All About Telehealth for Asthma Telehealth allows doctors to care for people virtually over a phone call, text message, or most commonly, video chat. Although some situations require an in-person visit, telehealth is a great option when you can't get to the doctor's office for your asthma. If you're new to telehealth, here's what you need to know. Medicare will cover telehealth visits just like in-person visits, but state Medicaid programs and private insurers vary, so confirm your coverage in advance. With telehealth, even though you're not in the doctor's office, your private health information is still covered by HIPAA, so it will remain confidential and secure. Although your asthma specialist can't give you a physical exam via telehealth, they can write prescriptions and offer quality care, especially if you prepare in advance. Before your telehealth appointment:- List any asthma symptoms (including dates and severity), such as chest tightness, shortness of breath, or wheezing- Keep note of triggers, like allergies, exercise, environmental factors, the cold or flu, and even time of day- Document any side effects from your asthma medications, including muscle weakness, cataracts, elevated blood sugar, high blood pressure, or psychological reactions- Compile a list of your health conditions and all medications- Track how many inhaler puffs you take each week- Record your weight and vital signs if you own a thermometer, blood pressure monitor, glucose monitor, or another device- Write down any questions you have for your asthma specialist- Charge your computer or phone- Make sure your internet is reliable- Download any telehealth apps your specific provider may require- Find a quiet, private space to conduct the call- Be prepared with pen and paper or a note-taking app Turn to Healthgrades to connect with the right specialist to treat asthma via telehealth. And share this video to spread the word!

Trent: It's far more uncomfortable now when I have a severe asthma episode. If you've ever known what it's like to just naturally breathe without thinking about it, when you have to pay attention and think about it, it feels like you're being smothered. Dr. Parikh: Hi, I'm Dr. Chiti Parikh. Severe asthma is a chronic lung condition characterized by inflammation in the airways. We're here with two patients today. We'll discuss their stories and what works for them and doesn't. John: My life has changed drastically because of asthma. Two years ago I was very heavy. I was over 500 pounds because of steroids, because of asthma. I had a near death experience. I let my asthma get out of control. I stopped taking my medicine and I had a huge asthma attack in my house. EMS gets to my house and they say, "I'm sorry. No one here is ALS certified." So they couldn't give me epinephrine. Basically, I had a paramedic look at me dead in the eye as I'm code blue and say, "I'm really sorry." Trent: Oh that's crazy. Dr. Michaud: Oh my goodness. John: Yeah. Dr. Parikh: Oh my god. John: And I was in the back of an ambulance for five minutes on the way to the hospital, just praying and pleading that I would get a second chance. I got there and thank god, you know, everything worked out well. Dr. Parikh: Mm-hmm (affirmative). John: And I took that opportunity to better my health, and I lost the weight. And I've noticed a night and day difference with my asthma. Dr. Michaud: I think having a very significant event is often life changing. With a significant event, it's in a teachable moment, but you have to take that opportunity and sit down and say, "Listen, you know what, you really could have died." Trent: As a kid, nobody took it seriously. And as an adult, it finally got my attention. And once I started seriously taking my medicine on a regular basis, I made sure I got a really good asthma doctor and that made a huge difference. The more I invested in taking my health seriously, the better I got. Dr. Michaud: Get a really good doctor but then listen to what they have to say. Compliance is the key to success with asthma control. Dr. Parikh: John, what does it feel like when you're having an asthma attack? John: It's like the whole world is on top of my chest and you just can't catch your breath. And nothing you do can, you know, get air into you. Trent: You're thinking about it. Dr. Parikh: Yeah. Trent: You don't think about breathing. John: But when you're going through an attack that's all you're thinking about. Trent: It's terrifying and if it's at night, whatever sleep you've got is gone. Dr. Michaud: You know, when you think about severe asthma, you also have to think about, what are the things in the environment that are actually probably triggering the asthma more frequently? John: Going over someone's house and them having a pet, or you know, dampness in a room. Anything is a trigger I've learned. Trent: I'll go to a house and I'll not know that they have a cat. And they're like, "Oh are you feeling it?" And it's like, it could be really bad or it could be nothing. John: I lived through parts of my life where I sheltered myself, and I stood home, and I stood inside but eventually enough is enough. And you know, what are you gonna do? You can't let asthma hold you back.

