<ul><li>Dexamethasone is one of the very few medicines with strong evidence of providing definite benefits in <keyword id="8764262" type="COMPANY" weightage="20" keywordseo="covid">Covid</keyword> management.</li><li><keyword id="8775508" type="PERSON" weightage="20" keywordseo="remdesivir">Remdesivir</keyword> has no impact on final mortality, and at best, can reduce the duration of the illness. </li><li>Antibiotics do not work against viruses; they only work on bacterial infections. COVID-19 is caused by a virus.</li></ul>(Disclaimer: This should not be considered medical advice. Please check with your doctor before taking treatment.) As of 23 April, India has 25,52,940 active cases and has witnessed 189,549 deaths, and the air is grim, to say the least. With a near-collapse of the healthcare system, people are understandably grasping at straws to try anything to keep the virus at bay or, if infected, help alleviate the symptoms. Since healthcare professionals are hard to reach, people are resorting to the next best thing, the internet, which is rife with suggestions and recommendations that are sometimes helpful, but most are borderline dangerous. But what is worrying is that doctors, too, are “recommending medications that have no proper evidence from clinical trials to back them up. One of these drugs is <keyword id="7429144" type="COMPANY" weightage="20" keywordseo="Ivermectin">Ivermectin</keyword>,” a concerned Dr Ghazzali Ahmad, who works in the UK’s National Health Service (NHS) as a frontline accident and emergency doctor tells Business Insider. He adds, “Don’t start randomly taking <keyword id="1056953" type="PERSON" weightage="20" keywordseo="azithromycin">Azithromycin</keyword> and Ivermectin and large quantities of <keyword id="90405" type="COMPANY" weightage="20" keywordseo="Zinc">zinc</keyword> and vitamin D. Covid-19 is (caused by) a virus, not a bacteria or parasite.” Dr Vipin Vashishtha — former convener, IAP Committee on immunisation and paediatrician at Mangla Hospital and Research Centre in Uttar Pradesh — echoes Dr. Ahmad’s opinion. <div type="ExtQuote" text="“Self-medication should be avoided. Very few drugs are effective treatments of Covid-19. They include steroids, anticoagulants and, to some extent, Remdesivir. No other drug provides consistent, reliable benefit. All these drugs should be used under the strict supervision of a clinician.&quot;" auname="Dr Vipin Vashishtha"></div> He adds that starting medicines without a physician’s advice may sometimes give the patient a false sense of security, and the key phases of illness may be missed. According to Dr Vashishtha, an essential parameter is constantly monitoring your oxygen saturation with an oximeter. Any drop below 94% should be treated as a red flag and demands urgent referral. “Patients sometimes may remain comfortable even at a low saturation level which is termed ‘happy hypoxia’ and the dip may be easily missed if one is not monitoring their oxygen saturation. Many self-administered drugs may further complicate the course of illness if not used at an appropriate time. For example, some patients start oral steroids in the first few days of illness that may suppress the normal immune responses,” he adds. Medications, their efficacy and side effects <cmsannotation type="cmsannotation" annotationid="Budesonide" comment="subhead" text="Budesonide"><keyword id="1368551" type="PERSON" weightage="20" keywordseo="budesonide">Budesonide</keyword></cmsannotation> Is an inhaled steroid used in the management of bronchial asthma. Its role in treating Covid-19 is not yet confirmed, but few <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00160-0/fulltext">reports</a> have indicated some benefits. Early administration of inhaled Budesonide reduces the likelihood of needing urgent medical care and reduces recovery time. If a patient is incessantly coughing, he/she can take it at home. The medicine has only a few minor side effects like redness, dryness of mouth, etc. <cmsannotation type="cmsannotation" annotationid="Dexamethasone" comment="subhead" text="Dexamethasone">Dexamethasone</cmsannotation> This is one of the very few medicines with strong evidence of providing definite benefits in Covid management and is one of the few drugs with <a href="https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-dexamethasone">WHO backing</a>. This corticosteroid is used to combat a variety of conditions due to its anti-inflammatory and immunosuppressant properties. Strong evidence suggests that treatment with dexamethasone reduces 28-day mortality in patients with Covid-19 who receive respiratory support. However, there are no benefits (and the possibility of harm) among patients who do not require oxygen. It should be started after one week of getting the illness. During treatment, typical side effects include high blood sugar level, acidity, gastric ulcer, exacerbation or superadded infection (added infections over an existing disease). <cmsannotation type="cmsannotation" annotationid="Remdesivir" comment="subhead" text="Remdesivir">Remdesivir</cmsannotation> It is an antiviral drug used initially in the treatment of the Ebola virus. There is still no incontrovertible proof of its efficacy against Covid-19. The drug has no impact on final mortality, and at best, can reduce the duration of the illness. The drug does help reduce viral replication, and if used, it should be used only in hospitalised, moderate-to-severe cases with low SpO2 and require oxygen. It has no prophylactic (preventing an illness) role and should not be administered at home. The drug may have serious side effects on the gastrointestinal, hepatic and renal system. <cmsannotation type="cmsannotation" annotationid="Becozinc" comment="subhead" text="Becozinc">Becozinc</cmsannotation>This has a high dose of around 50 mg of elemental zinc. There is no evidence that it has some impact either on the duration of the disease or outcome. High amounts of zinc may cause some adverse effects like nausea, vomiting, stomachache, diarrhoea, headaches, anorexia, muscle weakness, etc. <cmsannotation type="cmsannotation" annotationid="Vitamin C tablets" comment="subhead" text="Vitamin C tablets"><keyword id="20923" type="COMPANY" weightage="20" keywordseo="Vitamin-C">Vitamin C</keyword> tablets</cmsannotation>Although vitamin C is known to have antioxidant effects, the clinical implication of its use in Covid pneumonia is not established. There is no role of this drug in the prevention of Covid-19. There are reports of the use of high-dose intravenous vitamin C as part of treatment for acute respiratory distress syndrome (ARDS) associated with COVI-19 infection, but there are no randomised controlled trials or concrete evidence to support its use. <cmsannotation type="cmsannotation" annotationid="Doxycycline/Azithromycin" comment="subhead" text="Doxycycline/Azithromycin">Doxycycline/Azithromycin</cmsannotation>Antibiotics do not work against viruses; they only work on bacterial infections. COVID-19 is caused by a virus. Antibiotics should not be used as a means of prevention or treatment of COVID-19. In hospitals, physicians will sometimes use antibiotics to prevent or treat secondary bacterial infections, which can be a complication of COVID-19 in severely ill patients. They should only be used as directed by a physician to treat a bacterial infection. These antibiotics may have some side effects like diarrhoea, oral ulcers, among others. <cmsannotation type="cmsannotation" annotationid="Antipyretic drugs" comment="subhead" text="Antipyretic drugs">Antipyretic drugs</cmsannotation>This is a mandatory addendum to any Covid-management protocol. It is used for symptomatic relief for fever, headache, muscular pains, etc. However, its use should be restricted to provide temporary relief to associated symptoms. High doses of antipyretics (drugs that reduce fever) and non-steroidal anti-inflammatory drugs (NSAIDs) may lead to gastric irritation, acidity, and liver dysfunctions. <cmsannotation type="cmsannotation" annotationid="FabiFlu" comment="subhead" text="FabiFlu">FabiFlu</cmsannotation>This oral antiviral drug was approved for influenza in Japan and has shown potent in vitro activity (lab studies) against SARS-CoV-2. However, there is no evidence that this antiviral provides some protection against Covid-19. Some studies have shown that it can reduce the duration of Covid-19 by only 2-3 days. However, quality evidence is lacking. It has some side effects like diarrhoea, hyperuricemia (high levels of uric acid), psychiatric symptoms, etc. <cmsannotation type="cmsannotation" annotationid="Ivermectin" comment="subhead" text="Ivermectin">Ivermectin</cmsannotation> This is a broad-spectrum antiparasitic agent used against worm infestation. This is another widely used drug, but there is no evidence that it works. No clinical trials have reported a clinical benefit for Ivermectin in patients with Covid-19. The common side effects include tiredness, loss of energy, stomach pain, loss of appetite, dizziness, nausea, vomiting, and diarrhoea. Effectiveness of non-medical recommendations Masking: This is most definitely the way to go. In the current scenario, <a href="https://www.cnbc.com/2020/09/16/cdc-director-says-face-masks-may-provide-more-protection-than-coronavirus-vaccine-.html">some believe</a> it may be more beneficial than even vaccines. Steam inhalation: The steam inhalation practice is risky, and there is no scientific proof that it can prevent a <keyword id="1754604" type="PERSON" weightage="20" keywordseo="coronavirus">coronavirus</keyword> infection. Further, this steam inhalation can be unsafe and may lead to burns. Lying on your stomach to reduce breathlessness: Called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402434/">awake proning</a>, this technique helps tackle ARDS. Because of fluid accumulation, patients suffering from ARDS need mechanical ventilation since their lungs are unable to oxygenate blood on their own. Lying on the stomach relieves the excess pressure of fluid build-up around the lung tissues. Smelling a concoction of camphor, clove, carom seeds (ajwain), and eucalyptus oil tied in a muslin bag can help improve oxygen levels and congestion: No evidence that they provide any beneficial effects. Drinking a concoction of black pepper powder, honey, ginger juice will help keep the virus at bay: Again, no evidence to back the same. Divya Coronil: No good-quality evidence. The trials done by the manufacturer had several limitations. Drinking kadha: There is zero evidence that this ayurvedic drink that is primarily a decoction of various herbs and spices helps to combat the virus. See Also: <a href="https://www.businessinsider.in/business/corporates/news/indian-corporates-vcs-and-startups-are-now-looking-to-charter-flights-and-import-oxygen-cylinders-and-concentrators-into-the-country/articleshow/82230785.cms" data-type="tilCustomLink" target="_blank">Indian corporates, VCs and startups are now looking to charter flights and import oxygen cylinders and concentrators into the country</a> <a href="https://www.businessinsider.in/business/startups/news/covid-19-pandemic-has-thrown-the-spotlight-on-a-five-year-old-startup-with-emergency-ambulance-service/articleshow/82229745.cms">COVID-19 pandemic has thrown the spotlight on a five-year old startup with emergency ambulance service⁠</a> <a href="https://www.businessinsider.in/india/news/the-covid-19-crisis-would-be-much-worse-without-these-good-samaritans-of-india-providing-home-cooked-food-financial-assistance-and-medicines/slidelist/82230244.cms">The COVID-19 crisis would be much worse without these good samaritans of India providing home-cooked food, financial assistance and medicines</a>

