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An asthma attack is an acute flare-up of symptoms defined by sudden shortness of breath and difficulty breathing. Managing asthma attacks includes both proactively responding to symptoms when they arise and staying on track with treatment in the long term. Learn more here.

Treatment and Prevention of Asthma Attacks | Alto Pharmacy

Many individuals with asthma are familiar with the experience of an asthma attack — an acute flare-up of symptoms defined by sudden shortness of breath and difficulty breathing. These exacerbations vary in intensity and require efficient and prompt treatment.

Management of asthma attacks is twofold. To immediately address symptoms in the moment, work with your provider to identify your asthma attack warning signs and establish a treatment strategy. In the longer term, identify and avoid triggers and stay on track with treatment, so as to reduce the frequency and intensity of these flare-ups.

Here’s more on recognizing, treating, and preventing asthma attacks.

Effective management of an asthma attack starts by recognizing the signs and symptoms and understanding what to do when they occur.

While individual experiences of an asthma attack may vary, these are some common signs and symptoms. Your doctor can help you in identifying your individual warning signs of an asthma attack.

The following symptoms of a severe asthma attack warrant immediate medical attention:

Severe breathlessness or wheezing, especially at night or in the early morning

Difficulty speaking due to shortness of breath

No improvement from quick-relief medication

Everyone with asthma should have an asthma action plan that documents their treatment needs, including what steps to take when asthma symptoms intensify. Work with your doctor to create your individual asthma action plan.

If and when you experience a flare-up of asthma symptoms, follow the steps in your treatment plan. If your PEF readings fall between 51% to 79% of your baseline, a common first step is to take quick-relief or “rescue” asthma medications.

These medications are taken on an as-needed basis, as prescribed by your doctor, and relax airway muscles to open the lungs. They relieve shortness of breath and wheezing within minutes and can stop an asthma attack in progress.

Common quick-relief asthma medications include:

Albuterol (ProAir® HFA, Proventil® HFA, and Ventolin® HFA)

Inhalers are the most common form of quick-relief asthma medications. Albuterol and levalbuterol are also available as a liquid solution for nebulizer use.

A quick-relief medication may sufficiently relieve symptoms and improve PEF readings. If symptoms do not improve, emergency medical care may be necessary. Your asthma action plan should help you determine when to seek emergency care.

In many cases, asthma attacks may be preventable. When followed on an ongoing basis, the steps below can help lower your chances of experiencing an asthma attack.

1. Follow your treatment plan and take maintenance medications as prescribed (if applicable).

Many individuals with moderate to severe asthma take long-term maintenance medication in addition to a quick-relief medication.

These medications ease inflammation in the airways, preventing exacerbations and controlling symptoms. You must take them as prescribed every day to experience their benefits.

There are two main types of long-term asthma control medications:

Inhaled corticosteroids including Flovent® HFA and Qvar Redihaler® 

Combination inhalers that contain both corticosteroids and long-acting beta agonists (LABAs) including fluticasone and salmeterol (Advair Diskus®); budesonide and formoterol (Symbicort®); mometasone and formoterol (Dulera®); and fluticasone and vilanterol (Breo Ellipta®)

Asthma attacks may be caused by a variety of triggers including:

Each individual has different triggers. To identify yours, make a note of your asthma symptoms as they appear, including environmental factors that may have contributed to them. As you begin to learn your triggers, take necessary precautions to avoid them.

3. Avoid all cigarette smoke, including secondhand and thirdhand smoke.

Everyone with asthma can benefit from limiting their exposure to cigarette smoke, a frequent trigger of asthma attacks.

In addition to refraining from smoking yourself, avoid exposure to secondhand smoke and thirdhand smoke, the residual smoke that remains on clothing or surrounding indoor surfaces. (Don’t hesitate to ask your doctor for smoking cessation resources if needed.)

Allergic asthma accounts for 60% of all asthma cases in the U.S. and is triggered by allergens such as household dust mites, pet dander, and pollen. There are many ways to reduce the presence of allergens in your home, including:

Using the AC rather than opening windows when pollen counts are high

Using a dehumidifier to keep indoor air dry, which will in turn prevent mold growth and dust mites

Vacuuming at least once a week, ideally using a vacuum cleaner with a high-efficiency particulate air (HEPA) filter, which catches smaller particles like allergens

It’s especially important for those with asthma to stay current with vaccines, as respiratory infections like the flu can become more serious and/or trigger asthma symptoms.