John: You can't let your asthma define who you are. There's much more to life than being an asthmatic. Dr. Parikh: Hi, I'm Dr. Chiti Parikh. We'll discuss diet and lifestyle changes that can really have a significant impact on managing symptoms of severe asthma. John: Asthma held me back for years from playing sports as a kid, and eventually you just say, "enough is enough," and you don't let the ailment keep you back anymore because this world is huge. I feel like not enough people realize how much weight and eating factor into asthma. Dr. Parikh: With any kind of condition, exercise always good for you, but sometimes with asthma, it can actually trigger asthma symptoms. Dr. Michaud: You're correct. Exercise actually is a natural bronchodilator. It opens up the airways and holds them open, so we are really good about wanting people wanting to exercise if they possibly can. Some of the tricks are actually using your inhaler before exercise to allow you to do it. So use your bronchodilator 30 minutes before you're going to exercise. Dr. Parikh: Are there certain forms of exercise that can be gentler? Dr. Michaud: Cardiovascular exercise, in general, is really good for you. I think you need to do a combination of things to maximize your muscle strength but also trying to make sure that you're doing cardiovascular exercise, keeping your weight down. John: I work out every day. I do a lot of running now, and I do a lot of light weightlifting. For me, it keeps my lungs open. It keeps my asthma decent. Trent: As a kid, exercise-induced and the cold would get to me. Years ago, a friend said, "Oh, let's do this sprint triathlon," and I was like, "This is crazy. I'm never going to do that." Then I signed up, and we did it. I was so surprised that I was capable of doing it, but I have learned the more I run, the healthier I get, the better I breathe. I still wheeze, but I have great lung capacity. Dr. Parikh: What role does food allergies play in asthma? Dr. Michaud: It's not all allergies. Some of it are even sensitivities, so it really depends on what your allergy profile is and to know what the overlap is. Is it really that it's causing the asthma or is it actually causing very severe allergies? John: When I was younger, I was allergic to a lot of proteins. I was allergic to shellfish. I started to grow out of a lot of my food allergies, and I noticed that I could get away with eating a little bit more and it wasn't bothering me. Trent: I like healthy food, and I think healthy food likes me. I still drink a lot of hot coffee. Dr. Michaud: Caffeine is one of those medications that we use in small babies to actually help them with their breathing. It's a respiratory stimulant. Dr. Parikh: You always have to make sure you don't overdo it because- Dr. Michaud: Correct. Dr. Parikh: If you're taking bronchodilators, that can raise your heart rate, and the caffeine can do that too, so- Dr. Michaud: Correct. Dr. Parikh: You have to be careful with those things. Dr. Michaud: Yeah. I tell patients all the time, "Your lungs are like any muscle in your body. If you don't use it, you lose it," and it's really important to know that you don't turn around overnight. You have to actually build. Controlling what you're eating, controlling the timing of eating really can play a very significant role.

John: The first thing someone should do when diagnosed with asthma is always listen to your doctor. In the long run, they'll help you, and if you stay on track, you will never suffer a major episode where it'll take away from your normal life. Dr. Parikh: Hi, I'm Dr. Chiti Parikh. There are many treatment options available for severe asthma. Let's talk about them in more detail. Dr. Michaud: Severe asthma is asthma that, despite being maximally medically treated, they still have daily symptoms. They're waking up at night, they're requiring hospitalizations, emergency visits. Dr. Parikh: John, what type of treatments have you been on? John: Every day I take an inhaled steroid. I take my nebulizer. But when I have an attack, I get put on oral steroids. Trent: Once or twice a year, I may be on steroid pills. Now I'm on a leukotriene inhibitor that I take once a day, allergy pill du jour, a steroid inhaler every day. Dr. Parikh: So what are the treatment options for severe asthma? Trent: We're going to say that the patient is medically optimized. So they're on their regular inhalers, their inhaled steroid, a bronchodilator, and they have the rescue inhaler. Then what we start doing is we get into a category of what we call add-on treatments. Generally, we have three categories. We have the allergic asthma-type medications to try and decrease their IgE levels. So that's usually an injection once a month. Then we get into a category of biologic, that are given usually by injection, that try to control the disease and kind of control that pathway that actually causes the airways to be twitchy. Then endoscopic treatments, so going in through the airways and kind of burning those airways to try and get them to stop being so twitchy. Now what we're trying to do is trying to profile patients and figure out which ones they actually do respond to. Dr. Parikh: What are the other risk factors of not taking your medications? Trent: The simple things are you end up missing work. You miss out on life. With asthma you get these twitchy airways, and they collapse. Over time those airways can scar, which means that they're fixed. So you can actually develop like scarring of those small airways that is irreversible. So you take something that is a reversible disease and you make it irreversible, so there's no way to control that disease readily anymore. Dr. Parikh: What is important to getting things like vaccinations? Trent: It's extremely important with chronic lung disease, and asthma is a chronic lung disease. An episode of flu or a pneumonia could be life-threatening for somebody with chronic lung disease. Dr. Parikh: John, can you share some tips for other patients that have severe asthma? John: Always, always take your medicine, no matter what, and know what's in the environment around you. There could be a trigger anywhere, and it'll get you when you least expect it. Trent: Make sure you get the best doctor you possibly can. When you are under control, life is so much better, and you really need that physician to be your partner.

