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, 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/

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

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.

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

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

Long, hot days are great for outdoor activities, but pollen from trees, grasses, and weeds can threaten to keep you indoors if you have pollen allergies (also called “hay fever) and allergic asthma. They may leave you longing for a rain shower to wash the pollen away. But rain causes plant growth, which may result in more pollen, right? So is rain good for people with allergies or not?

The Good News About Rain and Pollen

Light, steady rain showers can wash the pollen away, keeping it from flying through the air. The humidity that follows helps keep pollen down too. Rain can have a welcome benefit for people with pollen allergies.

Did you know pollen counts may be higher when it’s dry and hot? You would expect rain to make plants grow, producing more pollen. Would a dry spell mean less pollen? Not really.

During dry, hot seasons, trees can actually release more pollen.¹ There is less moisture in the air to weigh down the pollen grains when the wind blows. This helps more pollen travel farther and more easily. Climate change can also lead to higher temperatures, changes in precipitation, increased carbon dioxide levels, and changes in plant growth patterns. These can all contribute to longer, more intense allergy seasons.

The Not-So-Good News About Rain, Pollen, and Other Environmental Allergens

While rain can be good if you have pollen allergies, it can cause issues for people with allergies to grass, weeds, dust mites, and mold.

When it rains when grass and weed pollen counts are high, raindrops can hit the ground and break clumps of pollen into smaller particles. They can then quickly scatter into the air, causing a sudden increase in allergy and allergic asthma symptoms during the rain shower. This tends to happen more often during sudden, heavy downpours and thunderstorms.

If you’re in a rainy and humid season, mold and dust mite counts can increase. Outdoor mold thrives in damp conditions. Remove leaves before they become moldy.

Also take steps to control your indoor allergens. Lower your indoor humidity (ideally between 30 to 50%) to manage mold and dust mites inside.

Watch the Weather and Seek Allergy Treatment

Rain can be a good thing for pollen allergies. But it is possible to have too much of a good thing. Next time the showers rain down, be grateful for the temporary relief. If the rain keeps pouring down, watch out for a spike in pollen counts, mold, and dust mites soon after.

You can manage your allergies and allergic asthma by visiting a board-certified allergist. Many treatments are available to help you manage your pollen allergies, no matter what the weather does. Tracking local weather reports and pollen counts can help you too. Talk with your doctor to come up with a treatment plan that works for you.

Medical Review: July 2024 by John James, MD

References
1. G. G. Franchi, B. Piotto, M. Nepi, C. C. Baskin, J. M. Baskin, E. Pacini; Pollen and seed desiccation tolerance in relation to degree of developmental arrest, dispersal, and survival. J Exp Bot 2011; 62 (15): 5267-5281. doi: 10.1093/jxb/err154

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

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 October, depending on where you live.

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

Ragweed Grows Throughout the United States

Ragweed is hard to escape. It grows throughout the United States. To help reduce your exposure to ragweed pollen, track ragweed season where you live. Check sites like AAAAI's National Allergy Bureau to follow pollen readings often.

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 pollen-food allergy syndrome (PFAS - also known as 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, PFAS can trigger anaphylaxis, a severe allergic reaction, so it is important to know if you have PFAS or a food allergy and how to treat it. Some of the symptoms of PFAS 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. Don’t let ragweed follow you around. Cover your hair, eyes, and face when you go outside. Shower at night to remove pollen. Also have everyone who enters your home leave their shoes at the door.

Immunotherapy May Provide Relief from Ragweed Pollen Allergy

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 you 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 with your doctor 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

Face masks can reduce your exposure to ragweed pollen. Wearing an N95 mask when outside can prevent pollen particles from entering your nose and lungs. This may lower 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 Healthier 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 Based off the webpage, “Ragweed Pollen Allergy,” reviewed August 2023 by Jill Poole, MD

Why You Need to Rinse and Spit

Did you know there is a connection between oral health and asthma?