Drugs used to combat COVID-19 ⁠— what works and what doesn’t

<ul class="summary-list"><li>Treating COVID-19 could be simpler soon, thanks to the next generation of treatments.</li><li>These could come in the form of <keyword id="12258955" type="UNKNOWN" weightage="60" keywordseo="pills" source="Orion">pills</keyword>, nasal sprays, or inhalers.</li><li>On Monday, Merck asked the FDA to authorize its <keyword id="12216042" type="UNKNOWN" weightage="60" keywordseo="antiviral" source="Orion">antiviral</keyword> pill, which would be the first <keyword id="11959748" type="UNKNOWN" weightage="60" keywordseo="covid-19-treatment" source="Orion">COVID-19 treatment</keyword> of its kind. </li></ul>COVID-19 could get a lot easier to treat in the near future.Thus far, doctors have relied on expensive, invasive drugs that are limited in supply and often complicated to administer. But biotech and pharma companies are now working on simpler treatments that people could take as pills, nasal sprays, or inhalers. An antiviral drug from Merck and Ridgeback Biotherapeutics is on track to become the first pill authorized to treat COVID-19. On Monday, the companies asked the Food and Drug Administration (FDA) to <a href="https://www.businessinsider.com/merck-covid-pill-fda-eua-authorization-antiviral-molnupiravir-drug-ridgeback-2021-10v">authorize that treatment</a>, which was found to reduce the risk of hospitalization or death among adults with mild to moderate COVID-19. If the FDA thinks the data is sound enough, it could greenlight the pill within weeks. So far, the FDA has fully approved just one treatment for COVID-19: the antiviral drug remdesivir, which is administered via injection. The drug has been shown to <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2007764">shorten the recovery time</a> of hospitalized patients.The FDA also authorized the emergency use of <a href="https://www.businessinsider.com/tennessee-vaccinated-denied-monoclonal-antibody-treatment-2021-9">monoclonal antibodies</a>, drugs that help keep people with mild or moderate symptoms from developing severe COVID-19. These come in two forms: infusions or injections.Pills or sprays, however, could make it easier for people to treat COVID-19 symptoms right away, perhaps without needing to visit hospitals. Pills are also likely to be cheaper than antibody infusions, which are free for patients but cost the US government <a href="https://www.npr.org/sections/health-shots/2020/10/28/928841997/government-signs-deal-for-covid-19-treatments-from-eli-lilly">more than $1,000 per dose</a>.The following drugs have shown the most promise in trials as potential COVID-19 treatments. None of them is a replacement for vaccines, though.<h2>Antiviral pills could lower the risk of hospitalization</h2><div type="image" title="Capsules of molnupiravir, an antiviral drug developed by Merck and Ridgeback Biotherapeutics that could treat COVID-19" height="2002" width="3000" msid="86820470" hostid="261"></div>Warding off severe COVID-19 could eventually be as simple as taking a few pills.Merck's antiviral, molnupiravir, was originally developed as a treatment for the flu. Now it's being evaluated for mild to moderate COVID-19 in a study of nearly 1,900 volunteers. So far, the pill has <a href="https://www.businessinsider.com/merck-covid-pill-fda-eua-authorization-antiviral-molnupiravir-drug-ridgeback-2021-10">halved the risk</a> of hospitalization or death among a group of 385 people, Merck <a href="https://www.merck.com/news/merck-and-ridgebacks-investigational-oral-antiviral-molnupiravir-reduced-the-risk-of-hospitalization-or-death-by-approximately-50-percent-compared-to-placebo-for-patients-with-mild-or-moderat/">announced earlier this month</a>. The participants took 40 pills in total: four capsules twice a day for five days.The pill belongs to a class of antiviral drugs called nucleosides, which try to block the virus from replicating inside cells.Two other companies, <keyword id="11909248" type="UNKNOWN" weightage="60" keywordseo="roche" source="Orion">Roche</keyword> and Atea Pharmaceuticals, are also jointly developing a nucleoside pill. That drug, called AT-527, was shown to <a href="https://ir.ateapharma.com/news-releases/news-release-details/ateas-527-oral-antiviral-drug-candidate-reduces-viral">reduce the amount of virus present</a> in hospitalized patients with moderate COVID-19. The study was small, though - around 60 people - so Roche is waiting on data from a study of nearly 1,400 people, which could be available before the end of the year.<h2>Not all prospective COVID-19 pills are the same</h2>Other companies are developing antiviral pills called protease inhibitors, which target an enzyme involved in the viral replication process.<keyword id="11897118" type="UNKNOWN" weightage="60" keywordseo="pfizer" source="Orion">Pfizer</keyword> is testing such a drug in combination with a low dose of another antiviral that slows the breakdown of the drug so it lasts longer in the body. The company kicked off a 3,000-person study in July and hopes to get data before the end of 2021.Meanwhile, a protease inhibitor from Japanese drugmaker Shionogi could help people with mild or asymptomatic infections. The company <a href="https://www.shionogi.com/global/en/news/2021/09/e-210928.html">began a late-stage study in September</a>. Two smaller biotech companies - Pardes Biosciences and Enanta Pharmaceuticals - are working on their own protease inhibitors, but they're far from late-stage studies. Pardes launched a 110-person trial in August, and those results could be ready by the end of the year. Enanta hopes to start initial testing of its pill in people in early 2022. The company previously developed a treatment for hepatitis C.<h2>Nasal sprays may be useful immediately after exposure to the virus</h2><div type="image" title="covid nasal spray" height="4024" width="6048" msid="86820473" hostid="261"></div>The <keyword id="11893194" type="UNKNOWN" weightage="60" keywordseo="coronavirus" source="Orion">coronavirus</keyword> first invades the body through the nose, eyes, and throat, so scientists think there's an advantage to administering treatments directly into those areas. Nasal sprays, for instance, could kill or weaken the virus in the upper airways, before it spreads to the lungs, where it's likely to cause the most damage.A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117664/">May study</a> found that a nasal spray from the biotech company SaNOtize reduced the amount of virus present among 40 people with mild COVID-19. The spray uses a colorless gas called nitric oxide that's found naturally in the body. Israel is now offering that drug in pharmacies.Another company, IGM Biosciences, is developing a nasal spray that contains an antibody engineered to neutralize the coronavirus. The spray <a href="https://igmbio.com/2021/06/03/igm-biosciences-announces-expansion-of-igm-platform-into-infectious-diseases-publication-of-preclinical-data-in-nature-demonstrating-engineered-igm-antibody-antiviral-activity-for-the-treatment-and-p/">reduced the amount of virus in the lungs of mice</a>, but scientists don't yet know whether it will be effective in humans. Zhiqiang An, a professor of molecular medicine who's involved in the research, <a href="https://www.nature.com/articles/d41586-021-01481-2">told Nature</a> that the spray could eventually serve as an emergency treatment after someone has been exposed to the coronavirus.<h2>Inhalers could shorten recovery among hospitalized patients</h2><div type="image" title="covid inhaler" height="3306" width="4959" msid="86820477" hostid="261"></div>A couple of inhaled COVID-19 medicines are also showing promise, though more research is needed.<a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30511-7/fulltext">In a study of about 100 hospitalized COVID-19 patients</a>, an <keyword id="12258956" type="UNKNOWN" weightage="60" keywordseo="inhaler" source="Orion">inhaler</keyword> from Synairgen was found boost the odds of improvement and lead to quicker recovery times relative to patients who received a placebo.The inhaler uses a naturally occurring protein to stimulate the immune response in the lungs. Synairgen <a href="https://www.synairgen.com/umbraco/Surface/Download/GetFile?cid=1c48c82b-86ce-4aa3-9613-3fcf2f7b2e7a">expects results</a> from a late-stage study in hospitalized patients in early 2022.A large study also found benefits from inhaled budesonide, a generic anti-inflammatory drug that treats asthma and chronic obstructive pulmonary disease. <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(21)01744-X.pdf">A UK study in high-risk COVID-19 patients</a> found that budesonide helped people recover about three days faster than those who received standard care. But the same study found that budesonide didn't significantly reduce hospitalizations or deaths.This story has been updated with new information. It was originally published October 6.

