ANNAPOLIS Aug 12, 2020 (Thomson StreetEvents) -- Edited Transcript of Altimmune Inc earnings conference call or presentation Wednesday, August 12, 2020 at 12:30:00pm GMT

* M. Scot Roberts

Altimmune, Inc. - Chief Scientific Officer

Altimmune, Inc. - Chief Medical Officer

* Vipin K. Garg

Altimmune, Inc. - President, CEO & Director

Altimmune, Inc. - CFO & Principal Accounting Officer

Greetings, and welcome to the Altimmune, Inc. Second Quarter 2020 Earnings Call. (Operator Instructions) As a reminder, this conference is being recorded. I would now like to turn the conference over to your host, Ms. Monique Kosse, Investor Relations for Altimmune. You may begin.

Thank you, Melissa, and thank you, everyone, for participating in today's Q2 2020 Earnings Conference Call. Leading the call today will be Dr. Vipin Garg, Chief Executive Officer of Altimmune. Also participating on the call today is Will Brown, Chief Financial Officer; Scott Roberts, Chief Scientific Officer; and Scott Harris, Chief Medical Officer.

After the prepared remarks, we will open up the call for a question-and-answer session. A press release with the Q2 2020 financial results was issued last night and can be found on the Investors page of the company's website.

Before we begin, I would like to remind everyone that remarks about future expectations, plans and prospects constitute forward-looking statements for the purposes of the safe harbor provisions under the Private Securities Litigation Reform Act of 1995. Altimmune cautions that these forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from those indicated, including those related to COVID-19 and its impact on our business operations, clinical trials and results of operations.

For a discussion of some of the risks and factors that could affect the company's future results, please see the risk factors and other cautionary statements contained in the company's filings with the Securities and Exchange Commission. I would also direct you to read the forward-looking statement disclaimer in our earnings release issued last night and now available on our website.

Any statements made on this conference call speak only as of today's date, Wednesday, August 12, 2020, and the company does not undertake any obligation to update any of these forward-looking statements to reflect events or circumstances that occur after or on today's date.

As a reminder, this conference call is being recorded and will be available for audio rebroadcast on Altimmune's website on http://www.altimmune.com.

With that, I will now turn the call over to Vipin Garg, Chief Executive Officer of Altimmune. Vipin, please go ahead.

Vipin K. Garg, Altimmune, Inc. - President, CEO & Director [3]

Thank you, Monique. Good morning, everyone, and thank you for joining us as we discuss our Q2 2020 financial results and corporate update.

Joining me on the call today is Will Brown, our Chief Financial Officer, who will review our Q2 financial results; as well as Scott Roberts, our Chief Scientific Officer; and Scott Harris, our Chief Medical Officer. After our discussion, we will open the call for Q&A.

The first half of 2020 has been transformational for Altimmune, and I'm very pleased with our progress to date. We have made significant strides towards developing 2 product candidates to address the COVID-19 pandemic, a highly differentiated intranasal vaccine and a novel immunomodulatory therapeutic candidate. We secured additional government funding and capitalized the company sufficiently to fully lean into the challenges that lie ahead of us.

Outside of COVID-19, we continue to push forward aggressively on our other product candidates. We have recently completed enrollment in our NasoShield anthrax vaccine trial, and we are on track to begin an ALT-801 first-in-human NASH trial in Q4. We also had a successful IND submission for our chronic hepatitis B therapeutic, HepTcell, that is slated for a Phase II trial to begin later this year. With these advancements, we are well poised to deliver shareholder value throughout 2020 and beyond.

With that backdrop, I would like to spend a few minutes on our areas of focus for the remainder of this year. First, we are focused on expeditiously moving AdCOVID towards an IND and a Phase I clinical trial in Q4. We look forward to building on AdCOVID's outstanding preclinical data by moving it into the clinic as quickly and safely as possible. We are pleased with robust mucosal and systemic immunity observed in preclinical studies conducted by our collaborators at the University of Alabama at Birmingham. We have simultaneously forged alliances with several manufacturing partners to secure clinical trial material and began that process in July.

As Scott Roberts, our CSO, will discuss momentarily, these activities are going well, and we remain on track to begin our Phase I clinical trial later this year.

Second, we continue to pursue non-dilutive funding for AdCOVID. As previously announced, we entered into a teaming agreement with DynPort Vaccine Company, or DVC, to pursue federal and nonprofit funding. DVC, a General Dynamics Information Technology company, has extensive experience in vaccine development and has been the prime contractor and systems integrator for many government projects. The partnership with DVC significantly expands Altimmune's capabilities to execute on government contact on government funding opportunities and accelerate the development of AdCOVID.

Third, we remain focused on executing the T-COVID trial and maintaining DoD support. During the second quarter, we announced not only that we had created a new program based on [respira-vac], our replication-deficient adenovirus 5 platform, but that the Department of Defense awarded Altimmune $4.7 million to fund the EPIC Trial, our Phase I/II clinical trial of T-COVID in the prevention of clinical worsening in COVID-19.

We are especially excited about this program as it represents a novel mechanism with tremendous promise, and we are one of the few therapeutics intended to stop the progression of early COVID-19 to severe disease and hospitalization. We are working very closely with our colleagues at the U.S. Army Medical Research & Development Command on this program. And as Scott Harris, our CMO, will more fully discuss, we look forward to enrolling our first patient imminently and delivering top line data readout from this trial in Q4 of this year.

I would now like to turn the call over to Scott Roberts, our CSO, who will fully update you on the progress we have made with AdCOVID; and then Scott Harris, who will discuss our clinical plans across our portfolio. Scott Roberts?

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M. Scot Roberts, Altimmune, Inc. - Chief Scientific Officer [4]

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Thank you, Vipin, and good morning.

We have made excellent progress toward our Phase I clinical trial of AdCOVID, a single-dose intranasal vaccine candidate for COVID-19. Earlier this year, we created different vaccine candidates based on our [respira-vac] replication-deficient adenovirus vaccine platform. Candidates expressing different portions of the viral spike protein were evaluated in a series of preclinical studies performed by our collaborators at the University of Alabama at Birmingham.

Based on those results, we selected the candidate that expressed the receptor-binding domain, or RBD, of this viral spike protein for clinical development. The RBD is essential for viral infection, and the great majority of neutralizing antibodies in convalescent sera are directed against the RBD, so it's clearly an important target for the immune system.

In our preclinical mouse studies, a single intranasal dose of AdCOVID stimulated strong serum antibody responses and high virus neutralizing titers. Importantly, AdCOVID also induced a very robust mucosal IgA antibody response in the respiratory tract. Mucosal IgA is a special type of immunity that is produced locally to provide local protection from infection. When stimulated in the respiratory tract, mucosal immunity offers a potential to not only block infection but also block transmission of the virus to others. By far, the most important way to induce a nasal IgA response is to administer the vaccine intranasally. Bear in mind that all of the vaccine candidates in advanced clinical testing are delivered by intramuscular injection. Not only is that method of dosing more complicated than intranasal dosing, it's also unlikely to elicit mucosal IgA immunity in the respiratory tract.

The presence of nasal IgA may be especially important for protection from COVID-19 because of 2 important considerations: one, the SARS-CoV-2 virus replicates well in the nasal cavity; and two, antibodies against the virus that are in your blood can't get into the nasal cavity very well. So in the absence of local mucosal IgA immunity, the nasal cavity may become a safe haven for the virus.

Over the next few weeks, we'll be reporting on the ability of AdCOVID to stimulate T cell immunity, a third type of immunity we expect to stimulate, in addition to the neutralizing antibody and mucosal IgA responses. Once we have the T cell data in hand, we plan to quickly publish the preclinical data, so we can share it with the scientific community.