Check with your doctor about which vaccines you need. For detailed vaccine recommendations by age group, reference the CDC’s recommended immunization schedules for children and adolescents and adults.

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

Reach out by phone at 1-800-874-5881 or in-app messaging to learn how we can support your treatment plan.

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.

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.

Treatment and Prevention of Asthma Attacks

Psoriasis is a skin disorder that occurs when new skin cells grow too quickly as the result of immune-related inflammation. It is characterized by thick patches of skin covered with white or silver scales. There are a variety of treatment approaches that help slow down the growth of skin cells and treat symptoms.

Psoriasis, Explained

Here’s what to know about the condition’s causes, symptoms, and treatment options.

Your body typically produces new skin cells over the course of several weeks. For those with psoriasis, new skin cells are formed in days. The excess cells accumulate on the surface of the skin, leading to the development of thick, scaly patches in most psoriasis cases.

Psoriasis scales may develop anywhere on the body. Some people have just a few small flakes on their scalp or elbow while others have larger patches covering much of their skin.

Individuals of all ages, sexes, races, and ethnicities may develop psoriasis. In the U.S., roughly one-third of all psoriasis cases develop before the age of 20. It is a lifelong condition, with the exception of a type of psoriasis that resolves after childhood.

The specific causes of psoriasis aren’t fully understood, however, the immune system, genetics, and environmental factors likely all contribute to its development. If one parent has psoriasis, you are more likely to also develop the condition. If both parents have it, your risk increases further.

Smoking can increase both an individual’s risk of psoriasis and the severity of the condition.

Psoriasis is not contagious and cannot be passed from one person to another.

For most people with psoriasis, symptoms fluctuate over time. Symptoms may be severe for a few days or weeks before clearing up. Some people then go on to experience years without symptoms. The periodic flare-ups are typically triggered by environmental factors such as the following:

Infections including strep throat and skin infections

Weather, especially cold temperatures and dry air

Skin injuries including cuts, scrapes, bug bites, and sunburns

While symptoms of psoriasis can vary significantly from one individual to another, common symptoms include the following:

White or silver scales, also referred to as plaques, on the inflamed patches

Soreness, itching, or burning sensations on or near patches of irritated skin

A basic physical exam is often sufficient in diagnosing psoriasis, as symptoms are both visible and distinct from those of other conditions. 

In cases where a diagnosis is less clear, your doctor may order a biopsy, which is a small sample of your skin. Biopsies are typically performed in a doctor’s office with a local numbing agent.

Your provider may refer you to a dermatologist who specializes in the treatment of skin conditions.

While there is no cure for psoriasis, there are many treatments that lessen skin inflammation and scales, remove plaques, and slow down the turnover of skin cells. Your doctor will recommend the best approach for your needs and symptoms, typically starting with less invasive options. 

Topical treatments, or medications applied to the surface of skin, are typically the frontline treatment for psoriasis. They slow down skin cell growth and reduce inflammation. There are several types of topicals:

Corticosteroids are anti-inflammatory agents that reduce swelling and redness, and the most commonly prescribed medications for mild to moderate psoriasis. They are available in many forms, including oils, ointments, creams, lotions, gels, and more. Mild corticosteroid ointments like hydrocortisone are frequently used for sensitive areas while stronger creams and ointments like triamcinolone (Trianex®) and clobetasol (Cormax®, Temovate®) may be used for less sensitive areas or patches that don’t respond to hydrocortisone.

Non-steroid topicals including synthetic forms of vitamin D such as calcipotriene (Dovonex®, Sorilux®) and calcitriol (Vectical®) may be prescribed as an alternative to steroids. Like steroids, these treatments can help control plaques. They may cause less irritation than other treatments.

There are also over-the-counter topical treatments in the form of lotions, foams, tars, shampoos, and more. The active ingredients salicylic acid and coal tar are FDA-approved for psoriasis treatment. Always consult your doctor before beginning an over-the-counter treatment.

