma Capitals report inspires action. It is possible to reduce asthma rates and deaths. And this report highlights where we can focus our efforts for healthier environments and communities.

Spotlights in this year’s Asthma Capitals report highlight the ongoing health disparities related to asthma, how to improve asthma outcomes, and how you can advocate in your community and state for people with asthma and allergies.

Reducing Health Disparities

AAFA’s Health Equity Advancement and Leadership (HEAL) program reinforces AAFA’s commitment to drastically reduce health disparities in communities that bear the heaviest burden of asthma. Through the HEAL program, AAFA provides funding and resources to local pilot programs tailored to at-risk populations most impacted by asthma.

Taking Steps to Improve Asthma Outcomes

AAFA is committing our resources to programs and policies with the aim to drastically reduce asthma rates, deaths, and disparities, as well as their impact on people and communities. We urge multiple stakeholders to join us to work together to improve and save lives.

Taking Action Through Advocacy and Policy

Advocacy is a critical part of AAFA’s mission to save lives and reduce the burden of disease for people with asthma, allergies, and related diseases. This year, AAFA is calling on our community to join us in these advocacy efforts – including at the state and local levels.

Your voice is critical to help build awareness in your community and to educate your elected officials who can lead change.

How Can I Learn More About Managing Asthma?

Managing asthma involves a multi-step approach. This involves taking asthma medicine and limiting exposure to your asthma triggers. Work with an asthma specialist to come up with the best plan for you. AAFA offers free resources to help:

• Online support community
• List of CERTIFIED asthma & allergy friendly® products to help you make your indoor air healthier
• Opportunities to participate in research to improve future asthma treatment

The 2023 Asthma Capitals report is an independent research project of AAFA and is made possible by a grant from Sanofi and Regeneron.

Studies show that poor outdoor air quality can worsen asthma and allergies.¹ This news may make you think you need to stay indoors to avoid air pollution. But your indoor air may actually be worse than the outdoor air.

Along with taking your medicines, avoiding your asthma triggers and allergens is an important part of asthma and allergy management. And one way to reduce your exposure is by improving and maintaining healthier indoor air quality.

The Truth About Indoor Air Quality

Particles or gasses that are not normally part of the air affect air quality. This is called air pollution. Air pollution can also happen indoors. Why is this?

1. Bad outdoor air can enter your home. You bring outdoor air inside any time you open a door or window. You can also bring in pollen and smoke. Leaks around doors and windows can let polluted outdoor air in too.
2. Indoor air also has allergens, such as dust, pet dander, and mold.
3. Building materials, furniture, carpets, scents, and cleaners can release chemicals into the air.
   
   

Clean outdoor air needs to replace indoor air often or else the indoor air becomes more polluted. That means allergens, smells, and pollutants stay in your home and recirculate.

So what can you do to improve your indoor air quality? One of the best things you can do is start reducing asthma triggers and allergens in your bedroom.

Improve Your Bedroom’s Environment

We spend one-third of our lives in our bedrooms. But they can have the worst air quality of any room in our homes. Your bedroom may be full of allergens, asthma triggers, scents, and chemicals.

Reduce Allergens and Triggers

The bedroom tends to have the highest amount of allergens. As you try to improve your indoor air quality, start with your bedroom first. Here are some ways to reduce bedroom allergens:

• Use CERTIFIED asthma & allergy friendly® allergen barrier bedding.
• Wash sheets once a week in 130 F water.
• Keep pets out of your bedroom and off your bed.
• Don’t let wet or damp clothing pile up.
• Replace your mattress every 10 years and pillows every two years.
• Vacuum floors and mattresses weekly.
• Use a CERTIFIED air cleaner.
• If possible, use central air conditioning with a CERTIFIED HVAC filter. If you don’t have air conditioning and the heat is also high, consider going to places like the mall or the library to avoid the poor air quality and the heat.
  
  

If your bedroom has a connected bathroom, don’t forget about the allergens in there too.

• Run a fan or vent for at least 15 to 20 minutes after showering to prevent mold.
• Fix leaks in or near sinks, toilets, tubs, and showers.
• Allow towels and washcloths to dry thoroughly after bathing.
• Clean your shower, tub, and sinks often with vinegar or detergent and water to keep mold from building up.
• Clean under sinks and behind toilets often where mold and other allergens may build up.
• If you already have mold, clean it as soon as possible with detergent and water. Wear a mask or have someone else clean it for you.
  