The first-ever COVID-19 pill may be just weeks away. A handful of other pills, inhalers, and nasal sprays also show promise.

The <keyword id="83655" type="COMPANY" weightage="20" keywordseo="Union-health-ministry">Union Health Ministry</keyword> has issued revised guidelines for <keyword id="8699674" type="UNKNOWN" weightage="20" keywordseo="Home-isolation">home isolation</keyword> for <keyword id="6364395" type="UNKNOWN" weightage="20" keywordseo="patients">patients</keyword> with mild or asymptomatic symptoms. The new revised guidelines said, "Patient under home isolation will stand discharged and end isolation after at least 10 days have passed from onset of symptoms (or from date of sampling for <keyword id="9100396" type="UNKNOWN" weightage="20" keywordseo="asymptomatic-cases">asymptomatic cases</keyword>) and no fever for 3 days. There is no need for testing after the home isolation period is over." As per the revised guidelines, the patient should be clinically assigned a mild/asymptomatic case by the treating Medical Officer."The asymptomatic cases are laboratory confirmed cases not experiencing any symptoms and having oxygen saturation at room air of more than 94 per cent. Clinically assigned <keyword id="9271864" type="UNKNOWN" weightage="20" keywordseo="mild-cases">mild cases</keyword> are patients with upper respiratory tract symptoms (and/or fever) without shortness of breath and having oxygen saturation at room air of more than 94 per cent are recommended for home isolation," the revised guidelines said. It said that a caregiver should be available to provide care on a 24x7 basis and a communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation.Elderly patients aged more than 60 years and those with co-morbid conditions such as hypertension, diabetes, heart disease, chronic lung/liver/ kidney disease, cerebro-vascular disease shall only be allowed home isolation after proper evaluation by the treating medical officer. Talking about treatment protocols, the revised guideline said, "Patients must be in communication with a treating physician and promptly report in case of any deterioration. If fever is not controlled with a maximum dose of Tab. Paracetamol 650mg four times a day, consult the treating doctor who may consider advising other drugs like non-steroidal anti-inflammatory drugs (<keyword id="805213" type="COMPANY" weightage="20" keywordseo="NSAID">NSAID</keyword>) (ex: Tab. Naproxen 250 mg twice a day)." It further stated that consider Tab Ivermectin (200 mcg/kg once a day, to be taken empty stomach) for 3 to 5 days. Inhalational Budesonide (given via inhalers with spacer at a dose of 800 mcg twice daily for 5 to 7 days) to be given if symptoms (fever and/or cough) are persistent beyond 5 days of disease onset. "The decision to administer Remdesivir or any other investigational therapy must be taken by a medical professional and administered only in a hospital setting. Do not attempt to procure or administer Remdesivir at home," it said. As per the guidelines,a patient under home isolation seeks immediate medical attention if serious signs or symptoms develop which could include difficulty in breathing, dip in oxygen saturation, persistent pain pressure in the chest and mental confusion or inability to arouse. SEE ALSO: <a href="https://www.businessinsider.in/stock-market/news/wazirx-users-dogecoin-cryptocurrency-report-failed-transactions-and-delays-in-orders/articleshow/82425709.cms">Dogecoin surge sends WazirX servers panting for help – users report failed transactions, delays in orders</a> <a href="https://www.businessinsider.in/india/news/india-supreme-court-quashes-election-commissions-plea-against-madras-high-court/articleshow/82427416.cms">‘Internet has revolutionised courtroom reporting’ – India’s Supreme Court quashes Election Commission’s plea against Madras High Court</a> <a href="https://www.businessinsider.in/tech/apps/news/battlegrounds-mobile-india-is-now-official-check-out-launch-date-downloads-and-more/articleshow/82427206.cms">Battlegrounds Mobile India is now official, but comes with several restrictions for minors</a>

COVID-19: No tests needed for mild or asymptomatic patients under home isolation after 10 days, says health ministry

<ul><li>The All India Institute of Medical Sciences (<keyword id="40458" type="COMPANY" weightage="20" keywordseo="AIIMS">AIIMS</keyword>) and Indian Council of Medical Research (<keyword id="6364396" type="UNKNOWN" weightage="20" keywordseo="ICMR">ICMR</keyword>) have combinedly issued new guidelines for treatment of mild, moderate and severe cases of COVID-19.</li><li>In case of mild COVID-19, AIIMS guidelines recommend home isolation and care.</li><li>For full details, check out the list below.</li></ul>The All India Institute of Medical Sciences (AIIMS) and Indian Council of Medical Research (ICMR) have combinedly issued new guidelines to identify COVID-19 treatment based on three levels of seriousness – mild, moderate and severe. With COVID-19 cases exploding across India and hospitals facing acute shortage of oxygen and other critical requirements, it’s important for you to keep a track of your health, and identify <keyword id="8889783" type="UNKNOWN" weightage="20" keywordseo="Covid-19-symptoms">COVID-19 symptoms</keyword> early. <cmsannotation type="cmsannotation" annotationid="Treatment of mild COVID-19 cases" comment="subhead" text="Treatment of mild COVID-19 cases">Treatment of mild COVID-19 cases</cmsannotation> In case you have a mild case of COVID-19, you can avoid the trip to the hospital and take care of yourself at home. Here’s what the new AIIMS guidelines suggest: How to identify A patient is said to have mild COVID-19 in case they have upper respiratory tract symptoms and/or fever without shortness of breath or hypoxia. Hypoxia means there is a shortage of adequate supply of oxygen at the tissue level. It can be identified by checking SpO2 levels using an oximeter. SpO2 levels should be between 92% to 98%, anything lower than 92% is considered as hypoxia. Suggestions AIIMS guidelines suggest home isolation and care. MUST DO <ul><li>Physical distancing, indoor mask use and strict hand hygiene.</li><li>Symptomatic management (hydration, antipyretics, antitussive, multivitamins).</li><li>Stay in contact with the treating physician.</li><li>Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers).</li></ul>Seek immediate medical attention if: <ul><li>Difficulty in breathing.</li><li>High grade fever/severe cough, particularly if it lasts for more than five days.</li><li>A low threshold to be kept for those with any of the high-risk features.</li></ul>MAY DO Note that these therapies are based on low certainty of evidence. <ul><li>Tab Ivermectin (200 mcg/kg once a day for 3 days). Avoid in case of pregnant and lactating women.</li></ul>OR <ul><li>Tab HCQ (400 mg twice for 1 day, followed by 400 mg once daily for 4 days) unless contraindicated.</li></ul>Inhalational Budesonide (given via Metered dose inhaler/ Dry powder inhaler) at a dose of 800 mcg twice for five days) to be given if symptoms (fever and/or cough) are persistent beyond five days of disease onset. SEE ALSO: <a href="https://www.businessinsider.in/politics/policy/article/if-the-covid-19-vaccine-prices-are-too-high-for-some-then-why-not-use-direct-benefit-transfer/articleshow/82200370.cms">If the COVID-19 vaccine prices are too high for some, then why not use direct benefit transfer</a> <a href="https://www.businessinsider.in/india/news/while-covid-19-is-making-millions-gasp-for-breath-in-india-state-administrations-are-trying-to-hoard-oxygen/articleshow/82199390.cms">The COVID-19 crisis in India is getting worse with state administrations trying to hoard oxygen</a> <a href="https://www.businessinsider.in/business/auto/news/covid-19-lockdowns-and-curfews-affecting-worlds-fourth-largest-automobile-market/articleshow/82195326.cms">There is a virtual lockdown in the world’s fourth largest automobile market</a>