Light therapy is often a first line treatment for moderate or severe psoriasis, alone or in tandem with medications. In this treatment, the skin is exposed to controlled amounts of natural or artificial light. There are many types of light therapy, from simple exposure to sunlight to controlled doses of UVB broadband and UVB narrowband light and more. Your doctor can help you determine if these therapies are appropriate for you.

If your symptoms are moderate to severe, or if they haven’t responded to frontline treatments, your doctor may recommend an oral or injected medication. Since some of these medications have the potential for more severe side effects, they are used for short periods of time or alternated with other medications.

Biologics, a class of medications that are derived from antibodies and act on your immune system to prevent inflammation

Retinoids, vitamin A-based treatment typically prescribed in a hospital setting for severe psoriasis. Due to the potential for birth defects, retinoids are not safe to take during pregnancy, or three years prior to pregnancy.

Cyclosporine (Sandimmune®) is an immunosuppressant medication that decreases your immune system’s response to ease psoriasis symptoms. Since it weakens your immune system, it can make you more susceptible to illness.

Methotrexate is another immunosuppressant that may be prescribed as an alternative to cyclosporine. There is the potential for serious side effects with long-term use, but when used in low doses in the short term, side effects are typically mild.

Managing psoriasis is easier with a reliable pharmacy partner by your side. Our pharmacists can answer any questions you may have about treatment, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

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

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the incubation team comes in.

Meet the Innovation Team Building Alto's Next Big Bets

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the innovation team comes in.

Newly launched in 2022, the team is small and scrappy by design. We’re a product manager, two engineers, a part-time designer, and a part-time manager with a single mission: to launch at least two significant new business experiments per year. If an experiment is successful, we’ll scale it into a full workstream before handing it off to a stand-alone product team.

We started with over-the-counter (OTC) medications. OTCs, or medications you can buy without a prescription, like Advil, are high-margin products that users are accustomed to purchasing at traditional, brick-and-mortar pharmacies. The goal of this experiment was to assess how much interest users have in adding OTCs to their order while checking out in the Alto app. We set a target conversion rate and offered OTCs only from our San Jose pharmacy, which is less busy than our San Francisco pharmacy but close enough to engineers in San Francisco for in-person troubleshooting.

Our initial hypothesis: if we present users with a small selection of OTCs targeted to their needs (based on the prescriptions in their cart), they’ll be more likely to convert. With support from our pharmacy partners, we carefully curated a recommendation algorithm that would suggest nine OTCs based on the medications already in the user’s cart.

In the interest of lean experimentation, we wanted a scrappy technical solution that could be implemented quickly while meeting our high user experience standards and minimizing operational risk. We settled on the following architecture:

We prioritized creating a clean API for Alto’s customer-facing app and using as much of our current infrastructure as possible. Although OTCs are distinct from prescriptions, we decided to reuse our existing prescription model rather than build a new one from scratch. This allowed us to leverage existing systems and operational workflows, reducing engineering time and risk of regression.

Behind the API, we opted to store our OTC formulary and associated metadata in in-memory data structures:

ADVIL = SkuId.new(sku: '...', sku_type: '...').freeze
CLARITIN = SkuId.new(sku: '...', sku_type: '...').freeze
FISH_OIL = SkuId.new(sku: '...', sku_type: '...').freeze
...
METADATA_BY_SKU_ID = {
  ADVIL.hash_code => {
    image_url: '...',
    name: 'Advil Ibuprofen 200mg Coated Tablets',
    quantity_description: '100 tablets',
    product_description: 'Easy to swallow powerful pain reliever for headaches, joint and muscle pain.',
  },
  CLARITIN.hash_code => {
    image_url: '...',
    name: 'Claritin 24 Hour Allergy Tablets',
    quantity_description: '30 tablets',
    product_description: 'Non-drowsy, 24 hour relief of symptoms due to allergies: sneezing, runny nose, itchy and watery eyes.',
  },
  FISH_OIL.hash_code => {
    image_url: '...',
    name: 'Fish Oil 500mg Softgels',
    quantity_description: '130 softgels',
    product_description: 'Dietary supplement with EPA and DHA omega-3 fatty acids to support heart health and maintain normal triglyceride levels.',
  },
  ...
}.freeze

This gave us a nice balance of speed and flexibility. We knew that we could optimize once we had established our OTC offering and gained an understanding of how it would evolve within Alto.

