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While many heart conditions develop gradually over time, there are others that start before birth. Congenital heart disease refers to a variety of structural problems with the heart that happen while a fetus is still developing. (An individual type of congenital heart disease may also be referred to as a congenital heart defect.) It is the most common birth disorder in the U.S., affecting about 40,000 babies each year, with 800,000 adults living with the condition.

Congenital Heart Disease, Explained

There is a spectrum of severity of congenital heart defects. While about 25% of all babies born with congenital heart disease have a critical heart defect (CHD) that requires surgery or other medical treatment, other types are mild. Take a look at some of the most common congenital heart defects.

In some types of congenital heart disease, the specific causes are unknown. Others have a genetic component and are passed through families. A mother’s health history and lifestyle habits can also affect how a baby’s heart develops in the womb. The following risk factors in a mother have been linked to a baby’s development of congenital heart disease.

Having type 1 or type 2 diabetes, hypertension, obesity, thyroid disorders, or epilepsy

Taking certain medications such as phenytoin and retinoic acid

If you are considering starting a family and have concerns about your baby’s risk of a genetic heart defect, ask your doctor about testing options that may detect a congenital heart disorder during pregnancy. In addition, consult with your doctor if you are unsure if a medication is safe to take during pregnancy.

Congenital heart disease may affect any of the following heart structures:

The right atrium, one of the heart’s two upper chambers which receives blood without oxygen from other parts of the body

The left atrium, the heart’s other upper chamber which receives oxygen-rich blood from the lungs

The right ventricle, one of the heart’s two lower chambers which pumps blood without oxygen from the right atrium to the lungs

The left ventricle, the heart’s other lower chamber which pumps oxygen-rich blood to the rest of the body

Coronary arteries, which supply your heart with oxygen-rich blood

The heart’s four valves, which keep blood flowing properly through the heart

The septum, the wall of tissue separating the left and right sides of the heart

These are the most common types of congenital heart disease affecting U.S. adults. Symptoms, treatment, and diagnostic tests vary by heart defect.

Comprising about 20% of all congenital heart disease cases, ventricular septal defect is the most common congenital heart defect in babies. It is a small or large hole between the ventricles. Treatment depends on the size of the hole. If a hole is larger, surgery may be required within a baby’s first four to six months of life. There is often no additional treatment needed after surgery.

Most infants with ventricular septal defect also have a heart murmur, a swishing sound that is audible with a stethoscope. Other symptoms include fast breathing, high heart rates, frequent sweating, even while at rest, and poor weight gain.

Another common type of congenital heart disease, atrial septal defect is a hole between the atria. Many infants with this defect do not have any symptoms.

In about 80% of cases, the hole closes naturally. If the hole does not close, a child may need surgery or a non-surgical procedure known as an interventional cardiac catheterization. As with ventricular septal defect, this condition typically does not require additional treatment after the first procedure.

Tetralogy of fallot (TOF) is a congenital heart defect in which the wall that separates the ventricles — the ventricular septum — is abnormally positioned, with a hole. It can obstruct the flow of blood through the heart, in some cases causing heart muscle to thicken. All TOF cases require surgery, typically within a baby’s first year of life.

Patent ductus arteriosus involves the connection between the aorta and the heart’s pulmonary artery. While in the womb, a baby’s aorta and pulmonary artery are linked by a blood vessel called the ductus arteriosus, which allows blood to flow directly to the aorta. In healthy babies, the ductus arteriosus naturally closes not long after birth. In babies with this heart defect, the blood vessel remains open, potentially causing heavy blood flow to the lungs. 

There are a variety of treatment options for patent ductus arteriosus, including medications, non-invasive procedures, and surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help close a premature baby’s patent ductus arteriosus but typically aren’t effective for full-term babies, children, or adults. If a baby has minimal symptoms, surgery is often delayed until they are between 6 to 12 months old. However, if a baby is experiencing poor weight gain or rapid breathing, surgery may be recommended during their first six months.

