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Many medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD) are taken by using a metered dose inhaler (MDI), also referred to as a hydrofluoroalkane (HFA) inhaler. These handheld devices — one of several types of inhalers used to treat asthma and COPD — are pressurized canisters of aerosol medication in a plastic container with a mouthpiece. They use a chemical propellant to release medication from the canister. 

The Right Way to Use a Metered Dose Inhaler

Many individuals use a plastic tube called a spacer with their metered dose inhaler, which can help ensure that the full dose of medication is received. Spacers may also be used to reduce side effects of corticosteroid inhalers such as mouth and throat irritation. Ask your doctor if a spacer is right for your health needs.

Taking your medication exactly as prescribed is critical to managing symptoms of asthma, COPD, and other lung diseases. If you and your doctor have decided that a metered dose inhaler is a good method of medication delivery for your treatment plan, it’s important to learn about proper use and cleaning of the device. Below, we explain how to use a metered dose inhaler with and without a spacer and share other considerations when using these devices.

The steps below offer a general overview of how to use a metered dose inhaler correctly. Consult with your doctor for more specific instructions. If using your inhaler for the first time, or if it’s been at least two weeks since your last use, be sure to prime your inhaler by spraying several puffs into the air to ensure that it is working.

1. Remove the cap from the inhaler and shake the inhaler for a few seconds. If using a spacer, remove the cap from the spacer and place the inhaler into the open end of the spacer.

2. If you are using your inhaler without a spacer, exhale completely and place the inhaler’s mouthpiece in your mouth and seal your lips around it. If you are using a spacer, place the spacer’s mouthpiece in your mouth first and then exhale completely.

3. Begin to inhale slowly, pressing down on the canister once.

4. Continue to inhale slowly and deeply for about five seconds.

5. Hold your breath for ten seconds so that the medication can enter your airways.

6. If your doctor has instructed you to take more than one puff of your medication, repeat these steps as needed, waiting about a minute between puffs.

If taking a corticosteroid medication, rinse your mouth with water after each dose to prevent mouth and throat irritation and oral yeast infections. Using a spacer will also minimize the chance of these side effects.

Cleaning your metered dose inhaler and spacer

Most metered dose inhalers can be cleaned by removing the medication canister and rinsing the plastic container under warm running water. If you are unable to remove the canister from the container, wipe the mouthpiece with a cloth or cotton swab. Refer to the manufacturer’s instructions for your inhaler as needed.

To clean your spacer, remove the soft ring at the end and soak both the tube and ring in warm water with light soap. Clean and rinse thoroughly and let the pieces air dry.

Frequency of cleaning depends on how often you take your medication. Consult with your doctor about when to clean your inhaler and spacer.

Keeping track of medication in your inhaler

It’s important to keep track of how much medication is left in your metered dose inhaler so that you can stay on top of refills and avoid any missed doses. For many metered dose inhalers, the total number of puffs will be printed on the medication canister. You must discard your inhaler after you have used that many puffs even if your inhaler continues to dispense medication. Priming puffs count toward the total number of puffs.

If you use a metered dose inhaler every day to take maintenance medication, divide the total number of puffs in your inhaler by the number puffs you take every day. That number is how many days you can use your inhaler before you need a refill. If you use your metered dose inhaler as needed for quick relief, you’ll have to keep track of each individual puff. Some metered dose inhalers now come with built-in counting devices, and there are also external dose counters that can attach to the inhaler. Ask your healthcare provider for recommendations.

There are other delivery methods available for asthma and COPD medications. Your healthcare provider can advise you on the best option for your individual treatment plan.

Dry powder inhalers are another option for medication delivery. Like metered dose inhalers, dry powder inhalers are a small handheld device, but the medication is in the form of a dry powder. Many dry powder inhalers provide a visual indication that the full dose of medication has been delivered, which is helpful for many individuals, as well as a built-in dose counter.

You can also take most asthma and COPD medications using a nebulizer, which transforms liquid medication into a fine mist. Nebulizers take longer than inhalers to deliver medication, but they are often helpful for those who find it difficult to properly use an inhaler. Many children with asthma use nebulizers.

Our team of pharmacists is here to help you get started with your medication for asthma or COPD. We can walk you through the steps of using your inhaler, discuss potential side effects, and answer any other questions you may have. In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with managing your asthma. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Inhalers and nebulizers are both effective at delivering medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). A nebulizer is a device that transforms a liquid medication into a fine mist which is then inhaled into the lungs through a mouthpiece. While nebulizers take longer to deliver medications than inhalers, their accurate dosage delivery is often a good fit for children living with asthma and other lung diseases, and many adults find them helpful as well. Here’s what to know if you’re considering using a nebulizer.

