Did you know there are different types of asthma, such as allergic asthma, non-allergic asthma, exercise-induced bronchoconstriction [BRAHN-koh-kahn-STRIK-shun]? Another subtype of asthma 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 where you have increased inflammatory cells called eosinophils [EE-oh-sin-oh-FILLS] in the airway. It usually affects adults and can often be severe. More than 27 million people in the United States have asthma and about 10% of them have poorly controlled, severe asthma. Many of these people could have eosinophilic asthma. It is important to know if you have this type of asthma because it affects your treatment options.  

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 your body produces these immune cells in higher amounts. They overreact and can cause inflammation in the body, including in the lungs. People who have high levels of eosinophils can have increased swelling in the airways which can lead to asthma symptoms.

Eosinophilic asthma is a type of severe asthma, which can cause more frequent attacks. It usually starts in adulthood and may not respond to treatment with a common asthma medicine called an inhaled corticosteroid.  Often it is hard to know the exact cause for this type of asthma. Adult asthma usually affects more women than men. But eosinophilic asthma affects them at about the same rate.

If you have eosinophilic asthma, you can have allergic or non-allergic asthma triggers. Other types of asthma, such as allergic asthma, are commonly 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 nitric oxide gas. Your doctor will also ask you about your past medical history, current and past symptoms, as well as any current and/or history of allergies. If your doctor diagnoses you with eosinophilic asthma, understanding this unique type of asthma is important to help you manage symptoms and have a better overall quality of life. Allergists and pulmonologists are the main types of medical specialists who evaluate and manage this lung disease.

Current management of eosinophilic asthma begins with standard guideline-based therapy. For example, people with asthma may be prescribed these types of medicines:

• A controller medicine treats airway swelling. It’s usually an inhaled corticosteroid. This is a maintenance medicine that controls and prevents asthma symptoms. They are generally safe, well-tolerated, and meant to be used regularly – even daily if prescribed.
• A quick-relief medicinehelps relieve symptoms when they occur by relaxing bronchospasms [brahn-ko-spaz-uhmz]. This is when muscles tighten and squeeze around the airways.
• A combination medicine has both quick-relief and controller medicines in one inhaler used for both short-term relief and control.
• A leukotriene modifier is a controller medicine that helps decrease inflammation in the lungs. Leukotrienes are chemicals produced by the immune system. They can add to the inflammation in the lungs caused by eosinophils.
  
  

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 the effective management of asthma symptoms.

For some people with eosinophilic asthma, 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 to make a plan for your treatment. You can work with your doctor 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 immune cells or molecules (pathways that are part of your immune system) to block swelling and inflammation and, in turn, 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 eosinophilic asthma include:

• Benralizumab
• Dupilumab
• Mepolizumab
• Omalizumab
• 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. Knowing the subtype of severe asthma you have (like eosinophilic asthma) may be very important for treating 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 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. See a board-certified allergist or pulmonologist if possible.

We also encourage health care professionals to work closely with their patients to understand the many ways severe asthma affects your quality of life. Talk about specific risks and benefits of potential asthma treatments. Together, people with asthma and their support teams can develop a shared understanding of asthma management and treatment goals.

Medical Review: May 2024 by John M. James, MD

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.

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;

COVID-19 is a disease caused by a virus called SARS-CoV-2 (a type of coronavirus). It causes respiratory symptoms, but it can also affect other parts of your body.

COVID-19 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, RSV, 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, respiratory syncytial virus (RSV), 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 in the United States. There vaccines available are: Pfizer, Moderna, 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.

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). At times, free tests are available from covidtests.gov.

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; updated November 2024

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/

With every cough or sniffle, you may wonder if it’s asthma or allergies, the flu, respiratory syncytial [sin-SISH-uhl] virus (RSV), 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 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
• 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

COVID-19 is caused by the SARS-CoV-2 virus. According to the Centers for Disease Control and Prevention (CDC), COVID-19 symptoms can include:

• Fever
• Chills
• Cough
• Shortness of breath or trouble breathing
• Feeling tired and weak – more than usual
• 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. Symptoms may appear 2 to 14 days after coming in contact with the virus. If you have any symptoms that are severe or concerning, call your doctor.