Transposition of the great arteries (TGA)

About 10% of all babies with congenital heart disease have transposition of the great arteries (TGA), a problem with the positioning of the two main arteries that carry blood away from the heart to other organs. Babies born with this condition have low oxygen levels, which may cause a bluish tint to the skin. The condition requires a surgical procedure called an arterial switch operation shortly after birth. In most cases, heart function is restored to normal after surgery.

Aortic valve stenosis is an issue with the aortic valve, from which oxygen-rich blood travels to other parts of the body. In healthy babies, the aortic valve has three flaps that open and shut to accommodate the flow of blood. Babies with this defect may have a small aortic valve or the flaps may not function properly. This structural problem can block the flow of blood from the heart, which can put additional pressure on the left ventricle. Treatment depends on the specific issue with the aortic valve and may include a non-invasive procedure or surgery.

Living with congenital heart disease as an adult

Living with congenital heart disease as an adult varies significantly by individual and by condition, given the wide spectrum of these defects. Most adults with a congenital heart defect are regularly monitored by a cardiologist who specializes in congenital heart disease throughout their lives. In some cases, you may have to take additional precautions to prevent complications related to certain types of congenital heart disease such as the following:

Infective endocarditis, an infection caused by bacteria in the heart lining, or in a heart valve or blood vessel. If untreated, it can lead to a blood clot, heart valve damage, or heart failure

Arrhythmia, an irregular heartbeat which can affect the heart’s ability to pump blood and increase your risk of developing a blood clot

Pulmonary hypertension, high blood pressure in the arteries that run from the heart to the lungs

Care for your heart with support from Alto

At Alto, we make it as simple as possible to manage heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

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.

Rheumatoid arthritis is an inflammatory autoimmune disorder in which your immune system mistakenly attacks the lining of your joints, leading to pain and inflammation throughout your body. While it can cause discomfort, there are many effective treatment options that can help reduce the frequency of flare-ups and prevent the condition from progressing to a more advanced stage.

Understanding Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory autoimmune disorder in which your immune system mistakenly attacks the lining of your joints, leading to pain and inflammation throughout your body. While it can cause discomfort, there are many effective treatment options that can help reduce the frequency of flare-ups and prevent the condition from progressing to a more advanced stage. Read on for information about rheumatoid arthritis symptoms and treatment.

Like all autoimmune disorders, rheumatoid arthritis occurs as the result of an improper immune response. However, the specific triggers of this response have not been identified. Evidence suggests that there is a genetic component; some individuals may be more sensitive to certain viruses and bacteria that can trigger rheumatoid arthritis, and having a family history of rheumatoid arthritis is a risk factor for the condition, especially if you smoke or are overweight.

Rheumatoid arthritis affects about three times as many women as men, potentially due to estrogen levels and sex differences in the physiological effects of stress. Women are also more likely to experience a more severe form of rheumatoid arthritis.

The condition often first develops during middle age, but it can affect anyone of any age. Children and adolescents under 16 may experience a form of arthritis called juvenile idiopathic arthritis (JIA).

Rheumatoid arthritis is characterized by inflammation and pain in the joints. In most cases, the pain happens on both sides of the body — a symptom that distinguishes rheumatoid arthritis from other types of arthritis. Some individuals also experience joint stiffness that intensifies in the morning and after periods of physical inactivity.

Early-stage rheumatoid arthritis often affects your smaller joints — for example, the joints between your fingers and hands and toes and feet — before spreading to the wrists, knees, ankles, elbows, hips, and shoulders. Additional symptoms may include fatigue, fever, loss of appetite, and a feeling of weakness.

Symptoms may vary by individual, and they can also fluctuate over time. Many people experience flare-ups in which symptoms intensify, followed by periods of mild symptoms or none at all.

As a progressive condition, rheumatoid arthritis can become more severe if untreated. The inflammation damages your joints, which can lead to chronic pain, balance issues, or misshapen joints. It can also lead to problems in other important organs like your lungs, heart, and eyes.