What to Know About Nebulizers

Three types of nebulizers can be used to treat asthma, COPD, and other lung diseases like pulmonary fibrosis.

Jet nebulizers transform liquid medication into an aerosol or fine mist using an air compressor. They are the most common type of nebulizer.

Mesh nebulizers use a fine mesh to create an aerosol from the liquid medication. They are the newest type of nebulizer and emit the smallest particles.

Ultrasonic nebulizers create an aerosol through high-frequency vibrations. They are typically used in hospitals or at doctors’ offices.

There are different models of nebulizers, including portable, battery-run nebulizers that can be taken with you on the go and larger tabletop nebulizers that require an electrical outlet. These devices can deliver a variety of medications, including quick-relief medications that treat acute symptoms of lung diseases as well as longer-term maintenance medications. They may even be used to deliver more than one medication at once.

Your healthcare provider can advise you on the best method of medication delivery for your individual treatment plan. As you explore your options, be mindful of the key differences between nebulizers and inhalers.

Inhalers deliver medication quickly, but they require enough coordination to inhale and spray the medication at the same time. Some individuals, particularly young children, may find it challenging to properly use an inhaler. This can result in not receiving the full dose of medication.

To receive a dose of medication from a nebulizer, all that’s required is to breathe normally. However, nebulizers will take at least five to ten minutes to fully deliver the medication. You may want to ask your doctor which type of device they recommend for treating acute symptoms during an asthma attack or COPD flare-up.

If you and your doctor have decided that a nebulizer is a good fit for your needs, learning about proper use and cleaning of the device is a key part of managing your health. It will also ensure that you are taking your medication as prescribed. Be sure to follow your doctor’s instructions and review the manufacturer’s instructions for your nebulizer before using it for the first time, as there is some variation among these devices.

All nebulizers have a medicine cup, a mask and/or mouthpiece, an air compressor, and plastic tubing to connect the compressor to the medicine cup. Always wash and dry your hands before using your nebulizer and make sure that all the pieces of your nebulizer are clean. Pour the correct dose of your medication into the medicine cup and connect the tubing to the air compressor and medicine cup. Turn on your nebulizer and ensure that it’s properly working. You should see a fine mist coming from the mask or mouthpiece.

Once you see a mist appear, your nebulizer is ready for use. To inhale your medication, secure the mask over your nose and mouth or put the mouthpiece in your mouth. Sit upright and breathe normally. Taking slower breaths can help the medication enter your airways. Continue to breathe normally until the medication is gone from the cup.

Bacteria and other germs can grow inside of a nebulizer that has not been properly cleaned, so it’s important to clean your device after every use and disinfect it once a week.

After you’ve finished using your nebulizer, wash the mouthpiece or mask and the medicine cup in warm soapy water and let them air dry. For weekly disinfecting, soak these pieces in a vinegar solution for 30 to 60 minutes, or for the amount of time specified by your doctor or in the manufacturer’s instructions. Your doctor may provide you with a disinfectant solution, but if not, you can mix one part white vinegar with three parts hot water. After the pieces are done soaking, let them air dry. Put these pieces in a plastic container or bag and store it in a cool, dry place.

As part of nebulizer maintenance, you should replace the plastic tubing on a regular basis. Ask your healthcare provider how often to replace the tubing.

When deciding whether a nebulizer is a good fit for your needs, be sure to consider your health insurance benefits. Most insurance plans have separate medical and pharmacy benefits in addition to a Durable Medical Equipment (DME) section. Many nebulizers fall under the DME category of your policy. There may be restrictions on the brands, suppliers, or types of nebulizers that are available, and it’s important to check with your specific policy to understand what will be covered and under which sections.

Alto makes it easy to stay on top of your asthma or COPD treatment, with free hand-delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions by phone or chat. 

Inhalers and nebulizers are both effective at delivering medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD).

We explain how to manage asthma at night through a combination of asthma medications, healthy lifestyle choices, and good sleep hygiene.

How to Manage Asthma at Night

Have you noticed that your asthma symptoms like wheezing, shortness of breath, and tightening of the chest intensify in the nighttime? You’re not alone: nocturnal asthma symptoms are common, especially if you are living with more severe asthma. A Journal of Asthma study involving around 14,000 individuals with asthma found that 60% of those with chronic asthma experienced nocturnal asthma symptoms.

Below, we explain how to manage asthma at night through a combination of asthma medications, healthy lifestyle choices, and good sleep hygiene.

Nocturnal asthma occurs when your symptoms are noticeably worse at night. (If you experience intense symptoms at any time of day, including nighttime, you may need to reevaluate your overall asthma treatment plan with your doctor.)

