Asthma#

Asthma is a long-term condition involving two main problems in the airways:

• Inflammation - the lining of the airways becomes swollen and produces extra mucus.
• Bronchoconstriction - the muscles around the airways tighten, narrowing the air passages.

The result is difficulty breathing, often with wheezing, coughing, chest tightness, and shortness of breath. Symptoms tend to come in episodes (flares) triggered by something - exercise, cold air, an allergen, a respiratory infection - with quieter periods in between.

Asthma usually starts in childhood but can develop at any age.

• Wheezing - a whistling sound when breathing out, sometimes also breathing in.
• Coughing, often worse at night or early morning.
• Shortness of breath, especially with exercise or exposure to a trigger.
• Chest tightness - a sense that you can't take a full breath.

Symptoms are typically intermittent. People with well-controlled asthma may have few or no symptoms most of the time, with occasional flares.

Severity is judged by how often you have symptoms, how often you wake at night because of them, how often you need your reliever inhaler, and how much they limit your activities:

• Well-controlled - symptoms a couple of times a week or less; no night-time waking; no activity limitation; reliever needed rarely.
• Partly controlled - symptoms more often, occasional night waking, occasional activity limit, reliever needed more often.
• Uncontrolled - frequent symptoms, frequent night waking, limited activities, frequent reliever use, or recent flare requiring oral corticosteroids or hospital care.

The goal of treatment is to get to and stay in the well-controlled category.

TeleTest is a good fit for:

• Renewing inhalers for stable, well-controlled asthma that has previously been diagnosed and confirmed by lung-function testing.
• Adjusting therapy for someone with diagnosed asthma whose symptoms have changed.
• Step-up therapy when a current regimen isn't keeping symptoms under control and the patient has had recent lung-function testing.
• Stepping down therapy for someone whose asthma has been very well controlled for several months on a higher-step regimen.

You'll be better served by in-person care if:

• You have never been formally diagnosed with asthma. TeleTest does not perform spirometry (lung-function testing), which is the standard diagnostic test. A first-time diagnosis needs in-person spirometry plus clinical assessment by a family doctor, walk-in clinician, or respirologist.
• You're currently in a severe flare - significant shortness of breath, difficulty speaking in full sentences, blue lips or fingernails - go to an emergency department now.
• You have severe or difficult-to-control asthma despite high-dose inhaled corticosteroid plus a long-acting bronchodilator. This needs respirology (lung specialist) care for advanced biologic treatments and ongoing management.
• You have frequent exacerbations requiring oral steroids or hospital visits. A respirologist should be involved.
• You have suspected occupational asthma or other complex contributors. Specialty input is important.

Asthma diagnosis combines:

• Clinical history - the pattern of symptoms (wheezing, cough, shortness of breath, triggers, response to bronchodilators).
• Lung-function testing - the cornerstone is spirometry, which measures how much and how fast you can breathe out. Asthma typically shows airflow obstruction that improves significantly after a bronchodilator (showing the airways open up in response).
• Sometimes additional testing - methacholine challenge testing in difficult-to-diagnose cases, fractional exhaled nitric oxide (FeNO) testing, allergy testing, chest imaging.

TeleTest does not perform spirometry. For a first-time asthma diagnosis, you need to be seen in person somewhere that performs spirometry - typically a family doctor's office, a walk-in clinic that offers it, or a respiratory clinic.

Other conditions can mimic asthma - chronic obstructive pulmonary disease (COPD, mostly in older patients with smoking history), vocal cord dysfunction, post-infection airway changes, severe acid reflux. Treatment for these is different. Confirming asthma with spirometry avoids prescribing the wrong long-term medication.

Not necessarily. If you have a clear history of asthma diagnosed in the past, have responded well to typical inhaled treatment, and your symptoms remain consistent with asthma, repeat spirometry isn't always required for ongoing care. The clinician will discuss this in your intake.

If your symptoms have changed (new chronic cough without wheezing, breathing problems that don't respond to your inhaler the way they used to, new sputum production), repeat lung-function testing is worth doing.

• What it does: opens the airways quickly during a flare or before exercise to prevent exercise-induced symptoms.
• When to use: as needed - when you feel wheezy, short of breath, or before triggering activity.
• How fast it works: a few minutes.
• How long it lasts: 4-6 hours.