Getting an early diagnosis makes a big difference in the prognosis and effectiveness of treatment. If you have any concerns about potential rheumatoid arthritis symptoms, contact your doctor as soon as possible for an evaluation.

The diagnosis process often involves several steps. Your doctor will first ask about your medical history and your experience of rheumatoid arthritis symptoms. They will then conduct a physical exam of your joints, checking for swelling, redness, and limitations in movement. 

After your physical exam, your doctor may recommend blood tests to check for antibodies and inflammation markers linked to rheumatoid arthritis, including:

An erythrocyte sedimentation rate (ESR) test, which examines how quickly your red blood cells sink to the bottom of a test tube. Higher rates of settlement may indicate inflammation.

A c-reactive protein (CRP) test, which identifies your blood levels of CRP, an inflammation-linked protein produced in your liver.

A rheumatoid factor (RF) test, which checks for rheumatoid factor, an antibody found in about 80% of individuals with rheumatoid arthritis.

Imaging tests like ultrasounds, X-rays, and magnetic resonance imaging (MRI) scans may also be used to support a diagnosis.

Rheumatoid arthritis is not curable, but there are a variety of treatment options that can help you manage the condition and prevent severe tissue damage.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil®), aspirin (Bayer®) or naproxen (Aleve®) can you help you manage pain and inflammation during flare-ups, as well as corticosteroids. Acetaminophen (Tylenol®) is also effective at reducing pain. Be sure to consult your doctor before taking any over-the-counter medication for an extended period of time.

Janus kinase (JAK) inhibitors such as baricitinib (Olumiant®), tofacitinib (Xeljanz®), and upadacitinib (Rinvoq®) can also help relieve pain and inflammation.

Other medications may be prescribed to slow the tissue damage caused by rheumatoid arthritis, including disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate (Rheumatrex®), sulfasalazine (Azulfidine®), and leflunomide (Arava®), which prevent your immune system’s response to triggers. If a traditional DMARD is not effective, your doctor may prescribe an injectable biologic DMARD, which targets a more specific pathway in your immune system. Commonly prescribed biologic DMARDs include etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), and certolizumab pegol (Cimzia®).

Many individuals with rheumatoid arthritis use cold compresses and ice packs or hot compresses and warm showers to treat inflammation and pain during flare-ups. Some people prefer a balance of hot and cold treatments.

Making lifestyle adjustments can improve your quality of life and lower your risk for RA-related health complications. 

While rheumatoid arthritis can affect your mobility and limit certain forms of exercise, it’s important to stay physically active. Gentle exercise like water exercise, tai chi, yoga, and stretching can reduce joint pressure and expand your joints’ range of motion.

Nutrition and diet choices can reduce inflammation and help you maintain a healthy weight. Avoid or reduce your intake of foods that may contribute to joint pain and inflammation including sugars and refined carbohydrates and gluten. In addition, consume alcohol in moderation.

Avoiding smoking and getting enough rest are also part of managing rheumatoid arthritis and preventing related health issues.

Since rheumatoid arthritis affects your immune system, those living with the condition often have a higher risk for other infections. Vaccines for the flu, pneumonia, shingles, and COVID-19 can protect you against illness. Check with your doctor about which vaccines you need.

Life with rheumatoid arthritis is easier with a reliable pharmacy partner by your side. Our pharmacists have specialized training in arthritis treatment and can answer any questions you may have, from medication side effects to non-pharmacological treatment options and navigating lifestyle changes. 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 your treatment.

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

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Heart failure, which affects approximately 6.2 million U.S. adults, can be a confusing term. Contrary to what many people assume, it does not mean that your heart no longer works, or has stopped beating, but rather that this vital organ cannot pump blood and oxygen as well as a healthy heart.

What to Know About Heart Failure

Heart failure, which affects approximately 6.2 million U.S. adults, can be a confusing term. Contrary to what many people assume, it does not mean that your heart no longer works, or has stopped beating, but rather that this vital organ cannot pump blood and oxygen as well as a healthy heart. While heart failure is a progressive condition with the potential for serious health complications, it can be managed through lifestyle changes and medication. Read on to learn about heart failure symptoms, causes, and treatment options.