If you have nocturnal asthma, you may experience the following symptoms while you sleep, and your sleep may be interrupted as a result.

Numerous factors can contribute to nocturnal asthma, including environmental triggers and your personal health history.

The presence of allergens like dust mites and mold can trigger asthma symptoms, especially if you have allergy-induced asthma. Dust mites are small pests that generate allergens. They often live in your pillows, blankets, and mattress, so exposure to them at night is common. In some cases, nocturnal asthma may also be a delayed reaction to exposure to an allergen during the day.

Inhaling cold air from an air conditioner or outside source may contribute to more intense asthma symptoms at night. In addition, sleeping in a reclining position causes your chest and lungs to experience additional pressure, which can also contribute to asthma symptoms. Elevating your shoulders and neck with additional pillows or lying on your left side with or without a pillow between your legs may help you sleep more comfortably.

Your circadian rhythm — the 24-hour natural process that regulates your sleep cycles — affects your nighttime levels of hormones like epinephrine, which relaxes and widens your airways, and histamine, which restricts your airways. Nightly fluctuations in these hormones may contribute to inflammation in your airways, prompting nocturnal asthma symptoms. You are most likely to experience nocturnal asthma symptoms when your epinephrine levels are at their lowest and your histamine levels are at their highest.

The following health conditions have also been linked to nighttime asthma:

Sinusitis, a condition in which there is increased drainage from your sinuses

Mental health disorders and chronic stress

If you have asthma and wake up several nights a week even after following your individual asthma treatment plan, consult with your doctor about additional treatment options. They can evaluate your symptoms, identify potential causes, and suggest modifications to your treatment plan if needed.

Common daily asthma medications can also help you manage worsening symptoms at night. Inhaled corticosteroids like Flovent® HFA and Qvar Redihaler®, which reduce inflammation and swelling in the airways, making them less likely to react to asthma triggers, are frequently prescribed for people who experience nocturnal asthma symptoms.

Quick-acting bronchodilators like albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) or levalbuterol (Xopenex HFA®) may also be used to treat acute asthma symptoms at night. These inhalers relax the muscles around your airways to make it easier to breathe and are taken on an as-needed basis for immediate relief of symptoms . Common side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches.

If you have any concerns about potential side effects of asthma medications, your doctor can explain more about the potential benefits and risks of taking corticosteroids or bronchodilators.

If allergens like dust mites are contributing to your nocturnal asthma symptoms, regularly washing your sheets, blankets, and mattress protector may help you avoid triggers. Wash bedding in hot water if possible, since this will help kill dust mites. In addition, maintain a comfortable temperature — 65-70 degrees Fahrenheit is a good range for many individuals with asthma — by making sure your room is well-insulated and shutting windows to keep cold air out. Using a humidifier to add moisture to the air inside your room can also help.

Better sleep hygiene isn’t a substitute for asthma medication, but getting a good quality of sleep at night can minimize the negative effects of any sleep disturbances you experience from nighttime asthma.

Avoid use of electronic devices like cell phones, tablets, and computers at least 30 minutes before you go to sleep, if possible. In addition to stimulating your brain, these devices emit blue light, which can affect your production of melatonin, a hormone that regulates your sleep.

Meditating and exercising before sleeping can also help you fall and stay asleep more easily, but avoid high-intensity exercise close to when you go to bed.

Create an environment that sets you up for a good night’s sleep. In addition to maintaining a comfortable temperature, make sure that your room is dark or dimly lit without distracting lights from electronic devices. You may also want to consider sleeping with your humidifier on, if you have one.

If you think you may have a sleep disorder like sleep apnea or insomnia, consult with your doctor for a diagnosis and treatment, in addition to taking the actions above.

Alto is here every step of the way to make it easy to manage your asthma symptoms at any time of day. Our team of pharmacists is available to answer questions about your asthma medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

 Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can support your asthma treatment plan.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Woman sleeping; asthma inhaler on bedside

When there are issues with your heart’s electrical signals it may beat too quickly, too slowly, or irregularly. This is called an arrhythmia. Learn more about the primary types of arrhythmias and the medications most commonly used to treat them.

Medications Commonly Used to Treat Arrhythmias

While a resting heart rate — the number of times your heart beats per minute when you’re at rest — will vary from one individual to the next, the healthy range for an adult is between 60 and 100 beats per minute. However, when there are issues with your heart’s electrical signals, which trigger each individual heartbeat, your heart may beat too quickly, too slowly, or irregularly. This is called an arrhythmia.