  

Keep the Outside From Getting In

When the outdoor air is poor, you’ll want to reduce it from getting inside as much as possible. It’s impossible to keep all outdoor allergens from getting in your bedroom. But there are things you can do to reduce exposure:

• Wear sunglasses and a hat or other hair covering when outdoors.
• Shower every night before bed to keep pollen from getting in your bedding.
• If you work outside, change clothes outside of the bedroom.
• Seal air leaks in windows and doors leading outside and keep your windows closed when pollen is high.
  
  

Reduce Scents and Chemicals

Scents and chemicals in your bedroom can affect your air quality. Even pleasant scents, like candles, plug-ins, essential oils, and potpourri, can cause asthma symptoms.

New furniture, especially mattresses, can have a strong scent. This is called offgassing. It is the release of gasses from chemicals called volatile organic compounds (VOCs).

While experts don’t know if VOCs have any long-term effects, they do know VOCs can have some short-term effects. Some VOCs can cause:

• Eye irritation
• Breathing problems
• Dizziness
• Nausea
• Allergic skin reactions²
  
  

If you have asthma, let your new bedroom furniture air out in another room or garage before you move it into your bedroom. Remove any plastic or wrappings. You could also check with the company you buy your furniture from to see if they would let your furniture air out in their warehouse before they deliver it.

Paint and new building materials can release VOCs too. So if you remodel your bedroom, make plans to use another room until the scents are gone.

But the bedroom is not the only place asthma and allergy triggers can hide. After you’ve improved the air quality in your bedroom, the next rooms to work on are your living room and kitchen.

Published October 2017. Updated October 2021.

Many products promise to help control allergens. To help you make informed decisions, we have CERTIFIED more than 200 products. When you are shopping for products for your home, look for the CERTIFIED asthma & allergy friendly® mark. It indicates the product has passed our testing standards.

Visit aafa.org/certified to search for CERTIFIED products. There you can also learn more about the asthma & allergy friendly® Certification Program.

References
1. Tiotiu, A. I., Novakova, P., Nedeva, D., Chong-Neto, H. J., Novakova, S., Steiropoulos, P., & Kowal, K. (2020). Impact of Air Pollution on Asthma Outcomes. International journal of environmental research and public health, 17(17), 6212. https://doi.org/10.3390/ijerph17176212
2. Volatile Organic Compounds' Impact on Indoor Air Quality. (2017, April 19). Retrieved September 14, 2017, from https://www.epa.gov/indoor-air...t-indoor-air-quality

As we bundle up during the winter season, people with asthma may notice they have a tougher time breathing during cold weather events. That’s because when you breathe in dry, cold air, your airways start to narrow, making it hard to breathe. Cold air can especially affect your airways when you are doing physical activities that make you breathe through your mouth. When you breathe through your mouth, the cold air can’t be warmed by your nose first before moving to your lungs. This may cause an asthma attack.

There are other reasons why your asthma may flare up in the wintertime, such as:

• Using a wood or gas fireplace to heat your home
• Being indoors more often and for longer periods of the day where indoor air pollution may be at unhealthy levels
• Higher mold counts in wet climates
• Tree pollen allergy if you live in the South where certain pollens like juniper are released in winter months
• Respiratory infections – a very common asthma trigger

There are a few things you can do to reduce your chance of having asthma symptoms or an attack this winter season:

• Wear a scarf or face mask over your mouth and nose when outside in cold temperatures. This will help warm and humidify the air you breathe. The face mask you wear to help prevent the spread of the coronavirus that causes COVID-19 offers this as an added benefit during cold weather.
  
  
• Have an Asthma Action Plan. This plan that you create with your doctor helps you know how to use your asthma medicines as prescribed and during an asthma flare-up.
  
  
• Know the signs of asthma and the asthma zones (Green, Yellow, Red) on your Asthma Action Plan so you can keep yourself in the healthy Green Zone. Early and prompt treatment when you enter the Yellow Zone can help you get back into the Green Zone.
  
  
• Choose indoor activities when the outdoor weather is cold. Yoga, basketball, volleyball, indoor swimming, and martial arts are some good choices to prevent exposure to cold, dry air.
  