In all cases of heart failure, the heart cannot deliver enough blood and oxygen to the rest of your body. Sometimes this is because weakened heart muscle leaves the heart’s main pumping chambers — the ventricles — unable to carry out their pumping function. This type of heart failure is called heart failure with reduced left ventricular function (HF-rEF). In other cases, the ventricles are too stiff to fill with enough blood between beats. This type of heart failure is called heart failure with preserved left ventricular function (HF-pEF).

Ejection fraction (EF) is an important measurement of heart function for those who have heart failure with reduced left ventricular function. Expressed as a percentage, EF measures the amount of blood pumped from the left ventricle when it contracts. An EF of 55 to 70% is considered a healthy range.

Since heart failure is a progressive condition, your EF gives your doctor insight into any changes in your heart function. An echocardiogram is the most common way to measure your EF, but a magnetic resonance imaging (MRI) scan or nuclear stress test may also be used.

Despite the importance of EF, it is not the sole determinant of heart function. Those who have heart failure with preserved left ventricular function may have a normal EF. These cases of heart failure are often caused by high blood pressure, which gradually thickens the ventricles. Stiff ventricles cannot relax enough to fill to their full capacity, which is why they do not pump out enough blood.

Heart failure can affect many other organs, including the lungs, liver, and kidneys. The potential for additional health complications increases as heart disease progresses, which is why it’s important to stay proactive about your health and follow your doctor’s recommendations for treatment.

Heart failure primarily occurs as the result of other health conditions that weaken or stiffen the heart. Coronary artery disease, the most common type of heart disease, is the leading cause of heart failure. The condition gradually narrows and thickens the arteries that supply your heart with blood and oxygen. Severe blockages in the arteries can prevent the heart from pumping enough blood, leading to the development of heart failure.

High blood pressure is another common cause of heart failure, particularly cases of heart failure with preserved left ventricular function (HF-pEF). If you have high blood pressure, your heart has to work harder to deliver blood to the rest of your body. Over time, this can make your left ventricle too stiff to properly pump out blood.

Both type 1 and type 2 diabetes are linked to heart failure, as high blood sugar can affect your blood vessels and cardiac nerves. Heart failure may also be caused by a variety of heart health conditions including cardiomyopathy, congenital heart disease, heart valve disease, and arrhythmias.

Lifestyle factors such as smoking, eating a high-cholesterol or high-sodium diet, heavy alcohol consumption, and a lack of physical activity may increase your risk for heart failure, especially if you have one of the conditions above.

These are some of the most common symptoms of heart failure:

Shortness of breath when exercising or lying down

Fatigue and a feeling of weakness in your legs

Swelling in your ankles, legs, and abdomen

A persistent dry, hacking cough or wheezing

There is a spectrum of severity of heart failure cases, and treatment varies by individual depending upon symptoms and heart function, as well as the underlying cause. If you have early-stage heart failure, your doctor may recommend lifestyle changes and prescribe medications that can alleviate symptoms and prevent the condition from progressing.

The following medication classes, many of which lower blood pressure, are commonly used to treat early stages of heart failure.

Angiotensin converting enzyme (ACE) inhibitors

Often used to treat high blood pressure, ACE inhibitors block production of a hormone that causes blood vessels to narrow, helping constricted blood vessels expand so that more blood can flow through.

Like ACE inhibitors, ARBs protect blood vessels from a hormone that causes them to narrow, lowering blood pressure.

Another medication class commonly used in the treatment of high blood pressure, beta blockers cause the heart to beat more slowly, which lowers your blood pressure and opens up your veins and arteries.

Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels so that the heart can beat with less force. This opens up narrowed blood vessels and lowers blood pressure.