The best course of action depends on the type of arrhythmia you have and your overall health. Many cases of mild arrhythmias do not require any treatment. But your doctor may recommend medication to control or resolve your arrhythmia if there is a risk that your arrhythmia could cause more serious heart health issues.

Below, we explain more about the primary types of arrhythmias and the medications most commonly used to treat them.

Arrhythmias are categorized by the speed of the resulting heart rate and the area of the heart in which they originate.

A tachycardia is a fast heart rate, typically over 100 beats per minute when you’re at rest. There are many different types of tachycardias, including the following:

Atrial fibrillation is a rapid heart rate caused by irregularities in the electrical signals in the heart’s upper chambers, or atria. The condition may be temporary in some cases, but it often requires retreatment. It has been linked to more serious health issues including strokes.

Ventricular tachycardia is a rapid but steady heart rate caused by irregular electric signals in the heart’s lower chambers, or ventricles. The condition may lead to health complications depending on your overall cardiovascular health.

A bradycardia is a slow heart rate, typically under 60 beats per minute when you’re at rest. There are several types of bradycardias, including:

Sick sinus syndrome is a condition in which your sinus node — the heart’s natural pacemaker — doesn’t properly send electrical signals, causing your heart rate to beat slowly. (In some individuals, sinus node problems may result in a heart rate that alternates between too slow and too fast, which is also called bradycardia-tachycardia syndrome.)

Heart block, or atrioventricular block, is a condition in which electrical signals running through the atria don’t reach the ventricles. There’s a wide range in the severity of heart blocks, so they are subclassified into first-degree (mildest), second-degree, and third-degree (complete) heart blocks.

It’s also possible to experience a premature heartbeat, which often feels like a skipped heartbeat but is actually an additional beat. Premature heartbeats may occur when you are at rest, or they may be caused by stress, physical exertion, or stimulants like caffeine or nicotine.

For many individuals, premature heartbeats do not lead to more serious health problems, but it may trigger a more persistent arrhythmia in others. If you have a preexisting heart disease, you are more likely to experience complications as the result of a premature heartbeat.

Monitoring your heart rate and diagnosing an arrhythmia

Regularly monitoring your heart rate and heart rhythm can help you identify any potential issues in advance and avoid more serious health complications. Read our previous blog, ‘What Your Heart Rate Can Tell You About Your Health’ for additional guidance on measuring your resting heart rate. And if you have any concerns about your heart rate, consult with your doctor for an evaluation of any heart-related health issues.

To make a formal diagnosis of an arrhythmia, your doctor may use one or more tests to capture your heart’s rhythm. The process often begins with an electrocardiogram (ECG), a test performed in your doctor’s office in which patches attached to various places on your chest, arms, and legs record your heart’s activity.

If you have a chronic, consistent arrhythmia, the ECG may accurately capture your arrhythmia. However, if your arrhythmia is less frequent, an ECG may not necessarily give your doctor the information needed for a diagnosis. If that’s the case, they may recommend additional tests, including monitors you can use at home to record your heart’s activity over a longer period of time.

Treating an arrhythmia with antiarrhythmics

Antiarrhythmics help restore a regular heart rhythm by acting on the electrical currents that cause your heart to beat. They are most commonly used to treat tachycardias or premature heartbeats, and the majority are taken orally as a pill on an ongoing basis.

These are some of the most commonly prescribed antiarrhythmics and their side effects:

Amiodarone works by slowing down your heart’s nerve activity. It will likely take several weeks of amiodarone use before you experience the medication’s full effects.

It isn’t uncommon to experience nausea, vomiting, constipation, loss of appetite, abdominal pain, or a combination of these effects from taking amiodarone. For that reason, your doctor may recommend that you take amiodarone with meals.

Additional side effects include tremors, lack of coordination, weakness, fatigue, and difficulty sleeping. If any of these are severe or long-lasting, or if you experience more serious side effects such as abdominal swelling or painful breathing, contact your doctor right away.

Flecainide is typically started in the hospital if you are admitted for an arrhythmic-related health issue so that your doctor can closely monitor your response to it. It comes in tablet form and is usually taken twice a day. If you experience an upset stomach from the medication, your doctor may recommend that you take it with food or milk.

Flecainide is most effective when there is a constant level of it in your bloodstream so it’s important that you take it exactly as directed by your doctor. Abruptly stopping use of flecainide can cause serious health complications, so be sure to follow your doctor’s recommendations and consult with them if you have any concerns.

Common side effects of flecainide include nausea, vomiting, or diarrhea; loss of appetite; tremors; blurred vision; sleep disruptions; weakness; and dizziness or faintness. Contact your doctor if these side effects are severe or long-lasting. If you experience any severe side effects such as chest pain, yellow eyes or skin, fever, or difficulty breathing, contact your doctor as soon as possible.