When you use an asthma inhaler that has corticosteroids [CORE-te-coh-STAIR-oids] in it, the medicine can stick to the inside of your mouth. When the medicine stays in your mouth, it may cause problems with your teeth, gums, tongue, and cheeks.

Using corticosteroid inhalers can lead to:

• Thrush – a fungal infection on your tongue or cheeks
• Dry mouth
• Gum irritation and swelling
• Cavities (dental caries)
  
  

Examples of inhalers that have corticosteroids include:

• Advair Diskus® and Wixela Inhub® (fluticasone/salmeterol)
• AirDuo® (fluticasone/salmeterol)
• ArmonAir™ Digihaler® (fluticasone propionate)
• ARNUITY® ELLIPTA® (fluticasone furoate)
• Asmanex® Twisthaler® (mometasone)
• Dulera® (mometasone/formoterol) HFA
• Fluticasone propionate (generic version of Flovent)
• Pulmicort® Flexhaler® (budesonide)
• QVAR® RediHaler™ (beclomethasone dipropionate)
• Symbicort® (budesonide/formoterol) HFA
  
  

If you aren’t sure if your inhaler has a corticosteroid in it, contact your doctor.

The good news is you can keep your mouth healthy! After you use your asthma inhaler, rinse your mouth well with water and spit it out or brush your teeth. If you have a child with asthma, they may be more likely to get cavities, so it is important to teach them to rinse and spit after using their asthma inhaler.

Don’t forget to also floss, brush your teeth twice a day, and limit sugary foods and drinks. See your dentist twice a year so they can make sure your mouth and teeth stay healthy.

AAFA is pushing to lower the costs of asthma and allergy medicines, including inhalers. We know the high cost of medicine can be a barrier to treatment.

Some major asthma inhaler manufacturers have announced $35 a month caps on out-of-pocket costs. The price cap will apply to people with commercial/private insurance or no insurance. The inhalers that will be price capped include:

AstraZeneca (effective June 1, 2024):

• AIRSUPRA® (albuterol and budesonide) inhalation aerosol
• BEVESPI AEROSPHERE® (glycopyrrolate and formoterol fumarate) inhalation aerosol
• BREZTRI AEROSPHERE® (budesonide, glycopyrrolate, and formoterol fumarate) inhalation aerosol
• SYMBICORT® (budesonide and formoterol fumarate dihydrate) inhalation aerosol
  
  

How it works:

• Commercially insured and covered: You can pay as little as $0 for AIRSUPRA and BREZTRI and pay no more than $35 for SYMBICORT and BEVESPI using the savings cards provided on brand websites. 
  • Here are the website links to access the savings cards: AIRSUPRA, BEVESPI, BREZTRI, and SYMBICORT
• Commercially insured but AstraZeneca inhaler is not covered in your plan: You or your health care providers can request a prior authorization or ask your doctor about a therapeutic alternative. 
• Uninsured: if eligible, you can use the $35 uninsured savings card accessible on the US Patient Support site. 
• Government insured (Medicare/Medicaid):  Federal law prohibits people on government programs from using a savings card, which is why they may be directed to AZ&Me. Qualifications for AZ&Me are based on where you live, insurance status, and income.
• For additional questions or more information, visit AstraZeneca’s patient support site or call: 1-800-236-9933
  
  

Boehringer Ingelheim (effective June 1, 2024):

• Atrovent® HFA (ipratropium bromide HFA) inhalation aerosol
• Combivent® Respimat® (ipratropium bromide and albuterol) inhalation spray
• Spiriva® HandiHaler® (tiotropium bromide) inhalation powder
• Spiriva® Respimat® 1.25 mcg (tiotropium bromide) inhalation spray
• Spiriva® Respimat® 2.5 mcg (tiotropium bromide) inhalation spray
• Stiolto® Respimat® (tiotropium bromide and olodaterol) inhalation spray
• Striverdi® Respimat® (olodaterol) inhalation spray
  
