By O. Mannig. Knoxville College.
In Australia 130mg malegra dxt free shipping, Canada discount malegra dxt 130mg without prescription, the Netherlands discount 130 mg malegra dxt with amex, other countries, though in the former of these two group- New Zealand, and the U. In the Exhibit 3 shows that Americans with one chronic United States and Germany, however, there was little dif- illness or none were more likely to fill one or more pre- ference between those with below-average income and scriptions than were persons of similar health status in those with average income. Resulting patient requests for prescriptions Americans may be receiving more medicines than they 4 The Commonwealth Fund Exhibit 4. Percent of Population Reporting Use of One or More financial Barriers and Prescription Prescription Drugs During the Previous 12 Months, Drug-Skipping by Country and Income Reported rates of cost-related nonadherence to prescribed All incomes Below-average income treatments add further evidence of inequity in access to Average income Above-average income Percent prescription drugs in the U. With or without adjusting for sex, age, income, income were far more likely than those with above- and health status, residents of all other countries studied average income to rate their health as fair or poor (31% were significantly less likely (50 percent or more) than vs. High- incomes in four of the survey countries have higher rates income Americans were as or more likely to report cost- of use than in this the U. Percent of Population Reporting Not Filling a Prescription or Skipping a Dose Because of Cost During the Previous 12 Months Unadjusted odds ratio Adjusted odds ratio Country rates (95% confdence interval) (95% confdence interval) United States 23. Prescription Drug Accessibility and Affordability in the United States and Abroad 5 Exhibit 6. Average income Above-average income Percent 50 out-of-Pocket Costs 40 Even with their higher rate of unfulfilled prescriptions, 30 Americans are much more likely than residents of the 20 other countries to report out-of-pocket spending in excess of $1,000 in the previous year. The next highest share of population paying $1,000 or more in out-of-pocket for prescription combined in every country except Australia. This likely reflects gaps in cover- In countries with comprehensive drug benefit age and high cost-sharing that even insured Americans programs that have low copayments—Germany, the often experience. Studies repeatedly find negative national differences in drug prices because standard health and total cost effects from high out-of-pocket pre- doses and package sizes vary from country to country scription costs for patients with chronic disease and other and are seldom taken into account in price comparisons. In other countries, a focus on health secure savings has the effect of driving up the list prices and drug benefit policy designed to provide universal of drugs, there is little doubt that uninsured persons in access to essential treatments works together with group the U. Thus, cross-national dif- Affordability of medicines for individual patients is ferences in drug spending likely result from the combined facilitated by policies that limit cost-sharing for covered effects of higher use of medicines in the U. Most of these countries do so with relatively low cost-sharing by Prescription Drug Accessibility and Affordability in the United States and Abroad 7 patients, especially for vulnerable populations (e. Such comparative assessment review can help spur Canadian system of public drug coverage is comparable both the development and adoption of innovative and to that of the U. However, public programs for coverage under a universal drug benefit system, a finance a greater share of total prescription drug costs in key consideration is the price that can be charged. In Canada, prices are limited in com- to geography, age, income, or employment—can be parison to those charged in seven comparator countries cost-effective when viewed from health system and (including the U. Consider public benefits in and 2) relative pricing policies and negotiations concern- New Zealand, which operate with a national formulary ing the price of medicines. Different formularies may uses a variety of supplier contracts and coverage policies apply to different patients, depending upon their insurer. Zealand, per capita pharmaceutical spending in the Therefore, the National Institute for Health and Clinical U. In other countries, every medicine is appraised to implied by such a thought experiment is on the order 8 The Commonwealth Fund of $80 billion in 2005 alone. Because uninsured management occurs despite the fact that the underlying Americans are currently more likely than their insured health systems are based on social insurance models with counterparts to go without