Standing up slowly from sitting or lying down can alleviate dizziness and drowsiness caused by the medication. You should also ask your doctor if there are any activities to avoid while taking this medication given these side effects.

Propafenone acts on the heart muscle to improve your heart rhythm. It is typically taken three times a day. You may begin taking it in the hospital so that your doctor can observe how it affects you.

To maintain a consistent level of propafenone in your bloodstream, it’s important to follow your healthcare provider’s recommendations and to take the medication exactly as prescribed. If you have any concerns about taking this medication, consult with your doctor, as abruptly stopping use of propafenone may lead to an irregular heartbeat. One exception is if you experience excessive drowsiness or a slow or irregular heartbeat, in which case you should stop taking the medication right away and contact your doctor.

Side effects are less common with propafenone than with other antiarrhythmics. However, you may experience nausea, vomiting, constipation, diarrhea, loss of appetite, stomach cramps, weakness or muscle aches. Contact your doctor if you have any concerns about these side effects.

Ask your doctor about any possible food restrictions or necessary changes to your diet, as potassium can interact with propafenone.

Dronedarone is primarily recommended for individuals who have previously had atrial fibrillation but now have a normal heart rhythm. It can reduce the likelihood of being hospitalized for the condition in the future.

Your doctor will likely consider your overall health when determining if dronedarone is a good fit for you, as the medication may increase your risk for complications of other heart conditions. It is not typically recommended for individuals who have severe heart failure or worsening heart failure symptoms, or if your atrial fibrillation has remained consistent.

This medication has been known to interact with other medications, including other heart rhythm medications; antiviral medications like ritonavir; certain antibiotics including clarithromycin and telithromycin; certain antidepressants including amitriptyline, clomipramine, and nefazodone; antifungal medications like itraconazole, ketoconazole, and voriconazole; and antipsychotic medications like chlorpromazine, fluphenazine, and thioridazine. Make sure your doctor is aware of any medications you take.

Antiarrhythmics may also be administered intravenously in the hospital during a medical emergency. Ibutilide (Corvert®) and lidocaine (Xylocaine®) are two of the most commonly used antiarrhythmics that are administered through an IV.

General guidance about antiarrhythmic use

There are some general practices to follow when taking any medication in this class to avoid more serious health complications and manage side effects:

Inform your doctor of any underlying health conditions you have, as these may interact with your medication, especially kidney disease, congestive heart failure, liver disease, diabetes, or respiratory disease.

Your doctor may recommend exams, electrocardiograms (ECGs), and blood tests to monitor the medication’s effectiveness. Stay current with these follow-up appointments and lab work. 

Use caution when driving, particularly while you are still adjusting to the medication, and ask your doctor if there are any activities that you should avoid.

Depending on the type of arrhythmia you have and your overall health history, your doctor may also recommend calcium channel blockers or beta blockers. Here’s what to know about these medication classes.

If you have chest pain or high or low blood pressure in addition to your arrhythmia, your doctor may prescribe a calcium channel blocker. Commonly used to treat high blood pressure, calcium channel blockers open up narrowed blood vessels, allowing for more blood to flow to your heart. They are also used to treat arrhythmias since the opening of blood vessels can also slow your heart rate.

Most calcium channel blockers prescribed for arrhythmias are taken orally as pills, but some of them may be taken intravenously, which is when a medication is sent directly into your veins using a needle or a tube, typically in a hospital or doctor’s office.

Calcium channel blockers commonly used to treat arrhythmias include:

Common calcium channel blocker side effects include dizziness, constipation, and headaches. More severe side effects include rash or swelling in your legs and feet. Contact your doctor if you have any concerns about these side effects.

Beta blockers are commonly used to treat high blood pressure. Since they cause the heart to beat more slowly and less forcefully, they are also effective at treating tachycardias.

Beta blockers commonly used to treat tachycardias include:

Common beta blocker side effects include cold hands, fatigue, headache, and weight gain. They may also affect your digestive system.

If you have diabetes and take insulin, it’s important to check your blood sugar levels often while taking beta blockers as beta blockers may block typical signs of low blood sugar such as a rapid heart rate. Beta blockers are not typically used by people with asthma, as they may trigger severe asthma attacks.

If your arrhythmia puts you at a greater risk for blood clots or a stroke caused by a blood clot, your doctor may add an anticoagulant to your medication protocol. These medications reduce the blood’s ability to form new blood clots and prevent existing clots from growing. They will not address your arrhythmia, however, so they are typically taken in combination with one of the medications described above.

