Proactively managing COPD with medication and lifestyle changes can help prevent periods of intensified symptoms, referred to as exacerbations or flare-ups. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

How to Manage and Prevent a COPD Flare-Up

Proactively managing chronic obstructive pulmonary disease (COPD) with medication and lifestyle changes can help slow the progression of the chronic lung disease and prevent periods of intensified COPD symptoms, commonly referred to as exacerbations or flare-ups. 

However, these flare-ups may occur even when closely following your doctor’s individualized treatment plan, especially during the more advanced stages of COPD, so it’s important to have a plan in place to quickly address symptoms. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

Recognizing the symptoms of a COPD flare-up

During a COPD flare-up, symptoms like shortness of breath and wheezing quickly intensify and lung function significantly changes. (Lung function refers to how well your lungs work, specifically how much air they can hold and how easy it is for them to empty air.)

Individual experiences of a COPD flare-up may vary, but many people often notice greater amounts of mucus clogging the bronchial tubes in their lungs and sudden tightening of muscles around their airways. Here are key signs and symptoms to be aware of.

More frequent or more intense coughing, wheezing, or shortness of breath

Changes in the color, thickness, or amount of mucus

Using more oxygen than usual, if your treatment plan includes supplemental oxygen

If you experience any of the symptoms above, the best step is to call your doctor right away. Each COPD flare-up can affect your long-term lung function, so it’s important to address symptoms as quickly as possible.

To effectively manage a COPD flare-up, you’ll want to create a COPD action plan with your doctor. Then, if you experience the signs of a flare-up, you’ll have a specific outline of the actions and medications that can help restore your breathing. Here are some of the medications your doctor may include in your individualized COPD treatment plan.

Short-acting medications like bronchodilators relax your airway muscles and open your lungs to quickly reduce discomfort. Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) is commonly used to treat COPD exacerbations. This medication is typically taken through an inhaler, but can also be taken as a liquid solution for nebulizer use. (A nebulizer is a device that turns a liquid medication into a mist that you can inhale through a face mask. It allows the medication to travel quickly to your lungs.)

Although not common, potential side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Your doctor can explain more about the risks and benefits of using a bronchodilator to treat COPD exacerbations when building your treatment plan.

Your doctor may also recommend oral corticosteroids, which are fast-acting medications that reduce swelling in your lungs and open your airways so that more air can move in and out of your lungs. They are primarily prescribed for short-term use, typically five to seven days.

Oral corticosteroids commonly used to treat COPD exacerbations include:

Prednisone (Prednisone Intensol®, Rayos®)

Some people experience mild side effects from short-term corticosteroid use, including swollen hands and feet, elevated blood pressure, increased appetite, and shifts in mood.

Many people with more advanced COPD use supplemental oxygen to increase their tolerance for physical activities, while others use it only to relieve shortness of breath during an exacerbation.

If your flare-up is more mild, you may take oxygen at home. When writing your prescription for oxygen therapy, your doctor will explain how and when to use the oxygen. It is important to follow all of your doctor’s instructions, including the flow rate setting (how much oxygen you’ll need per minute). The American Lung Association has resources for anyone starting oxygen therapy.

If your COPD has progressed to a later stage, some flare-ups may require treatment in a hospital setting. This allows healthcare professionals to more closely observe your symptoms and monitor vital signs like your pulse, temperature, and blood pressure. Consult with your doctor about specific symptoms to look out for that may indicate a need for more intensive treatment or monitoring.

How to lower your risk of COPD exacerbations

There are many steps you can take to lower your risk of a COPD exacerbation and reduce the frequency of COPD-related hospitalizations.

First, it’s important to closely follow your doctor’s recommendations, including taking any maintenance medications exactly as prescribed. (We designed our app to make it as simple as possible to do so, with medication management tools like reminders and auto refills that help you stay on track.)

In addition, try to limit your exposure to leading triggers of COPD exacerbations, including cigarette smoke (this includes secondhand smoke), indoor and outdoor air pollution, cold air, and household dust.

To keep the air inside your home as clean as possible, avoid perfumes and cleaning and hygiene products with strong odors. Use air purifiers and vacuum cleaners with a high-efficiency particulate air (HEPA) filter.

Lastly, the flu and pneumonia can worsen COPD symptoms and potentially lead to a flare-up, so it’s important to get your yearly flu shot and ask your doctor or pharmacist if you are eligible for the pneumonia vaccine.

We’re here to support your COPD treatment

COPD flare-ups can cause discomfort, but we’re here every step of the way to help you manage 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 through the Alto app. Reach out any time by phone at 1-800-874-5881 or in-app messaging.

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

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

While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

All About HIV: Stages, Symptoms and Treatment

More than 40 years have passed since AIDS, the disease caused by HIV, was first identified in the United States. While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

HIV (human immunodeficiency virus) is a virus that attacks your immune system, making you more vulnerable to other illnesses. It is transmitted through contact with the blood, semen, or vaginal fluids of someone who has HIV.

If untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome), which is also considered the last stage of HIV. When HIV progresses into AIDS, your immune system has been significantly weakened by the virus.

Currently, there is no cure for HIV, but taking HIV medicine called antiretroviral therapy (ART) as prescribed stops the progression of the disease. As a result, most people living with HIV in the U.S. do not develop AIDS. There are also HIV prevention medications, PrEP and PEP, which are effective at preventing the transmission of HIV through sex or intravenous drug use.