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
• New and sudden confusion
• 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
  
  

People ages 6 months and older can get a COVID-19 vaccine.

What to Do If You Have COVID-19 Symptoms

If you have any of the symptoms above or if you have been exposed to someone who has COVID-19, get tested. If you test positive, contact your doctor right away. They may want you to take an antiviral medicine and or additional medicines to support your symptoms.

Also wash your hands often, wear a mask, and stay home if you are sick. Pay attention to your symptoms, and if they get worse, call your doctor and get emergency care right away. Get plenty of rest and continue to take your asthma medicines as prescribed by your health care provider.

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°F 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 of complications from the flu.

It is important to get the flu vaccine every year. It can reduce your chances of having complications (serious health problems).

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 antiviral treatments for the flu that can lessen symptoms and may shorten the time you are sick. But you have to take them within 1 to 2 days of getting sick.

If you start having flu symptoms and have trouble breathing, follow your Asthma Action Plan and contact your doctor right away.

Respiratory Syncytial Virus (RSV)

RSV is a virus that affects your lungs. It is a common virus with cold-like symptoms that can affect people of all ages. RSV is the most common cause of pneumonia and airway inflammation in children in the United States younger than 1 year of age.

Most people have mild symptoms and recover from RSV within a week or two. But RSV can be serious for certain people who are at high risk, like infants and older adults.

RSV symptoms can take as long as 4 to 6 days to show up after contact with the virus. Symptoms include:

• Runny nose
• Stuffy nose
• Eating less or not interested in eating
• Coughing
• Sneezing
• Red, inflamed eyes (conjunctivitis)
• Fever
• Wheezing (a whistling sound when breathing)
  
  

Symptoms in very young infants may be different. They can include:

• Being irritable or cranky (fussiness)
• Eating or drinking less or not interested in eating
• Decreased activity and poor responsiveness
• Trouble breathing (for example, cough, shortness of breath, wheezing, and respiratory distress)
• Faster breathing than usual
• Pauses in breathing that last more than 10 seconds
  
  

Call your child’s doctor right away if your child is having trouble breathing, not drinking enough fluids, not responding well, and/or their symptoms are getting worse.

What to Do If You Have RSV Symptoms

If you have asthma, contact your doctor right away if you have symptoms of RSV. Or if your infant has RSV symptoms – whether they have asthma or not – contact their doctor.

Most RSV infections will go away on their own. RSV is caused by a virus, so antibiotics will not help. Talk with your doctor about taking over-the-counter medicines to help with symptoms, like pain relievers or cough and cold medicine. Be sure to talk with your doctor about how to take these medicines appropriately. Ask about nasal suction and lubrication – such as a nasal saline spray, mist, or drops – which may help ease congestion. Drink plenty of fluids and rest. Limit your time around other people to prevent spreading RSV.

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, follow your Asthma Action Plan. Contact your doctor if symptoms do not improve. And get medical help right away for emergency asthma symptoms.

Nasal Allergy (Rhinitis) Symptoms

Irritants and allergens can cause inflammation (swelling) in your nose. This is called rhinitis. When you have symptoms during a certain season of the year or when you are exposed to certain allergens, it’s commonly called allergic rhinitis or “hay fever.”

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 COVID-19. 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 as soon as possible.
  
  

For pollen allergy:

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

In general:

• Replace the filters on your heating/air conditioning units as recommended by the 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. If you have allergies, it’s important to get treatment to make sure they are well-controlled.

How to Reduce the Spread of COVID-19, the Flu, and Other Respiratory Illnesses

What can you do to reduce your chances of getting sick? To stop the spread of respiratory infections:

• Get vaccinated
• Wash hands often for at least 20 seconds with soap and water
• Wear an N95 face mask when respiratory infections are high in your community
• 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.