The results of phase 1 were a bit disappointing, but very interesting: the conversion rate of users who checked out with an OTC was just under our target. However, nearly half of all users who saw the experience would scroll down to peruse all nine OTCs that were offered.

Based on this positive sign of engagement, we hypothesized that perhaps we just weren’t showing the right OTC products to the user. For phase 2, we decided to scrap the limited recommendations and allow users to explore an entire catalog of OTCs.

Phase 2 required categorizing our list of OTCs into buckets such as “Top Sellers,” “Covid Care,” and “Allergy & Asthma.” We built a new fetch_categorized endpoint to return our OTC catalog structured by category, adding search functionality into the client so that users could quickly filter for a specific product. This search field was also heavily tracked with analytics events to help us learn which products to add to our catalog in the future.

This new experience immediately outperformed phase 1. After a few performance improvements (speeding up our catalog and product image load times), we eventually hit our target conversion rate — even managing to surpass it on some weeks!

Our eventing did show that a significant number of users with multiple prescriptions or smaller screens were not even seeing the OTCs in Cart, as they were pushed below the fold. We tried experimenting with alternate spots to show our catalog:

1. An interstitial that shows after Cart and before Checkout - this didn’t perform any better than the control and was quickly scrapped.

2. A single carousel at the top of Cart - this out-performed the control but at the cost of our guardrail metric. With a decrease in the overall checkout rate, we decided to stick with the control for now.

This phase of UI experimentation validated that our users wanted an offering of categorized OTCs. However, our initial technical solution wouldn’t scale as we rolled out to more of our pharmacies. The following questions led us to this conclusion.

How might we support changes to our OTC catalog on a per-pharmacy basis?

Given factors such as inventory, geography-related price sensitivities, and experimentation, we wanted to make sure that we could tweak the OTC experience for users getting deliveries from a specific pharmacy.

In the status quo implementation, that would have likely meant adding an additional layer to our data structures like so:

SKUS_BY_PHARMACY_AND_CATEGORY = {
  SF_PHARMACY_ID => [
    AddOnOtcCategoryType::TopSellers => [
      IHEALTH,
      FLONASE,
      ASPIRIN,
      ...
    ],
    ...
  ],
  ...
}

We weren’t worried about memory space limits given our relatively small number of pharmacies and OTC catalog. We were concerned, however, that each modification would require an engineer to go in and make code changes, get PR approval, and wait for a full deploy for the update to go live. This would be a bad use of engineering time, and our CI/CD process would become a bottleneck to otherwise quick modifications.

How might we add and remove OTCs from our catalog?

Similarly, we knew that adding and removing OTCs from our catalog would also be a somewhat regular workflow. There are some other considerations when adding a new OTC (Is it in our product database? Do we need any new procurement/inventory workflows to make sure it gets stocked in our pharmacies? Do we have a nice image to render in the app?), but we wanted to automate the technical side as much as possible — or at least be able to automate it.

The natural next step was to move our OTC catalog into the database.

Alto’s OTC Database Schema. Some columns excluded for brevity.

Now, rather than grabbing from in-memory data structures, we are efficiently querying the database for the OTC catalog of a user’s specific pharmacy, preloading all of the associated models needed for our API response.

OtcCategory
  .includes(otc_category_products: { otc_product: :otc_product_metadata })
  .where(otc_category_products: { pharmacy_id: pharmacy_id })
  .where(otc_product_metadata: { pharmacy_id: pharmacy_id })


At the time of writing, an engineer is still required to go in and make the changes at the database level. However, we plan to build an admin dashboard so that designated pharmacy partners can tweak our OTC catalog without the help of an engineer.

We’re excited about our next iteration, which will allow users to add OTCs to their upcoming deliveries at any point, not only when checking out. It will likely be live by the time you read this.

Once that’s released, we will continue to learn, iterate, and pay down technical debt — more specifically, maturing the OTC data model in our backend and eliminating the need for them masquerade as prescriptions.

Looking even further ahead, the innovation team has more exciting and impactful projects on our roadmap. We can’t wait to share what’s in store!