Mild covid 19 symptoms and treatment as per AIIMS new Guidelines

<ul class="summary-list"><li>Chronic <keyword id="12063384" type="UNKNOWN" weightage="60" keywordseo="cough" source="Orion">cough</keyword> is any cough that lasts for at least 4 weeks in children and 8 weeks in adults.</li><li>If you can't stop coughing it could be due to asthma, post-COVID-19, GERD, COPD, and more.</li><li>Once the underlying condition is treated, your chronic cough should go away.</li></ul>About <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496056/" target="_blank" rel="noopener">4% to 10% of the adult population</a> experiences chronic cough — a cough lasting <a href="https://www.mayoclinic.org/diseases-conditions/chronic-cough/symptoms-causes/syc-20351575" target="_blank" rel="noopener">eight weeks or more</a>, or at least four weeks for children.A chronic cough doesn't call for immediate medical attention <a href="https://www.health.harvard.edu/staying-healthy/that-nagging-cough" target="_blank" rel="noopener">unless</a> you experience it with other symptoms like fever, shortness of breath, chest pain, or coughing up blood, which may <a href="https://my.clevelandclinic.org/health/symptoms/17696-coughing-up-blood" target="_blank" rel="noopener">indicate</a> a serious underlying medical condition.Chronic cough generally <a href="https://www.mayoclinic.org/diseases-conditions/chronic-cough/symptoms-causes/syc-20351575" target="_blank" rel="noopener">goes away</a> once the underlying problem(s) has been addressed. So, to help you with that, here are 10 potential causes of chronic cough and how you can treat each.<h2>1. Asthma</h2>Asthma is a <a href="https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653" target="_blank" rel="noopener">chronic condition</a> where the airways become inflamed and narrow and start producing extra mucus. This causes symptoms like wheezing, shortness of breath, chest tightness, and coughing.However, there is a <a href="https://acaai.org/asthma/symptoms/asthma-cough/" target="_blank" rel="noopener">form</a> of asthma called "cough-variant asthma" wherein the only symptom is a chronic cough. This tends to be <a href="https://www.caageorgia.com/about-us/blog/2021/september/how-is-cough-variant-asthma-treated-/" target="_blank" rel="noopener">more common</a> among children."Cough-variant asthma is actually a relatively rare diagnosis in my experience," says <a href="https://wexnermedical.osu.edu/find-a-doctor/megan-conroy-md-76567" target="_blank" rel="noopener">Megan Conroy, MD</a>, a pulmonologist at <a href="https://wexnermedical.osu.edu/" target="_blank" rel="noopener">The Ohio State University Wexner Medical Center</a>. "Cough as a symptom of the asthma may mean that your asthma is under-treated or poorly controlled."How to treat it: Cough-variant asthma <a href="https://acaai.org/asthma/symptoms/asthma-cough/" target="_blank" rel="noopener">cannot</a> be treated with over-the-counter cough medications. You would need prescription asthma medication like bronchodilators, a group of drugs that <a href="https://my.clevelandclinic.org/health/treatments/17575-bronchodilators--asthma" target="_blank" rel="noopener">relieve</a> asthma symptoms.More data is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182093/" target="_blank" rel="noopener">needed</a> to ascertain the dose or duration of treatment for cough-variant asthma, but the coughing may improve <a href="https://pubmed.ncbi.nlm.nih.gov/9308510/" target="_blank" rel="noopener">within a week</a> of taking bronchodilators.If not treated, cough-variant asthma can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182093/" target="_blank" rel="noopener">progress</a> to classic asthma where patients experience more symptoms other than a cough, which might <a href="https://acaai.org/asthma/treatment/medication/" target="_blank" rel="noopener">require</a> long-term control medications or biologic therapies.<h2>2. Post-COVID-19</h2>A cough is a <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963" target="_blank" rel="noopener">common symptom</a> of COVID-19, and in some cases, it will linger post-COVID and become chronic.In fact, chronic cough is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041436/" target="_blank" rel="noopener">common</a> in post-COVID syndrome (aka long COVID), a <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html" target="_blank" rel="noopener">range of symptoms</a> that lasts for weeks or months after the initial SARS-CoV-2 infection. Other <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html" target="_blank" rel="noopener">symptoms</a> of post-COVID-19 include: <ul><li>Headache</li><li>Fever </li><li>Muscle aches</li><li>Loss or change in taste or smell</li><li>Sleep issues</li><li>Lightheadedness</li><li>Diarrhea</li></ul>How to treat it: We are still learning more about post-COVID syndrome and its treatment, says Rob Rohatsch, MD, emergency medicine physician and chief medical officer at <a href="https://www.solvhealth.com/" target="_blank" rel="noopener">Solv Health</a>.For now, the management of COVID-19-associated cough is still <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041436/" target="_blank" rel="noopener">unclear</a>. To find relief, try drinking hot beverages that might warm your airways and <a href="https://www.umms.org/coronavirus/what-to-know/treat-covid-at-home" target="_blank" rel="noopener">break up</a> any mucus in your throat. Drinking water throughout the day will also keep your throat moist, which can make you feel more comfortable."Any cough lasting more than six to eight weeks after a viral infection warrants further discussion with your doctor, COVID included," says Conroy.<h2>3. Upper airway cough syndrome (UACS)</h2>Upper airway cough syndrome (UACS), previously called post-nasal drip syndrome, is <a href="https://pubmed.ncbi.nlm.nih.gov/32228010/" target="_blank" rel="noopener">one of the most common causes</a> of chronic cough."If you have uncontrolled sinus and nasal congestion, it's likely that some of that mucus is dripping back behind your nose [and] down your throat to trigger cough receptors, and also landing mucus in your lungs that you need to cough up," says Conroy.Quick tip: Cough receptors are nerve endings that trigger cough in the body. They are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415124/" target="_blank" rel="noopener">located</a> in the trachea, airways, pharynx, auditory canals, diaphragm, stomach, and more.How to treat it: Treating the cough requires managing the sinus congestion, she adds. The use of a nasal steroid spray with over-the-counter fluticasone or triamcinolone may reduce swelling, inflammation, and mucus in the sinuses. If congestion persists, prescription nasal sprays like ipratropium or azelastine may be needed.If allergies contribute to your sinus congestion, reduce your exposure to allergens like pollen or pet dander."It often takes a few weeks from complete control of post nasal drip to see improvement in the cough from upper airway cough syndrome, often four to six weeks after treatment regimen has been started," says Conroy.<h2>4. Chronic obstructive pulmonary disease (COPD)</h2>Chronic obstructive pulmonary disease (COPD) is a <a href="https://medlineplus.gov/copd.html" target="_blank" rel="noopener">group</a> of lung diseases, including emphysema and chronic bronchitis, where the airflow from the lungs is obstructed, making it harder to breathe. It also causes the lungs to produce excess mucus, which may <a href="https://my.clevelandclinic.org/health/articles/8697-coughing-controlled-coughing" target="_blank" rel="noopener">lead</a> to frequent coughing, in addition to other <a href="https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679" target="_blank" rel="noopener">symptoms</a> like chest tightness and wheezing. How to treat it: "Treatment of the cough is really treatment of the underlying COPD and centers around the use of the right inhalers for the patient. This may not completely get rid of the cough, but is likely to provide some control," says Conroy.The treatment for COPD <a href="https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685" target="_blank" rel="noopener">depends</a> on the severity of the disease. If you have a mild case, you may be asked to quit smoking or take medications like bronchodilators or corticosteroids. Severe cases might require oxygen therapy or surgery. However, more studies are <a href="https://coughjournal.biomedcentral.com/articles/10.1186/1745-9974-9-17" target="_blank" rel="noopener">needed</a> to identify how well cough responds to the treatment for COPD.Guaifenesin, an over-the-counter medication that <a href="https://medlineplus.gov/druginfo/meds/a682494.html" target="_blank" rel="noopener">relieves</a> chest congestion, may help minimize the coughing caused by chronic mucus production, says Conroy.<h2>5. Medications</h2>Drug-induced chronic cough is <a href="https://apm.amegroups.com/article/view/50825/html" target="_blank" rel="noopener">rare</a> and may be connected with <a href="https://pubmed.ncbi.nlm.nih.gov/2659385" target="_blank" rel="noopener">bronchial hyperreactivity</a>, or when your airways become more sensitive to a variety of factors that may narrow the airways.Drugs that are <a href="https://www.mayoclinic.org/diseases-conditions/chronic-cough/symptoms-causes/syc-20351575" target="_blank" rel="noopener">commonly used</a> to treat high blood pressure and heart failure — such as angiotensin-converting enzyme inhibitors (ACEI) — may <a href="https://apm.amegroups.com/article/view/50825/html" target="_blank" rel="noopener">cause</a> chronic cough. <a href="https://www.health.harvard.edu/staying-healthy/that-nagging-cough" target="_blank" rel="noopener">About 20%</a> of people taking ACEIs experience a persistent cough.How to treat it: The only way to <a href="https://www.health.harvard.edu/staying-healthy/that-nagging-cough" target="_blank" rel="noopener">eliminate</a> drug-induced cough is by <a href="https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580" target="_blank" rel="noopener">switching</a> to another type of medication that does not cause coughing.If the cough was induced by the drug, it should go away <a href="https://apm.amegroups.com/article/view/50825/html" target="_blank" rel="noopener">within one to four weeks</a>.<h2>6. Gastroesophageal reflux disease (GERD) </h2>GERD is a <a href="https://www.mayoclinic.org/diseases-conditions/heartburn/expert-answers/heartburn-gerd/faq-20057894" target="_blank" rel="noopener">more severe form</a> of acid reflux where stomach acid travels up the esophagus, which may irritate the esophageal lining and <a href="https://www.mayoclinic.org/diseases-conditions/chronic-cough/symptoms-causes/syc-20351575" target="_blank" rel="noopener">trigger</a> chronic cough."If the cough is due to GERD, treating the GERD will typically improve the cough substantially, if not resolve it altogether," says <a href="https://www.yalemedicine.org/specialists/carolyn_rochester" target="_blank" rel="noopener">Carolyn L. Rochester, MD</a>, professor of medicine at the <a href="https://medicine.yale.edu/" target="_blank" rel="noopener">Yale School of Medicine</a> and director of the <a href="https://medicine.yale.edu/intmed/pulmonary/clinical/programs/copd/" target="_blank" rel="noopener">Yale COPD Program</a>.How to treat it: Lifestyle modifications are often the <a href="https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959" target="_blank" rel="noopener">first line of treatment</a> for GERD. Avoid eating fatty foods, chocolate, and peppermint, which may <a href="https://www.mayoclinic.org/diseases-conditions/heartburn/expert-answers/heartburn-gerd/faq-20057894" target="_blank" rel="noopener">trigger</a> acid reflux. Also, make sure to elevate your head while sleeping so your stomach's contents <a href="https://www.health.harvard.edu/staying-healthy/that-nagging-cough" target="_blank" rel="noopener">don't flow</a> backward.If lifestyle modifications don't work, antacids that <a href="https://medlineplus.gov/ency/patientinstructions/000198.htm" target="_blank" rel="noopener">neutralize</a> stomach acid or proton pump inhibitors that <a href="https://medlineplus.gov/ency/patientinstructions/000381.htm" target="_blank" rel="noopener">reduce</a> the amount of stomach acid may significantly minimize — if not fully resolve — the coughing, says Rochester. <h2>7. Chronic and eosinophilic bronchitis</h2>Chronic bronchitis is a <a href="https://medlineplus.gov/chronicbronchitis.html" target="_blank" rel="noopener">type</a> of COPD that specifically <a href="https://medlineplus.gov/chronicbronchitis.html" target="_blank" rel="noopener">refers</a> to the inflammation and irritation of the airways, which may be <a href="https://medlineplus.gov/chronicbronchitis.html" target="_blank" rel="noopener">caused</a> by inhaled irritants like air pollution or tobacco smoke. It is diagnosed when someone produces excess mucus regularly for <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/chronic-bronchitis" target="_blank" rel="noopener">at least three continuous months out of the year</a> for two or more years in a row, says Rochester.The inflammation of the airways may <a href="https://www.health.harvard.edu/staying-healthy/that-nagging-cough" target="_blank" rel="noopener">lead</a> to a chronic cough. Other symptoms of chronic bronchitis include chest tightness and wheezing.Eosinophilic bronchitis is a <a href="https://journal.chestnet.org/article/S0012-3692(15)52839-0/fulltext" target="_blank" rel="noopener">common cause</a> of chronic cough. It occurs when there is an increased presence of eosinophils — a type of white blood cell — in the mucus produced by the lungs.How to treat it: Chronic bronchitis is <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/chronic-bronchitis" target="_blank" rel="noopener">incurable</a>, but its symptoms can be <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-bronchitis" target="_blank" rel="noopener">minimized</a> by quitting smoking, avoiding irritants, and taking inhaled bronchodilators or other medications that reduce airway inflammation.Chronic cough <a href="https://pubmed.ncbi.nlm.nih.gov/10430705/" target="_blank" rel="noopener">caused</a> by eosinophilic bronchitis can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531654/" target="_blank" rel="noopener">treated</a> with the use of inhaled corticosteroids like budesonide. It may improve the inflammation in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531654/" target="_blank" rel="noopener">about two months</a>.<h2>8. Bronchiectasis</h2>Bronchiectasis is a chronic lung condition where the airways <a href="https://www.nhlbi.nih.gov/health-topics/bronchiectasis" target="_blank" rel="noopener">dilate</a> and lose the ability to clear mucus out. The inflammation and accumulated mucus in the airways can lead to a chronic cough, says RochesterBronchiectasis is <a href="https://my.clevelandclinic.org/health/diseases/21144-bronchiectasis" target="_blank" rel="noopener">most common</a> in people over 75. Other symptoms include wheezing, chest tightness, coughing up mucus and/or blood, and weight loss.How to treat it: Potential treatments include mucolytic agents such as guaifenesin, which helps thin the mucus in the airways, says Rochester.Taking albuterol or plain saline solution via nebulizer machine, followed by the use of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125886/" target="_blank" rel="noopener">positive expiratory pressure (PEP) devices</a>, may also treat bronchiectasis-associated cough by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110869/" target="_blank" rel="noopener">helping expel</a> mucus, she adds.<h2>9. Other infections</h2>"Both viral and bacterial infections such as bronchitis and pneumonia are common causes of cough. When bacterial infections are adequately treated, the cough associated with them typically resolves," says Rochester.How to treat it: Antibiotics may be <a href="https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580" target="_blank" rel="noopener">prescribed</a> if chronic cough was caused by a bacterial infection."Cough related to viral infections such as the common cold, or influenza often typically resolves as the infection is cleared from the body," says Rochester. It often <a href="https://www.minervamedica.it/en/journals/minerva-pediatrics/article.php?cod=R15Y2017N05A0444" target="_blank" rel="noopener">goes away</a> spontaneously after a few days.Post-infectious cough — cough that persists <a href="https://www.minervamedica.it/en/journals/minerva-pediatrics/article.php?cod=R15Y2017N05A0444" target="_blank" rel="noopener">more than three weeks</a> after recovering from a viral infection — may occur if the cough receptors in the body have <a href="https://www.ncbi.nlm.nih.gov/books/NBK493221/" target="_blank" rel="noopener">increased</a> sensitivity and the airways are temporarily hyper-responsive. It is <a href="https://journal.chestnet.org/article/S0012-3692(15)52842-0/fulltext" target="_blank" rel="noopener">self-limited</a>, which means it typically resolves on its own over time.<h2>10. Cancer</h2>Lung cancers and other forms of cancer that spread to the lungs can cause coughing if they irritate cough receptors in the body, says Rochester.Other cancers that may spread to the lungs and cause persistent cough include the following, she adds:<ul><li>Breast cancer</li><li>Gastrointestinal cancers</li><li>Kidney cancer</li><li>Prostate cancer</li><li>Thyroid cancer</li><li>Head and neck cancers</li><li>Malignant melanoma</li></ul>"In some cases, it is possible to achieve excellent relief from the cough related to cancer. In other cases, the cough can be troublesome and persistent," says Rochester. How to treat it: The treatment of cough related to cancers depends on the underlying cancer, but <a href="https://pubmed.ncbi.nlm.nih.gov/11762966/" target="_blank" rel="noopener">cough suppressants</a> and <a href="https://www.frontiersin.org/articles/10.3389/fmed.2021.544826/full" target="_blank" rel="noopener">airway clearance techniques</a> may provide some relief, she adds.<h2>Insider's takeaway</h2>If you find yourself constantly coughing for more than eight weeks straight, you should get in touch with your primary care provider to figure out and address any possible underlying cause(s).Persistent coughing is not necessarily a matter of concern unless you experience chest pain, fever, or shortness of breath, which might require immediate medical attention.