prescribed medications, this 13 many competing insurers. One message from mation to guide and inform benefit designs and pricing abroad is clear: sustainability, affordability, and equity in policies can help moderate cost increases while assuring pharmaceutical coverage will require commitment to uni- access to effective medications, including new products. Interviews were conducted with 1,000 adults in Australia and in New Zealand; 1,500 adults in Germany, in the Netherlands, and in the United Kingdom; 2,500 adults in the United States; and 3,000 adults in Canada. In our analyses, we weighted individual responses to be representative of national populations. Where we report shares of populations providing specific answers to survey questions, we used chi-squared tests to determine whether there were statistically significant differences between countries and to determine whether there were statistically significant differences across age, income, and health status within countries. We report adjusted odds ratios that compare specific results across all countries, using the U. These models are adjusted for sex, age, income, and health status (number of chronic conditions reported). We com- pare accessibility results across specific subpopulations of working-age adults in the U. Prescription Drug Accessibility and Affordability in the United States and Abroad 9 8 Notes R. Copayment on Rational Drug Use,” Cochrane 3 Database of Systematic Reviews: Reviews, Jan. Ross-Degnan, “The Case for a Medicare Policy Systems: A ‘Triple-A’ Framework and Example Drug Coverage Benefit: A Critical Review of the Analysis,” The Open Health Services and Policy Journal, Empirical Evidence,” Annual Review of Public 2009 2(1):1–9; J. Goetzel, “The Effects of States and Canada: A System-Level Comparison Prescription Drug Cost Sharing: A Review of the Using the 2007 International Health Policy Survey Evidence,” American Journal of Managed Care, in Seven Countries,” Clinical Therapeutics, Jan. Berkman, “Social Epidemiology: Social Prescription Drugs: Coverage, Cost-Sharing, and Determinants of Health in the United States: Are We Financial Protection in Six European Countries Losing Ground? Descriptions of health care systems: Australia, Canada, Denmark, England, France, Germany, Italy, 12 S. Mitton, the Netherlands, New Zealand, Norway, Sweden, “Centralising Drug Review to Improve Coverage Switzerland, and the United States (New York: The Decisions: Economic Lessons from (and for) Commonwealth Fund, forthcoming). Mintzes, “Outcomes-Based Drug Coverage in British Columbia,” Health Affairs, May/June 2004 23(3):269–76. Health Reform from the German and Dutch Multipayer Systems (New York: The Commonwealth Fund, Dec. Morgan, “Cost-Related Prescription Nonadherence in the United States and Canada: A System-Level Comparison Using the 2007 International Health Policy Survey in Seven Countries,” Clinical Therapeutics, Jan. Morgan, “A Cross-National Study of Prescription Nonadherance Due to Cost: Data from the Joint Canada –U. Murukutla, “Toward Higher- Performance Health Systems: Adults’ Health Care Experiences in Seven Countries, 2007,” Health Affairs Web Exclusive, Oct. His work combines quantitative health services research with comparative policy analysis to help identify policies that achieve balance between three sometimes-competing goals: providing equitable access to necessary care, managing health expenditures, and promoting valued innova- tion. Morgan earned degrees in economics from the University of Western Ontario, Queen’s University, and the University of British Columbia; and received postdoctoral training at McMaster University. He is a recipient of career awards from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research, an alumnus of Harkness Fellowships in Health Care Policy, and a former Labelle Lecturer in Health Services Research. He worked as a research associate at the World Institute on Disability before he received his doctorate in health services and policy analysis at the University of California, Berkeley, in 1996. Kennedy’s research focuses primarily on access barriers to prescription medicines, medical care, rehabilitation, and long-term services, with particular emphasis on at-risk groups, including persons with disabilities, older adults, and the uninsured. Aminosalicylates can be used in Crohn’s disease or ulcerative colitis, however they are often more effective in ulcerative colitis. Aminosalicylates have been shown to independently induce and maintain remission in mild to moderate ulcerative colitis. However, recent research suggests that they often need to be used in conjunction with other therapies to adequately control inflammation and prevent complications in Crohn’s disease. Sulfasalazine is still used, however, some patients experience side effects due to the sulfa component (see below).
