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Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Why We Switched to React Query for Managing Server State

Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Below, we’ll dive into how we’re using React Query at Alto to solve these problems and achieve separation of client and server state.

The Old Way: Fetch Server Data and Store It in State

Historically, we would fetch data and set the response in our React component state.

fetchUser(params) {
 this.setState({ isLoading: true });
 
 return getUser(params)
   .then(({ data }) => {
     this.setState({
       isLoading: false,
       user: data.user,
     });
   })
   .catch(() => {
     toaster.toast({ title: 'Something went wrong...' });
     this.setState({ isLoading: false });
   });
}

To make that data accessible from other components, we’d set that data in the global Redux store. This works fine, except that you have to manage your own loading state, the logic for when and when not to make the request, updating the store when mutating data on the server, and knowing when data is stale.

The React Query Way: Fetch and Cache Server Data

With React Query, fetching data and using that data is more declarative.

const { data, error, isLoading } = useQuery(
 // This is our Query Key, which is unique per query so that React
 // Query can manage the cache for us.
 ['user', { userId }],
 
 // This is our Query Function that actually does the data fetching.
 // We can use anything we want: built-in fetch, axios, etc.
 fetchUser({ userId }),
 
 // This query will not execute until the userId exists.
 { enabled: !!userId },
);

Here, we define our query for a user with a Query Key and a Query Function. The Query Key is unique per query, so React Query can manage our cache for us, and if any part of the Query Key changes, the query will automatically fetch new data. In this example, if the user ID changes, the query will fetch new data for that specific user and store that data in the cache.

Naming is hard, but caching is harder. React Query gives us caching of server data out of the box with cache invalidation and request deduping. If we use this same query with the same Query Key in another component, it'll check the cache: if the data is already there, React Query will simply return it, avoiding extra network requests!

Additionally, useQuery runs wherever you use it — no more fetching data when a component mounts. You just use the query and display the data when it’s ready. The cherry on top? The query returns status updates by default, so we don’t need to store isLoading in component state all the time.

Three Optimizations We Get With React Query

When we rebuilt Alto Connect, our web app for healthcare providers, we found impactful benefits in using React Query to help us manage server state instead of using Redux. Alto Connect provides instant access to patient and prescription information and enables messaging with the pharmacy. Because healthcare providers need to quickly switch between patients and clinics, caching data is important to provide a delightfully fast experience. Apart from the cache, what other optimizations do we get by using React Query? Below are a few that helped us.

Once we’ve queried for some data, it gets entered into our cache, so we can utilize that cached data when using the same query in a different component or when fetching new data for a stale query in the background.

React Query is configured with aggressive but sane defaults and considers cached data as stale. Stale queries will always query for new data when the following criteria are met:

The query is optionally configured with a refetch interval

The fetching for new data when the browser window or tab is refocused is especially useful because the healthcare providers using Alto Connect often switch between multiple browser tabs. If there’s an update to a task, status, or message while they’re checking a patient’s medical chart, it will be immediately reflected in the UI when they come back to Alto Connect.

We also set a refetch interval for our queries involving messages. In the old app, we used WebSockets to enable real-time messaging. Although it’s possible to integrate WebSockets with React Query, we opted for a polling solution instead. Because our app isn’t a real-time messaging application, and we don’t need messages to show up immediately, we set a refetch interval on our messages query to poll for new messages every 30 seconds.

const { data, error, isLoading } = useQuery(
 ['user', { userId }, 'messages'],
 fetchMessages({ userId }),
 {
   // This query is disabled from automatically running if we don’t have a userId
   enabled: !!userId,
 
   // Refetch every 30 seconds
   refetchInterval: 30000,
 
   // Continue to refetch while the tab/window is in the background
   refetchIntervalInBackground: true,
 },
);

This is where the enabled option, which disables a query when it evaluates to false, is particularly powerful. We can pause polling for messages if we route to another page and we know that we won’t make any unnecessary requests if there isn’t a valid userId. We don’t have to worry about closing any socket connections or manually clearing an interval.

Most web apps have some sort of navigation menu, and if you already measure or understand your user behavior, you can prefetch data before users even navigate to a different page. Custom hooks makes it easy to expose a function to prefetch data:

export const usePrefetchUsers = () => {
 const queryClient = useQueryClient();
 const prefetchUsers = async () => {
   await queryClient.prefetchQuery(
     ['users'],
     fetchUsers,
   );
 };
 
 return { prefetchUsers };
};

We prefetch queries when users mouseover or hover over a navigation item so that when they navigate to the next page, the data is either actively being fetched or is already in the cache waiting.