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. It can cause significant pain in some cases and is often a factor in female infertility.

Various forms of pain relief and fertility treatment can help address endometriosis symptoms and related health complications. Here’s what to know about the condition’s causes, symptoms, and treatment options.

Endometriosis: A Leading and Treatable Cause of Female Infertility

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. It can cause significant pain in some cases and is often a factor in female infertility.

Various forms of pain relief and fertility treatment can help address endometriosis symptoms and related health complications. Here’s what to know about the condition’s causes, symptoms, and treatment options.

The endometrium is the tissue that typically lines the lining of the uterus. Endometriosis occurs when this type of tissue grows outside of the uterus, most commonly in the ovaries, fallopian tubes, and lining of the pelvic cavity. It may also grow in the intestines, rectum, bladder, vagina, cervix, or vulva. In extremely rare cases, it may be found outside of the pelvic area.

Just like endometrial tissue that grows normally in the uterine lining, the abnormal tissue that characterizes endometriosis thickens and bleeds during each menstrual cycle. However, whereas normal endometrial tissue is shed with the cycle, the abnormal tissue cannot leave the body. This can lead to inflammation and scarring of the surrounding tissue, as well as adhesions that bind the pelvic organs to one another.

In cases of endometriosis where tissue grows in the ovaries, the condition may lead to the development of cysts in the ovaries.

There is a spectrum of severity of endometriosis cases, defined by the amount of excess tissue and resulting cysts, scar tissue, or adhesions. The level of pain, which varies by individual, does not always correlate to the stage or severity of the condition. Pain typically peaks during a menstrual period.

The specific causes of endometriosis have not been identified, but the medical community believes that the following factors may contribute to its development:

Retrograde or reverse menstruation, in which endometrial tissue flows backwards through the fallopian tubes and into the abdomen during a menstrual cycle

Transformation of the cells that line the inside of the abdomen into endometrial-like tissue as the result of hormone or immune factors

Transformation of embryonic cells into endometrial-like tissue during puberty as the result of hormone factors

Attachment of endometrial cells to an incision during surgical procedures such as a hysterectomy or c-section

Transport of endometrial cells to other parts of the body via blood vessels or lymphatic fluid

Issues with the immune system that keep the body from destroying abnormal endometrial tissue

In addition, the following risk factors are often linked to endometriosis:

Getting your first menstrual cycle at an early age

Having an abnormally short menstrual cycle (e.g., less than 21 days)

Abnormally heavy menstrual periods lasting beyond seven days

Other health conditions that prevent the flow of menstrual blood during a menstrual period

There is also evidence that endometriosis may have a genetic component. You may have a higher risk of developing it if you have a mother, sister, or aunt with the condition.

Common symptoms of endometriosis include:

Pain, especially severe menstrual cramps in the abdomen or lower back

Painful urination or bowel movements during menstrual periods

Gastrointestinal issues including diarrhea, constipation, and nausea

Endometriosis can look very different from one individual to another, with varying experiences of symptoms. In some cases, the condition may not be accompanied by any noticeable symptoms.

How endometriosis affects female fertility

Endometriosis is a leading cause of female infertility, as abnormal growth of endometrial tissue can block the fallopian tubes, preventing the fertilization of an egg. It accounts for 24-50% of all female infertility cases, and one-third to one-half of individuals with the condition experience difficulty conceiving.

In mild or moderate cases of endometriosis, surgery to remove adhesions, cysts, and scar tissue is all that is needed to restore fertility. In other cases, additional procedures or fertility treatment may be required.

Getting an accurate diagnosis is critical to effectively treating the condition. However, the diagnosis process can be lengthy, with multiple steps, as symptoms frequently overlap with those of ovarian cysts, pelvic inflammatory disease, and irritable bowel syndrome (IBS).

An evaluation for endometriosis begins with a conversation about your health history. Several tests may be used during the diagnostic process, including the following.

A transvaginal or abdominal ultrasound, which provides images of your reproductive organs to help your doctor identify cysts potentially related to endometriosis

A laparoscopy, a procedure that inserts a small camera through the abdomen with the goal of directly identifying endometrial tissue outside of the uterus. This is the only procedure that can definitively confirm a diagnosis of endometriosis.