Important: if you need your reliever inhaler more than twice a week for non-exercise symptoms, your asthma is not well-controlled and a controller inhaler should be considered. Using a reliever alone for ongoing symptoms is a sign you need more treatment - it does not treat the underlying inflammation.

• What it does: treats the underlying inflammation in the airways. Used daily, it gradually reduces airway sensitivity and prevents symptoms.
• When to use: every day, on a regular schedule (typically once or twice daily) regardless of symptoms.
• How fast it works: improvement over days to weeks. Not a quick fix - this is a maintenance medication.
• Side effects: at the doses used for asthma, side effects are generally mild. Most common are oral thrush (yeast) and hoarse voice - both reduced by rinsing your mouth with water after each dose.

For most patients with asthma symptoms more than twice a week, ICS is the foundation of treatment.

• What it does: combines an inhaled corticosteroid with a long-acting bronchodilator that keeps the airways open for 12-24 hours.
• When to use: every day. Some combination inhalers can be used both as a controller AND as a reliever - this is the single maintenance and reliever therapy (SMART) approach, which has the best evidence for many patients. The clinician will discuss whether SMART is right for you.
• Why combine: lower-dose ICS plus a long-acting bronchodilator often works better than higher-dose ICS alone, with fewer side effects.

If asthma isn't controlled on a moderate-dose combination inhaler, the next steps are:

• Higher-dose combination inhaler (more ICS plus the long-acting bronchodilator).
• Adding a third bronchodilator class (long-acting muscarinic antagonist, LAMA).
• Add-on tablets (leukotriene receptor antagonist).
• Respirology assessment for biologic therapies (targeted injectable medications for severe asthma). TeleTest does not arrange respirology referrals - your family doctor or a local in-person clinician can arrange this.

The clinician can step you up within the inhaler categories above, but if your asthma needs higher-step care (especially biologic therapy), you will need to see a respirologist. TeleTest does not arrange these referrals; your family doctor or a local in-person clinician can.

Short courses of oral steroids are sometimes used during moderate-to-severe flares that aren't controlled by inhaled medication alone. TeleTest can prescribe a short course for an asthma flare when it's clinically appropriate, but frequent or chronic oral steroid use is a sign that asthma control isn't good enough and the long-term plan needs adjustment - usually with respirology input. TeleTest does not arrange respirology referrals; your family doctor or a local in-person clinician can.

The choice depends on:

• How often you have symptoms.
• Triggers and pattern (exercise-induced, allergy-triggered, year-round).
• Past response to medications you've already tried.
• Inhaler technique - some devices are easier to use than others (metered-dose inhalers vs. dry-powder inhalers vs. soft-mist inhalers). The clinician will discuss what you can use reliably.
• Cost and insurance coverage.
• Side-effect tolerability.

Bring information about what you've used in the past and what worked or didn't - this is the most useful information for the clinician.

Very important. A significant portion of patients use their inhaler incorrectly, which delivers far less medication to the lungs and leaves symptoms inadequately controlled. Common issues:

• Not shaking metered-dose inhalers before use.
• Inhaling too fast or too slow.
• Not coordinating the puff with the breath.
• Not using a spacer when one would help.
• Not holding the breath after inhaling.

Ask your pharmacist for a technique check when you fill the prescription. They will show you the correct method for your specific device. Spacers (chambers that attach to metered-dose inhalers) are useful for many patients and significantly improve delivery.

• Respiratory infections - colds and flu are the most common triggers for flares.
• Allergens - dust mites, pet dander, pollen, mould.
• Air quality - smoke, wildfire smoke, traffic pollution, ozone.
• Cold or dry air, especially with exercise.
• Strong smells - cleaning products, perfumes, paint fumes.
• Exercise - common, especially in cold or dry conditions.
• Stress and strong emotions - can trigger flares.
• Hormonal changes - some women notice patterns around menstruation.
• Medications - non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, beta-blockers, ACE inhibitors - though these affect only some patients.
• Acid reflux, sleep apnea, obesity - underlying conditions that worsen asthma control.