We’ve been talking a lot about queries, but what about mutating data? Mutations, in contrast to queries, are imperative. While queries run automatically when we use them, we need to fire a mutation method in order to run mutations. And in order for our user experience to feel snappy, we can optimistically update the cache and then invalidate it after successfully executing the mutation. useMutation gives us some nice side-effect handlers to deal with every stage of the mutation lifecycle. Now when the user sends a message, that new message is immediately reflected in the UI and we keep the data in sync by invalidating the cache and refetching the messages.

With Redux, we needed to build out solutions to each challenge of managing server state. React Query, on the other hand, gives us those tools right out of the box. We no longer need to worry about when to invalidate or fetch new data, making the user experience more predictable — and the developer experience more enjoyable.

It’s understandable to feel overwhelmed after receiving a diagnosis of chronic obstructive pulmonary disease (COPD) — living with a chronic lung disease brings changes to many aspects of life. Many people don’t realize that the condition is highly treatable, and that there are things you can do to slow the progression of COPD. To help you better understand and manage your COPD, let’s take a look at five common misconceptions surrounding this lung disease.

Misconception About COPD

Chronic obstructive pulmonary disease refers to a group of progressive lung diseases. The two primary diseases under this umbrella are chronic bronchitis and emphysema. Most people with COPD have both conditions, but it’s possible to have just one.

Chronic bronchitis and emphysema affect the lungs in different ways. Chronic bronchitis causes inflammation in the airways leading to your lungs, which leads to a chronic cough and increased mucus. Emphysema destroys your lungs’ fragile air sacs, or alveoli, obstructing airflow. When alveoli become damaged, the lungs cannot fully expel air carrying carbon dioxide out of the body, so some of it remains trapped in your lungs. Oxygen-rich air is then blocked from entering the lungs, which causes gradually worsening shortness of breath.

COPD may not be curable, but it is highly manageable. There are many treatment options that can ease symptoms and improve your quality of life, while also preventing the condition from progressing into a more advanced stage. In addition to lifestyle changes, COPD treatment may consist of medications, supplemental oxygen therapy (typically used for COPD caused by emphysema), and surgery in more advanced cases.

Medications commonly used to treat COPD include bronchodilators, which relax the muscles around the airways to make breathing easier, and inhaled corticosteroids, which reduce inflammation in the airways and prevent COPD exacerbations, or flare-ups.

Other medications may be used to treat exacerbations or more severe cases of COPD, including oral steroids and phosphodiesterase-4 inhibitors.

3. After a COPD diagnosis, it’s too late to quit smoking.

There is never a bad time to stop smoking and quitting is the most important thing you can do to manage COPD. Since COPD is a progressive lung disease, symptoms gradually become more severe over time. While it’s true that you cannot reverse the damage to your lungs caused by smoking, you can prevent COPD from progressing into a more advanced stage by maintaining healthy lifestyle habits. In fact, many people with early-stage COPD are able to regain near-normal lung function after quitting tobacco use. Even if your COPD has already progressed to a more advanced stage, quitting smoking will help reduce symptoms and prevent flare-ups and other health complications.

If you are having trouble quitting, ask your doctor for smoking cessation resources. They may be able to prescribe nicotine replacement therapy to help with withdrawal symptoms and cravings. Watch our webinar for more on the role of smoking cessation in COPD treatment.

The lung damage caused by COPD can affect other areas of the body. The condition can increase your risk of developing heart disease or having a heart attack. It may also lead to pulmonary hypertension, a condition characterized by high blood pressure in the arteries that transport blood to your lungs. The risk of these potential health complications is one reason it’s so important to get an early diagnosis, and to follow the treatment plan your doctor recommends in order to slow progression.

People with COPD are also more likely to contract the flu or pneumonia — and to have more intense symptoms of these illnesses — so as part of your COPD treatment plan, stay current with your yearly flu and pneumonia vaccines.

Quite the opposite — regular physical activity is key to maintaining a good quality of life and living healthily with COPD. While it may seem counterintuitive to exercise when you’re short of breath, physical activity can make it easier to breathe in the long run by strengthening your respiratory muscles.

It’s important to take it slow and practice gentle exercises that don’t overexert your lungs. Your doctor can help you determine appropriate activities based on your experience of COPD.