Now having identified the vaccine candidate we are taking forward, we initiated a dual-track approach towards the manufacturing of AdCOVID. While moving quickly to provide clinical trial material to conduct our Phase I trial later this year, we will begin scaling the manufacturing process in parallel to meet the requirements of Phase III testing and commercial launch of AdCOVID. To accomplish these aggressive goals, we have established multiple alliances with key manufacturing partners that have deep experience in the manufacturing of viral vectors.

Notably, we are using the same manufacturing process for AdCOVID as for our other vaccine candidates, including our NasoShield intranasal anthrax vaccine that we are developing with BARDA; and NasoVAX, our intranasal influenza vaccine. Using the same manufacturing process allows us to manufacture quickly and with confidence.

Additionally, vaccine candidates based on our respira-vac platform have shown excellent stability at room temperature, potentially allowing for the distribution of AdCOVID without the refrigeration or freezing that is normally required for other vaccines, greatly simplifying getting the vaccine to those who need it.

With that, I will turn the call over to Scott Harris, who will provide a clinical update on our programs. Scott?

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Matthew Scott Harris, Altimmune, Inc. - Chief Medical Officer [5]

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Thank you, Scott, and good morning, everyone. Continuing with our -- with the AdCOVID program, we expect to file the IND and launch the Phase I clinical trial of AdCOVID in the fourth quarter of 2020. This trial will include approximately 120 subjects. And while our preclinical studies and clinical trial data from our other intranasal replication-deficient adeno 5 virus (sic) [adenovirus 5] vaccine trials have not suggested the role for a prime boost, we nonetheless plan to evaluate the effects of 1 and 2 doses of vaccine to confirm this hypothesis. Immunogenicity analyses will include total serum IgG, neutralizing antibodies, nasal, mucosal immunity and T cell responses. We anticipate the data readout for the trial in the fourth -- in the first quarter of 2021 and launch a Phase II trial on the heels of this readout.

Based on the preclinical findings discussed earlier and prior experience with our other intranasal vaccines, we expect potent responses in all aspects of immunity and for AdCOVID to be safe and well tolerated, with adverse events and reactogenicity events similar to placebo.

We also previously announced that we're awarded $4.7 million by the U.S. Army Medical Research & Development Command to fund the entire cost of conducting a clinical trial with T-COVID. This trial will be known as the EPIC Trial or the Efficacy and Safety of T-COVID in the Prevention of Clinical Worsening in COVID-19. We have completed all of the government contracting processes and institutional reviews, and clinical sites are now active with enrollment expected to commence imminently.

T-COVID is an immune modulator for pulmonary viral infections and is differentiated for most other COVID-19 therapeutics in development, as it is focused on non-hospitalized patients prior to the development of pulmonary dysfunction and the need for hospitalization. Because of the broad protection T-COVID could afford against a variety of other respiratory pathogens, we believe it could be used to defend against future strains of coronavirus or other pandemics. The data readout from this trial is expected in the fourth quarter of 2020. And if successful, we plan to initiate a Phase II/III trial early next year and commence discussions regarding emergency use authorization.

We recently announced that we completed enrollment in our Phase Ib trial of NasoShield for anthrax and expect data readout on target in the fourth quarter of 2020. If NasoShield is shown to be safe and effective, the remaining options of our $133.7 million contract with BARDA could be awarded to complete Phase II clinical testing and begin stockpiling of NasoShield in the strategic reserve.

We also remain on track with IND-enabling studies in manufacturing to commence dosing in our first-in-man clinical trial for ALT-801, our GLP-1/glucagon dual agonist for NASH, in Australia in the fourth quarter of this year. We expect to have a readout on body weight loss and reduction in liver fat toward the end of the first quarter of 2021. This will be a value-driving event for investors as it will place ALT-801 squarely in the forefront of NASH development. We expect ALT-801 to be better tolerated than similar therapies and achieve weight loss and improvement of liver fat in the Phase I trial without the need to dose titrate for GI intolerability, which has impacted the GLP-1 development space.

At the conclusion of this first-in-human trial, we plan to file an IND in the U.S. and initiate a 12-week trial in patients with nonalcoholic fatty liver disease. We expect a data readout on this trial in the third quarter of 2021 and a transition rapidly to a full Phase IIb biopsy-based trial based on NASH endpoints by the end of 2021. Pending the results of the first-in-human trial, we may also elect to initiate a separate program in the treatment of obesity.

We feel confident that the efficacy and pharmacokinetic profile of ALT-801 in preclinical studies will translate to improve weight loss and tolerability, with more potent effects on weight loss and reduction in NASH activity compared to other agents.

Finally, we successfully filed the IND for HepTcell, our chronic hepatitis B immunotherapeutic. The Phase II trial is designed to evaluate the antiviral activity of HepTcell in chronically infected patients as an -- and is an important milestone in our goal to develop a functional cure for this disease.

Depending on the patient population being treated, the immunotherapeutic mechanism of HepTcell is intended to work alone or in combination with the new antiviral therapeutics that are being developed for this disease. We expect to initiate enrollment in the fourth quarter of 2020, pending evaluation of the impact of the COVID-19 pandemic.

And with that, I'll turn things back over to Vipin Garg. Vipin?

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Vipin K. Garg, Altimmune, Inc. - President, CEO & Director [6]

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Thank you, Scott.

As you may have noticed from Dr. Harris' remarks, it is important for us to continue the development of our portfolio outside of COVID-19. In addition to developments with AdCOVID and T-COVID, we expect to have a data-rich time period over the next 12 months, with data readouts from NasoShield in our anthrax trial, ALT-801 with our NASH trials and the initiation of a chronic hepatitis B trial with HepTcell.

One of the key tenets of our philosophy is to have multiple shots on goal, and we look forward to sharing the results of these clinical trials as they become available.

With that, I'll turn the call over to Will Brown, our Chief Financial Officer, who will provide an update on our financials. Will?

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William Michael Brown, Altimmune, Inc. - CFO & Principal Accounting Officer [7]

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Thank you, Vipin, and good morning, everyone.

For today's call, I'll be providing an update regarding our second quarter financial results.

Our cash and short-term investments balance was $80 million at June 30 for an increase of $47 million since the first quarter. The increase is attributable to $31.3 million of warrant exercises and nearly $23 million from our aftermarket facility. Since quarter end, we've received an additional $9.6 million from the exercise of warrants and $2.5 million from ATM sales. Additionally, we closed a public offering for gross proceeds of $132.2 million. With these additional cash receipts, Altimmune has more than $200 million of cash and investments on hand and is well positioned to advance its pipeline for at least the next 2 years.

As Scott Roberts discussed, a major use of the cash will be on the scale-up of manufacturing for both AdCOVID and T-COVID to meet the demands of both those COVID-19 product candidate.

Turning to the income statement. Revenues for the second quarter were $720,000, which is a reduction of $900,000 compared to the second quarter of last year. Our revenue was lower year-over-year, considering the NasoShield clinical trial and preclinical work performed during 2019 compared to clinical trial startup activities only performed in 2020.

Research and development expenses were $23.8 million for 2020 compared to $6.2 million in the same period last year. The increase year-over-year of $13.6 million is primarily attributable to stock-based milestone payments associated with ALT-801. We carry a liability on our balance sheet for the fair market value of these noncash payments. And during this quarter, we recognized $11.9 million of expense for an increase in the fair market value of the liability due to an increase in our stock price and an increase in the probability of success. Also impacting the change are increases in spend for the development of AdCOVID and T-COVID in addition to a decrease in spend for NasoShield due to the cycle of product development.

