Adult asthma treatment by telehealth in Puerto Rico

Asthma is a lung disease in which the airways become inflamed and narrow, which makes it harder to breathe. It is a long-term condition: symptoms can come and go, and flare suddenly during an asthma attack. With the right treatment, most people keep it under control.

It works the same from anywhere in Puerto Rico:

Asthma causes wheezing, shortness of breath, chest tightness and coughing, especially at night or early in the morning. Symptoms can come and go, and get suddenly worse during an attack.

Controller medicines are used every day, even when you feel well, so you have fewer and milder attacks. The most common is an inhaled corticosteroid; it can cause hoarseness or a yeast infection in the mouth, which rinsing your mouth after each use helps prevent. Others include long-acting bronchodilators, leukotriene modifiers and biologic medicines.

Rescue medicines relieve symptoms during an attack. If you need your rescue inhaler often, your asthma is not well controlled and the doctor reviews your treatment with you. None of these inhalers is a controlled substance; the doctor decides which one is right for you.

Spirometry is the lung function test that measures how much air you breathe out and how fast, and it helps confirm the diagnosis. If you need it, the doctor gives you an order to have it done at a pulmonary function lab near you.

An action plan is a written document that tells you:

• Which triggers to avoid.
• How to recognize an asthma attack and what to do.
• Which medicines to take and when.
• When to call the doctor and when to go to the emergency room.
• Who to call in an emergency.

Avoiding what sets off your symptoms is part of treatment. The CDC lists these common triggers:

• Cigarette smoke, including secondhand smoke
• Dust mites
• Air pollution, including smoke from fires
• Cockroaches and other pests
• Furry pets
• Mold, which grows in damp places such as kitchens and bathrooms
• Infections such as the flu, colds and respiratory syncytial virus (RSV)
• Sinus infections, allergies and pollen
• Strong chemicals and fragrances
• Acid reflux
• Bad weather, exercise and strong emotions

The Puerto Rico Department of Health BRFSS trends report (2011 to 2021) found that adult asthma stayed stable over those years and was about twice as common in women as in men.

In a warm, humid climate, mold and dust mites are triggers worth controlling at home. And because storms can cut off access to a pharmacy, keep a supply of your inhalers: see medications and hurricanes.

Every summer, clouds of Saharan dust reach Puerto Rico. According to NOAA, the Saharan Air Layer usually ramps up in mid-June, peaks from late June to mid-August, and subsides quickly after that. The EPA lists aggravated asthma among the health effects of particle pollution.

NOAA advises people with asthma to keep their condition under control and limit time outdoors during dust events. Keep your rescue inhaler handy, follow your action plan and, if you need your rescue inhaler more than usual, get checked. More in our Saharan dust guide.

We see children of all ages. If your child has asthma, the doctor evaluates them by video, checks their inhaler and action plan, and helps with refills: see our online doctor visits for kids. For their safety, if a child is breathing fast, the skin between the ribs pulls in, the lips look bluish or they cannot talk, call 911.

For your safety, call 911 or go to the nearest emergency room if you have any of these signs. See also when to go to the ER.

• Your rescue inhaler does not help or breathing is still very hard
• Trouble talking or walking because you are short of breath
• Lips, nails or skin with a bluish tint