Asthma in Doral, FL

What Asthma Is and How It Develops

Asthma combines three processes: persistent inflammation of the airways, bronchoconstriction (narrowing of the smooth muscle around the bronchi), and hyperreactivity — an amplified sensitivity to triggers that people without asthma tolerate without issue. The inflammatory component is why daily controller inhalers are the foundation of treatment; reducing inflammation over time prevents acute episodes and progressive loss of lung function. In South Florida, the most common triggers we see in adult patients are mold exposure (indoor humidity), seasonal pollen (especially oak and grass in spring, ragweed in fall), wildfire smoke drift, cockroaches, and dust mites. In children, respiratory viruses are usually the dominant trigger.

Asthma Symptoms We Evaluate

• Wheezing or whistling when breathing, especially on exhalation
• Persistent cough, typically worse at night or on waking
• Shortness of breath with exercise, stairs, or trigger exposure
• Chest tightness or pressure
• Sleep disruption from coughing or wheezing (a sign of poor control)
• Rescue inhaler use more than twice a week (a sign of poor control)
• Nighttime awakenings from symptoms more than twice a month

How We Diagnose Asthma — Spirometry and FEV1

Asthma diagnosis is not based on symptoms alone. The GINA 2024 guideline and the NHLBI EPR-4 guideline both require objective documentation of reversible airflow obstruction. In our office we perform spirometry — a 5-minute breathing test that measures FEV1 (forced expiratory volume in 1 second) and the FEV1/FVC ratio. An FEV1 increase of ≥12% and ≥200 mL after an inhaled bronchodilator confirms asthma in most patients. For patients with normal spirometry but clear symptoms, we may order additional testing or home peak flow monitoring. Fractional exhaled nitric oxide (FeNO) testing and consultation with board-certified allergists is available for complex cases.

Asthma Severity Levels (GINA 2024 Classification)

We classify severity using symptom frequency, nighttime awakenings, rescue inhaler use, and spirometry results. The four levels define the initial treatment plan:

• Intermittent asthma — symptoms ≤2 days/week, nighttime awakenings ≤2/month, FEV1 ≥80%
• Mild persistent asthma — symptoms >2 days/week but not daily, awakenings 3-4/month
• Moderate persistent asthma — daily symptoms, awakenings >1/week, FEV1 60-80%
• Severe persistent asthma — continuous symptoms, frequent awakenings, FEV1 <60%

How We Treat Asthma — Medication Classes

Asthma treatment uses a stepped approach. Our provider walks through each class, the options covered under your insurance, and when to step up or down. We never prescribe an inhaler without teaching you how to use it correctly — poor technique is the #1 reason a 'stubborn' asthma stops being stubborn once it's corrected.

• Short-acting bronchodilators (SABAs) — rescue use for immediate symptom relief
• Inhaled corticosteroids (ICS) — daily controllers that reduce airway inflammation
• ICS + long-acting beta agonists (LABAs) combinations for moderate-to-severe persistent asthma
• Leukotriene receptor antagonists — oral option for asthma with allergies or a nasal component
• Biologic therapies — for severe eosinophilic or allergic asthma refractory to standard treatment
• Written action plan in English or Spanish with green/yellow/red zones

When to Use a Rescue Inhaler vs. a Controller Inhaler

This is the #1 confusion we see. The controller inhaler (usually an inhaled corticosteroid) is used every day, twice a day, whether or not you have symptoms — its job is to prevent inflammation. The rescue inhaler (a short-acting bronchodilator) is used only when you already have symptoms or before a known trigger like exercise. If you are using your rescue inhaler more than twice a week (other than before exercise), your asthma is not controlled — that is a signal you need to be seen.

Pediatric Asthma

Our providers evaluate asthma in children from preschool age onward. Diagnosis in children under 5 relies more on symptom patterns and response to trial treatment (reliable spirometry is usually not possible before age 5-6). We work closely with parents and schools — we provide signed school asthma action plans, fully bilingual in English and Spanish, and coordinate with board-certified pediatric allergists when asthma is moderate-to-severe.

Exercise-Induced Asthma

Exercise-induced bronchoconstriction affects up to 90% of people with asthma and about 10% of people without diagnosed asthma. Symptoms typically begin 5-15 minutes after starting exercise and can persist 30-60 minutes. Standard treatment is a short-acting bronchodilator 15 minutes before exercise, in addition to adequate baseline asthma control. For athletes or very active patients, allergist consultation can help with a more complete strategy.

South Florida Pollen and Asthma

South Florida has a near-continuous pollen calendar: oak January-April, Bermuda grass May-October, ragweed August-November. Sustained humidity (>70% most of the year) means mold — a major asthma trigger — is present year-round, especially after hurricane season. In visits we educate patients on when to check local pollen counts, when to change HVAC filters (at least every 3 months, MERV 11 or higher), and how to identify mold early in homes with sustained humidity.

Allergy Testing and When to Refer to Allergy

Not every patient with asthma needs allergy testing. We order it when asthma is persistent despite adequate treatment, when there is significant coexisting allergic rhinitis, or when patients want immunotherapy (allergy shots) or are considering biologic therapy. We work with board-certified in-network allergists when asthma is severe, poorly controlled despite adequate stepped treatment, or requires specialized intervention. Viva Medical Center is a partner in care — we do not claim to be the sole treatment needed for severe asthma.

Bilingual Education and the Written Action Plan

A major cause of poorly controlled asthma is that the patient never received a clear plan they could read and understand. Every patient leaves our office with a written action plan in their preferred language — what to do when symptoms are mild (green zone), moderate (yellow zone), and severe (red zone), including when to call the office and when to go to the ER. We demonstrate inhaler technique at every visit using a placebo device and review it at follow-up visits.

Telehealth and Same-Day Visits

• Same-day appointments subject to availability when symptoms flare
• Telehealth follow-ups for control review, medication adjustments, and lab results
• In-office spirometry at every initial evaluation and as clinically indicated
• Bilingual communication in English and Spanish
• Coordination with in-network allergy and pulmonology when needed
• Prescription renewals through the patient portal between visits

Insurance We Accept for Asthma Treatment

Viva Medical Center is in-network with the major carriers serving Miami-Dade. Evaluation, follow-up visits, spirometry testing, and prescribed medication are covered under your plan's appropriate primary care or specialty benefit. Our front desk verifies your specific plan details before the first visit — call (305) 209-0001.