Choose a pharmacy that never skips a beat

At Alto, we’re committed to making it as simple as possible to manage your arrhythmia and strengthen your heart. We offer free same-day delivery and medication management tools like reminders and auto refills in our app. And our team of pharmacists is always here to answer your questions by phone or through the Alto app, and will even remind you when your medications are due for a refill.

Reach out any time via phone at 1-800-874-5881 or in-app messaging.

Pharmacist discussing medication with patient

Our pharamcists explain more about the various types of allergies, how an allergist or immunologist can help, and when it may be time to see one.

When to See a Healthcare Specialist for Allergy Treatment

There’s a wide spectrum of allergy conditions, from mild seasonal allergies to more severe symptoms that persist year round. It makes sense, then, that there is also a spectrum of allergy treatment options.

Some people are able to manage mild symptoms with occasional use of over-the-counter allergy medications, including oral antihistamines like Claritin®, Allegra®, and Zyrtec®; decongestants like Afrin® and Sudafed®; and nasal corticosteroids like Flonase® and Nasacort®. But if allergies impact your focus at work or school, or prevent you from living a more active life, you may consider consulting with a healthcare professional about treatment options.

In addition to your primary care provider, there are specialists with extensive training in allergy treatment such as allergists and immunologists. They can help you better understand the cause of your symptoms so that you can determine a more effective allergy treatment plan. Below, we explain more about the various types of allergies, how an allergist or immunologist can help, and when it may be time to see one.

There are many types of allergies, but all are produced by a reaction in your immune system. In people with allergies, the immune system interprets substances like dust, pollen, and pet dander as harmful. The immune system then kicks into defense mode, producing antibodies to attack the allergen, which in turn causes symptoms such as wheezing, sneezing, and itching in the eyes, nose, ears, or mouth.

There is often a hereditary component to allergies, so you may be more likely to develop allergies if you have a family history of the condition. While many allergies begin during childhood, they may also occur for the first time in adulthood. Some childhood allergies improve with time, but they can also reappear later in life after years without symptoms.

Here are some of the most common allergy conditions. 

Allergic rhinitis is a broad term for any sinus-related allergic reaction. Symptoms generally include watery eyes; itchy eyes, nose, ears, and mouth; runny or stuffy nose; sneezing; puffy eyes; and post-nasal drip. This reaction can be triggered by a range of allergens and may occur year round or seasonally.

Pollen and outdoor mold typically trigger seasonal allergic rhinitis — sometimes referred to as hay fever — while dust mites, pet dander, and indoor molds can trigger these symptoms at any time of year in certain individuals.

Asthma is a lung condition in which the airways narrow and become inflamed, making it difficult to breathe. Coughing, wheezing, and shortness of breath are some of the most common symptoms. As with allergies, there’s a wide spectrum of severity. For some individuals, asthma symptoms are an occasional annoyance, but for others they can be life-threatening.

Allergy-triggered asthma, which is relatively common in children, occurs when allergens affect the lungs and lead to asthma symptoms. Allergy-triggered asthma can result from allergens linked to both seasonal and year round allergies.

If you or your child suffer from allergy-induced asthma, allergy medications will likely be a part of your asthma treatment plan, but they are not a substitute for asthma medication. In addition to consulting an allergist, speak with your primary care provider as soon as asthma symptoms appear so that you can find the best treatment plan.

Many common skin conditions, including eczema and hives, are an allergic reaction caused by various triggers, including pet dander and certain types of medication or food. Part of an allergist’s role is to help you determine if a skin condition is allergy-related. A dermatologist can also help you understand the underlying cause of your skin condition and recommend treatment options.

For some individuals with severe allergies, exposure to an allergen can become life-threatening. This is called anaphylaxis, an extreme allergic reaction to food, medication, or venom. Bee stings or foods like peanuts and tree nuts are among the most common triggers of anaphylaxis.

If you have been diagnosed with anaphylaxis, your healthcare provider will likely prescribe epinephrine to use in the event of an emergency. This medication prevents anaphylactic shock from becoming life-threatening.

When should I see an allergist or immunologist?

Allergy and immunology is an area of medicine focused on the treatment of conditions related to the immune system, including allergies. Allergists and immunologists are specialists in diagnosing allergy conditions and asthma. (In the United States, the two roles are essentially interchangeable.) They can help identify the specific triggers of your allergy symptoms and prescribe the most effective medication for your allergies. To be certified by the American Board of Allergy and Immunology, these specialists must complete two or three years of study in allergy and immunology in addition to a three-year residency after earning their medical degree.