Second quarter G&A expenses of $2.5 million is $300,000 higher than the second quarter of 2019 due to an increase in compensation, legal and professional costs. Our income tax benefit for the quarter was $1.6 million, which represents the second quarter portion of our 2020 net loss, which we expect to file a refund claim next year.

Finally, net loss attributed to common stockholders for the second quarter was $16.8 million compared to $3.4 million in the same period last year, with net loss per share equaling $0.94 in the second quarter of 2020 versus $0.26 per share for the second quarter 2019.

With that, I would like to now open the call for questions and answers. Operator?

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Questions and Answers

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Operator [1]

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(Operator Instructions) Our first question comes from the line of Yasmeen Rahimi with Piper Sandler.

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Yasmeen Rahimi, Piper Sandler & Co., Research Division - Director & Senior Research Analyst [2]

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Congrats on the continued progress. Two questions for you. The first question is, can you shed light on what type of preclinical data we should be seeing between now and initiation of the Phase I study maybe to the level of granularity that you can provide us?

And then the second question is for Vipin. Can you shed light on the manufacturing? Maybe what is left in order to kick off the Phase I study? Are you thinking about working and adding on multiple manufacturers and continuing growing that?

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Vipin K. Garg, Altimmune, Inc. - President, CEO & Director [3]

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Yes. Yasmeen, thank you for the question. I would let Scott Roberts first to answer your first question, and I'll take the second question. Scott?

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M. Scot Roberts, Altimmune, Inc. - Chief Scientific Officer [4]

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Yes. Yasmeen, thanks for that question. So as far as the preclinical data between now and the clinical trial, as I mentioned during the call, the most immediate will be the T cell data. This is activation of T cell responses that are able to kill infected cells and reduce the infection that way. And we expect to have those data here very shortly. We'll also be reporting at that time on additional neutralizing antibody data that we've obtained that we're looking forward to sharing.

Beyond that, there'll be a continued evaluation of the specific types of antibody responses, what are the epitopes that are being targeted by both T cells and B cells. And we'll be looking at challenge models of COVID-19 in both rodents and nonhuman primates.

So that's kind of the broad brushstrokes of where we're going with that, and we look forward to sharing that data as it becomes available.

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Vipin K. Garg, Altimmune, Inc. - President, CEO & Director [5]

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And Yasmeen, with regards to manufacturing. As far as Phase I is concerned, we are well on our way to manufacturing materials for Phase I, as we announced almost over a month ago now that we entered into a partnership with Vigene Biosciences, and we've been working with them for a while. So they have -- they're in the process of manufacturing the Phase I materials and actually Phase I and Phase II materials.

But in addition to our partnership with Vigene, we have entered into an agreement with another large manufacturer, international manufacturer and a third manufacturer. We have not announced the names of these 2 manufacturing partners, but we are well on our way to securing sufficient manufacturing capacity for Phase III and beyond into commercialization of AdCOVID.

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Yasmeen Rahimi, Piper Sandler & Co., Research Division - Director & Senior Research Analyst [6]

Read more from the original source:
Edited Transcript of PIP earnings conference call or presentation 12-Aug-20 12:30pm GMT - Yahoo Finance

Junior Dos Santos vs. Jairzinho Rozenstruik Odds & PicksDos Santos odds+120 [BET NOW]Rozenstruik odds-150[BET NOW]Over/Under2.5 (+101/-129) [BET NOW]VenueUFC Apex, Las VegasTimeSaturday at 11 p.m. ETChannelESPN PPV

Odds as of Wednesday at 12 p.m. ET and via DraftKings. Get up to a $1,000 sign-up bonus at DraftKings today or see more offers and reviews for the best online sportsbooks.

With all eyes on the heavyweights Daniel Cormier and Stipe Miocic for UFC 252s Main Event, two other heavyweights will match up in hopes of pushing up the list of a jumbled weight class.

Former UFC heavyweight champion Junior Dos Santos will try to reestablish himself in the division he used to own after suffering back-to-back knockout losses. Hell be facing Jairzinho Rozenstruik, the -150 favorite, who soared up the heavyweight ranks before Francis Ngannou viciously knocked him out in UFC 249.

Dos Santos, the +120 underdog, is 36 years old and moving further and further away from his title run in 2013. Tied with Cain Velasquez for second all-time with 10 knockouts as a heavyweight, Dos Santos was stopped early in his past two fights against the aforementioned Ngannou and Curtis Blaydes. However, in his fight prior to that in March 2019, it was Dos Santos who gave Derrick Lewis heavy hands and knocked the contender out in Round 2.

His opponent, Rozenstruik, enjoyed a meteoric rise up the weight class ahead of his fight in May against Ngannou, highlighted by his near buzzer-beating knockout against Alistair Overeem.

Rozenstruik is 4-1 in the UFC with quick work in his three victories before the Overeem classic. There is no denying his knockout power and his finish in the final seconds of a five-round fight at his size is commendable. With a ton of upside, Rozenstruik will try to shake off the nasty KO, and Dos Santos will be a good barometer to see where he stands on the heavyweight totem pole.

Dos Santoss odds closed lower than the opening number in his past two losses and his record as an underdog hasnt been promising. Dos Santos hasnt made it out of the first round in his past three fights as a dog against strong competition in Blaydes, Ngannou and current champ Stipe Miocic in 2017.

Rozenstruik has seen the market move toward him in the past due in large part to his ability to end things quickly in his brief UFC career. That he opened as the favorite against a veteran like Dos Santos is a testament to his recent history before the loss. We could see his odds drop as fight night gets closer later in the week.

From a statistical perspective, Dos Santos throws about one more significant strike per minute than Rozenstruik. However, it is on defense where the former champ sees a difference.

The veteran Dos Santos defends 58% of significant strikes thrown at him while Bigi Boy only avoids 34%. Staying clear of each others knockout power punches is going to be key, and Dos Santos has shown over his lengthy career that he can do it.

Looking at this fight, both men are going to stand and throw looking for a quick finish. Both have fight stopping power and dont do much work on the mat. Rozenstruiks quick start thrust him up the weight class, but it may have been smoke and mirrors.

While he had his hand raised against Overeem, Rozenstruik was likely going to be handed his first loss in the UFC if it wasnt for his last-second knockout. After that, he seemingly bit off more than he can chew against Ngannou and was humbled. Mind you, that fight was in May and this is a very quick turnaround for someone who was knocked out in that fashion.

Cigano is on a cooler, and his best days may be behind him, but his experience may prove to be the difference here. Dos Santos has seen it all in his time in the octagon and Rozenstruik, while possessing serious power, is not a new challenge for him.

Its fair to question Dos Santos chin at this pointafter the two knockouts, but unlike his opponent, he will be the fresher man, having last fought in November.

Looking at the odds, it is fair to question Dos Santos at age 36, but the sample on Rozenstruik is not large enough for me to make him a -150 favorite if he doesnt land in the final seconds against Overeem, where is he in the class?

Early numbers from our SportsInsights tools show that Dos Santos has an edge in terms of the amount of betting tickets being wagered, though Rozenstruik has slight edge in money percentage (55% for Bigi Boy). I make this fight close to a coin flip and recommend taking Dos Santos +120 now and see value in Dos Santos up to -110.

The Pick: Dos Santos +120

[Bet Dos Santos +180 at DraftKings with a 50% profit boost]

The rest is here:
Junior Dos Santos vs. Jairzinho Rozenstruik Odds, Pick & Prediction: The Early Bet to Make for UFC 252 - The Action Network

Youre likely already well acquainted with an unforgiving element of our new realitythe Zoom call. While staring at other people virtually, were also staring at ourselves virtually, and also staring at a hard truth: Sometimes we could use a little work.