10 reasons why you can't stop coughing and what to do about it

<ul><li>Drug pricing regulator NPPA's new notification caps prices of 42 cancer drugs </li><li>Roche, Biocon, Mylan, and Dr Reddy's Laboratories among companies that may be hit </li><li>The new notification has also fixed the retail margin on drug for type-2 diabetes</li></ul>India's National Pharmaceutical Pricing Authority (NPPA) has capped the prices of 42 medicines that are used to treat different types of cancers. The formulations whose retail prices have been fixed include Trastuzumab injection indicated for treatment of metastatic breast cancer and gastric cancer. The regulator has also fixed the prices for Metformin plus Gliclazide tablets used for treatment of type 2 diabetes, among others. Retail price of these drugs cannot be more than 30% over their cost of procurement. "Due to prevalent inequalities, out of pocket expenditure on medicines is the single largest contributor to pushing families beyond poverty threshold in the country. Thus, ensuring affordable drugs is a necessary pre-requisite for bringing down the overall healthcare expenses and to achieve the overall goal of affordable healthcare for all," the notification said. One major factor that contributes to high drug prices in India is unreasonable high trade margin. The high margins are in form of incentive and an indirect marketing tool employed by drug companies, the NPPA said citing the findings of the Competition Commission of India. Among the formulations whose ceiling prices have been revised include Budesonide inhalation used for preventing symptoms of asthma and Gentamicin injection used for treatment of bacterial infections. Here is the full list of cancer drugs who prices have been capped. 1 Azacitidine 2 Bendamustine Hydrochloride 3 Bortezomib 4 Crizotinib 5 Cytarabine 6 Dasatinib 7 Decitabine 8 Doxorubicin HCI Pegylated Liposomal Injection 9 Enzalutamide 10 Epirubicin 11 Eribulin mesylate 12 Erlotinib HCI 13 Estramustine phosphate 14 Everolimus 15 Exemestane 16 Fulvestrant 17 Irinotecan HCI Trihydrate 18 Lapatanib 19 Leuprolide acetate depot for Inj. 20 Lomustine 21 Mitoxantrone 22 Nilotinib 5 23 Plerixafor 24 Carfilzomib 25 Cladribine 26 Triptorelin 27 Pomalidomide 28 Osimertinib 29 Pegasperagase 30 Regorafenib 31 Ribociclib 32 Clofarabine 33 Sunitinib 34 Olaparib 35 Olaratumab 36 Paclitaxel (Protein-bound particles) 37 Cabazitaxel 38 Bevacizumab 39 Lenalidomide 40 Pegfilgrastim 41 Mitomycin 42 Pemetrexed