You may also benefit from a pulmonary rehabilitation program, which helps many people with COPD manage their condition and improve their quality of life. Pulmonary rehabilitation is an outpatient exercise and education program where physical therapists, dietitians, and other healthcare professionals share breathing techniques, nutritional advice, exercise recommendations, and other strategies for living with COPD.

Let Alto Pharmacy support your COPD treatment

We’re here every step of the way to help you manage COPD symptoms and get the medications you need, with free same-day delivery and easy-to-use medication management reminders in our app.

And our team of pharmacists are always here to answer your questions by phone or in the Alto app. Reach out any time through in-app 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.

Arteries are a critical part of your circulatory system, transporting blood and oxygen from the heart to the rest of the body. As you age, a variety of substances collectively referred to as plaque — including fats, cholesterol, and calcium — may accumulate in these blood vessels. A condition called atherosclerosis occurs when the buildup of plaque causes the arteries to narrow and obstructs overall blood flow throughout the body. It is a leading factor in the development of coronary artery disease, the most common type of heart disease.

Atherosclerosis, Explained

Many of the key risk factors of atherosclerosis can be managed, and there are effective treatment options that can prevent the condition from worsening. Here’s what to know about causes, symptoms, treatment, and prevention.

Atherosclerosis involves slow, progressive changes to the structure of your blood vessels. These changes typically intensify with age. As plaque accumulates, the walls of your arteries become thicker. This gradually narrows the channel within the artery through which blood flows, reducing the amount of oxygen and other nutrients that the rest of your body receives. In some cases, pieces of plaque can break off into the bloodstream and lead to the development of a blood clot.

There are arteries in nearly every part of the body, and three main types of arteries: elastic arteries, muscular arteries, and arterioles.

Elastic arteries come out of the heart and contain more elastic tissue than other types of arteries. Their flexibility allows them to receive blood at high pressure. Examples include the pulmonary artery and aorta.

Muscular arteries have less elastic tissue and more smooth muscle fiber, which allows them to expand and contract to control the flow of blood. Examples include the coronary and femoral arteries.

Arterioles are smaller vessels that branch out from the arteries and help distribute blood into microscopic capillaries.

Atherosclerosis is not limited to a certain area or type of artery. Plaque may develop in arteries in the heart, brain, pelvis, legs, arms, or kidneys. The type of artery affected in atherosclerosis can impact an individual’s symptoms, along with their risk for related health complications.

Different health conditions may arise depending on where plaque accumulates.

Coronary artery disease occurs when plaque accumulates in the arteries in or leading to the heart.

Angina, a type of chest pain, can also arise from plaque accumulation in the coronary arteries. It results from decreased blood flow to the heart muscle.

Carotid artery disease occurs when plaque accumulates in the neck arteries that deliver oxygen-rich blood to the brain.

Peripheral artery disease (PAD) occurs when plaque accumulates in the arteries in the arms and legs.

Kidney disease occurs when plaque accumulates in the renal arteries, which transport oxygen-rich blood to your kidneys.

In addition to the conditions above, extensive plaque accumulation can lead to other health complications, including heart failure, a heart attack, an abnormal heart rhythm, a stroke, and an aneurysm. Treatment can help slow the progression of atherosclerosis and prevent more serious complications.

Many factors play a role in the development of atherosclerosis, including the following.

Atherosclerosis is among the more common aging-related health issues. Your heart and blood vessels have to work harder as you age. These changes can stiffen the arteries, which makes it easier for plaque to accumulate in them.

Cholesterol is a waxy, fat-like substance that’s produced naturally by the liver and also found in certain foods. It isn’t inherently bad — your body needs a certain amount of cholesterol to produce cell membranes, hormones, and nutrients. However, high levels of low-density lipoprotein (LDL) cholesterol (“bad” cholesterol) can accumulate in the walls of your arteries and turn into plaque, factoring into a person’s risk for heart disease and stroke. (Conversely, a healthy level of high-density lipoprotein (HDL) cholesterol can potentially lower your risk for heart disease.)

Smoking damages your blood vessels and accelerates the buildup of plaque. It is a leading risk factor for peripheral artery disease. 80% of those with PAD are current or former smokers. Smoking is also associated with plaque accumulation in the aorta — the main artery of the body —  and in the coronary arteries.

High blood pressure strains and damages your coronary arteries, causing them to gradually narrow as plaque accumulates.

You may have a greater risk for atherosclerosis if you have diabetes or a family history of atherosclerosis. Physical inactivity and obesity also play a role.