  
• Carry your asthma inhaler that you use to treat symptoms with you everywhere you go. Keep it accessible before, during, and after exercise.
  
  
• Get your flu vaccine. Influenza (flu) can worsen your asthma. Getting a flu vaccine can significantly cut your risk of complications.
  
  
• Check your indoor humidity levels. If your home is too humid, it will encourage mold and dust mite growth – both of which can trigger asthma. If your home is too dry, it will dry out your nasal passages and can also impact your breathing. The optimal range for relative humidity is 35 to 50%. If your home’s furnace doesn’t have a built-in option for measuring humidity, you can get a hygrometer (humidity gauge) from hardware stores.
  
  
• Improve air flow in your home. Use exhaust fans to vent humid air outside. Inspect your chimney or fireplace if you have one to reduce indoor air pollution from wood burning.
  
  
• Consider using a CERTIFIED asthma & allergy friendly® air cleaner to help you improve your indoor air if you will be spending more time indoors during the cold weather. Indoor air quality can often be worse than air quality outside.
  
  
• Use AAFA’s Healthier Homes checklist or interactive tool to address other common asthma triggers in your home.
  
  

Remember, it is important to keep your inhaler from being fully exposed to extreme cold temperatures. Pack and carry it in an insulated bag or keep it in an inside coat pocket. Don’t store your medicines in your car or somewhere where they may freeze.

We hope these tips are helpful this winter season. Visit aafa.org/weather for need more information on weather-related triggers for asthma.

Medical Review: January 2022 by Neeta Ogden, MD

How do you manage your asthma during winter weather? What are your tips for preventing the cold from triggering your asthma symptoms?

Join our online community to talk to other people about managing asthma and allergies during cold weather.

JOIN NOW

If you have asthma or allergies, costs for medicines, lab tests, lung function tests, and visits to see a specialist all add up. Health insurance can help with some of these costs. What do you need to know about your insurance options during open enrollment this year?

Open enrollment refers to when you can add, change, or switch health insurance plans. For people who get health insurance through work, your employer and the insurance company set the dates for open enrollment periods.

The Affordable Care Act (ACA) makes health insurance more affordable and available to people without insurance benefits through their employer, Medicare, Medicaid, or another source. It includes other important provisions for people with allergic diseases. For example, if you buy a Marketplace plan, you cannot be denied because you have a pre-existing condition, such as asthma.

How Do I Enroll in a Health Insurance Plan?

If your job offers health insurance benefits, you will need to follow your employer's instructions on how to enroll.

If you do not have health insurance benefits from your employer, or if you are uninsured, you can apply through the Marketplace. You can preview and compare plans before you choose a plan.

Here is a checklist of what information to have on hand to help you make a decision:

• Your household size
• Home and/or mailing address for everyone needing coverage
• Information about everyone needing coverage, like birth dates and Social Security Numbers
• Information about any professional person who is helping you apply (for example, agent or broker)
• Information on how you plan to file your taxes in 2024
• Income information, such as pay stubs and W-2s for every member of your household
• Policy numbers from your current health care plans
• Estimated household income in 2024
• Completed "Employer Coverage Tool" if anyone in your household can get insurance through an employer
• Notices from your current Marketplace plan, if you had one for 2023
• Documents for legal immigrants and naturalized citizens in your household
  
  

Healthcare.gov also has a checklist to help you get ready to apply.

When looking at plans on the Marketplace, you can choose to “estimate total yearly costs.” To do so, you will be asked to select the level of care you expect to use this year. It's OK if you end up using more or less. This won't change your premiums or cost-sharing, or limit how many services you can use.

You might select "Low Use" if you expect:

• Few doctor visits
• Occasional prescription drugs
• No expected hospital visits
  
  

You might select "Medium Use" if you expect:

• Regular doctor visits
• Regular prescription drugs
• No expected hospital visits
  
  

You might select "High Use" if you expect:

• Frequent doctor visits
• Frequent prescription drugs
• At least one hospital visit
  
  

What Is Important to Consider If I Have Asthma or Allergies?