If you have atrial fibrillation — an irregular heart rate condition — or another heart health condition, your treatment plan for heart failure may include anticoagulants, medications that reduce the blood’s ability to form new clots and prevent existing clots from growing.

Cholesterol-lowering medications such as statins may be used to treat those who have early-stage heart failure and high cholesterol.

Many people with heart disease retain fluid. Diuretics, also referred to as water pills, can help eliminate excess water and sodium, which reduces the heart’s workload.

Small lifestyle changes are an important part of managing mild to moderate cases of heart failure. They can help alleviate symptoms and slow the progression of the condition. Here are some of the lifestyle changes your doctor may recommend.

Avoiding or limiting your caffeine intake

Anyone can benefit from these lifestyle changes, even those who do not have heart failure. Heart-healthy living is a lifelong practice, and the best way to prevent health issues like heart failure in the future is to prioritize your heart health today.

Some individuals with more advanced heart failure may need a procedure such as coronary bypass surgery or an angioplasty, both of which target a blocked coronary artery. Pacemakers may also be used to help control the rhythm of their heart, often in tandem with a bypass surgery and medications. 

Protect your heart with support from Alto

At Alto, we make it as simple as possible to manage your risk for heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

Cystic fibrosis is a progressive genetic condition that primarily affects your respiratory and digestive function. More than 30,000 children and adults in the U.S. are living with cystic fibrosis. Currently, there is no cure for this condition, but it is manageable. With advances in treatment, people with cystic fibrosis are able to experience a better quality of life and live to a longer age. Here’s what to know about managing cystic fibrosis.

Understanding Cystic Fibrosis

Our bodies all produce mucus, digestive enzymes, and other fluids that lubricate our organs and tissues. People with cystic fibrosis have a genetic mutation that increases the thickness of these fluids. This can affect many organs in your body, particularly your lungs and digestive tract. Cystic fibrosis makes it more difficult for air to pass through your lungs and for the intestine to absorb vital nutrients. In more advanced stages, cystic fibrosis may result in severely impaired respiratory function. The thicker fluids can also trap bacteria, making individuals with cystic fibrosis more susceptible to a variety of infections.

Cystic fibrosis is caused by a mutation to a gene — the cystic fibrosis transmembrane conductance regulator (CFTR) gene — that affects how water and salt move through your body’s cells. Both parents must carry a mutated copy of this gene in order for a child to develop cystic fibrosis. However, having two carrier parents does not guarantee that a child will have cystic fibrosis; there is a 25% chance.

A child with just one carrier parent will not have cystic fibrosis, but they may become a carrier themselves, increasing their own children’s risk for the condition. Genetic testing can identify a child’s risk of developing cystic fibrosis or becoming a carrier. Tests may also be performed during pregnancy if you have concerns about your baby’s potential risk for cystic fibrosis.

There is a spectrum of severity in cystic fibrosis, and early symptoms may vary for different individuals. In some cases, symptoms first develop early during childhood or infancy, but in others, symptoms appear later in life.  Many primary symptoms are respiratory or digestive-related, including:

A persistent cough, often with thick mucus or blood

Another key trait of cystic fibrosis is very salty sweat, since the condition affects how salt moves through the body. If an individual has symptoms of cystic fibrosis, a sweat test, which measures the amount of salt in a person’s sweat, may be used to confirm a diagnosis.

Having an effective treatment plan for your individual needs is a big part of managing life with cystic fibrosis and will improve your comfort and quality of life. Your treatment plan may include airway clearance exercises, medications taken orally or via inhalation, and proper nutrition and fitness.

Airway clearance techniques use coughing or huffing to loosen the mucus in your lungs. These exercises are performed multiple times each day, often alongside medications like inhaled bronchodilators and antibiotics. A respiratory therapist can demonstrate different airway clearance exercises and help you find the best fit for your needs.

Several types of medications may be used to treat symptoms of cystic fibrosis or related health complications. Bronchodilators relax airway muscles and are available as an inhaler or in a vial for nebulizer use. Inhaled and oral corticosteroids can help reduce inflammation in the airways.