  

How it works:

• If you have commercial insurance and are eligible, the reduced out-of-pocket cost will be automatically applied at participating retail pharmacies. More than 90% of pharmacies across the country are participating in the program, making the change seamless and automatic for most people. There are no forms to fill out or websites to go to – the discount happens electronically with no action required.
• All other eligible people, including those whose pharmacies do not participate and people without insurance, can visit www.InhalerOffer.com to enroll for a savings card to present at pharmacies to receive the same $35 cap of out-of-pocket costs.
• Federal law prevents people on government insurance programs (Medicare/Medicaid/TriCare) from being eligible for this price cap program.
  
  

GSK (with price change going into effect no later than Jan. 1, 2025):

• Advair Diskus (fluticasone propionate and salmeterol inhalation powder)
• Advair HFA (fluticasone propionate and salmeterol inhalation aerosol)
• Anoro Ellipta (umeclidinium and vilanterol inhalation powder)
• Arnuity Ellipta (fluticasone furoate inhalation powder)
• Breo Ellipta (fluticasone furoate and vilanterol inhalation powder)
• Incruse Ellipta (umeclidinium inhalation powder)
• Serevent Diskus (salmeterol xinafoate inhalation powder)
• Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol inhalation powder)
• Ventolin HFA (albuterol sulfate inhalation aerosol)

AAFA is leading the way to reduce health care costs for people with asthma

"On behalf of the 27 million people in the United States with asthma, we appreciate the leadership of President Biden and Senator Sanders to bring down costs for asthma treatments. Pricing announcements made in March by some manufacturers of inhalers will mean lower costs and improved access to asthma medicine for many people with asthma starting this June,” said AAFA President and CEO Kenneth Mendez. “As President Biden indicated, more can and should be done. It’s not just drug companies, others need to step forward. We welcome continued efforts to improve affordability and accessibility of these essential medicines so all patients can get the treatment they need.”

AAFA continues to raise the voice of the patient community and draw attention to the ways America’s complex drug pricing ecosystem makes asthma medications more expensive for people who need them most. Drug manufacturers, pharmacy benefit managers, insurers, employers, and the government must work together to improve affordability and access.

Access to affordable drugs is a critical component of reducing racial disparities in asthma. Black and Hispanic individuals not only experience higher rates of asthma but also are more likely to be uninsured or underinsured. Deaths due to asthma – although decreasing overall – occur at a much higher rate in the Black and Puerto Rican populations than in the White population. Black individuals are nearly three times as likely to die from asthma than White individuals.

Last fall, AAFA shared patient stories and its Asthma Disparities in America report with the Senate Health, Education, Labor, and Pensions (HELP) Committee which then launched an investigation into the high price of asthma inhalers early this year.

AAFA’s research indicates that when the cost of medicine becomes a barrier to treatment, people with asthma resort to rationing or simply discontinue use.

Access to asthma medications can save lives, reduce hospitalizations, and lower the more than $82 billion in annual costs to the U.S. economy from this chronic disease. But the U.S. health care system is complex, and often leaves patients with few affordable options.

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

US FDA approves SYMBICORT for the treatment of asthma in pediatric patients

[Press Release]

AstraZeneca announced that the US Food and Drug Administration (FDA) approved SYMBICORT® (budesonide/formoterol fumarate dihydrate) Inhalation Aerosol 80/4.5 micrograms for the treatment of asthma in pediatric patients aged six up to 12 years. SYMBICORT 80/4.5 and 160/4.5 are already approved in the US to treat asthma in patients 12 years and older. SYMBICORT 160/4.5 is also approved for the maintenance treatment of airflow obstruction in Chronic Obstructive Pulmonary Disease (COPD) in adults.