Vanessa: The worst times for me are the winter. The heat's on, there's not a lot of moisture in the air, my sinuses become really dry. Dr. Greenspan: The airways are lined with smooth muscle, and in the same way that our skeletal muscles get tight when we're in the cold, the smooth muscle of the airways have a similar impact. So, a lot of times, you leave your house, as soon as that cold air hits your airways, that muscle clamps down, making it more difficult for you to move air in and out. Ben: Now that I have an asthma diagnosis and a love for running, especially in cold weather, as the weather gets colder, I need to pay attention to my breathing in those temperatures. Erika: I can feel a general constriction in my chest, and I find that I'm losing my breath. Kouryou: Sometimes, when it's cold out and I wake up, I'm already wheezing from the get-go. Mark: And then it gets more of a tightness around here. And sometimes I feel my sinuses over here. Dr. Greenspan: Make sure that you keep your face covered. They make products that will actually help you cover your face while still being able to breathe and keeping the air warm. Sha: As the weather's changing, I can feel a cough coming on, sickness coming in. Catherine: A cold or a flu can exacerbate the symptoms of asthma. Vanessa: I sort of know when I'm going to get sick, so I know to go to the doctor's. Catherine: Explain your condition, make sure that you are in agreement with exactly what medicines you should be taking. Vanessa: Because if I don't go to the doctor's and I don't prioritize my health, then things can very easily spiral. So it's all about early prevention. Catherine: Try not to touch your eyes, your nose, your mouth, when your hands aren't clean. Dr. Greenspan: Make sure that you're well hydrated in the wintertime. A lot of times, people are dehydrated. Catherine: The best approach is to have a proactive approach.

Dr. Greenspan: Nutrition is crucial. Dr. Mahmoud: The story starts and ends with taking care of your diet. Susan: I stay away from any foods or drinks that will cause inflammation in the system. Dr. Greenspan: The content of your food can also impact your breathing. Susan: So I stay away from any processed food, any foods high in sugars, things that are fermented, like wine or beer. Dr. Greenspan: When you eat carbohydrates, as compared to, let's say, a protein or a fat, you're actually producing much more carbon dioxide. Erika: I also cut out certain foods, like dairy, which cause me to have more congestion and generally irritate my respiratory system. Dr. Greenspan: So imagine you just ate a giant pasta meal. Now, your stomach's full of pasta. Your diaphragm is having difficulty contracting downward, because you now have this mechanical obstruction, and it's also pouring carbon dioxide into your blood that's sending a signal to your brain that's saying, "Breathe. Breathe. Breathe. Breathe. Breathe." That's why a lot of people, they'll say, "You know what? I don't understand this. I went to the restaurant the other night. I was feeling great. I had dinner. I came home. I had to take a cab, because I couldn't walk. I was so short of breath." Very, very common. Erika: Drink as much water as you possibly can. Natalie: A lot of times people are not hungry, they are thirsty. Dr. Mahmoud: Don't eat the food that has been known to cause problems in the past. Susan: I stay away from breads, carbohydrates, anything that will have starch in it and will turn into a sugar. Natalie: You want to make sure that you have enough good protein sources in your diet, so a mix of fish, lean beef, chicken. Dr. Greenspan: Okay. You want to eat the right foods. You want to be at the right weight. Natalie: Eating probably about five meals a day, smaller meals, instead of skipping breakfast and then having a huge dinner. Dr. Greenspan: Being the right weight is very, very important. Dr. Mahmoud: And it is in your own hands. You can do it.