Mucus-thinning medications such as hypertonic saline and dornase alfa (Pulmozyme®) may be used to help you cough up mucus and clear your airways. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are sometimes used to treat airway inflammation. Some research indicates that NSAIDs are most effective in cystic fibrosis treatment for those between ages 6 and 17. Your doctor may also prescribe antibiotics to treat lung infections.

Many people with cystic fibrosis experience gastroesophageal reflux disease (GERD), commonly referred to as heartburn or acid reflux. Proton pump inhibitors including omeprazole (Prilosec®), lansoprazole (Prevacid®), and esomeprazole (Nexium®) and H2 blockers including ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®) may also be used to treat this condition.

An over-the-counter medication called polyethylene glycol (MiraLAX®, GoLYTELY®, and NuLYTELY®) can help reduce constipation, a common symptom of cystic fibrosis.

People with cystic fibrosis have to pay extra attention to what they eat. It isn’t uncommon for individuals with the condition to consume twice as many calories as others of a similar age, weight, and height, since they use more energy to breathe, fight lung infections, and compensate for poor digestion. Your doctor will make recommendations about nutrition and diet tailored to your individual needs, which may include treatments or medications to help you digest food, absorb nutrients, and maintain a healthy weight.

A consistent exercise routine is also an important part of managing cystic fibrosis, as it provides more energy for daily activities and improves lung function. Work with your care team to develop an appropriate fitness routine for your health needs.

Living with a chronic condition like cystic fibrosis affects many aspects of life, so it’s important to build a strong support system and take care of your emotional health. In addition to support from friends, family, and mental health professionals, there are many resources that can help you navigate life with cystic fibrosis and connect with others who share your experiences. As a starting point, explore what these leading cystic fibrosis organizations can offer:

The right pharmacy for your cystic fibrosis treatment

Here at Alto, we make it as easy as possible to follow the treatment your doctor has recommended. We offer free hand-delivery of your medication, 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, text, or chat.

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

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. 

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).

When inflammation persists, it no longer serves a helpful purpose. This type of inflammation, also referred to as chronic inflammation, occurs when your body consistently acts like it’s under attack, releasing white blood cells indefinitely. In the long term, an elevated white blood cell count can affect other organs such as your heart, lungs, and kidneys. Research has also found a connection between chronic inflammation and other chronic diseases including heart disease, diabetes, cancer, Alzheimer’s disease and Crohn’s disease.

Inflammation, Explained

Acute inflammation is the body’s natural way of fighting infections and injuries as part of the healing process. When you have an injury, blood flow increases as your body instinctively releases white blood cells, proteins, and other inflammatory chemicals to protect the wounded area. This leads to redness, swelling, and pain at the site of injury. The body reacts similarly when you have a virus or cold, but in these instances, the blood cells and inflammatory chemicals are released throughout the whole body rather than to one spot. This type of inflammation is good for you, as it allows your body to heal.

But when inflammation persists, it no longer serves a helpful purpose. This type of inflammation, also referred to as chronic inflammation, occurs when your body consistently acts like it’s under attack, releasing white blood cells indefinitely. In the long term, an elevated white blood cell count can affect other organs such as your heart, lungs, and kidneys. Research has also found a connection between chronic inflammation and other chronic diseases including heart disease, diabetes, cancer, Alzheimer’s disease and Crohn’s disease.

Read on for more information about the causes and symptoms of chronic inflammation and how to prevent or treat it.

Causes and symptoms of chronic inflammation

Several known factors can trigger chronic inflammation:

Lifestyle factors including obesity, diet, smoking, alcohol use, stress, and sleep disorders

Autoimmune diseases like type 1 diabetes or lupus, in which the body mistakenly attacks itself

Long-term exposure to pollution, industrial chemicals, or other toxins

Some individuals with this type of inflammation experience fatigue, fever, and joint and muscle pain. However, while there are clear physical signs of acute inflammation, chronic inflammation does not always have visible symptoms.