If your allergy symptoms persist after trying over-the-counter medications and consulting with your primary care provider, it may be time to see an allergist or immunologist for more lasting relief. And if you have used over-the-counter medications for longer than several weeks to treat allergy symptoms, you may also benefit from consulting a specialist, as these medications aren’t meant for long-term use and become less effective with time

Understanding the source of your allergy symptoms is key to effective treatment, and allergists and immunologists are able to help you identify your trigger(s). They may recommend a skin test in which they will lightly prick or scratch your finger with a small amount of a suspected allergen, like pollen. Then, they can watch how your body absorbs that substance to determine if you have an allergic reaction. They may also use a blood test to determine what’s triggering your allergies.

Avoiding allergens as much as possible plays a big role in controlling symptoms. However, if you are unable to avoid the substance that triggers your allergies, a specialist can recommend treatment options, including prescription medications and immunotherapy.

It may be possible to train your body to become less allergic to a specific trigger through a process known as immunotherapy. In this preventative treatment, a doctor will gradually give you larger doses of the substance that triggers your allergies. As you become exposed to larger amounts of the allergen, your immune system will become less sensitive to it. Ideally, this will help you experience fewer allergy symptoms when you encounter the allergen in the future.

There are several types of immunotherapy, including allergy shots and sublingual tablets, which are placed under the tongue. This treatment approach is most effective if a doctor has isolated one or more specific allergens as the source of your symptoms, which is why testing is so important.

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Alto makes it as simple as possible to follow the treatment your doctor recommends. Our team of patient care pharmacists will work with your doctor to get you the allergy or asthma medications you're prescribed at the best price, and we’re happy to answer your questions about medication side effects or any other health concern. Reach out any time through phone at 1-800-874-5881 or in-app messaging.

In recent years, dry powder inhalers have become increasingly common in asthma treatment thanks to their ease of use and portable size. Read on to learn how to use a dry powder inhaler correctly.

What to Know About Dry Powder Inhalers

Medications play a critical role in managing asthma by reducing the frequency and severity of symptoms and allowing for a more active life. There are a variety of asthma medications that your healthcare provider may prescribe for you, including quick-relief medications to treat acute symptoms and long-term control medications to prevent flare-ups.

Most asthma medications are taken via an inhaler. There are three types of inhalers used for asthma treatment: hydrofluoroalkane (HFA) inhalers, sometimes referred to as metered dose inhalers, dry powder inhalers (DPIs), and the less commonly used respimat inhalers.

In recent years, dry powder inhalers have become increasingly common in asthma treatment thanks to their ease of use and portable size, which makes them convenient to use if symptoms flare up unexpectedly. As with any device, proper use of your DPI is essential to receiving the full benefits of your medication, and it’s important to be mindful of several differences between DPIs and other inhalers. Read on to learn how to use a dry powder inhaler correctly.

A dry powder inhaler is a handheld device that allows you to inhale your asthma medication in the form of a dry powder. It is a breath-activated device, so it will activate and release your medication automatically as soon as you start inhaling. Unlike HFA inhalers, which use a chemical propellant to deliver a dose of your medication in aerosol form, DPIs do not contain any ingredient other than the medication itself.

Your doctor may prescribe a DPI because of  dosage reliability. With an HFA inhaler, it may be difficult to know that you’ve received the entire metered dose. In contrast, most DPIs are specifically designed with a spinning technology that ensures you receive the full dose of your medication. DPIs also typically give you a visual indication that the full dose has been delivered. For example, the Advair Diskus® has a built-in dose counter which updates after each use.

If your doctor prescribes your medication to be administered with a DPI, your prescription will include both the DPI device and the medication. Commonly prescribed DPI medications include the Advair Diskus®, the Pulmicort Flexhaler®, and the Asmanex Twisthaler®.

How to use a dry powder inhaler correctly

Here is a step-by-step breakdown of how to use a dry powder inhaler correctly.

Remove the cap from your dry powder inhaler if there is one.

Load a dose of medicine, if needed. Some DPIs have a supply of medicine in them already while others require you to load each dose of medication. Follow your healthcare provider’s guidance.

Tilt your head back and breathe out to empty your lungs as much as possible. Make sure to hold your inhaler away from your mouth while you exhale, as breathing into your inhaler can blow out some of the medicine.

Place the mouthpiece of your inhaler in your mouth. Close your lips tightly around the opening so that the medicine cannot get out.

Inhale quickly and deeply for 2-3 seconds. Since DPIs are breath-activated, it’s important to breathe deep and fast so that the right dose of medicine is triggered.

Once you have inhaled the powder, remove the inhaler from your mouth and hold your breath to let the medication settle into your lungs. Then exhale slowly.

If your doctor has prescribed more than one dose of your medication, wait about a minute before taking your next dose.