Atherosclerosis symptoms typically do not appear until an artery has become severely narrow or clogged, to the point where blood flow is affected. There often aren’t noticeable symptoms of mild atherosclerosis. Symptoms of moderate to severe cases vary by the affected artery.

Atherosclerosis in coronary arteries: chest pain or pressure

Atherosclerosis in the arteries leading to your brain: sudden numbness or weakness in arms or legs, difficulty speaking, confusion, or drooping facial muscles

Atherosclerosis in the arteries in your arms and legs: pain in your legs while walking or decreased pressure the affected limb

Atherosclerosis in the arteries leading to your kidneys: high blood pressure or weakened kidney function

If you have any concerns about potential symptoms of atherosclerosis, contact your doctor as soon as possible for an evaluation.

Atherosclerosis cannot be reversed, but it is treatable. A heart-healthy lifestyle and medications can help slow the accumulation of plaque and prevent the condition from worsening.

Lifestyle changes such as quitting smoking, planning a heart-healthy diet, and exercising more frequently are often a first step in treating mild atherosclerosis. The American Heart Association suggests aiming for about 150 minutes a week of moderate-intensity aerobic activity. Building these healthy habits early on can also help prevent atherosclerosis from developing to begin with.

Your doctor may also recommend medications to prevent atherosclerosis from progressing further. The following medications are commonly used to treat atherosclerosis.

Statins such as atorvastatin and simvastatin act on the liver to prevent LDL cholesterol from forming and limit the overall amount of cholesterol circulating in your bloodstream.

Fibrates such as fenofibrate and gemfibrozil can raise HDL cholesterol and lower LDL cholesterol.

Niacin is a B vitamin that reduces the liver’s production of blood fats and can lower LDL cholesterol.

For more on cholesterol-lowering medications, read How to Manage High Cholesterol: Diet, Medications, and More.

Beta blockers such as metoprolol and carvedilol cause the heart to beat more slowly and less forcefully, lowering your blood pressure.

Calcium channel blockers such as amlodipine and diltiazem prevent calcium from entering the smooth muscle cells of the heart and blood vessels, which opens up narrowed blood vessels and lowers blood pressure.

ACE inhibitors such as lisinopril and benazepril block production of a hormone called angiotensin II, which causes blood vessels to narrow. This helps constricted blood vessels expand so that more blood can flow through.

Angiotensin II receptor blockers (ARBs) such as losartan and valsartan function similarly to ACE inhibitors and protect blood vessels from angiotensin II.

For more on blood pressure medications, read Common Types of Blood Pressure Medications.

Antiplatelet medications such as aspirin and clopidogrel may be prescribed to reduce your risk of blood clots.

Surgery may be necessary to treat severe cases of atherosclerosis, or if there is risk of serious damage to your muscle or skin tissue.

At Alto, we make it as simple as possible to manage your risk for chronic health conditions and to stay on top of your cholesterol-lowering or blood pressure medications. 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 via phone at 1-800-874-5881, or in-app messaging.

Many of us are familiar with the disappointment of a failed New Year’s resolution. Only 35% of Americans who made one in 2020 kept at it until the end of the year, and a study from 2015 found that 80% of New Year’s resolutions fail by mid-February.

The Science of Habit-Forming

Since healthy lifestyle choices are a key part of preventing or managing many chronic conditions, it’s important to continue working toward your health and wellness goals, no matter how frustrating it may feel. And while giving up old habits or cultivating new ones is never easy, you have more control over this process than it may seem.

Habits don’t start from nothing. They are a three-part psychological process of triggers, actions, and rewards, often referred to as the habit loop. This process can unfold passively, as if you’re on autopilot when engaging in many familiar behaviors. But fortunately for those with new habit goals, the habit loop can also be a more intentional rewiring of your brain to turn aspirations into lasting change. Here’s how.

As humans, we’re wired to search for feel-good experiences (and quick hits of dopamine, the brain’s feel-good chemical). Habits are born when the brain recognizes a connection between action and reward. It stores this information in a region of the brain called the basal ganglia. Unlike the prefrontal cortex, the area of your brain that makes conscious decisions, what happens in the basal ganglia is largely beyond your conscious control. That’s why it can be so challenging to break an old habit: sometimes you don’t even realize you’re doing it.

Cue — a stimulus, like a certain location, smell, person, or emotional state, sends the brain into autopilot and motivates you to act.

Action — you then perform a repeated behavior associated with the cue.