India has capped the retail prices of 42 cancer drugs

<ul class="summary-list"><li>Inhalers expire after about a year.</li><li>Expired <a href="https://www.insider.com/how-to-use-an-inhaler" target="_blank" rel="noopener">inhalers</a> are not dangerous to use, but they may be less effective, which may be dangerous in situations of an <keyword id="6465125" type="UNKNOWN" weightage="60" keywordseo="asthma">asthma</keyword> attack.</li><li>The expiration date is usually located on the packaging of your inhaler, so it's important to write it down on the inhaler itself so that you know when it expires.</li><li>This article was <a href="https://www.insider.com/insider-medical-review-board" target="_blank" rel="noopener">medically reviewed</a> by <a href="https://www.providence.org/doctors/profile/299517-osita-innocent-onugha" target="_blank" rel="noopener">Osita Onugha</a>, MD, thoracic surgeon and assistant professor of thoracic surgical oncology at John Wayne Cancer Institute at Providence Saint John's <keyword id="6354750" type="UNKNOWN" weightage="100" keywordseo="health">Health</keyword> Center in Santa Monica, California.</li></ul>Inhalers are crucial tools for people with lung conditions such as <a href="https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653">asthma</a> or <a href="https://medlineplus.gov/ency/patientinstructions/000025.htm">chronic obstructive pulmonary disease (COPD)</a>. Some people use their inhaler on a daily basis while others may only need it for emergency relief, such as during an <a href="https://www.insider.com/am-i-having-an-asthma-attack">asthma attack</a>. Here's what you need to know about how long inhalers last and the safety of using an expired inhaler.<h2>How long do inhalers last?</h2>An inhaler's expiration date is typically about one year after your prescription is filled, says <a href="https://wexnermedical.osu.edu/find-a-doctor/jonathan-parsons-md-4884" target="_blank" rel="noopener">Jonathan Parsons, MD,</a> a pulmonologist and professor of Internal Medicine at <a href="https://wexnermedical.osu.edu/" target="_blank" rel="noopener">The Ohio State University Wexner Medical Center.</a>The expiration date of an inhaler refers to when the medicine inside is no longer fully effective. There are multiple types of inhaler medications including:<ul><li>Long term <a href="https://www.aaaai.org/conditions-and-treatments/library/asthma-library/inhaled-asthma-medications" target="_blank" rel="noopener">control medications</a>, which are used daily to control asthma symptoms:</li><ul><li>Beclomethasone </li><li>Budesonide </li><li>Ciclesonide (Alvesco)</li><li>Fluticasone </li><li>Formoterol</li><li>Mometasone (Asmanex Twisthaler)</li><li>Salmeterol</li></ul><li><a href="https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-medications/art-20045557" target="_blank" rel="noopener">Quick relief </a>or "rescue" medications, which are generally used to stop wheezing once it has already started: </li><ul><li>Albuterol</li><li>Levalbuterol</li></ul></ul><h2>Yes, you can still use an expired inhaler</h2>In a situation where you need a rescue inhaler, it's better to use an expired inhaler than no inhaler at all, Parsons says. An expired inhaler will not harm you and cause adverse effects, but it may not provide you with the same amount of relief. Although the inhaler's expiration date is about one year after the purchase date, you'll likely run out of it before that time if you're prescribed it for daily use. On the other hand, if your inhaler is only for occasional or rescue use, like during an <a href="https://www.insider.com/am-i-having-an-asthma-attack">asthma attack</a>, it might expire before you use up all the metered puffs. Inhalers don't have chemicals that are going to be dangerous to you when they expire, it's more about the effectiveness. An inhaler that's expired will not do as good a job of helping you breathe as an inhaler that has not expired, but it can still be useful. Parsons says it's generally safe to use an inhaler beyond the expiration date, but you should be aware that it likely won't be as effective as before it expired. Plus, it's just good practice to stay on top of getting your refills in time.<h2>How to tell if your inhaler is expired</h2>When you first purchase your inhaler, always check the packaging for the expiration date. It will likely be located on the box or foil wrapping. Parsons says because the expiration date is usually on the box or packaging, and not the inhaler canister, tt's best to hold on to the packaging so you can easily reference the expiration date. Keep it with your other medications so you will know where to find it. Additionally, some inhaler canisters might have a handy blank space for you to actually write the expiration date on the canister itself. Otherwise, you can also use a fine-tip permanent marker and write it somewhere on the canister.If you don't have the packaging and are unsure of the expiration date, there really aren't any ways to tell if it's expired. If you aren't sure when you got the inhaler, you can call up your pharmacy and they can check their records to determine when your prescription was filled and give you a rough idea of an expiration date. Aside from being aware of the expiration date, Parsons recommends <a href="https://medlineplus.gov/ency/patientinstructions/000041.htm" target="_blank" rel="noopener">storing your inhaler the proper way</a> while not in use: in a clean (not dusty) place at room temperature (around <a href="https://www.fda.gov/media/73450/download#:~:text=Inhaler%20Storage-,Store%20at%20controlled%20room%20temperature%2C%2025%C2%B0C%20(77%C2%B0,the%20date%20of%20first%20use." target="_blank" rel="noopener">59 – 86° Fahrenheit</a>). It should also always be stored with the cap on to keep dust and other debris out of the mouthpiece so it doesn't get clogged up.<h2>What to do with an expired inhaler</h2>Once you have a new inhaler, you shouldn't just throw your old inhaler away with your normal trash. According to the FDA, <a href="https://www.fda.gov/consumers/consumer-updates/where-and-how-dispose-unused-medicines" target="_blank" rel="noopener">some inhalers can be dangerous if they are punctured or put in an incinerator</a>, so it's best to call your local trash facility or pharmacy to ask what they recommend. It can vary based on where you live.You can also check handling instructions for disposing of your inhaler on the packaging. <h2>The bottom line </h2>When in doubt, ask your doctor for a new prescription for a fresh inhaler, so you can be sure it's effective, and make sure to take note of the expiration date this time. If you're experiencing an asthma attack or severe difficulty breathing and your expired inhaler is not helping you, Parsons says you should go to an urgent care center or emergency room to get the assistance that you need.<h2 id="related-articles-from-health-reference:">Related articles from <a href="https://www.insider.com/health-reference" target="_blank" rel="noopener">Health Reference</a>:</h2><ul><li><a href="https://www.insider.com/am-i-having-an-asthma-attack" target="_blank" rel="noopener">Am I having an asthma attack? How to tell and what to do about it</a></li><li><a href="https://www.insider.com/how-to-use-an-inhaler" target="_blank" rel="noopener">How to use an inhaler: A step-by-step guide to use and care</a></li></ul>