The FDA approval is based on the CHASE (ChildHood Asthma Safety and Efficacy) clinical trial program, which included the CHASE 3 Phase III trial. This trial demonstrated SYMBICORT 80/4.5 micrograms delivered in a pressurized metered-dose inhaler (pMDI) significantly improved lung function in pediatric patients with asthma aged six up to 12 years who were symptomatic on low-dose inhaled corticosteroid versus budesonide pMDI 80 micrograms, both delivered as two inhalations twice daily. The safety profile in pediatric patients aged six up to 12 years is similar to the safety profile in patients aged 12 years and older. Common adverse reactions that occurred in patients treated with SYMBICORT 80/4.5 with a frequency of ≥3% and more frequently than patients treated only with budesonide pMDI 80 micrograms included upper respiratory tract infection, pharyngitis, headache, and rhinitis.

Gregory Keenan, Vice President, Medical Affairs and US Head Medical Officer, said:

“SYMBICORT is a cornerstone product in our growing respiratory franchise and we are pleased to now be able to offer this medicine to younger patients, helping to control and prevent asthma symptoms.”

With this expanded indication, SYMBICORT can now be used to treat a wider range of patients suffering from asthma. SYMBICORT is an ICS/LABA (inhaled corticosteroid/long-acting beta2-agonist bronchodilator) controller medication that has been shown to help control asthma by reducing inflammation in the lungs and keeping airways open. It is not indicated for the relief of acute bronchospasm.

An estimated 6.3 million children under the age of 18 years in the US have been diagnosed with asthma. Well-controlled asthma results in the prevention of symptoms such as coughing or wheezing and can help maintain good lung function and normal activity.

INDICATIONS

SYMBICORT is indicated for the treatment of asthma in patients 6 years and older (also see Boxed WARNING and DOSAGE AND ADMINISTRATION).

SYMBICORT 160/4.5 is indicated for the maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

SYMBICORT is NOT indicated for the relief of acute bronchospasm.

IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING

• WARNING: Long-acting beta2-adrenergic agonists (LABA), such as formoterol, one of the active ingredients in SYMBICORT, increase the risk of asthma-related death. A placebo-controlled study with another LABA (salmeterol) showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol is considered a class effect of LABA, including formoterol. Currently available data are inadequate to determine whether concurrent use of inhaled corticosteroids or other long-term asthma control drugs mitigates the increased risk of asthma-related death from LABA. Available data from controlled clinical trials suggest that LABA increase the risk of asthma-related hospitalization in pediatric and adolescent patients
  
  
• When treating patients with asthma, prescribe SYMBICORT only for patients not adequately controlled on a long-term asthma control medication, such as an inhaled corticosteroid or whose disease severity clearly warrants initiation of treatment with both an inhaled corticosteroid and LABA. Once asthma control is achieved and maintained, assess the patient at regular intervals and step down therapy (eg, discontinue SYMBICORT) if possible without loss of asthma control, and maintain the patient on a long-term asthma control medication, such as an inhaled corticosteroid. Do not use SYMBICORT for patients whose asthma is adequately controlled on low or medium dose inhaled corticosteroids
  
  
• SYMBICORT is NOT a rescue medication and does NOT replace fast-acting inhalers to treat acute symptoms
  
  
• SYMBICORT should not be initiated in patients during rapidly deteriorating episodes of asthma or COPD
  
  
• Patients who are receiving SYMBICORT should not use additional formoterol or other LABA for any reason
  
  
• Localized infections of the mouth and pharynx with Candida albicans has occurred in patients treated with SYMBICORT. Patients should rinse the mouth after inhalation of SYMBICORT
  
  
• Lower respiratory tract infections, including pneumonia, have been reported following the inhaled administration of corticosteroids
  
  
• Due to possible immunosuppression, potential worsening of infections could occur.
  