Reward — you experience a sense of pleasure or relief as a result of the action, reinforcing the link between cue and action (and perpetuating the habit loop).

It’s easy to see how unhealthy behaviors might emerge from this cycle, but with some effort, the habit loop can result in healthy changes, too. You can replace a bad habit with something more positive, like reading a book, going for a walk, or meditating instead of smoking or overdoing screen time. Or you can use this knowledge of how the brain works to develop a new habit without giving anything up. Either way, you’re more likely to find success if you connect a positive habit with an immediate reward, like linking physical activity with your favorite song or podcast.

In addition to considering the connection between your default behaviors and rewards, the following tactics can set you up for success as you commit to your physical and mental well-being. 

Start small and aim for incremental progress

It’s admirable to have big ambitions for your fitness routine, but it often takes time to build up your strength. Sometimes the disappointment of not arriving at a goal quickly enough is what causes people to set down their goals and resolutions altogether. Many health experts suggest starting with a small and specific action rather than the end state. Rather than focusing on running a half marathon, try to run a little more than you did the day before. The same principle applies to other habits like meditating or reading instead of social media scrolling.

At the same time, taking it slow doesn’t mean being inconsistent. Studies show that it can take anywhere from 18 to 254 days to form a new habit, and the best way to establish a routine is to actually do it. If your goal is to be more physically active, try doing a small, gentle exercise every day — a certain number of jumping jacks or push-ups, or a quick walk — and building up from there once you’ve got a foundation in place.

Since we’re all creatures of habit, there are probably many patterns in your day that can help you cultivate your new routine. For instance, try meditating after your morning cup of coffee, or going for a walk after your lunch break.

This approach is referred to as habit stacking, and it uses our tendency towards autopilot — and the habit loop fundamentals — to our advantage. Your new habit will quickly become linked to what the brain already knows, increasing your chances of success.

While change is never easy, you can make it easier by removing the obstacles that stand between you and your health goals. So rather than trying to muster up more will power, add a visual cue to your new routine, or remove a preparation step. This could mean packing your bag for your morning workout and leaving it by the door before going to bed, choosing an exercise you can easily do from home, or putting heart-healthy snacks in a visible spot on your kitchen counter. Whatever you’re trying to achieve, there’s probably a way to minimize the time and effort it requires.

Let Alto support your health and wellness

At Alto, we believe that staying on top of your health should be as simple as possible, and we’re here to support you with exceptional pharmacy care all year long. We offer free, same-day delivery and medication management tools like reminders and auto refills in our mobile app.

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

Your heart’s ability to pump oxygen-rich blood throughout the body depends on the functioning of many different structural components. The heart’s four valves allow blood to flow through your heart in the right direction. When they don’t open or close properly, the flow of blood throughout your body is disrupted.

Understanding Heart Valve Disease

Heart valve disease refers to several conditions in which one or more of your heart valves doesn’t function properly. Without treatment, heart valve disease can potentially lead to other heart health issues, but it can be managed with heart medications, lifestyle changes, and, in more severe cases, surgical procedures. Here’s what to know about recognizing and treating heart valve disease.

Your heart has four chambers: the two upper chambers, or atria, which receive blood, and the two lower chambers, or ventricles, which pump blood. Each time blood leaves or enters one of these chambers, it passes through one of the heart’s four valves:

The mitral valve, located between the left atrium and left ventricle

The tricuspid valve, located between the right atrium and right ventricle

The aortic valve, located between the left ventricle and the aorta, the heart’s main artery to the body

The pulmonic valve, located between the right ventricle and pulmonary artery, which transports blood without oxygen from the heart to the lungs

Each valve has flaps that open and close with every heartbeat. The tricuspid, aortic, and pulmonary valves all have three flaps, and the mitral valve has two. Heart valve disease occurs when one or more of the valves doesn’t open or close, affecting blood flow. These conditions typically develop from one of two main issues with heart valves: regurgitation and stenosis.

Regurgitation refers to leakage of a heart valve. When a heart valve doesn’t shut completely, blood flows backwards. This reduces forward blood flow, causing the heart to fill with too much blood.

Stenosis refers to the narrowing of a heart valve, which constrains blood flow out of the ventricles. This causes the heart to pump blood more forcefully in order to get blood to pass through the stiff, or stenotic, valve.

Regurgitation and stenosis are not mutually exclusive; one valve can develop both issues at the same time. An individual with a heart valve disease may also have issues with more than one heart valve.