By the beginning of June, when the entire Washington area had entered Phase One of reopening, elective surgeries were happening once more. What became apparent is that many peoplelong cooped up, with endless time to consider their corporeal shortcomingswanted their damn glow-ups already.

We call it the Zoom neck lift, says Arlington plastic surgeon Talal Munasifi, referring to requests he has fielded for face work after people have suddenly stopped midvirtual gathering and thought, holy crap, they could use a touchup. They say, Oh, I didnt realize things look like this.

Typically, Munasifi says, summer is a slow time for cosmetic work because of vacations. But this past June, his practice saw almost 30 percent more traffic than usual. We have been extremely busy, he says. It was amazing how quickly it came back.

DC plastic surgeon Catherine Hannan says more patients are inquiring about skin-brightening peels or lasers. Someone may sit in on a Zoom call with poor lighting and not be able to stop thinking about those sunspots or under-eye bags. They might not be that bad in person, but the shadowing is making it look worse to them, Hannan says.

A large part of the increased business is due to people finally having the time to recover from a procedureno more summer-camp carpools or in-office meetings. When you say the downtime is ten days or a week or two weeks, not many people have the luxury of taking a week or two weeks in a row, says Munasifi. Now they can.

Its not just Zoom-inspired nips and tucks. Hannan says most of her patients are requesting body work, such as breast augmentation and liposuction: Theyve spent a lot more time at home thinking about it. They think its an ideal time to have a procedure.

Another factor that doctors say could be adding to an increase in patients: virtual consultations. Neither Munasafi nor Hannan frequently saw patients by video call prior to the pandemic, but now that theyve used it over the past few months, they believe the ease may make some people reach out who ordinarily wouldnt.

I think telehealth has opened up a new world for plastic surgery, says Hannan, who isnt charging a fee for virtual consultations (but does for in-person meetings). It can be done from home, ten minutes in between your other work that youre already doing on your computer.

Erin Kelly, a 30-year-old who works in PR, recently had a virtual consult with Hannan about getting liposuction under her chin and on her stomach. Kelly ordinarily lives in New York City but has been staying with her parents in Olney and working remotely during the pandemic.

Shes long wanted to get work doneprobably since the first time someone called me Chipmunk Cheeks, she saysbut hadnt found the right time. Until a pandemic struck. And, as with many people who have gotten refunds for vacations or other activities that couldnt happen, she had extra money to spend after moving in with her parents and canceling her gym and Rent the Runway memberships. The stars kind of aligned, and I decided if now wasnt the time, then when?

Many Washingtonians, of course, have prioritized their physical well-being over their physical appearance during the crisis. Staying Covid-free, it could be argued, is more important than getting a facelift or Botox. Plus youre not going to see anyone, so whats the point?

Its the same principle as hair salons, says Hannan. Some people are desperate to get their hair cut, and a lot of us are like, Well, I wear it in a ponytail all day,

Thats seemingly the case for a 41-year-old Arlington woman who works in real estate (and asked to remain anonymous). Shes gotten Botox before and has breast implants, and she just underwent a medically necessary surgery to replace the implants with new ones. Yet her approach to self-maintenance has changed over the past few months.

I like to go to the spa, I like to get my nails done, I like to get my hair done, she says. With the lockdown, obviously all that had to end. I think Ive gotten back to much more natural.

Even for those embracing natural beauty, though, the lure of coming out of quarantine looking especially well rested cant be ignored.

When were talking about Botoxthats different, the woman clarifies. Turns out she got some just a few weeks ago.

These surgeonsall of whom were named Top Doctors in our November 2019 issueare recommended for cosmetic procedures on adults looking to rejuvenate face and body

While most of these physicians can do any type of cosmetic surgery, weve listed special interests they have.

Stephen B. Baker

3800 Reservoir Rd.,NW; 202-444-9302;also McLean

Mary Ella Carter

5215 Loughboro Rd., NW; 202-363-6844

Special interest in facial rejuvenation, facial fillers

Christopher Charles Chang

8100 Boone Blvd., Vienna; 703-945-1700; also Chevy Chase

Special interest in breast augmentation, rhinoplasty, facelift

Steven P. Davison

3301 New Mexico Ave., NW; 202-966-9590

Special interest in breast augmentation, breast lift, facelift

Konrad L. Dawson

106 Irving St., NW; 202-726-1000

Special interest in tummy tuck, liposuction, breast reduction/augmentation/reconstruction

Gregory O. Dick

9711 Medical Center Dr., Rockville; 301-251-2600

Special interest in cosmetic surgery of the face, breasts, and abdomen; laser skin care; breast reconstruction

Gloria Duda

6845 Elm St., McLean; 703-893-1111

Special interest in cosmetic and reconstructive breast surgery

Craig R. Dufresne

8501 Arlington Blvd., Fairfax; 703-207-3065; also Chevy Chase

Special interest in facial rejuvenation, facelift, neck lift

William Epps

8008 Westpark Dr., McLean; 703-287-4600

Jules A. Feledy Jr.

5530 Wisconsin Ave., Chevy Chase; 301-654-5666; also Stafford

Special interest in breast reconstruction, body contouring, aesthetic surgery

Douglas L. Forman

11210 Old Georgetown Rd., North Bethesda; 301-881-7770

Special interest in breast surgery, facial plastic surgery, body contouring

James H. French

3299 Woodburn Rd., Annandale; 703-560-2850; also Chevy Chase

Special interest in facial, breast, and abdominal surgery

Roger J. Friedman

11210 Old Georgetown Rd., North Bethesda; 301-881-7770

Special interest in facial rejuvenation, rhinoplasty, breast and body contouring

Wendy R. Gottlieb

1800 Town Center Dr., Reston; 703-668-9499

Special interest in breast reconstruction, breast and body aesthetic surgery, facial cosmetic surgery

Catherine Hannan

2440 M St., NW; 202-785-4187; also Northwest DC

Special interest in breast, body, and facial rejuvenation

Kathy Huang

11210 Old Georgetown Road, North Bethesda; 301-881-7770

Special interest in breast augmentation, reduction, lift, and reconstruction; body contouring

Philip Iorianni

10810 Connecticut Ave., Kensington; 301-929-7100

A. Dean Jabs

6430 Rockledge Dr., Bethesda; 301-265-5242

Special interest in facelift, breast augmentation

Joanne J. Lenert

2300 M St., NW; 202-741-3242

Special interest in breast reconstruction, reconstruction after major weight loss, body contouring

Sheilah A. Lynch

5530 Wisconsin Ave., Chevy Chase; 301-652-5933; also Easton

Special interest in face and neck rejuvenation, body contouring, tummy tuck

Derek Masden

106 Irving St., NW; 202-877-3300

Vineet Mehan

2755 Hartland Rd., Falls Church; 703-544-8971

Alex N. Mesbahi

7601 LewinsvilleRd., McLean; 703-287-8277; also downtown DC

Special interest in body contouring

Joseph Michaels

11404 Old Georgetown Rd., North Bethesda; 301-468-5991; also Fairfax

Special interest in body contouring, plastic surgery after weight loss, cosmetic breast surgery

Talal A. Munasifi

1635 N. George Mason Dr., Arlington; 703-841-0399

Maurice Nahabedian

7601 Lewinsville Rd., McLean; 703-287-8277; also downtown DC

Special interest in breast augmentation, reduction, and reconstruction

Marilyn Nguyen

1625 N. George Mason Dr., Arlington; 703-717-4217

Special interest in breast reconstruction

Michael Olding

2300 M St., NW; 202-741-3241

Lauren Patrick

2440 M St., NW; 202-785-4187

Special interest in cosmetic surgery of the face, breast, and body; Botox and other injectables

Troy Pittman

Read more:
Zoom Is Motivating People to Get New Sorts of Plastic Surgery - Washingtonian

Photo credit: Kaylee LaMoine/Courtesy of David Freeman

From Men's Health

While the coronavirus (COVID-19) pandemic has halted the cadence of everyday life for just about everyone, the world is now beginning to adjust. We're all handling the challenges of social distancing and self-isolation differentlybut that doesn't mean that we have to go it completely alone in every sense.