  
• A more serious or even fatal course of chickenpox or measles can occur in susceptible patients
  
  
• It is possible that systemic corticosteroid effects such as hypercorticism and adrenal suppression may occur, particularly at higher doses. Particular care is needed for patients who are transferred from systemically active corticosteroids to inhaled corticosteroids. Deaths due to adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic corticosteroids to less systemically available inhaled corticosteroids
  
  
• Caution should be exercised when considering administration of SYMBICORT in patients on long-term ketoconazole and other known potent CYP3A4 inhibitors
  
  
• As with other inhaled medications, paradoxical bronchospasm may occur with SYMBICORT
  
  
• Immediate hypersensitivity reactions may occur, as demonstrated by cases of urticaria, angioedema, rash, and bronchospasm
  
  
• Excessive beta-adrenergic stimulation has been associated with central nervous system and cardiovascular effects. SYMBICORT should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension
  
  
• Long-term use of orally inhaled corticosteroids may result in a decrease in bone mineral density (BMD). Since patients with COPD often have multiple risk factors for reduced BMD, assessment of BMD is recommended prior to initiating SYMBICORT and periodically thereafter
  
  
• Orally inhaled corticosteroids may result in a reduction in growth velocity when administered to pediatric patients
  
  
• Glaucoma, increased intraocular pressure, and cataracts have been reported following the inhaled administration of corticosteroids, including budesonide, a component of SYMBICORT. Close monitoring is warranted in patients with a change in vision or history of increased intraocular pressure, glaucoma, or cataracts
  
  
• In rare cases, patients on inhaled corticosteroids may present with systemic eosinophilic conditions
  
  
• SYMBICORT should be used with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines
  
  
• Beta-adrenergic agonist medications may produce hypokalemia and hyperglycemia in some patients
  
  
• The most common adverse reactions ≥3% reported in asthma clinical trials included nasopharyngitis, headache, upper respiratory tract infection, pharyngolaryngeal pain, sinusitis, pharyngitis, rhinitis, influenza, back pain, nasal congestion, stomach discomfort, vomiting, and oral candidiasis
  
  
• The most common adverse reactions ≥3% reported in COPD clinical trials included nasopharyngitis, oral candidiasis, bronchitis, sinusitis, and upper respiratory tract infection
  
  
• SYMBICORT should be administered with caution to patients being treated with MAO inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents
  
  
• Beta-blockers may not only block the pulmonary effect of beta-agonists, such as formoterol, but may produce severe bronchospasm in patients with asthma
  
  
• ECG changes and/or hypokalemia associated with nonpotassium-sparing diuretics may worsen with concomitant beta-agonists. Use caution with the coadministration of SYMBICORT

Please see full Prescribing Information, including Boxed WARNING and Medication Guide.

NOTES TO EDITORS

About Asthma
Asthma is the most common chronic respiratory disease and it affects the health and day-to-day lives of more than 300 million adults and children worldwide. It is characterized by recurrent breathlessness and wheezing, which vary in severity and frequency from person to person.

About SYMBICORT
SYMBICORT is a combination formulation containing budesonide, an inhaled corticosteroid (ICS), and formoterol, a long-acting beta2-agonist bronchodilator (LABA), in a single inhaler.

About AstraZeneca in Respiratory Disease
Respiratory disease is one of AstraZeneca’s main therapy areas, and we have a growing portfolio of medicines that reached more than 17 million patients in 2015. Our aim is to transform asthma and COPD treatment through inhaled combinations at the core of care, biologics for the unmet needs of specific patient populations, and scientific advancements in disease modification. We are building on a 40-year heritage in respiratory disease, and our capability in inhalation technology spans both pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs), as well as our innovative Co-SuspensionTM Delivery Technology. Our research is focused on four key biological pathways: eosinophilic disease, Th2-driven disease, epithelial-driven pathobiology and autoimmunity.

About AstraZeneca
AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines, primarily for the treatment of diseases in three main therapy areas - Oncology, Cardiovascular & Metabolic Diseases and Respiratory. The Company also is selectively active in the areas of autoimmunity, neuroscience and infection. AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. For more information, please visit www.astrazeneca-us.com and follow us on Twitter @AstraZenecaUS.