You can still use an expired inhaler, but it's not an ideal treatment

<ul class="summary-list"><li>To use an inhaler correctly start by standing up straight, shaking the inhaler several times, and then exhaling all of the air out of your lungs.</li><li>To clean an inhaler, remove the medication canister and then rinse the mouthpiece and cap with warm water.</li><li>Be sure to replace your inhaler if you run out of numbered puffs or if your inhaler expires.</li><li>This article <a href="https://www.insider.com/insider-medical-review-board" target="_blank" rel="noopener">was medically reviewed</a> by <a href="https://www.providence.org/doctors/profile/759045-omid-benjamin-mehdizadeh" target="_blank" rel="noopener">Omid Mehdizadeh</a>, MD, otolaryngologist and laryngologist at the Pacific Neuroscience Institute's Pacific Eye, Ear &amp; Skull Base Center at Providence Saint John's <keyword id="6354750" type="UNKNOWN" weightage="100" keywordseo="health">Health</keyword> Center in Santa Monica, CA.</li></ul>Inhalers may be prescribed to people who have a variety of health conditions both chronic and acute, including <a href="https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653" target="_blank" rel="noopener">asthma</a>, <a href="https://medlineplus.gov/ency/patientinstructions/000025.htm" target="_blank" rel="noopener">chronic obstructive pulmonary disease (COPD)</a>, and <a href="https://www.aafp.org/afp/2010/1201/p1345.html" target="_blank" rel="noopener">bronchitis</a>.If you're new to using inhalers, no matter your condition, here are some tips for how to get the most out of your inhaler and how to care for it properly, so you'll be on your way to breathing easy. <h2>Step-by-step instructions on how to use an inhaler</h2>When using an inhale, it's important to follow your doctor's exact instructions to get the most benefit. According to <a href="https://medicine.yale.edu/profile/elaine_fajardo/" target="_blank" rel="noopener">Elaine Fajardo, MD</a>, Medical Director for Respiratory Therapy and Pulmonologist at Yale Medicine, and Assistant Professor at Yale School of Medicine, these are the general step-by-step instructions to using your inhaler properly: <ol><li>Stand up straight or sit upright.</li><li>Shake the inhaler three times to agitate the solution inside the canister. The canister contains both medicine and propellant, which helps push the medicine out. Shaking an inhaler helps mix the two together to make sure you get a good ratio of both. </li><li>Remove the inhaler's cap and attach a spacer (a tube-like device that goes between the inhaler and the patient's lips) if one is available. If you don't have a spacer handy, then just inhale straight from the mouthpiece.</li><li>Exhale deeply and completely, depleting as much air from your lungs as possible. This is important because it ensures that you'll be able to take a deep breath when you use the inhaler and fill your lungs with the medication. </li><li>Place the inhaler to your lips.</li><li>Inhale sharply while you push down on the canister to spray. If you are using a spacer, spray into the spacer and then inhale deeply.</li><li>Hold your breath for 10 seconds, or as long as comfortable, to ensure that enough medication is deposited in your lungs. </li><li>Exhale slowly to allow the medicine to continue to settle into your lungs, according to the <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/patient-resources-and-videos/videos/how-to-use-a-metered-dose-inhaler" target="_blank" rel="noopener">American Lung Association</a>. </li><li>If your doctor has prescribed you to take two puffs, be aware of how long it says to wait before administering the second dose. Usually, it is one minute, then, repeat steps three through six.</li></ol>Quick bonus tips for inhaler use:<ul><li>Know whether or not you should use a spacer. Fajardo says spacers are not meant for use with dry powdered inhalers, since they have a differently shaped mouthpiece that won't fit in a spacer. Discuss with your doctor if a spacer would be beneficial or not for you. </li><li>If your inhaler contains a <a href="https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/inhaled-corticosteroids" target="_blank" rel="noopener">corticosteroid</a>, Fajardo recommends rinsing your mouth out immediately after use in order to prevent <a href="https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533" target="_blank" rel="noopener">thrush</a>, an oral yeast infection. This is because corticosteroid is a steroid, which can slightly make you more prone to this fungal oral infection. Corticosteroid is common in inhalers prescribed to people with <keyword id="6465125" type="UNKNOWN" weightage="60" keywordseo="asthma">asthma</keyword>. Some <a href="https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-medications/art-20045557" target="_blank" rel="noopener">inhaler brands that have corticosteroids</a> are Fluticasone, Budesonide, Mometasone, Beclomethasone, and Ciclesonide. </li><li>Do not share your inhaler with others, because you risk contracting or spreading anybacterial or viral infection.</li></ul><h2>How to store and clean your inhaler</h2>Cleaning an inhaler is easy. Fajardo says you can remove the medication canister, leave that aside, and then <a href="https://medlineplus.gov/ency/patientinstructions/000042.htm" target="_blank" rel="noopener">rinse the mouthpiece and cap with warm water</a>, no soap. Simple as that. Fajardo recommends doing this daily or after a few usages to prevent medication or other debris drying up and causing a blockage.After cleanings or general usage, Fajardo says to store the inhaler with the cap on, at room temperature. You also want to be sure to keep it away from direct sunlight, hot temperatures, and anything that could puncture it. <h2>When to replace your inhaler </h2>Many inhalers have a dose counter that tells you when your inhaler is running low on medication. This should let you know how many doses are left so that you can call your doctor to get a replacement. But aside from running out of puffs on your inhaler, there are some other signs that your inhaler should be replaced. Fajardo recommends looking out for the following red-flags:<ul><li>Expiration date</li><li>Rust</li><li>Cracks</li><li>Melted areas</li></ul>If your medication isn't dispensing from the inhaler and you don't see any of the above signs, your inhaler might just need a cleaning, Fajardo says. Remove the canister and clean the mouthpiece as directed above. If the medication still won't dispense, call your doctor to get a prescription for a new one.<h2>Related articles from our <a href="https://www.insider.com/health-reference" target="_blank" rel="noopener">Health Reference</a> library:</h2><ul><li><a href="https://www.insider.com/is-it-a-cold-or-allergies" target="_blank" rel="noopener">Is it a cold or allergies? How to categorize your symptoms and treat them appropriately</a></li><li><a href="https://www.insider.com/how-to-get-rid-of-a-runny-nose" target="_blank" rel="noopener">How to get rid of a runny nose from both allergies and illness</a></li></ul>