1. Are your current health care providers in-network, such as your primary care doctor and your specialists?
2. Does the plan include care from an asthma and allergy specialist?
3. What medicines are covered by the plan? Look for the drug list or formulary.
4. Does the health insurance plan require a referral required to see a specialist? Be aware that the number and type of plans will vary by states. Some states may have a wide choice of plans. Others may offer a health maintenance organization (HMO), which may require you to get a referral to see a specialist.
5. What kind of treatments for asthma or allergies are covered by the plan?
6. Will the plan pay for more advanced treatments, or will it limit the kind of treatment you can receive?
7. Does the plan cover diagnostic tests for diagnosing asthma or allergies, such as lung function tests and skin prick testing?
8. Will the plan cover medical devices such as spacers and nebulizers?
9. Does the plan offer an asthma management program? Under program “details,” you can see if the health insurance plan covers asthma management. Many plans do. Asthma management programs may include a nurse hotline, help identifying your asthma triggers, assistance understanding your medicine, or using equipment like nebulizers and spacers.
   
   

What Are the “Metal” Categories in the Health Insurance Marketplace?

ACA plans fall under the categories of Bronze, Silver, Gold, and Platinum. The levels have nothing to do with quality. They refer to how you and your insurance plan split costs, known as cost-sharing.

Consider Silver if you qualify for extra savings on out-of-pocket costs, or if you want more of your costs covered.

• If you qualify for extra savings (“cost-sharing reductions”), your deductible will be lower, and you’ll pay less each time you get care. These extra savings are only available through the Silver plan. This can save you hundreds or even thousands of dollars a year if you use a lot of care. Silver carries moderate premiums and deductibles.
• While a Silver plan may have a monthly premium that’s higher than a Bronze plan’s premium, be sure to consider the total cost of your medical care. Your total costs include not just monthly premiums but the payments you make when you get care.
• If you have a Silver plan and qualify for extra savings, the deductible can be thousands of dollars less than a typical Bronze plan’s deductible. So, you may end up spending less on health care overall if you enroll in a Silver plan.
  
  

Consider Gold or Platinum if you expect a lot of health care visits or need regular prescriptions.

These plans generally have higher monthly premiums but pay more of your costs when you need care.

What Are Advance Premium Tax Credits?

Advance premium tax credits (APTC) can help lower the cost of your monthly premium. Whether or not you qualify depends on your household size and household income.

When you apply for coverage through Healthcare.gov, you will find out instantly if you qualify for this credit or not. You can also quickly check if you might qualify on their website without an application.

The government may pay your tax credit directly to the insurance company, lowering the cost of the monthly premium that you pay out of pocket. Or you may choose to pay the full premium amount and get a refund at the end of the year.

What If I Have Low Income?

When you apply for coverage, you will also find out if you qualify for:

• Medicaid
• CHIP (the Children’s Health Insurance Program)
  
  

Both provide free or low-cost health coverage for some people, including low-income adults, children, pregnant women, seniors and people with disabilities. Medicaid provides insurance to more than 70 million people in the United States.

These programs may be known by different names in each state.

I Have Insurance Through My Job. Should I Look at the Marketplace?

You can, but the Marketplace is intended for people without health insurance. Since the ACA was passed, job-based health insurance must meet certain standards. You will pay full price for a Marketplace plan unless your coverage through work does not meet those standards.

Should I Buy “Catastrophic” Coverage, Short-Term Insurance or Hospital-Only Coverage?

The Catastrophic health plans may look like health insurance, but they do not meet the minimum standard for ACA plans or job-based health plans. For instance, they will not include prescription medicine or preventative care, both of which are important for people with asthma and allergies.

These health plans are available for:

• People under the age of 30
• People 30 years or older with a hardship exemption or affordability exemption
  
  

Will I Pay a Penalty If I Don't Buy Health Insurance?

As of 2019, you no longer have to pay a tax penalty if you are uninsured. But you might still be subject to a state tax penalty.

How Can I Get More Help While Applying?

Enter your zip code or city and state and get connected to someone who can help you locally.

Where Can I Learn More?

AAFA’s advocacy resources has more details about health care coverage and insurance issues, including Medicaid, Medicare and CHIP.

MyHealthPlan offers information about how insurance works.

Updated November 2023

If you're reading this, there's a good chance you're one of the millions of Americans with a dust mite allergy. But how well do you know these microscopic creatures? Let's look at some common misconceptions about dust mites and dust mite allergy.

Myth #1: Dust mites are found in dust.