Susan: I'm a singer and an accordion player, and I've had asthma for about three years. Erika: I was first diagnosed with asthma in 2004. Susan: There was a night when I couldn't breathe when I was sleeping. Erika: I was really out of breath all the time, short of breath, and I finally made a decision to go to the doctor and see what was going on. Ben: And he says, "You have asthma," and I said, "What?" Susan: Well, what do I do? Catherine: Once you have a diagnosis, there's treatment. Dr. Greenspan: I think it's really important that you be managed by a specialist, so a pulmonary doctor, who really specializes in asthma. Catherine: Part of the treatment will be an action plan. Dr. Greenspan: Number 1: medical. Having the right doctor. Taking the right medications. Taking those medications properly. Dr. Greenspan: Number 2: exercise. Vigorous aerobic exercise. Strength training. Breathing re-training. Flexibility exercises. Catherine: Understand your symptoms, and according to your symptoms, know exactly what to do. Dr. Greenspan: Number 3: nutrition. Being the right weight, not being overweight, not being underweight. Dr. Greenspan: Number 4: stress management. Relaxation training. Trying to calm down your nervous system. Dr. Greenspan: Number 5: prevention of infection. Erika: It is very manageable. I find that it's not a huge upset in my life. Vanessa: I mean, I grew up using a peak flow meter, and my doctor always had me... I had a chart where I had to fill out... I think I did it a couple times a day. Catherine: A peak flow meter is a device that measures the forced breath that you breathe out in a second. Vanessa: And I'd have to check to see where my breathing levels were. Catherine: Are they 80% or better of predicted, which is the green zone. Vanessa: You know, if I was in that range it was good. Catherine: Less than 80%, the yellow zone. 50% means you're in the red zone. Kouryou: Know your limits. Don't try to be Superman. But don't let it hold you back. Susan: Everything's going to be fine. Just keep breathing.

Erika: I'm Erika. I am a mom, a fitness professional, and a movement coach, and I have asthma. Dr. Greenspan: When people talk about exercised-induced asthma, what they're talking about is somebody who, once they begin to move around or once they begin to exercise, starts to get symptoms due to airway constriction. Kouryou: I loved running and then I stopped because I thought I couldn't. Don't. Vanessa: On a daily basis basically having to exercise, it totally affects my asthma. Natalie: When you stop any exercise, it could cause more harm than good. Dr. Greenspan: I've put on 25 pounds over last year. If I were to hand you two bowling balls and say, walk around with these all day, every day, well, naturally you're going to be more short of breath. Talk to your doctor about the possibility of pre-medicating before you exercise. Vanessa: I always make sure to take my asthma medication prior to exercise, but in addition too, I always take my medication in with me when I'm going into class. Dr. Greenspan: It's very important to gradually increase the intensity of the exercise. Ben: I don't really have any noticeable breathing problems as a result of running, and I'm medicated. I'm thinking, "Okay, I think I'm probably okay doing this." Natalie: You need to see what your limitations are. Dr. Greenspan: Starting off very slow. Starting with breathing exercises, breathing in through your nose, out gently through your mouth through pursed lips. Kouryou: Warm up. Stretch your heart and lungs, just like any other muscle. New Speaker: Take your hands behind your back, clasp your hands together, lift your shoulders up and back. Take your elbows back as far as they can go, and lift your chin. The key is to open up the front of the body. Dr. Greenspan: Only if you feel comfortable should you go to the next stage, and if you feel like your airways are starting to tighten up, make sure you back off to a level at which you feel comfortable again. Natalie: You can train the body to do anything. It's just with asthma, it might take a little bit longer. Vanessa: The pros to exercising with asthma are the same pros as if you didn't have asthma. It's great for your cardiovascular system. It builds confidence. It makes people feel empowered. Ben: It seems like following through with taking care of asthma is step towards continuing having running in my life for a long time.

Catherine: What is going on when I get an attack? Kouryou: It's like a 500 pound sumo wrestler is sitting on your chest. Susan: Your lungs feel really heavy and squishy. Ketty: Your airways be closing little by little. Dr. Mahmoud: Your chest is heaving, your shoulders are going up. Mark: It feels like you're trying for something and you just can't get it. Sha: It's all in the tickle. You have to be very in-tune with this part of the throat. Kouryou: You're always afraid you're not getting enough oxygen. You're afraid like, "I can't breathe." Ketty: You feel like you are going to just pass out. Mark: You can't do what you want to do at that moment. Susan: And then all of a sudden you realize how important air is for your survival. Erika: I just have to be prepared and know that if I'm having an issue with my asthma, that I have the tools handy. Kouryou: Any time I go anywhere, I'm like, "Wait. Do I have my inhaler?" Catherine: Always make sure that you have your relief medication. Erika: Set an alarm to take a pill or to take an inhaler. Whatever your treatment is, plan it in your day and let your phone tell you when to do it so you don't have to think about that. Natalie: Get away from the scene if they are in a crowded area because everybody else will make them more panicked. Kouryou: My only job right now is to breathe, to slow everything down, relax, close my eyes. Natalie: Just take it nice and easy and don't think about anything else. Don't worry about anything else. Kouryou: Inhale, exhale. Susan: When I'm around allergens or other things that can cause potential flare-ups, I've learned to just speak up.