How to use an inhaler: A step-by-step guide to use and care

<ul class="summary-list"><li>Types of <keyword id="6465125" type="UNKNOWN" weightage="60" keywordseo="asthma">asthma</keyword> include allergic asthma, exercise-induced asthma, cough-variant asthma, asthma-COPD overlap, nocturnal asthma, occupational asthma, and non-allergic asthma.</li><li>Some of the jobs that carry the greatest risk for occupational asthma include animal handling, farming, and food production, since they all involve inhaling particulates that could irritate the lungs.</li><li>If your main asthma symptom is a persistent dry cough, without typical signs of wheezing, then you may have cough-variant asthma. </li><li>This article was reviewed by <a href="https://health.tamu.edu/experts/jason-mcknight.html" target="_blank" rel="noopener">Jason R. McKnight</a>, MD, MS, a family medicine physician and clinical assistant professor at <a href="https://medicine.tamu.edu/" target="_blank" rel="noopener">Texas A&amp;M College of Medicine</a>. </li></ul>Asthma is a chronic respiratory disease that affects more than<a href="https://www.aafa.org/asthma-facts/" target="_blank" rel="noopener"> 25 million people</a> in the US. Asthma generally causes swelling of your airways, making it harder to breathe and causing symptoms like coughing. However, there are many different types of asthma, like allergic or occupational asthma, that can have a variety of symptoms. Finding out which type of asthma you have can help you figure out the best way to treat it.Here is what you need to know about the different types of asthma and how each is treated.<h2>Allergic asthma</h2>Allergic asthma is the most common type of asthma, and affects about<a href="https://www.aafa.org/allergic-asthma/" target="_blank" rel="noopener"> 60% of asthmatics in the US</a>. If you have allergic asthma, your symptoms, like coughing or struggling to breathe, are triggered when you breathe in allergens.Some of the <a href="https://www.insider.com/what-triggers-asthma" target="_blank" rel="noopener">most common allergens</a> are:<ul><li>Pollen</li><li>Dust mites</li><li>Mold</li><li>Pet dander</li></ul>When you are exposed to these triggers, your immune system interprets them as harmful invaders and<a href="https://www.aafa.org/allergic-asthma/" target="_blank" rel="noopener"> releases antibodies that cause your airway to swell up</a> and become narrower, making it harder for you to breathe.Your doctor can determine what allergen triggers your symptoms by doing<a href="https://www.aafa.org/allergic-asthma/" target="_blank" rel="noopener"> blood or skin tests</a>. If you have allergic asthma, you will need to avoid allergy triggers and you may need to take a prescription medication like<a href="https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/allergies-and-asthma/art-20047458" target="_blank" rel="noopener"> Montelukast (Singulair</a>), which helps decrease the inflammatory response that tightens airways. Your doctor may also suggest<a href="https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/allergies-and-asthma/art-20047458" target="_blank" rel="noopener"> allergy shots</a>, which slowly introduce small amounts of an allergen into your body so that you gradually build up a tolerance. You may also need an <a href="https://www.insider.com/how-to-use-an-inhaler" target="_blank" rel="noopener">albuterol rescue inhaler</a>, which can quickly open your airway during an asthma attack.<h2>Exercise-induced asthma</h2>Exercise-induced asthma is a more mild form of asthma in which your symptoms only arise after exercising. "Symptoms do not start during exercise when the airways are dilated, but rather 10-15 minutes after when adrenaline levels, which help dilate the airways, come down," says<a href="https://researchdirectory.uc.edu/p/floraaa" target="_blank" rel="noopener"> Arjan Flora, MD</a>, a professor of pulmonology at the University of Cincinnati.You are most likely to have asthma symptoms like<a href="https://www.mayoclinic.org/diseases-conditions/exercise-induced-asthma/symptoms-causes/syc-20372300" target="_blank" rel="noopener"> chest tightness or wheezing</a> after exercising in cold, dry air, since it can make your airways swell and constrict. According to Flora, the best ways to prevent exercise-induced asthma are:<ul><li>Improving your cardiac fitness so you don't breathe as hard during exercise.</li><li>Avoid working out in cold weather.</li><li>Taking two puffs of an albuterol inhaler 5 to 20 minutes before exercising to open up your airways.</li><li><a href="https://www.insider.com/best-exercises-for-asthma" target="_blank" rel="noopener">Do exercises like yoga, tennis, or hiking</a>, as opposed to endurance-centered workouts.</li></ul>And be sure to always carry an <a href="https://www.insider.com/how-to-use-an-inhaler" target="_blank" rel="noopener">inhaler</a> when you know you are going to be working out. <h2>Cough-variant asthma</h2>If you have cough-variant asthma, your main asthma symptom is a persistent dry cough. It's typical not to have other asthma symptoms like shortness of breath or wheezing."Treatment for cough variant asthma is largely the same as for regular asthma, using the same medications," says<a href="https://www.mountsinai.org/profiles/e-neil-schachter" target="_blank" rel="noopener"> Neil Schachter, MD</a>, a professor of pulmonary medicine at the Icahn School of Medicine at Mount Sinai.This includes<a href="https://acaai.org/asthma/asthma-symptoms/asthma-cough" target="_blank" rel="noopener"> daily corticosteroid inhalers</a> like budesonide (Rhinocort) and flucytosine (Flovent) to reduce swelling in your airways and<a href="https://acaai.org/asthma/asthma-symptoms/asthma-cough" target="_blank" rel="noopener"> an albuterol rescue inhaler</a> for flare-ups."However, the most important feature of treatment is making sure that the diagnosis is correct," Schachter says. This is because other conditions like<a href="https://www.insider.com/what-is-hay-fever" target="_blank" rel="noopener"> hay fever</a> or<a href="https://www.insider.com/home-remedies-for-acid-reflux" target="_blank" rel="noopener"> acid reflux</a> can also cause a chronic cough. Discussing your symptoms with your doctor can help rule out other possible conditions.<h2>Asthma-COPD overlap</h2><a href="https://www.insider.com/what-are-the-symptoms-of-copd" target="_blank" rel="noopener">Chronic obstructive pulmonary disease </a>(COPD) is a chronic lung disease that prevents your airways from expanding properly, leaving some air trapped inside your lungs when you exhale. COPD symptoms usually begin<a href="https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/" target="_blank" rel="noopener"> in middle age</a> and the main symptoms are shortness of breath, coughing, and excess phlegm.If you have asthma-COPD overlap (ACO), you may exhibit all the symptoms of COPD along with typical <a href="https://www.insider.com/am-i-having-an-asthma-attack" target="_blank" rel="noopener">asthma symptoms</a> like wheezing and chest pain. ACO can cause attacks that are especially severe and can<a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/asthma-copd-overlap-syndrome" target="_blank" rel="noopener"> lead to hospitalization</a>.The<a href="https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679" target="_blank" rel="noopener"> most common cause</a> of COPD is exposure to cigarette smoke, though some people may develop the condition after long-term exposure to irritating gases or fumes like <a href="https://www.cdc.gov/asthma/triggers.html" target="_blank" rel="noopener">car exhaust</a>. By the time your symptoms appear, "the lungs are frequently damaged beyond repair," says Schachter. This means that while you can get your symptoms under control, you generally can't stop the disease from progressing.Though ACO can be more serious than asthma, "in many ways the treatment is the same," Schachter says. This can include taking a long-acting airway opener like Singulair, a corticosteroid inhaler like Pulmicort, and an albuterol rescue inhaler for attacks. You may also need to add on<a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/asthma-copd-overlap-syndrome" target="_blank" rel="noopener"> additional medication</a> to prevent mucus build-up.<h2>Occupational asthma</h2>Occupational asthma occurs when you develop asthma symptoms after being exposed to irritating substances like chemical fumes, animal waste, or smoke in your workplace. There have been over<a href="https://www.mayoclinic.org/diseases-conditions/occupational-asthma/symptoms-causes/syc-20375772" target="_blank" rel="noopener"> 250 different agents</a> identified that can trigger occupational asthma.Occupational asthma develops when you regularly inhale substances that can irritate your lungs, which leads to swelling of your airways and difficulty breathing. This irritation can be caused by an allergen, like animal dander or plant substances, or a universally irritating substance, like chlorine gas, chemicals in detergents, or metals like platinum.According to Flora, some of the most high-risk jobs for exposure to allergens are:<ul><li>Animal handlers</li><li>Farmers</li><li>Food production workers/seafood processors</li></ul>The most high-risk jobs that may expose you to general lung irritants are:<ul><li>Metal workers/welders</li><li>Carpenters</li><li>Hairdressers</li><li>Insulation installers</li><li>Commercial painters</li></ul>The best way to prevent and treat occupational asthma is for companies to provide protective gear and train workers to safely handle irritants. Under the<a href="https://www.mayoclinic.org/diseases-conditions/occupational-asthma/symptoms-causes/syc-20375772" target="_blank" rel="noopener"> Occupational Safety and Health Administration (OSHA) guidelines,</a> your employer is legally required to offer you these protections. You can also meet with your doctor to come up with an individual safety plan and get standard asthma medications.<h2>Nocturnal asthma</h2>Nocturnal asthma occurs when your asthma symptoms get significantly worse at night. Nocturnal asthma is common and can happen along with<a href="https://www.fccmg.com/blog/nocturnal-asthma/" target="_blank" rel="noopener"> any type of asthma</a>, including allergic or non-allergic.The symptoms of nocturnal asthma are the same as regular, daytime asthma, but you may also experience symptoms like<a href="https://www.fccmg.com/blog/nocturnal-asthma/" target="_blank" rel="noopener"> daytime sleepiness and frequent waking in the night</a>. This is because frequent bouts of nocturnal asthma can interfere with your natural sleep schedule and lower the quality of your sleep.Experts aren't sure why asthma symptoms can become worse at night, but one factor may be your hormones. In particular,<a href="http://www.asthmaed.com/journal/2015/8/5/why-nocturnal-asthma" target="_blank" rel="noopener"> levels of a hormone called histamine</a> can spike while you are asleep , which can lead to swelling of your airways and awaken you from sleep."Additional complicating factors include dust mites and pet dander which can be in bed sheets, pillows, and mattresses," says Flora. So if you have allergic asthma, you may need to wash your bedding more often and keep pets out of the bedroom to fight off nighttime symptoms.<h2>Non-allergic asthma</h2>Non-allergic asthma occurs when your asthma symptoms are triggered by factors unrelated to allergens like pollen and dust. Non-allergic asthma generally starts later in life –<a href="https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-019-1040-2" target="_blank" rel="noopener"> most people over 40</a> who develop asthma for the first time will have non-allergic triggers.<a href="https://www.asthma.org.uk/advice/understanding-asthma/types/" target="_blank" rel="noopener">Experts are not certain why</a> non-allergic asthma develops, but having repeated<a href="https://www.frontiersin.org/articles/10.3389/fimmu.2018.01416/full" target="_blank" rel="noopener"> infections in your airway</a> like bronchitis can increase your risk of non-allergic asthma, Flora says.There are<a href="https://acaai.org/asthma/types-asthma/nonallergic-asthma" target="_blank" rel="noopener"> many possible triggers</a> for non-allergic asthma, including:<ul><li>Respiratory infections like the flu</li><li>Irritants in the air including perfumes, cleaning supplies, and smoke</li><li>Weather conditions, particularly cold air</li><li>Stress and anxiety</li></ul><a href="https://acaai.org/asthma/types-asthma/nonallergic-asthma" target="_blank" rel="noopener">The symptoms</a> of non-allergic asthma are essentially the same as allergic asthma, including chest tightness, coughing, and difficulty breathing. After having an allergist rule out the possibility of an allergy, your doctor may work with you to identify your triggers.<a href="https://acaai.org/asthma/types-asthma/nonallergic-asthma" target="_blank" rel="noopener"> The treatment</a> is also similar to allergic asthma, using long-term preventative medications and fast-relief inhalers.<h2>The bottom line</h2>If you find yourself having asthma symptoms, it's important to meet with a doctor as soon as possible to help get your symptoms under control. Monitoring your own symptoms can also help out with diagnosis, Flora says. "Keeping a diary of onset of symptomatic episodes with potential triggers/exposures, time of day, location (ie work, outdoors), and the presence of other medical conditions can help you and your doctor discover what type of asthma you have and how you may prevent symptoms from occurring."<h2 id="related-articles-from-health-reference:">Related articles from <a href="https://www.insider.com/health-reference" target="_blank" rel="noopener">Health Reference</a>:</h2><ul><li><a href="https://www.insider.com/am-i-having-an-asthma-attack" target="_blank" rel="noopener">Am I having an asthma attack? How to tell and what to do about it</a></li><li><a href="https://www.insider.com/how-to-use-an-inhaler" target="_blank" rel="noopener">How to use an inhaler: A step-by-step guide to use and care</a></li><li><a href="https://www.insider.com/is-asthma-genetic" target="_blank" rel="noopener">There is a strong genetic component to asthma, but it's not the only risk factor</a></li></ul>

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