Severe pain from endometriosis can affect daily activities, and there are a variety of pain relief options, including both medications and surgery. Your doctor will likely try non-surgical interventions as a starting point and recommend procedures if the condition does not respond to initial treatment.

The following treatments may be used to treat discomfort caused by endometriosis or related health issues:

Over-the-counter pain medication such as ibuprofen

Supplemental hormones including the male hormone androgen, which can regulate hormonal production or minimize fluctuation to prevent abnormal tissue growth

Hormonal birth control including pills, patches, and vaginal rings, which prevent abnormal tissue growth by decreasing fertility

Gonadotropin-releasing hormone (GnRH) agonists, which block the production of estrogen to prevent menstruation

If symptoms do not improve after the treatments above, your doctor may recommend surgery. In addition to its usage during the diagnosis process, a laparoscopy can remove abnormal endometrial-like tissue. 

A hysterectomy, which removes the uterus and cervix, is typically reserved for severe cases. The procedure permanently affects your fertility, and you will not be able to become pregnant after the procedure. It’s important to consult your doctor about your options as well as your reproductive goals before moving forward.

In vitro fertilization (IVF) — a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy — can help individuals experiencing endometriosis-related infertility conceive.

In cases where fallopian tubes are blocked or severe scar tissue is present, your doctor may recommend proceeding directly to IVF before trying to conceive naturally.

Since 2016, Alto has supported more than 50,000 fertility journeys. We understand that fertility treatment is a significant investment — physically, emotionally, and financially — and we see ourselves as a partner in your health.

We offer free, same-day delivery seven days a week and temperature controlled packaging to ensure that your fertility medications always arrive in the right condition. And our fertility-trained pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to offer any support you need.

All air quality significantly impacts your respiratory health, not just outdoor air pollution. Indoor air is often filled with irritants including smoke, allergens, and chemicals. These substances can irritate the lungs and airways, causing inflammation and reducing lung function, which refers to how well your lungs work.

How to Improve Indoor Air Quality at Home

Given that the average American spends approximately 90% of their time inside, it’s important to keep the air inside your home as clean as possible, especially if you are susceptible to seasonal allergies or have respiratory conditions such as asthma or COPD.

Use the simple precautions below as a starting point for better breathing at home.

Exposure to secondhand smoke, or exhaled cigarette smoke, adversely impacts respiratory health. It is a contributing factor to the development of COPD and may also cause a flare-up of COPD symptoms, also referred to as an acute exacerbation. For some individuals with asthma, secondhand smoke can trigger an asthma attack, which is defined by sudden shortness of breath and difficulty breathing.

Thirdhand smoke, or the residual smoke that remains on clothing or surrounding indoor surfaces after a person smokes, is an additional health risk that affects air quality.

Avoiding all indoor smoking is one of the most important actions you can take to improve indoor air quality at home. Of course, outdoor smoking also contributes to lung diseases. In addition to limiting your exposure to secondhand and thirdhand smoke at home, ask your doctor for support with smoking cessation if needed.

2. Avoid cleaning products with certain chemicals and strong scents.

Certain household products are worse for your respiratory health than others. Some disinfectants, personal hygiene products, and cleaning supplies contain chemicals known as volatile organic compounds (VOCs), which can tighten the airways and make it more difficult to breathe. Examples of common VOCs include formaldehyde, benzene, and toluene.

Ammonia, hydrogen peroxide, and chlorine bleach are other chemicals that should be avoided, along with scented products.

As an alternative, opt for natural, non-toxic products. You may even be able to create cleaning solutions from ingredients that are already in the house. Try using baking soda or a mixture of soap and water to scrub and wipe down surfaces. A combination of vinegar and water can be used to clean glass.

If you are using a product that contains a VOC or other harmful chemicals inside of your home, ventilate the area as much as possible by using exhaust fans and opening windows and doors. ​​You may also want to invest in an air purifier, which extracts irritants from the air.

Household allergens including dust mites and animal dander can trigger asthma symptoms and COPD exacerbations. Unfortunately, dust mites love to make themselves comfortable in your pillows and blankets as much as you do, so regularly wash pillows and bedding. Consider using dust mite pillow and mattress covers.