At Men's Health, we're using this period as an opportunity to build up our community and share as much useful, positive information as possible. For everyone stuck missing their typical workout routines with gyms and fitness centers closed down, we've done our best to provide as many at-home workout options as possible. But that's just the start. We're also hosting live workout sessions on Instagram with some of our favorite trainers to fill the fitness class-shaped void in your daily routine.

David Freeman, national program manager of Life Time's Alpha program, hosted the latest session from his home. The strength interval workout, which requires your to have a kettlebell (or another similar load you can hold in the same way), will challenge you to use your muscles and work as hard as possible in short bursts of effort.

To pack in a ton of work in such a short amount of time, this session uses an EMOM protocol. You'll perform a set number of reps of a given exercise each minute, then rest until the next minute begins. Once the clock resets, start on the next set.

Freeman makes a point to provide a 'life habit' for every single workout session to encourage everyone to think beyond their sweat. His theme for today is G.R.E.A.T., which stands for Get Really Excited About Today. "When you wake up, you should be excited about today," he says. "You've got to be in the moment, present, and understand the value of your life and what you can do within that day."

Story continues

At the start of each minute, perform the exercise for the number of reps required. Rest for the remainder of the period. Once the next minute starts, move on to the next exercise on the list and repeat the process. Perform 3 rounds of the full series.

Staggered Kettlebell Romanian Deadlift (right) - 15 reps

Staggered Kettlebell Romanian Deadlift (left) - 15 reps

Biased Kettlebell Pushups (right) - 15 reps

Biased Kettlebells Pushups (left) - 15 reps

Reverse Crunch - 30 reps

Controlled Breathing

Split Straddle

Stay up to date with our workouts every single weekday at 12 p.m. ET. Want to keep up with the sessions you've missed? Check out the whole collection here.

Want some more workouts from Freeman? Check him out on Instagram and on All Out Studio.

You Might Also Like

See original here:
This Great Interval Workout Aims to Make You Stronger in Just 15 Minutes - Yahoo Lifestyle

Provided by Popular Science You don't even need a mat or an outfit change.

Joy Puleo, mother of two, has been in the fitness industry for more than 24 years and is currently the Education Program Manager at Balanced Body, the leading Pilates education and equipment manufacturing company. She is also the founder of Body Wise Connection, an organization which brings fitness and Pilates-inspired movement to women newly diagnosed with breast cancer.

This story originally featured on Working Mother.

For working moms, time is precious. With so much on our plates, its not surprising that when were working, were staying focused and sitting for long periods of time. Recent studies show an alarming number of Americans sitting for eight hours a day. Often referred to as the new smoking, the deconditioning effects, including decreased cardiovascular health and increased susceptibility to diseases such as diabetes and some cancers, are similar to the ill effects of smoking.

In addition, sitting too long leads to muscle weakness and imbalances, leaving us vulnerable to chronic discomfort and pain. Energy levels and mental states are impacted, as are vulnerabilities to obesity, energy loss and feelings of discontent and depression. What stands, literally, between the deconditioning cycle and health, is movement.

This simple, 20-minute Pilates-inspired workout is designed to fight the negative effects of sitting, increase flexibility and circulation, and enhance overall health and vitality. They can be done standing at your desk.

Heel raises

From tall standing posture, rise up onto the balls of your feet. As you lower heels back to the ground, keep lengthening and reaching the crown of your head to the ceiling. In other words, as you lower heels to the ground, imagine you are actually getting taller. This will not only work ankles and feet but also postural muscles along your spine. Five to eight of these will leave you feeling grounded in your legs, taller and more upright.

Standing roll down

Take a moment to take stock in your standing posture. Nod your head, then imagine rolling through your spine, one vertebra at a time. Roll down as far as comfortable and stop if you experience any back pain. As you roll down imagine drawing your abdominals in and up to support the front of your spine.

Note: If the floor seems too far away, stand close to a desk and roll down until your hands find support of the desk. Once the desk is achievable, then try for something lower, such as a chair seat and finally, the floor. To reverse, plant feet firmly into the ground and start to roll up your spine. As you return to standing, imagine stacking one vertebra on top of the one below it. Three to five of these are plenty.

Leg stretches

Keep these stretches dynamic by keeping movement continuous. Repeat as desired.

Hamstrings (back of the thigh): From the roll down position, bend your knees and bring your thighs toward your chest, as close to your thighs as possible. From this position, straighten your legs while trying to keep your chest as close to your thighs as possible.

Adductors (inner thigh): Open your legs wider than hip width and place your hands on a counter, table or desk. Shift weight to one leg by bending your knee. Keep your other leg straight; this leg should feel the stretch. Repeat on the other side.

Abductor (outside of the thigh): Stand beside a desk. For a deeper stretch, stand under a doorway. Cross your right leg in front of your left at the ankles. Place your left hand on a table or hold onto the door jam. Side bend to the left. As you do so, you can reach your right arm up and overhead. If you're inside of the door jam, hold the jam as you focus on stretching into your right hip.

Standing reach and extension

Standing upright, open your arms out to the side, raise your arms overhead, and reach for the ceiling while extending the spine. Release by lowering arms, bending knees and flexing spine. Repeat.

Squats and lunges

As fitness staples, these are excellent for building leg strength and strengthening pelvic floor.

Be careful not to let your knees go past your toes.

Squats

Narrow: Stand with your legs hip width or slightly wider, feet parallel. Lower into a squat by bending at the hips, knees and ankles. Keep your spine straight as your torso tilts over your thighs. At the bottom of the squat you should feel work in your quadriceps and hamstrings, and your weight should be balanced over your legs.

Wide: Open legs wider than your hips and slightly turn out your legs. With a wider stance you can lower farther down.

Try 10 repetitions, then on the final repetition, hold your position and count to 10 slowly. You can also pulse in squat position. Try lifting heels as you pulse and wow, quads on fire!

Lunges: Ten repetitions of each lunge in succession will create strength and muscular balance quickly.

Back leg focus: Stagger your legs in a split stance, one forward and one behind. Keep your torso upright and spine straight. Bend both knees and lower into a lunge. Your back knee should be directly under your pelvis, creating a straight line from head to torso to knee. Note: for support, place one hand on a desk as you lower into the lunge. Just that small amount of contact will allow you to lower deeper, while providing control and balance.

Front leg focus: Stand tall with weight even on both legs. Step forward with one leg and bend your knee to lower into a lunge. Keep your back leg straight and tilt your body forward over the lunging leg.

Sidestepping: From standing, step out to the side with your right leg while stepping behind with the left. Bend both knees and lower into a side-stepping lunge. Stand up to return to starting position and reverse sides.

Countertop push-ups

Place your hands on top of a desk, and step back until your body is in one long diagonal line. Bend and straighten your arms. As your arms bend, your body lowers toward desk; as your arms straighten, your body returns to starting position. Although your arms are working hard, your spinal muscles and core are working to support the spine, and legs should be active to support lower body. Ten repetitions is all you need.