Catherine: In asthma, there are several triggers that can cause people to have an increase in symptoms. Dr. Greenspan: Things like cigarette smoke, pollution, pet dander, dust, smells like chemicals, cold, exercise. Mark: My trigger's definitely the cold. Ketty: My asthma's been very bad lately since the weather's been changing a lot. Dr. Greenspan: Cold air hits their airways, and they lock up, so people wind up staying indoors for the whole winter. Vanessa: If it's very cold outside. I always have to make sure that I have a big scarf with me. I'm always covering my mouth. Erika: The reason why I was flaring up at that moment was because of the new cat, so we had to get rid of him. Susan: I'm really affected by cat hair and smoke. Kouryou: I definitely avoid places that are super dusty. Vanessa: If I ever go the mall, I always avoid the fragrance section and the perfume section. That's a big trigger for me. Sha: It was like an allergic reaction. I'd be around dust. I'd start sneezing. I'd start coughing. I'd need my inhaler. As a preventative measure in that, if I'm around something that's out of place, I'll just clean it immediately. Mark: Stress sometimes will trigger. Susan: Because stress is another one of those things that doesn't really help you breathe. Erika: Some stretching, and also massage, I find helps a lot. Susan: I deal with the stress by meditating before I go to bed, when I wake up. Ketty: I actually sit down down in my yoga mat and just take a deep breath and just relax. Susan: Can you see that?

5 Things You Didn’t Know About Severe Asthma 1. When asthma doesn’t respond to treatment, it’s considered severe.Of the 25+ million people in the U.S. living with asthma, 5 to 10% have severe asthma. 2. You can develop severe asthma at any age.Severe asthma can affect anyone. It may become severe for no reason, or certain triggers might make it worse. 3. Severe asthma can cause long-term damage to your lungs.Frequent asthma attacks can cause airways to narrow, thicken, or scar, making it harder to breathe. 4. Recent advances are changing severe asthma treatment.New injectable drugs called biologics target cells that cause inflammation and breathing difficulties. 5. The right doctor can make a world of difference.Find the best doctor to improve your quality of life. Turn to Healthgrades.com to search for the right doctor for you. Share this video to help educate others about severe asthma!

Asthma is a chronic disease that affects about 1 in 12 Americans. If you have asthma, your airways are always inflamed, which makes it hard to breathe in and out. Since asthma is relatively common, most of us probably know a little bit about it, but there's a lot about asthma you might not know. 1. Don't let asthma stop you from being active. Many athletes have asthma and go on to do great things. If you have asthma, plan ahead before exercising. Warm up slowly, and take your medication as directed. 2. Asthma attacks can be triggered by lots of different things, like pollen and pets, exercise, smoke, pollution, and colds. 3. Some people think asthma is a kids disease, but it's not necessarily. Of the nearly 25 million Americans with asthma, 18 million of those are adults. Asthma usually begins in childhood, and it can change over time, but most people have asthma for the rest of their lives. That's why it's important to work with your doctor to adjust your treatment plan as you get older. 4. By using Healthgrades' Guided Physician Search, it's easy to find a doctor who's the best fit for you and your condition. 5. We can't cure asthma, but we can control it with the right treatment. Getting a diagnosis and a treatment plan can help you manage the disease, relieve symptoms, and prevent asthma attacks. Talk to your doctor about the right treatment plan for you. 6. Studies show when people have a close working relationship with their asthma doctor, they have more control of their symptoms. Seeing your doctor regularly can reduce asthma symptoms, ER visits, hospital stays, and healthcare costs. Uncontrolled asthma accounts for about 14.2 million lost work days for adults. The condition can change over time, so it's important to keep up with your doctor's appointments. Remember, you can find the right doctor to treat your asthma at Healthgrades.