CONTACTS

Media Inquiries

Michele Meixell +1 302 885 2677
Abigail Bozarth +1 302 885 2677

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 but not all of them do. 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 to help you have a healthier home.

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

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

If your allergies are worse in the spring and summer time, you may have a grass pollen allergy.

What Is a Grass Pollen Allergy?

Grasses are one of the most common causes of allergy. Each year, plants (including grasses) release tiny pollen grains to fertilize other plants of the same species. Unfortunately for people with grass allergies, this pollen triggers allergic reactions. Symptoms of a grass pollen allergy include:

• Runny nose
• Sneezing
• Itchy nose, eyes, ears and mouth
• Stuffy nose (nasal congestion)
• Red and watery eyes
• Swelling around the eyes
  
  

You may not see the grass pollen in the air, but your body can react to even small amounts.

Many people know pollen allergy as “hay fever.” Experts usually refer to pollen allergy as “seasonal allergic rhinitis.”

What Types of Grasses Cause Allergy Symptoms?

If you have a grass pollen allergy, you may be allergic to more than one type of grass.

There are hundreds of types of grasses, but only a few are responsible for allergy symptoms. Your geographic location may determine which grasses may be responsible for your symptoms.

The most common types of grasses that cause allergies are:

• Bermuda
• Johnson
• Kentucky
• Orchard
• Rye
• Sweet Vernal
• Timothy
  
  

When Is the Grass Pollen Season?

In northern regions of the United States, grasses usually pollinate in the late spring or early summer. In southern regions, grasses may pollinate throughout many seasons and could trigger symptoms throughout the year.

These small, light and dry grass pollen grains are released into the air and can travel for hundreds of miles by the wind.

How Can I Prevent Allergic Reactions to Grass?

Here are 11 ways you can reduce allergic reactions to grass pollen:

How Can I Manage My Grass Allergy Symptoms?

The first step is to get properly tested and diagnosed. Once your allergist knows what specific allergens cause your symptoms, they can work with you to create a plan.

There are over-the-counter and prescription pills, liquids, or nasal sprays that can help reduce or prevent grass allergy symptoms. These medicines include antihistamines, decongestants, and nasal corticosteroids. Most allergy medicines work best when you start taking them before pollen season begins. This allows the medicine to prevent your body from releasing histamine and other chemicals that cause your symptoms.

But if you do not get complete relief from your grass pollen allergy symptoms from these medicines, you may benefit from immunotherapy (allergy shots). Immunotherapy is a long-term treatment that can help prevent or reduce the severity of allergic reactions. It can change the course of allergic disease by modifying the body’s immune response to allergens.

There are two types of immunotherapy available for grass allergy: allergy shots and allergy tablets.

• Allergy shots – Subcutaneous immunotherapy (SCIT) is given at your doctor’s office. It involves getting injections of allergens in an increasing dosage over time. During the course of immunotherapy, a person with grass allergy becomes progressively less sensitive to that allergen. You may experience relief within one to three years of starting SCIT. The most common side effects for SCIT include local reactions at the injection site, such as redness, itching, swelling, tenderness, and pain. Less common systemic reactions may include generalized redness, hives, itching, swelling, wheezing, and low blood pressure.
  
  
• Allergy tablets – Sublingual immunotherapy (SLIT) is a form of immunotherapy that can be done at home. It is needle free and involves placing a tablet containing the allergen under your tongue for one to two minutes and then swallowing it. Treatment begins prior to the grass allergy season and continues throughout the grass allergy season. By taking these tablets every day, you may reduce your grass allergy symptoms. This treatment offers people with these allergies a potential alternative to allergy shots. SLIT tablets also have side effects and some may be serious, which is why it’s important to talk with your doctor about your treatment options.
  
  

Both forms of allergy immunotherapy (shots and tablets) are prescribed by your doctor. Talk to your doctor to get started on your allergy treatment plan.