Video: Why Skipping Leg Day Is a No, No (Buzz60)

Why Skipping Leg Day Is a No, No

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This quick workout will help your sore hips and back - MSN Money

Along with higher levels of resistance to insulin, which have also been spotted in the sleep-deprived, changes in levels of cortisol can lead to weight loss becoming much more difficult for those who dont sleep properly.

We are not saying that the weight will drop off if you get an extra hours sleep but I would expect to see changes within weeks rather than months.

Sleep reduces leptin levels which is a hormone working to manage appetite. Leptin reduces hunger making it easier for you to consume less food.

Dr Mosley explains: Researchers at the University of Chicago monitored hormonal levels and appetite in a group of 11 subjects during two 6-day periods. During the first six days, the volunteers received four hours of sleep during the night; during the second six days, they were allowed to sleep for twelve hours.

Dr Michael Mosley says As anyone who has tried to lose weight will testify, fighting a losing battle against your own willpower can be a dispiriting experience. Too often, diets leave people weighing even more than they did to begin with, as they struggle with constant hunger, cravings and loss of energy.

There is a better way. By getting enough sleep, your body will re-set its hormones to make better food choices. And this is just the start: with a high-fresh, low-carb diet, intermittent fasting, and exercise tailored specifically for the needs of those who want to lose weight, you can completely re-set your appetite.

You wont want to eat unhealthy food, and the weight that you lose wont come back.

Dr Michael Mosley is the journalist and qualified doctor who invented The Fast 800 diet, based on cutting your calorie intake to just 800 a day to help you lose weight.

Lose a Stone in 21 Days with Michael Mosley is on Channel 4 at 9pm every Wednesday.

Originally posted here:
Weight loss: Michael Mosley on why sleep could be the key to losing fat - Express

Did you know that adding olive oil to your diet, especially a plant-based diet, is beneficial to your weight loss regimen?

You might not have known of its weight loss benefits because the olive oil is more popularly known for its health benefits.

Olive oil is a rich source of monounsaturated oleic acid which is why it is known as one of the healthiest fats in existence.

The many beneficial effects of this fatty acid make it one of the healthy choice of oils for cooking.

What's more, the olive oil contains large amounts of powerful antioxidants plus vitamins E and K which are all very good for your health.

Listed among its health benefits are reducing inflammation, supporting your heart health and lowering your blood pressure. And, because it has powerful antioxidants, it can even have anticancer effects.

So, how can the olive oil exactly help you in losing weight? If the fact that it is one of the main components of a Mediterranean diet cannot convince you, then perhaps science will.

While we already know that olive oil is rich in monounsaturated fatty acids, it also contains medium-chain triglycerides. And, these two are known for their benefits in weight loss diets.

However, take note that it can only be useful in your goal of losing weight if you use a specific amount in a certain way.

Only small amounts because much like the avocado, olive oil is high in calories.

So, remember, only small amounts for it to be beneficial. Thus, you can use it as dressing for your salads, or mixed into your pasta or soup, you can also drizzle it onto your pasta or vegetable or incorporate it into your baking. This means that it can be a healthy swap for butter. A small amount can really go a long way with olive oil.

According to the Daily Express, a study had shown a significant weight loss among obese men who had their saturated fat intake replace with monounsaturated fats.

A diet that is rich in monounsaturated fat is also known to prevent weight gain, one of the problems that many weight losers struggle with especially when they tend to lose fat in a fast way.

Losing weight is better achieved if you pair a healthy diet with regular exercise. And, olive oil can also aid you here because its fats are said to be great energy boosters which means that adding it to your diet can help you perform better when you are doing your exercises.

So, you might consider adding olive oil to your diet not only to help you with your weight loss regimen but also for your health.

Image credit courtesy of Smabs Sputzer (1956-2017)/Flickr

See more here:
Weight Loss: Shed off extra pounds and belly fat by adding olive oil to your diet - EconoTimes

Vegan? Check. Organic? Check. Totally delicious? You betcha. Its no easy feat to make icing without butter or cream, let alone one that tastes amazing and has a healthy-ish nutrition profile.

But thats exactly what food gamechanger, Emily D. Edwards, founder of Paradise Snaxdid with her creation of Emilys Foods which creates organic, vegan hybrid icing/dips in both chocolate and caramel sea salt vanilla flavors. Sold either as standalone tubs or in the formSnax Paxicing-covered gluten-free pretzelsthe vegan icing is made with five grams of satisfying pea protein per serving.

Perfect for an afterschool snack or to make just-another-boring muffin more indulgent, the smooth texture of the icing is much like the real dealhold the animal cruelty and insane amounts of excess sugar. So how did Edwards stumble upon this idea? A former social worker in private practice, Edwards was first inspired to start the company in 2018 when she was striving to improve her health.

During this time I also went on a weight loss journey and soon discovered that it was hard to find snacks low in sugar and high in protein that satisfied my taste buds, Edwards shared recently in a company profile on BLACK ENTERPRISE.

After devoting many months to tweaking and tasting her vegan icing recipe in her own kitchen, she worked at Purdue Universitys food lab for a year conducting research and refining product development. The result was a pea protein-based dip you can feel good about eating.

Fast forward to today and you can order Edwards delectable icings on the Paradise Snax website here. Trust us when we say the six-pack Snax Pax of chocolate and caramel sea salt vanilla-covered pretzels are about six hundred too few. Happy munching!

Read the original here:
This Black-Owned Business Has Created Vegan Pea Protein Icing - The Beet

Below is a list of the top and leading Physiotherapists in Fort Worth. To help you find the best Physiotherapists located near you in Fort Worth, we put together our own list based on this rating points list.

The top rated Physiotherapists in Fort Worth are:

Green Oaks Physical Therapy has been serving the local community of Fort Worth since 2006. Using the Mckenzie system of diagnosis and treatment, they ensure to find the core problem to apply customized care and treatment that will ensure the quickest healing of the pain and injury that they have. They provide comprehensive treatment for all musculoskeletal problems and disorders.

Housing a team of expert and highly-trained staff, they can work conditioning back your body to its normal capacity. The office hours of the clinic are from Monday to Thursday from 7 AM to 7 PM and on Friday from 7 AM to 4 PM. They also accept most commercial insurance plans so treatment at Green Oaks will not deplete your budget.

Products/Services:

Physical Therapy, Industrial Rehab, Aquatic Therapy, Insurance

LOCATION:

Address: 160 W Magnolia Ave #2, Fort Worth, TX 76104Phone:(817) 335-7946Website:www.greenoaksptfw.com

REVIEWS:

Very friendly and excellent staff. Everyone talks and helps everyone all smiles everywhere. Carla Marroquin

Sports Rehabilitation Spec specializes in physical therapy of both surgical and non-surgical bone, joint and muscle injury. They offer a full range of services and treatments that include general orthopedic rehab and therapy as well as sports-specific rehab and treatment. They accept patients from pre-teens to senior years and create a personalized treatment plan that will custom-fit the condition and injury of the patient and ensure a fast healing process for them.

This therapy clinic is privately owned and houses the best rehab specialists that have almost 20 years of experience in the field. They are open to accommodate you from Monday to Thursday from 7:30 AM to 7 PM and from 8 AM to 12 Noon on Friday. Let go of the physical pain that you are feeling and schedule an appointment with them now so that they can help you achieve the ultimate healing that your body needs.