• Reduce indoor allergens - dust-mite-proof bedding covers, regular vacuuming, washing bedding in hot water, reducing carpet, keeping humidity moderate (not too dry, not too damp).
• Pet management - if pet dander is a major trigger and you can't part with the pet, keep them out of the bedroom.
• Air quality - air purifiers with HEPA filters can help indoor air. Check air-quality forecasts; reduce outdoor activity on high-pollution or wildfire-smoke days.
• Annual influenza vaccination - flu can trigger severe asthma flares.
• COVID vaccination - for similar reasons.
• Quit smoking if you smoke, and avoid second-hand smoke.
• Treat acid reflux if you have it.
• Manage weight - obesity worsens asthma control.

Exercise-induced bronchoconstriction is common in asthma and isn't a reason to avoid exercise - regular exercise actually improves overall asthma control over time.

• Warm up properly before vigorous activity.
• Use your reliever inhaler 15-30 minutes before exercise if symptoms are predictable.
• Avoid exercising in very cold, dry air or use a scarf over your mouth and nose to warm the air.
• If you regularly have exercise-induced symptoms, your controller therapy may need adjustment - speak to the clinician.

An asthma action plan is a written, personalised plan that tells you:

• What to do when you're feeling well (your usual daily inhaler regimen).
• What to do when symptoms are getting worse (when to step up reliever use, when to start oral steroids if pre-prescribed, when to contact a clinician).
• What to do in an emergency (when to call 911 or go to an ER).

Every patient with asthma should have an action plan. The clinician can issue or update yours during a TeleTest consultation - bring along your current plan if you have one.

Warning signs that asthma is moving toward an exacerbation:

• Increased reliever use - you're using your reliever inhaler more often than usual.
• Symptoms at night - waking with cough, wheezing, or shortness of breath.
• Less response to reliever - relief is partial or short-lived.
• Increased shortness of breath with usual activities.
• A cold or flu starting - respiratory infections often trigger flares.

If you notice these, step up your treatment per your action plan and contact your clinician. Don't wait for a severe flare to develop.

Some children "outgrow" their asthma - symptoms may significantly improve or disappear in adolescence or adulthood. Adult-onset asthma is less likely to resolve completely, but can be very well-controlled with treatment. Some adults experience long symptom-free periods on minimal treatment.

Yes. Inhaled corticosteroids at standard doses are very well-studied and considered safe for long-term use. They reach the airways where they're needed, with little systemic exposure. Side-effect concerns (bone density, cataracts) are mostly relevant at very high doses over many years - not standard doses for asthma.

The benefits of well-controlled asthma far outweigh the risks of inhaler use for the vast majority of patients.

Long-term oral steroids carry significant side effects (bone loss, diabetes, cataracts, weight gain, mood changes, infection risk) and are reserved for very severe asthma that hasn't responded to other options. If you're on chronic oral steroids, respirology evaluation is important to see if other therapies (including biologic injections) could replace them. TeleTest does not arrange respirology referrals; your family doctor or a local in-person clinician can.

Asthma control matters during pregnancy - uncontrolled asthma is more harmful to a pregnancy than well-controlled asthma is. Most asthma medications used in pregnancy are considered safe; the main message is continue your medication and stay well-controlled.

If you become pregnant on asthma medication, message your clinician to review your plan. Don't stop medication without discussing it first.

Yes - regular exercise improves overall asthma control and general health. Many elite athletes have asthma. The approach is to keep asthma well-controlled with a controller inhaler, use the reliever before exercise if symptoms are predictable, and choose activities and conditions that don't trigger severe symptoms.

Not for everyone. Allergy testing is useful if:

• You have clear allergic triggers that you'd like to identify.
• You have severe or uncontrolled asthma and an allergic cause is suspected.
• You're considering immunotherapy (allergy shots) for long-term management.

Allergy testing is typically done through a family doctor or an allergist. TeleTest does not currently arrange allergy testing or allergist referrals.

• Some inhalers are covered by provincial drug plans for eligible patients (e.g., low-income, age-based programs). Coverage varies and changes over time.
• Most private insurance plans cover inhalers, often with a small co-pay.
• Without coverage, costs vary substantially (see the table above). Generic equivalents are often available and significantly cheaper than brand names - ask your pharmacist.

No. The TeleTest fee covers the consultation, the clinical assessment, and prescribing or renewing the inhaler. The inhaler itself is paid for at the pharmacy. Some inhalers are dramatically cheaper at one pharmacy vs another - it's worth calling around.