Medical Review: based on the following webpages: COVID-19 (Coronavirus Disease), Asthma, and Allergies reviewed September 2024 by Neeta Ogden, MD; Flu (Influenza) reviewed September 2024 by John James, MD; Respiratory Syncytial Virus (RSV) October 2024 by John James, MD; and Nasal Allergies (Rhinitis)

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

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

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

Flovent HFA and Flovent Diskus are inhaled corticosteroid medicines used as a controller medicine to treat asthma. Flovent HFA is also used to treat eosinophilic esophagitis (EoE). Glaxo Smith Kline (GSK), the manufacturer of Flovent, discontinued production of Flovent HFA and Flovent Diskus. As part of this process, GSK is making an “authorized generic” which is the exact same medicine with the same dosing but without the branding.

Below are some answers to frequently asked questions about this change.

1. What’s the difference between the brand name Flovent inhalers and the generic fluticasone inhalers?

The authorized generic options for Flovent HFA and Flovent Diskus are the same inhaler devices and medicine (fluticasone) as found in the brand name Flovent. They work exactly the same. They just don’t have the brand label.

2. How do I know if the generic fluticasone will be covered by my insurance?

Access to the authorized generic fluticasone (active ingredient in Flovent) will depend on your health insurance and your pharmacy benefits or formulary. While we hope most insurance plans will replace the brand name Flovent with the authorized generic, there may be some that don’t. It may create delays for people to get the medicine they need.

If you are currently using brand name Flovent HFA or Flovent Diskus, check with your insurance to see if the authorized generic versions are covered. For some people, the out-of-pocket costs may unexpectedly be higher with the generic if your plan doesn’t have the authorized generics on your insurance plans preferred drug lists.

3. What do I do if I have asthma and can’t get the authorized generic fluticasone or if my insurance doesn’t cover it?

If the authorized generic is not covered by the insurance provider, you can work with the insurance company to ask for a “formulary exception” to determine if your insurance company will provide an exemption and cover the medicine.

If your insurance plan will not cover the authorized generic fluticasone and a formulary exception is not available, there are other inhaler options for the treatment of asthma. Talk with your doctor about inhaler options, what dose to take if you are prescribed another medicine, and ask them to show you how to use these inhalers.

If your prescription changes from fluticasone propionate HFA or fluticasone propionate Diskus to something else, you need to be aware of what medicine you have been prescribed and how to use it. Not all inhalers are used the same way. Some insurers are transitioning to breath-actuated inhalers (like the Diskus versions) on their preferred drug lists, but these are not appropriate for some people with asthma.

4. What do I do if I have EoE and can’t get the authorized generic fluticasone or if my insurance doesn’t cover it?

If your insurance plan will not cover the authorized generic fluticasone, call your doctor to talk about your treatment options. Your doctor may need to follow up with your insurance company to appeal for the generic fluticasone to get covered. There aren’t other substitutes available for the treatment of EoE. Your doctor may talk with you about changing your treatment to a different medicine (budesonide).

5. What can I do now to prepare for a possible switch to the authorized generic or another medicine?

It is really important for people with asthma to continue their asthma control medicines, especially during respiratory illness season. Fluticasone works by controlling inflammation and swelling in the airways to prevent asthma attacks.

If you are currently using Flovent, you should check with your doctor or pharmacist about the best next steps for them. The authorized generic of Flovent is the exact same product without the brand label.

If you are switching to a different medicine, you should consult your doctor about appropriate dosing and also ask for training on how to administer the medicine.

If you use Flovent, you should speak with your doctor as soon as possible to determine the best course of action to continue treatment.

6. What do I do if I get a different inhaler than I’ve used before?

Not all inhalers are used the same way. Be sure you are aware of what medicine you are prescribed and ask your doctor about dosing and how to use the inhaler.

7. Why does the authorized generic cost me more? If it is the same exact drug, why isn’t it covered by my insurance?

The authorized generic fluticasone may have higher or lower out-of-pocket costs for patients than the brand name Flovent.

The U.S. has a complicated drug pricing ecosystem. Manufacturers, pharmacy benefit managers, insurance companies, and federal policies can create situations that reduce access to critical medicines for patients.

It’s not yet clear what impact this situation will have on pricing. GSK (the maker of Flovent) has released the statement below offering their perspective on this issue.

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.

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