Products/Services:

Physical Therapy, General Orthopedic Rehab, IASTM/Graston Technique, Cupping Therapy, Spine Stabilization Program, Sport Specific Rehab, Home Exercise Programs, Kinesiology Taping, Dry Needling

LOCATION:

Address: 1901 Cooper St, Fort Worth, TX 76104Phone:(817) 877-8977Website:www.sportsrehabspecialists.net

REVIEWS:

The employees and owners here know what theyre doing! Do what they tell you and you will heal. I wont consider going anywhere else. Tina Roberts

Bonnette Elite Physical Therapy and Wellness Hulen is comprised of board-certified orthopedics that provides physical therapy and orthopedic care. They offer various services that cover fitness, therapy, training and weight loss. Some of the services and treatments that they provide are manual therapy, medical massage, therapeutic exercise, lumbar and cervical decompression, dry needling and more.

They guarantee a one on one session with their expert physical therapists to ensure that proper focus and attention are given to each patient for their fast recovery. They are open from 7 Am to 7 PM from Monday to Friday. They accept walk-ins and by appointment schedule and offer same-day evaluations and treatment.

Products/Services:

Fitness, Therapy, Weight Loss, Training

LOCATION:

Address: 6049 S Hulen St #113, Fort Worth, TX 76132Phone:(817) 885-0668Website:www.fortworthphysicaltherapist.com

REVIEWS:

Professional staff, clean facilities and after only 2 visits Im feeling really good. Jose Jaen

Greater Therapy Centers is a full-service physiotherapy clinic that offers a wide range of services that will help its clients with the issue that they are having. They offer different services like physical therapy, manual therapy, pelvic floor therapy and the McKenzie method. They design a progressive treatment plan with their main goal of bringing back the normal bodily function of their patient prior to the injury of the patient.

They use different techniques in ensuring the return and to maximize the performance of the patients injured body parts. From initial assessment, they are continuing to re-assess the patient to ensure that treatment is working well and to apply other treatments as needed.

Products/Services:

Hand Therapist, Dry Needling, Physical Therapy, Stretching and Mobilization, Manual Therapy, The McKenzie Method, Pelvic Floor Therapy

LOCATION:

Address: 5950 Bryant Irvin Rd #100, Fort Worth, TX 76132Phone:(817) 294-4646Website:www.gtc-pt.com

REVIEWS:

We could not have selected a better therapy center for my wifes knee replacement recovery. The entire staff is extremely professional, highly knowledgeable and a pleasure to work with. Jerry Turner

Hey Busy Mothers of Fort Worth,Headaches Seem to Last All Day?Im Dr. Nathaniel Ried and I am doing something

Posted by Ried Physical Therapy onSunday, June 7, 2020

Ried Physical Therapy is a premier center that helps patients manage the chronic pain that they are feeling due to several conditions. They also help patients get back on track after a serious injury or surgery. A center that is focused on the health and wellbeing of the community, they ensure to provide the best service and help people recover as fast as they could.

With highly-qualified professionals under their helm from physical therapists and exercise specialists, you can be assured help from nothing but experts in the field. The clinic itself is using the latest technology that will help properly diagnose the issue to be able to provide the perfect solution for the problem that you have. They are open from 8 AM to 6:30 PM so do not hesitate to contact them to schedule a much-needed appointment.

Products/Services:

Dry Needling, Iontophoresis, Kinesio Taping, TENS/IFC, Ultrasound, Manual Therapy, Head, Neck, TMJ and Face Pain Treatments

LOCATION:

Address: 4900 Overton Ridge Blvd #200, Fort Worth, TX 76132Phone:(817) 380-8077Website:www.riedpt.com

REVIEWS:

I went for approximately 3 months of physical therapy, first for a foot issue. This was quickly resolved through strengthening exercises. Laura West

David Atkins is the senior editor for Kevs Best. David has been working as a journalist for nearly a decade having published pieces in many print and digital publications including the Argus Leader and the Huffing Post. David is based in St Louisand covers issues affecting his city and state. When hes not busy in the newsroom, David enjoys backpacking.

See the original post:
5 Best Physiotherapists in Fort Worth - Kev's Best

Shortness of breath or breathing difficulties can be a frightening symptom, whether it is something that has happened to you out of the blue or something you have had to learn to live with through chronic disease.

Shortness of breath is the most common reason for attending Accident and Emergency and one of the most common reasons for calling an ambulance, yet not so many people consult their GP about their breathing as they should.

Around 10 per cent of the UK adult population suffer with shortness of breath and almost a third of the older population. Many people struggle on with symptoms at home and could better manage their breathlessness by working with their medical team closely.

We talk to Dr Louise Wiseman about some possible causes of feeling breathless in adults.

The medical term is dyspnoea. Shortness of breath can be subjective, in other words, when we are not breathing as we normally do. We may feel that we cannot take a deep breath in, or that our breathing is shallower and faster than normal, or difficult and uncomfortable. This may affect us when sitting still or only when we exert ourselves.

Real breathlessness can be related to many physical factors within our body and our environment and how we are feeling in ourselves. If we are feeling anxious our symptoms may worsen and a vicious cycle develops.

Exercise is like a natural test for our heart and lungs. It is normal and healthy to get out of breath when you exert yourself, whether this be running a mile or walking up the stairs. Your own limit will depend on your overall fitness and level of exertion that you exhibit daily. With exercise training, you will usually notice your tolerance improves and shortness of breath becomes less of a problem as you climb the stairs at the shopping mall car park.

Sometimes though, exercise can unveil a medical problem that you would not notice at rest. Exercise may bring on asthma or may reveal cardiac problems if you are suddenly limited more than normal.

For this reason some asthma medications, e.g long acting beta-agonists, are slow release helping to stop the airways spasming on exertion and are used prior to exercise.

Our body reflects closely the activity in our brain and if you are generally feeling anxious your heart and breathing rate may increase. You can recognise the feeling and the need to calm yourself. Sometimes though, this feels out of control and can become a panic attack. You can find yourself hyperventilating (over-breathing) or breathing fast.

Slowing down your breathing can help reverse the feeling. When you hyperventilate, you blow out your carbon dioxide more than normal and this causes physiological changes in your body that can make your hands tingle and you feel light headed. To stop this, you must try and increase your carbon dioxide back up. If you know you are hyperventilating, you can try breathing slowly into a paper bag or cupped hands and breathe deeply into your tummy more than shallowly into your chest. Concentrate on slowing your breathing and relaxing.

If panic attacks or anxiety are a recurrent problem, you should discuss with your doctor. Cognitive Behavioural Therapy or similar is hugely helpful and of course you must address the underlying cause of your anxiety. Mindfulness Based Stress Reduction techniques can be remarkably useful for everyone with a busy, stressful life.

Hay fever or sensitivity to house dust mites and similar can trigger asthma in sensitive individuals. You may be aware that with the pollen calendar you suffer at certain points of the hay fever season and that sneezing and upper respiratory inflammation can worsen your asthma.

Ensure you take your antihistamine as prescribed by your doctor and any preventative and treatment inhalers during this time.

The most common symptoms of asthma are wheezing, breathlessness, tight feeling in chest and coughing. You can have each of these symptoms in other conditions, but if they happen frequently you must see your doctor to get a proper diagnosis. They may happen randomly or in response to pet fur or exercise, sometimes symptoms are worse at night and early in the day. The asthma is due to the airways being extra responsive and tightening or going into spasm.

A severe asthma attack needs urgent medical attention and may include; severe wheezing/coughing/tightness of the chest, being unable to speak, eat or sleep, racing heart and breathing faster, drowsiness, dizziness, confusion, fainting, blue lips or fingers

Management of asthma is by combined care with your GP, practice nurse and often local respiratory hospital team. Success is by knowing your body and your asthma and working to prevent flare ups.