Your doctor can help determine if you have chronic inflammation. They will likely ask about your symptoms and perform a physical exam as a first step. They may then order additional tests to detect inflammation. These tests look for various indications of inflammation in your body, but they cannot formally diagnose inflammation or any other health condition. Rather, they provide a more comprehensive picture of your health so that your doctor can recommend the best next steps.

Potential tests your doctor may recommend during this process include a C-reactive protein (CRP) test and/or an erythrocyte sedimentation rate (ESR) test. A CRP test identifies your blood levels of CRP, a protein produced in your liver. Chronic and acute inflammation have both been linked to high levels of CRP.

An ESR test examines how quickly your red blood cells sink to the bottom of a test tube, with higher rates of settlement pointing toward more inflammation. Doctors often recommend this test when there is a possibility of high inflammation.

Sometimes these tests may help your doctor diagnose an inflammation-linked condition, such as rheumatoid arthritis or type 2 diabetes.

Chronic inflammation and other health conditions

There is a connection between chronic inflammation and many other health conditions. Inflammation can occur directly as the result of rheumatoid arthritis, which is both an autoimmune condition and an inflammatory disease. If you have rheumatoid arthritis, your immune system attacks your joints — often in your hands, writs, and knees — which leads to inflammation. There is also a direct link between inflammation and other inflammatory diseases, like ulcerative colitis and Crohn’s disease.

Inflammation has also been linked to heart disease and diabetes, but research into this connection is ongoing. While inflammation is more common in individuals with these health conditions, there is not yet definitive evidence that inflammation by itself directly increases your risk for these conditions.

Inflammation in the walls of your blood vessels has been linked to atherosclerosis, the accumulation of fats, cholesterol, and other substances in your arteries. In the long term, atherosclerosis increases your risk for a heart attack or stroke.

Since obesity, smoking, and physical activity are all risk factors for inflammation, heart disease, and diabetes, the overlap of these risk factors likely plays a role in the connection between the conditions. The good news is that a single healthy choice can lower your risk for all three diseases at once.

Your healthcare provider will recommend treatment based on the type of inflammation you have, however not all cases of chronic inflammation require medication.

Two types of medications are commonly used to lower both acute and chronic inflammation: nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil®), aspirin (Bayer®) or naproxen (Aleve®) and oral steroids including prednisone (Deltasone®, Prednicot®), methylprednisolone (Medrol®), and dexamethasone (Decadron®, Dexasone®). Steroid injections can reduce inflammation in a specific joint or muscle and are often used to treat rheumatoid arthritis.

If you have an inflammatory disease, your doctor may recommend medications specifically used to treat that disease. Medication classes commonly used to treat inflammatory diseases include:

Disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate (Rheumatrex®), sulfasalazine (Azulfidine®), and leflunomide (Arava®). These medications can slow the progression of rheumatoid arthritis.

Statins, a type of medication commonly used to treat high cholesterol. They have anti-inflammatory effects and can lower CRP levels.

You can also fight inflammation simply by what you eat. An anti-inflammatory diet includes antioxidant-rich foods like the following: 

Cherries, blueberries, oranges, and other fruits

There are also some foods that have been linked to higher levels of inflammation. If you have chronic inflammation, your doctor may suggest limiting your intake of the foods below as part of your treatment plan:

White bread, pasta, pastries, and other refined carbohydrates

Soda, fruit juices with added sugar, energy drinks, and other beverages high in sugar

Red meat and processed meat like hot dogs and sausage

Blog

Congenital Heart Disease, Explained

Understanding Rheumatoid Arthritis

What to Know About Heart Failure

Understanding Cystic Fibrosis

The Right Way to Use a Metered Dose Inhaler

What to Know About Nebulizers

Inflammation, Explained

Emphysema: Causes, Symptoms and Treatments

How to Keep Your Heart Healthy During the Holidays

How to Manage Asthma at Night

How Sleep Affects Heart Health & Tips for Better Sleep

How to Prepare for Cold and Flu Season

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