All types of heart valve disease cause the heart to work harder to pump blood. Since heart valve issues can significantly disrupt blood flow, these disorders can lead to other heart health issues without effective treatment. Heart valve disease is a contributing factor in many cases of heart failure, and it can also cause strokes, blood clots, or abnormal heart rhythms.

There are several factors involved in the development of heart disease, including the following.

A history of other heart health issues, including other types of heart disease or a history of one or more heart attacks

A history of other health conditions linked to heart valve problems, including infective endocarditis and rheumatic fever

Heart disease risk factors such as high blood pressure, high cholesterol, and diabetes

Aging may also play a role in the development of heart valve disease, as the heart valves — particularly the mitral valve — can degenerate slowly over time. In addition, aging can cause calcium to accumulate on the heart valves, most commonly the aortic valve, leading to aortic stenosis.

Some types of heart valve conditions are the result of congenital heart defects, meaning they are present at birth, including the following:

The severity of heart valve disease can vary significantly by individual. Some individuals may live with a heart valve condition for many years before experiencing any symptoms, and more mild cases may never cause any symptoms at all. When symptoms of heart valve disease are present, they often include the following.

An irregular heartbeat and/or heart palpitations

Low or high blood pressure, depending on the specific heart valve condition

Treatment of heart valve disease varies by individual, as there are many types of heart valve conditions and a wide spectrum of severity.

Some mild to moderate cases of heart valve disease may not initially require treatment; your doctor may want to observe the heart valve issue for a period of time. Other cases of mild to moderate symptoms may be successfully managed with medications. Medications commonly used to relieve symptoms of heart valve disease include:

Heart rate controlling medications such as beta blockers, calcium channel blockers, and digoxin (Digox®, Lanoxin®, and Digitek®)

Blood pressure medications such as diuretics — which lower blood pressure by removing excess sodium and water — and vasodilators, which relax the muscles in the walls of blood vessels to improve blood flow

Some individuals with a heart valve condition may need surgery. There are different types of procedures that may be used, including heart valve repair surgery or heart valve replacement surgery. Sometimes a less invasive procedure called a balloon valvuloplasty is used for various types of heart valve stenosis.

The importance of a heart-healthy lifestyle

Not all types of heart valve issues are preventable, but some are. By managing your heart disease risk factors, you can lower your risk for heart health issues later in life, including heart valve disease.

Regular exercise can help you maintain healthy blood pressure, cholesterol, and blood sugar levels. The American Heart Association suggests aiming for about 150 minutes a week of moderate-intensity aerobic activity.

As you plan a heart-healthy diet, load up on foods that are low in saturated fats and trans fats. The AHA also recommends capping your sodium intake at 1,500 mg/day, as high sodium levels can raise your blood pressure. In general, processed or prepackaged foods like soups, cold cuts, bread, and frozen meals are high in sodium.

Read our previous blog, How to Prevent Heart Disease at Any Age, to learn about important heart disease prevention actions for your age group.

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.

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.

Cardiomyopathy refers to a variety of diseases of the heart muscle that affect the heart’s ability to carry out its pumping function. It is a progressive condition that can lead to other heart health issues including heart failure, but it can be managed through a combination of medications, lifestyle changes, surgical procedures, and other types of treatment. Here’s what to know about causes, symptoms, and treatment options for the main types of cardiomyopathy.

Cardiomyopathy, Explained

Cardiomyopathy can be either acquired or inherited. While not all cases of cardiomyopathy have known causes, the following health factors or conditions have been linked to certain forms of cardiomyopathy.

A family health history of cardiomyopathy, heart failure, or sudden cardiac arrest

Coronary artery disease or a history of a heart attack

Endocrine diseases including type 1 and type 2 diabetes and thyroid disorders

Diseases that weaken muscle tissue such as muscular dystrophy 

Cardiomyopathy symptoms vary by individual, and by the specific type of cardiomyopathy. The following signs often become more apparent as the condition progresses.

Difficulty breathing or shortness of breath, even while at rest

An irregular heartbeat, heart murmur, or heart palpitations

Dizziness, lightheadedness, fainting, or briefly passing out

The most common type of cardiomyopathy and a leading cause for heart transplants, dilated cardiomyopathy occurs when the left ventricle — one of the heart’s main pumping chambers — becomes enlarged and cannot pump blood to other organs as effectively as a healthy heart. It can affect individuals of all ages but is most common during middle age. Men are more likely than women to develop dilated cardiomyopathy. Coronary artery disease and heart attacks are common causes, but the condition may also stem from genetics. Those with dilated cardiomyopathy may face a greater risk for heart failure in the long term.