As the HIV epidemic emerged in the U.S. in the 1980s and 90s, gay and bisexual men were disproportionately affected — in part because the virus transmits more easily through anal sex than vaginal sex — and subsequently stigmatized as carriers of the virus. However, the medical community soon discovered that anyone can contract HIV regardless of gender identity or sexual orientation, as the virus can be transmitted through anal sex, vaginal sex, or the sharing intravenous drug equipment such as needles or syringes.

In recent years, there has been significant progress toward reducing the annual HIV infection rate, and new cases of HIV among gay and bisexual men ages 13-24 dropped by 33% between 2015-2019. Still, gay and bisexual men accounted for 69% of all new HIV diagnoses in the U.S. in 2019. And in recent years, Black and Latinx individuals have been disproportionately affected by HIV. Racial and ethnic discrimination and disparities in healthcare access — which can discourage people from seeking HIV prevention services and testing — factor into HIV’s outsized impact on these communities.

There are three primary stages of HIV: acute HIV infection, chronic HIV infection, and stage 3 HIV, or AIDS.

Acute HIV infection, the first stage of HIV, may develop within two to four weeks of contracting the virus. During this stage of HIV, the virus multiplies rapidly and there is a high amount of HIV in your bloodstream (also known as your viral load). While the virus replicates and spreads, it destroys your CD4 cells, a type of white blood cell that plays a role in your immune system.

Some people with acute HIV infection quickly experience flu-like symptoms including fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. The only way to know your HIV status is by getting tested. If you have any of these symptoms and believe you may have been exposed to HIV, seek prompt medical care and take an HIV test. Find a free and confidential HIV testing site near you..

Experiencing these symptoms does not necessarily mean that you have HIV, as they overlap with symptoms of the flu and other illnesses. And some individuals with HIV develop these symptoms later, while others never develop them at all, which is why it’s critical to get tested for HIV on a regular basis — ideally every three months. You can still transmit the virus to others even if you do not have noticeable symptoms of HIV.

During the chronic HIV infection stage, the virus replicates less rapidly than it did in the acute stage, but it continues to damage your CD4 cells and weaken your immune system.

Many people experience no symptoms or mild symptoms during this latent period, which is also sometimes referred to as asymptomatic HIV infection or clinical latency. However, just like during the acute HIV infection stage, you can still transmit the virus to others even if you are not experiencing symptoms.

Without effective treatment, your viral load will increase and your CD4 cell count will decrease as this stage of HIV progresses. You are more likely to experience symptoms of HIV when your viral load is high and your CD4 cell count is low. Taking HIV medication as prescribed can help you maintain a low or even undetectable viral load and prevent your HIV from progressing into AIDS.

AIDS is the third and most advanced stage of HIV. In this stage, your immune system is severely weakened, your viral load continues to increase, and your CD4 cell count continues to decrease. 

HIV progresses into AIDS when you have a CD4 cell count of less than 200 cells per cubic milliliter or when you develop an opportunistic infection (OI), an illness that occurs more frequently in individuals with HIV because of their weakened immune systems.

Opportunistic infections experienced by individuals with HIV include kaposi’s sarcoma, a type of cancer that develops in your blood and lymph vessels; pneumocystis pneumonia (PCP), and mycobacterium avium complex (MAC), tuberculosis-related bacteria. However, OIs continue to occur less frequently as HIV treatment becomes more effective.

There are many effective HIV treatment options that can keep you healthy and help you maintain a low viral load. The primary treatment for HIV is called antiretroviral therapy (ART), a combination of medications that lower the amount of HIV in your bloodstream.

If you take your HIV medication every day as prescribed, you can maintain an undetectable viral load. This will preserve the strength of your own immune system and prevent you from transmitting the virus to others.

Starting ART as soon as possible after you receive an HIV diagnosis is critical to lowering your risk of developing AIDS and preventing you from transmitting the virus to others. If you have tested positive for HIV, reach out to your healthcare provider right away to begin treatment.

If you have tested negative for HIV, there are important HIV prevention medications that can help you continue to protect your health: PrEP and PEP.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. Pharmacists in a growing number of states can now prescribe PrEP.

PEP, or post-exposure prophylaxis, is a medication taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. It can be prescribed by a healthcare provider at emergency rooms, sexual health clinics, community-based health centers, and, in some states, pharmacies. PEP is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, speak with your doctor about potentially taking PrEP for long-term protection.

We’re here to help you navigate HIV treatment and prevention therapies

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with antiretroviral therapy, PrEP, or PEP. We will coordinate with your doctor and your insurance provider to ensure that you’re receiving the best option for your needs at the best price. 

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

Editor’s Note: This post was originally published in December 2021 and has been updated for accuracy and completeness.

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. 

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Ask your doctor to send your prescription directly to Alto or ask us to transfer refills from your old pharmacy. We’ll look for any savings, including coupons and assistance programs, and reach out when it’s time to schedule your free delivery.

Yes. As a full-service pharmacy, Alto can fill nearly all medications, including specialty, over-the-counter, brand, and generic. Alto’s pharmacists have deep expertise in many clinical areas, including heart and lung health, diabetes, fertility, HIV/PrEP/HRT, and more.

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Your doctor’s orders are ours, too.

We’re specialists in medication for:

HIV

Hepatitis C and Infectious Diseases

Asthma and COPD

And more

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

From Our Blog

The Right Way to Use a Metered Dose Inhaler

All About HIV: Stages, Symptoms and Treatment

How to Manage and Prevent a COPD Flare-Up

Ask your pharmacist, not the Internet.

Free hand-delivery to your door.

FAQs

How does Alto work?

Do you carry my medication?

Will I be covered by my insurance?

Switch to a better pharmacy.