Fact: Dust in your home is mostly made up of human debris (skin cells, hair and “other”). It also contains dirt, pollen, mold spores, microplastics and fibers. If you have animals in your home, it will contain a larger amount of animal dander as well. (All homes have animal dander even if they don’t have pets.) Sometimes dust mites are found in dust. But they don’t live there for long, especially if the dust is on a hard surface.

To live, dust mites need moisture and to feed on human skin cells. They thrive in humid locations like your bed (you sweat and breathe, trapping humidity under your covers). They are also found in your fabric furniture (couches, chairs) and carpet. They are sometimes found in your curtains. They like stuffed animals, especially those allowed on the bed. Dust mites thrive in these areas because these are not normal places you clean for dust.

Myth #2: Dust mites are only found in the Southeast United States because it's more humid.

Fact: To prevent dust mites, you have to reduce humidity or block their access to human skin. Some dry, high elevation places have low concentrations of dust mites, such as Colorado, but everywhere in the U.S. has dust mites.

Myth #3: Dusting is the best way to get rid of dust mites.

Fact: There are two ways to prevent exposure to dust mites:

• Reduce humidity
• Block access to human skin cells (barrier)
  
  

CERTIFIED asthma & allergy friendly® allergen-barrier mattress or pillow covers prevent dust mite colonies from booming in your bed. They will still live in your sheets, pillowcases and blankets, but with regular washing with hot water, you can keep the numbers down.

Myth #4: People with asthma don’t have to worry about dust mites.

Fact: Dust mites are a concern for people with dust mite allergy. And many people with dust mite allergy also have eczema and asthma that is triggered by dust mites.

But dust mites are also a problem people with asthma even if they aren't allergic to dust mites. The dust mite debris (dead bodies, fecal matter) they create is considered an irritant that worsens indoor air pollution. The dust mite debris is then inhaled and is an irritant to inflamed lungs.

Myth #5: Since dust mites are microscopic, they don't affect indoor air quality.

Fact: If you want to improve your indoor air quality, dust mite containment and prevention is a key step. Dust mite debris can become airborne, affecting indoor air quality.

Now that we've debunked some common myths about dust mites, what's next? These tiny creatures are everywhere, so is possible to keep them under control?

There's good news. If you are allergic to dust mites, there are ways you can manage them to keep your symptoms under control:

• Use CERTIFIED asthma & allergy friendly® allergen-barrier mattress or pillow covers
• Wash bedding in water that's at least 130 F weekly
• Keep the humidity in your home below 50%
• Get rid of fabric items you cannot wash regularly (carpeting, curtains, upholstered furniture, etc.), if possible
• Talk to a board-certified allergist about allergy testing and long-term allergy treatment
• Use other CERTIFIED asthma & allergy friendly® products to create a healthier home environment, such as air filters and vacuum cleaners

A healthy living space begins with good indoor air quality (IAQ). Allergens, scents, chemicals, volatile organic compounds (VOCs), and outdoor air pollution can affect the IAQ in your home.

Good IAQ is an important part of asthma and allergy management. But asthma triggers and allergens can hide all over our homes. So where do you begin when it comes to making your home healthier?

Some asthma and allergy triggers are easy to spot – such as dust that can contain pollen and dust mite allergens, and mold. But there are other potential asthma triggers in your indoor air. You can improve your indoor air quality by reducing the sources of allergens and asthma irritants throughout your home.

The Asthma and Allergy Foundation of America (AAFA) has a Healthier Home Checklist to help you learn ways to improve your IAQ and reduce asthma and allergy triggers in your home. On our Healthier Home webpage, mouse over (or click if you’re on mobile) rooms of the house for tips for each area of your home. The tips point out some of the top asthma and allergy triggers you’ll find in each room or area.

You’ll find tips to improve IAQ in your:

• Living room
• Kitchen
• Bedrooms
• Bathrooms
• Attic/roof
• Basement
• Garage
• Laundry
  
  

You can also download and print our free Asthma-Friendly Home Checklist. You can go through the checklist to improve IAQ. It will help you learn about and control your asthma triggers. If you rent, you can share it with your property owner or landlord after identifying potential issues.

Download, Print and Share

Now that you know about our Healthier Home Checklist, you may be wondering what room to start in. We recommend starting with your bedrooms. Bedrooms tend to have the highest number of allergens and the worse IAQ of any room of your home. Since we spend one-third of our lives in our bedrooms, that’s the best place to start improving your home’s health.