A good approach is to be aware of the following points:

Have an 'asthma action plan' this will tell you what medicine to use if things worsen. You may have a peak flow diary where you measure how your airways are by breathing into a special peak flow meter at home.

Using your preventer medicine well will mean using it when you are well as it builds up protection over time

Carrying your reliever inhaler with you and knowing how much extra use means a consultation is sensible e.g. more than three times a week

Using your inhaler properly which may mean use of a spacer

Attending your annual asthma review

Having your annual flu vaccine if appropriate

Your medicine will be a combination of relievers (to treat any symptoms promptly) and preventers (to prevent flare ups).

Relievers work quickly in the lungs to relax the spasm that can occur.

Preventers usually contain a low dose of steroid medication to reduce inflammation and swelling in the lungs. You may not need one, or only need it for seasonal use or be advised to use it daily. If taking it for hay fever, sometimes it is advised to start it two weeks before your season. Because there is steroid in most preventers they can cause thrush or sore throat symptoms these are prevented by using a spacer, a good technique and rinsing your mouth with water and spitting out after use.

Inhalers can be a spray, or an inhaler where you need to inhale to activate it, or a dry powder. Your nurse will check your technique in your annual check.

Apart from obesity making every day activities a little more difficult for the body, there are many ways it can affect breathing. Extra fat around the chest and neck can make the work of breathing heavier but also put pressure on the heart and lungs in terms of the work they have to do. Extra fat may produce hormones that affect the metabolism. This can all make the feeling of breathlessness more likely.

Your doctor may examine you and calculate your BMI or measure your waist circumference. Sometimes obesity can affect sleep and breathing at night and sleep apnoea may be a problem. Losing weight and steadily increasing exercise to be at a healthy BMI and lose waist circumference can reverse this. CPAP machines at night can help prevent sleep apnoea and will often be provided after specialist consultation at a sleep clinic.

Most cases of COPD (chronic bronchitis and emphysema) are caused by smoking or rarely environmental pollutants or genetic factors. The flow of air in the lungs is limited and unlike asthma not so easily reversed. This can have a huge impact on quality of life causing chronic breathlessness

As with many other lung conditions you will usually have shared care between the GP and a specialist clinic. Lung function tests including chest x-rays, spirometry and scans will be used to assess extent and progress of your disease.

There will be a low threshold for treating any infections and you will most likely be managed with regular inhalers. Pulmonary rehabilitation really helps patients optimise their fitness and breathing techniques may be taught to help catch your breath and focus on breathing out not in which is because the body is not able to get rid of carbon dioxide so well with this disease. Simple measures like a handheld fan can help.

Acid reflux can be more common if you are overweight or have a hiatus hernia. Acid comes up the oesophagus and can irritate upper airways or trigger a response to cause an asthma-like reaction. Patients will often describe acid reflux as being worse when lying down or at night, after eating or exercising, gardening leaning forward and so on.

Losing weight can help, as can reducing stomach acid by medication such as proton pump inhibitors or antacids. A wedge shaped or extra pillow at night can help elevate the upper body and reduce reflux. At worse reflux could potentially lead to an aspiration pneumonia as an acute cause of infection and shortness of breath.

Any infection can lead to shortness of breath, whether it is a simple cold causing viral induced wheeze or sinusitis causing congestion. More severe infections can cause pneumonia which can impair the lungs ability to exchange gases across the surface and will require medical treatment and possible hospital admission. You may have a productive or dry cough alongside shortness of breath.

Your doctor will assess the whole clinical picture by asking you questions and examine your chest for signs of infection and organise investigations and treatment as appropriate.

In light of COVID, an excellent resource for managing breathlessness at home under guidance of your doctor has been produced by King's college. This would of course be alongside any medical advice given to you by your GP and should not replace it.

Pulmonary embolism is a blood clot (or many clots) in the lungs and this can damage the lung, decrease oxygen levels in the blood and affect other organs. It can of course be fatal. They are often caused by a deep vein thrombosis from the leg or pelvis and these can be from trauma e.g. muscle or bone injury, being immobile (long plane ride/hospital bedridden stay) or certain medical conditions (e.g. malignancy, surgery). Other factors such as pregnancy and certain hormonal contraception can put you more at risk as can genetic factors.

This is a medical emergency and alongside shortness of breath there will also be a rapid heartbeat and possible coughing up blood and chest pain.

Various heart conditions can cause shortness of breath two-thirds of cases of breathlessness in all are actually due to cardiopulmonary causes.

Examples are heart attack, heart valve problems, heart failure, heart rhythm problems.

Symptoms may include chest pain or irregular or fast heart beat, fainting or dizziness and in cases of heart failure swelling of ankles and possible worsening of symptoms when lying flat. These are complicated scenarios that need careful clinical assessment.

Anaemia means there is less oxygen carrying capacity of the blood so it stands to reason that our breathing will increase to try and compensate so we feel as though we are out of breath. There are many causes of anaemia and these would be investigated by blood tests and other investigations by your doctor. With treatment of anaemia one would expect shortness of breath to resolve if it was the primary cause.

All of these conditions require specialised care:

Lung disease is a cause of chronic breathing difficulties and illness. Examples include;

Cystic fibrosis is a genetic condition causing the body to produce thick mucus affecting lungs and digestive system and requires specialist management.

Pulmonary fibrosis is a disease that occurs when lung tissue damaged and scarred and because it is thickened it makes it difficult for the lungs to function properly. Patients tend to become slowly progressively short of breath.

Bronchiectasis involves one or more of the large airways being abnormally widened allowing more mucus to collect and more chance of infection. This can occur after other infections causing damage or immune problems or certain fungi allergies. Often the cause is unknown.

If you are otherwise well but still experiencing breathlessness, the following tips may help:

Quitting smoking is a massive component of reducing lung disease, shortness of breath symptoms and preventing many diseases and causes of premature death. Talk to your doctor if you feel you cannot give up smoking alone cold turkey as there are many options that can help.

Improving your fitness levels and reducing excess weight in turn help reduce the load on our hearts and lungs and will improve any breathing problems. Start gently and listen to your body and always discuss with a healthcare professional if you have ongoing health problems and are thinking of drastically changing your lifestyle.

After a heart attack or spell in hospital for lung disease, many patients are seen by physiotherapy and rehabilitation specialists who may advise special breathing exercises to maximise lung capacity and oxygen levels. These may be good habits for dealing with mild shortness of breath at home.

Understanding any medicine for your breathing is paramount in getting you to take it and for it to work correctly. Make sure you attend medication reviews with your doctor and if something feels like it is no longer working report it to your practice or respiratory nurse.

It is important that you do not simply self-diagnose your own shortness of breath. Your clinician will make a diagnosis based on talking to you, asking some simple questions and examining you. They may also perform some investigations to get a clear clinical picture.

Types of questions your doctor will ask you in a consultation include:

When did it start was it sudden or gradual? Do you normally have an inhaler and is it helping? Do you have allergies or hay fever?

Did anything trigger it how severe it is? How far can you walk or exercise?

Have you been abroad? Have you had a fever or recent virus? Exposed to unusual infections such as TB? Long duration on an aeroplane or immobile?

Do you have any chest pain? Do you ever notice your lips or fingers going blue?

Do you have a cough? Is there any sputum or blood? Weight loss?

Are your ankles or leg swollen? Is it worse when you lie down?

For chronic shortness of breath, such as with COPD, a doctor will often use a special scale devised by the Medical Research Council to assess how your daily life is affected.

You must call 999 if you are struggling to breathe or suddenly become short of breath, and:

Or:

Other reasons to speak to your doctor urgently include:

Last updated: 11.08.2020

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