It’s best to vacuum at least once a week, ideally with a high-efficiency particulate air (HEPA) vacuum that catches smaller particles like allergens. An air purifier can also be used to remove allergens from indoor air.

During prime allergy season, avoid bringing pollen inside by changing and washing your clothes and removing your shoes after time outdoors. Dry clothes in a dryer instead of on a clothesline, where they’re likely to gather more pollen.

Dust mites aren’t the only indoor allergen to avoid. Mold exposure can also intensify symptoms of allergies, asthma, and COPD.

Moisture is typically the underlying cause of mold growth inside the home. As part of your allergy-proofing efforts, use a dehumidifier to keep indoor air dry during more humid seasons. (This can also help keep the dust mites away!) Keep bathrooms well ventilated and remove any visible mold as quickly as possible.

In addition, try to increase ventilation in the bathroom and kitchen, as well as other areas where steam accumulates. Use a fan or crack open a window when showering or cooking.

5. Clean air filters and increase ventilation.

There are steps you can take to keep clean air flowing throughout your home as much as possible.

First, change any filters in your home’s heating and cooling systems on a regular basis. If your house or apartment has a forced-air heating system — which uses air ducts and vents to circulate temperature-controlled air throughout your house or apartment — it’s especially important to change the filters regularly.

In addition, make sure that any air ducts inside of your home are clean, since they are a frequent source of dust accumulation.

If pollen is low, opening windows to let outdoor air flow throughout the building may also help improve indoor air quality. Most weather apps include a local daily pollen count.

Alto Pharmacy is here every step of the way to help you manage respiratory conditions like asthma, COPD, and allergies. Our team of pharmacists is available to answer questions about your medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

While fertility treatments like in vitro fertilization (IVF) have become an increasingly common path to parenthood, helping millions of individuals conceive throughout the past four decades, they remain a significant financial investment.

How Alto Lowers the Cost of Fertility Treatment Through Better Medication Management

Fertility medications used to support egg production, retrievals, and implantations frequently factor heavily into the overall cost of treatment. An average IVF cycle costs between $10,000 and $15,000, with medications an additional $5,000 or more depending on factors like a patient’s age and health history and a clinic’s treatment approach. Unfortunately, a portion of these medications often go unused, as many fertility treatment plans involve last-minute medication changes unsuited for the traditional retail pharmacy model.

As part of our commitment to your financial well-being, we offer a medication management experience that reduces fertility medication waste to lower the cost of treatment, developed in collaboration with Progyny. Take a closer look at our approach.

IVF is a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy. Multiple medications are used on a precisely timed schedule to grow follicles — fluid-filled sacs in the ovaries that potentially contain an egg — retrieve eggs, and, finally, implant a fertilized egg into the uterus. 

Here’s a snapshot of a typical IVF medication schedule:

Days 1-4: stimulation medications such as Gonal-f®, Follistim®, Menopur®, or Low-Dose hCG to stimulate egg production, so that you produce multiple follicles

Days 5-10: continuation of stimulation medications and introduction of antagonists such as Fyremadel™ (ganirelix acetate) and Cetrotide® to prevent premature ovulation

Days 10+: trigger shots of leuprolide acetate, Ovidrel®, and/or Novarel®/Pregnyl® to stimulate final growth spurt and ovulation

After transfer: estrogen and progesterone to support successful implantation of the embryo

Fertility medications are complex, with nightly dosages dependent upon hormone levels measured through bloodwork and ultrasounds. Not only do medication protocols vary from one individual to another, they are typically adjusted throughout the course of a cycle as hormones fluctuate.

Unused medication during fertility treatment

To prevent any missed doses, providers typically prescribe all medications that could be needed in bulk at the beginning of fertility treatment. However, dosages often decrease once a cycle is underway based on a provider’s discretion, ultrasounds, and bloodwork.

At traditional pharmacies, patients undergoing fertility treatment might end up paying for unused medication, as all potential medications are filled upfront. This contributes to the $5.4 billion epidemic of medication waste in the U.S. — one that is particularly acute in fertility, leading some individuals to buy and sell excess medication to each other on social media sites.

Our approach to fertility medication management

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