Published June 2018, Updated June 2021

Every September, asthma hospital stays rise. Doctors see more people with asthma episodes and attacks. The 3rd week of the month is the worst. It is called the September Asthma Epidemic or Asthma Peak Week.

Everyone with asthma needs to take extra steps to manage their asthma during September. Children are affected the most during the month. But adults are at risk too.

As we head into Asthma Peak Week, it’s important to know if your asthma is under control, how to avoid getting sick, and what to do if you do get sick.

Why Is Asthma Worse in September?

People with asthma and allergies are exposed to several triggers in September. Ragweed, the most common fall pollen allergy, is highest in September in the United States. Mold counts go up as leaves collect outside. Children return to school and may catch respiratory infections. Flu and cold season is starting too.

Being around all of these asthma triggers at the same time can make it hard to keep your asthma under control.

How Can I Manage Asthma During September?

The best way to deal with asthma attacks is to prevent them before they begin. If your asthma is not under control, talk with your doctor as soon as possible.

Here are some steps you can take to manage your asthma in September:

• Follow your Asthma Action Plan to keep your asthma under control.
• Get vaccines for respiratory infections such as influenza (the flu), COVID-19, respiratory syncytial virus (RSV), and pneumonia.
• Manage your allergies and your indoor air quality.
• Wear a mask in crowded places, washing your hands properly, and staying away from sick people.
• Get rest, adequate sleep and hydration, and healthy food.

To learn more about managing your asthma, visit: aafa.org/asthmapeak

How Do I Know If My Asthma Is Not Under Control?

If your asthma is under control, you are more likely to get better faster or avoid complications (serious health problems) when you are sick. It’s important to know if your asthma is under control, especially as respiratory illnesses are going around.

Controlled asthma means:

• You have asthma symptoms 2 or fewer times per week
• You use your quick-relief medicine 2 or fewer times per week
• You wake up from asthma 2 or fewer times per month
• You use oral corticosteroids to treat your asthma fewer than 2 times per year
  
  

If any of these things happen more than 2 times, your asthma is not under control.

Also, if you take oral corticosteroids (such as prednisone) 2 or more times a year, ask your doctor about other options. Oral corticosteroids can have serious, long-term side effects. Some of them may include osteoporosis (brittle bones), diabetes, and cataracts (when the lens of your eyes becomes cloudy).

Your doctor may run more tests or have you try other asthma treatments. Biologics are a type of treatment used to treat severe, uncontrolled asthma. They may reduce the number of asthma attacks you have and reduce the need for oral corticosteroids. Biologic treatments are shots or infusions you are given every few weeks. The treatment targets and blocks a cell or protein in your body that can inflame your airways.

What If I Have an Asthma Attack?

No matter how hard you try, sometimes you may still have an asthma attack. As soon as you have asthma symptoms, follow the Yellow/Caution Zone on your Asthma Action Plan. If your symptoms don’t get better, or if you have a respiratory illness, call your doctor. If you treat asthma symptoms sooner, you have a better chance of keeping them from getting worse.

Your doctor may give you a new treatment plan to follow while you have symptoms or are sick. Asthma can be serious, and you may need a course of oral corticosteroids to open up your airways and help you breathe.

If you are sick, get plenty of rest. Drink water and eat healthy foods. Continue to avoid your asthma triggers. Don’t ignore it or try to push through it. That can make it harder to get your asthma under control if you need emergency treatment. It can also be serious.

Know your Red/Danger Zone signs on your Asthma Action Plan. If you move into the Red/Danger Zone, call 911 or go directly to the emergency room.

Proper asthma control year-round is key to staying healthy during September. Stick with your treatment plan, avoid your triggers, and pay attention to your asthma control. Then next year, you’ll be better prepared to face Asthma Peak Week.

This content is developed independently by AAFA and made possible by support from Amgen.

Medical Review: August 2024 by Neeta Ogden, MD