If you are using an inhaled corticosteroid, gargle and rinse your mouth afterward with water to prevent throat irritation and oral yeast infections, two potential side effects of this medication class.

You may not necessarily taste or feel the dry powder after taking your medication, but as long as you’ve followed the steps above, you will receive the full dose.

It’s normal to have questions when starting a new medication, and our team of pharmacists is here to offer guidance. We can walk you through the steps of using your inhaler, discuss potential side effects, and answer any other questions you may have. In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with managing your asthma.

To learn more or get started, reach out any time through in-app messaging or by phone at 1-800-874-5881. 

With effective treatment, including blood pressure medications, you can live an active life. Learn about the common blood pressure medications and their side effects.

Common Types of Blood Pressure Medications

High blood pressure, which affects nearly half of all U.S. adults, occurs when the force of the blood flowing through your arteries is consistently too high, forcing the heart to work harder. Over time, high blood pressure can damage major organs including the heart, brain, kidneys, and eyes and lead to life-threatening issues like heart disease, heart attack, and stroke.

With effective treatment, including both heart-healthy lifestyle habits and prescription blood pressure medications, you can control your blood pressure and live an active life. There are a variety of blood pressure medications, and it may take some time for you and your doctor to determine the best treatment for your needs. The good news is that with so many available and effective medications, you’re likely to find one that’s right for you. Read on to learn more about the most common classes of blood pressure medications and their side effects.

Diuretics lower blood pressure by helping the body get rid of excess sodium and water, reducing the volume of fluid in blood vessels. They are often a frontline treatment for high blood pressure, as research studies have found them to be one of the most effective blood pressure medication classes at preventing stroke and heart attack fatalities.

Diuretics commonly used to treat high blood pressure include:

Chlorthalidone (Thalitone®, Tenoretic®, and Clorpres®)

Hydrochlorothiazide (HydroDiuril®, Microzide®, and Esidrix®)

Common side effects of diuretics include dehydration, thirst, low sodium levels, headaches, and dizziness. In some cases, drinking more fluids isn’t enough to treat dehydration. Contact your doctor if you experience severe thirst, mouth dryness, or constipation; if your urine is a deep yellow; or if you have a bad headache. Taking multiple medications may exacerbate these side effects. To minimize medication interactions, speak with your doctor about the ideal timing of doses for each medication.

Some diuretics decrease your potassium levels, in which case you may experience weakness, leg cramps, or fatigue. Eating potassium-rich foods can help combat these side effects. Consult with your doctor about taking potassium supplements if you experience any of these symptoms.

Diuretics may increase blood sugar levels in people with diabetes. Adjusting your diet or the dosages of your diabetes medication(s) often addresses this issue. Learn more about how Alto can support your diabetes treatment.

Beta blockers cause the heart to beat more slowly and less forcefully, lowering your blood pressure. They also help improve overall blood flow by opening up your veins and arteries.

Beta blockers commonly used to treat high blood pressure include:

Common side effects from taking beta blockers include:

Beta blockers may block signs of low blood sugar such as a rapid heart rate in people with diabetes. If you have diabetes and take insulin, it’s important to check blood sugar levels often while taking beta blockers.

These medications may also affect your cholesterol and triglyceride levels. Most often, they cause a modest increase in triglycerides, a type of fat found in your blood, and a slight decrease in HDL (high-density lipoprotein), or “good” cholesterol. These changes are usually temporary.

Beta blockers aren’t typically used by people with asthma, as they may trigger severe asthma attacks. Abruptly stopping use of beta-blockers may increase your risk of a heart attack or other health complications, especially if you have been taking the medication for a long time. Consult with your healthcare provider about the potential risks and benefits of treating your hypertension with beta-blockers.

ACE inhibitors lower blood pressure by blocking production of a hormone called angiotensin II, which causes blood vessels to narrow. These medications help constricted blood vessels expand so that more blood can flow through.

ACE inhibitors commonly used to treat high blood pressure include:

With effective treatment, including both heart-healthy lifestyle habits and prescription blood pressure medications, you can control your blood pressure and live an active life. Read on to learn more about the most common classes of blood pressure medications and their side effects.

Blog

The Right Way to Use a Metered Dose Inhaler

What to Know About Nebulizers

How to Manage Asthma at Night

Medications Commonly Used to Treat Arrhythmias

When to See a Healthcare Specialist for Allergy Treatment

What to Know About Dry Powder Inhalers

Common Types of Blood Pressure Medications

A Guide to Common Asthma Medications

The Best Ways to Prepare for Seasonal Allergies

How to Manage Your Child’s Asthma

5 Science-Backed Ideas for Healthy Living

Understanding Chronic Obstructive Pulmonary Disease (COPD)

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