One of the most common forms of genetic heart disease, hypertrophic cardiomyopathy is an inherited condition characterized by thickening of the heart muscle, often in the left ventricle. It affects individuals of all ages but often develops during childhood or early adulthood. There is a strong genetic component to this condition, and most affected individuals have a family history of hypertrophic cardiomyopathy. If you have a family history of hypertrophic cardiomyopathy, you may want to consult with your physician about genetic testing options. Some individuals with hypertrophic cardiomyopathy develop an arrhythmia, which is an irregular heartbeat.

The least common of the three main types of cardiomyopathy, restrictive cardiomyopathy occurs when the heart muscle stiffens and cannot fill with enough blood between heartbeats. It is most common in older age groups and often occurs as the result of another heart-related health condition such as amyloidosis, hemochromatosis, scleroderma, or sarcoidosis. Restrictive cardiomyopathy itself is not believed to be inherited, but many of the related conditions mentioned above have a genetic component.

Arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia occurs when muscle in the right ventricle is replaced by fat or scar tissue, potentially leading to heart rhythm issues. It is a rare form of cardiomyopathy that often develops as the result of a genetic mutation and most commonly affects teens and young adults.

Cardiomyopathy treatment varies by individual. Your doctor may recommend a combination of medications, medical devices, or surgical procedures to control your cardiomyopathy symptoms and slow the progression of the condition.

Medications may be used to improve blood flow and the heart’s pumping function, lower blood pressure, slow your heart rate, and/or prevent blood clots. The following types of medications are commonly used in the treatment of cardiomyopathy.

Blood pressure medications such as ACE inhibitors, angiotensin II receptor blockers (ARBs), and diuretics

Blood thinners and antiplatelet medications such as warfarin (Coumadin®) and novel oral anticoagulants (NOACs)

Antiarrhythmic medications such as amiodarone (Pacerone®) and dronedarone (Multaq®)

If you are experiencing an arrhythmia as the result of cardiomyopathy, your doctor may recommend a device such as a pacemaker or an implantable cardioverter defibrillator (ICD) to help control your heartbeat. Other devices including a cardiac resynchronization therapy (CRT) device and a left ventricular assist device (LVAD) may be used to improve the heart’s pumping function and control blood flow.

Some individuals with cardiomyopathy need a non-surgical procedure to treat their condition or a related arrhythmia. Common procedures include a septal ablation, in which a portion of the thickened heart muscle is destroyed to allow for more blood flow, and a radiofrequency ablation, which targets a portion of abnormal heart tissue to address an abnormal heart rhythm. In more severe cases, open-heart surgery or a heart transplant may be required.

Maintaining a heart-healthy lifestyle is another aspect of managing cardiomyopathy, as lifestyle choices can affect the progression of the condition and the severity of symptoms. If you have cardiomyopathy, your doctor may recommend that you quit smoking (if applicable), limit your alcohol intake, plan a heart-healthy diet, and exercise more frequently. While inherited forms of cardiomyopathy cannot be prevented, these healthy habits can lower your risk for related health complications and help you experience an active life.

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There are more than 25 million individuals in the U.S. living with asthma, including more than 5 million children. While most asthma cases involve the same common symptoms — shortness of breath, chest tightness, and wheezing — day-to-day life with the condition can vary significantly from one person to another. Not only is there a wide spectrum of the severity and frequency of symptoms, but there are also different types of asthma with distinct causes and triggers. (They are not mutually exclusive, so it’s possible to fulfill the diagnostic criteria for more than one type of asthma.) Here’s what to know about the main types of asthma, including important treatment considerations.

Understanding the Different Types of Asthma

Asthma is a chronic respiratory condition in which the airways in your lungs become narrow and inflamed, often leading to difficulty breathing. There are several different types of asthma: allergic asthma, non-allergic asthma, nocturnal asthma, occupational asthma, cough-variant asthma, and a related condition called exercise-induced bronchoconstriction. While there is variation among these asthma types with respect to causes, triggers, and treatment options, there are also some similarities, including the core symptoms of asthma such as coughing, wheezing, chest tightness or pain, and shortness of breath.

Some people with asthma experience intermittent flare-ups while others have symptoms the majority of the time, or persistent asthma. Persistent asthma can be categorized further as mild persistent, moderate persistent, or severe persistent depending on the severity of symptoms.

Allergic asthma is the most common form of asthma, accounting for about 60% of all asthma cases in the U.S. It occurs when an individual’s immune system interprets substances such as household dust mites, pet dander, or pollen as harmful and releases antibodies that ultimately lead to inflammation in the airways. Allergic asthma frequently involves allergy symptoms like nasal congestion, a runny nose, and itching in the eyes, nose, or ears in addition to core asthma symptoms. There is often a genetic component.

Read When to See a Healthcare Specialist for Allergy Treatment

10-33% of all individuals with asthma experience symptoms caused by triggers other than allergies including a history of smoking or exposure to secondhand smoke, respiratory infections, pollution, cold weather, humidity, and exercise. This is referred to as non-allergic asthma. It often develops later in life in comparison to allergic asthma. As part of the diagnosis process, your healthcare provider will rule out allergies as the cause of your asthma symptoms.

60% of all individuals with persistent asthma also experience nocturnal asthma, a type of asthma in which symptoms worsen at night. Those with nocturnal asthma frequently have their sleep interrupted as a result of coughing, wheezing, or chest tightness. There are many factors involved in the development of nocturnal asthma including smoking; dust or other allergens; and other illnesses or health conditions such as the cold, flu, sinusitis, gastroesophageal reflux disease (GERD), and sleep apnea. Your circadian rhythm and nightly fluctuations in the hormones epinephrine and histamine are also believed to play a role.

Since your daytime breathing can’t be used to diagnose nocturnal asthma, your doctor may ask you to test your breathing at home or participate in a sleep study to confirm a diagnosis.

Occupational asthma occurs when you are exposed to chemicals in your work environment that affect your respiratory function and breathing such as paint, cleaning products, mold, fungi, or dust. 11 million individuals in the U.S. are exposed to an occupational asthma-linked substance at their workplace. Workers who may have a higher risk for occupational asthma include bakers, farmers, metal and plastics workers, woodworkers, and those who work in manufacturing.

As many as 90% of individuals with asthma experience respiratory symptoms during physical activity — a subcategory of asthma known as exercise-induced bronchoconstriction (EIB). Exposure to airborne irritants including smoke, pollution, and pollen and/or to cold, dry air may contribute to symptoms.

There is much variation in individual experiences of EIB symptoms. Some individuals begin to have difficulty breathing right when they start exercising while others have more noticeable symptoms shortly after they return to a state of rest. Symptoms quickly disappear in some cases but last up to 24 hours in others.

If you have symptoms of exercise-induced bronchoconstriction, it’s important to stay active. Rather than avoiding exercise to prevent an asthma flare-up, speak with your healthcare provider about your asthma treatment plan and look for forms of exercise with an appropriate level of intensity.

In some cases, a dry cough is a symptom of cough-variant asthma. This type of asthma is more common in children than adults. It can be difficult to diagnose since a dry cough is also linked to other health conditions. If your cough wakes you up at night, worsens in cold, dry weather or after exposure to allergens, or occurs after exercise, you may have cough-variant asthma.

30% of all individuals with cough-variant asthma eventually develop classic symptoms of asthma. The goal of treatment for cough-variant asthma is to prevent the condition from progressing into a more severe form. Inhaled corticosteroids, which reduce inflammation and swelling in the airways, are the frontline treatment for cough-variant asthma.

All types of asthma can be managed with a combination of asthma medications, healthy lifestyle habits, and additional preventive measures to avoid triggers. However, given the spectrum of severity of symptoms — and the variety of asthma triggers — there isn’t a one-size-fits-all approach to treatment. Your doctor will advise you on the most effective treatment plan for your individual needs. 

If you have mild asthma, you may only need quick-relief rescue medications to manage acute symptoms. Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) and Levalbuterol (Xopenex HFA®) are common quick-relief asthma medications. They may be taken via inhaler or nebulizer.

If you have moderate to severe asthma, you may need long-term maintenance medication in addition to a rescue medication for flare-ups. 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®)

If you have allergic asthma, your doctor may also recommend over-the-counter or prescription allergy medications such as oral antihistamines (Claritin®, Allegra®, Zyrtec®), decongestants  (Afrin® and Sudafed®), and corticosteroid and cromolyn nasal sprays. While these medications can help you avoid allergy-induced asthma attacks, they are not a substitute for classic asthma medication. If you have nocturnal asthma, your doctor may recommend adjustments to the timing of your dosages to help you experience a better quality of sleep.

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