The inactivation required should be identified from the Drinking Water Safety Plan risk assessment for individual works malegra dxt 130 mg low cost. For good quality order malegra dxt visa, well protected groundwaters buy malegra dxt 130mg amex, 2 log inactivation should be sufficient, but for lowland surface waters a target of more than 3 log inactivation would be needed. If risks from human sewage sources are identified in the catchment, requirements for viral inactivation would need to be taken into account, but if microbial risk was only from animal sources (e. The World Health Organisation guidelines recommendation of 30 minutes contact time at a minimum of 0. It is possible to achieve the same Ct by increasing C where t is inadequate and vice versa. Where possible, a site specific cumulative calculation of effective contact time should be undertaken by the Water Services Authority or private water supplier, based on the Ct of chlorinated water retained in dedicated contact tanks within treatment plants, dedicated treated water rising mains (without consumer connection) up to but not including the downstream service reservoir, unless there is no dedicated contact tank at the treatment works. Service reservoirs are not designed for providing efficient contact time (see Section 4. This is taken into account below in the calculation of effective contact time for service reservoirs, by assuming poor flow characteristics. In the absence of reliable site specific information to the contrary, a minimum effective Ct (see below) of 15 mg. Good quality groundwater (raw water) must be verified with at least 5 years of samples showing no faecal contamination in at least four samples in each year. It is also necessary to demonstrate that the source is adequately protected, there are source protection plans in place and the borehole(s) meet best practice design criteria. Modification of Ct for temperature and pH should be made as indicated in Section 7 of this Appendix. The effective contact time is related to both the volume of the contact tank and its design/structure (see Section 4. In the absence of any tracer test data for the tank, the effective contact time can be estimated from: 3 3 Effective contact time (minutes) = tank volume (m ) x 60 x D / flow (mf /h) where: Water Treatment Manual: Disinfection tank volume = length x width x minimum depth D is a factor related to the efficiency of the system to minimise short circuiting through the tank, asf discussed in Section 4. The tank volume should be the based on the minimum depth of water in the tank, for tanks where operating depth varies. The effective Ct is the effective contact time multiplied by the target chlorine concentration after the tank. Example calculation: Tank volume 10m long, 5m wide and with 3m minimum depth of water L W D 3 10 5 3 Volume = 10 x 5 x 3 = 150 m Tank design Assume “average” D = 0. The available contact time in the main is calculated from: 2 Pipe volume = πr x L where r = pipe radius (m) and L = pipe length (m). Pipe sizes are usually quoted as diameter, which should be halved to provide the radius. Water Treatment Manual: Disinfection Example calculation 3 Assuming a 1 km (1000 m) length of 0. The effective contact time in the service reservoir is calculated as for a contact tank, assuming “Poor” design i. The total effective contact time is that for the pipe and service reservoir added together. The effective Ct is the total effective contact time multiplied by the chlorine concentration after the service reservoir. Water Treatment Manual: Disinfection Calculation tool for pipe plus service reservoir Service reservoir volume Flow (F) Effective contact time in service reservoir 3 L W D Df m /h = L x W x D x 60 x D /Ff 0. Consideration of source contamination risk, the targeted reduction in pathogens and the scheme specific decay profile in conjunction with the effective contact time of scheme headworks elements should inform decisions relating to the disinfectant dose. The provision of adequate chlorine contact time before the water supply reaches the first consumers may be a particular problem in small water supplies and pumped distribution networks. Inadequate chlorine contact to inactivate bacteria and viruses may also exist in situations where existing site constraints do not permit the addition of adequate effective contact volumes in accordance with this manual. Proper disinfectant mixing using static or mechanical mixers, correct pH control of water to be dosed and improved residual monitoring will all help to mitigate the risk to human health posed by insufficient chlorine contact. In the case of larger schemes with long distribution systems, the provision of adequate effective contact time is often not a problem due to the scale of the scheme headworks comprising treated clear water tank, the size of dedicated rising mains and storage tanks. By contrast, the chlorine dose to be applied at the treatment plant may be largely effected by issues other than adequate chlorine contact. These issues may involve balancing the conflicting need to maintain adequate chlorine residual at the extremities of the large network while managing the taste and odour perception of consumers close to the scheme headworks. In this instance, the regular scouring of distribution mains in conjunction with the Water Treatment Manual: Disinfection location of addition secondary chlorination systems on the network may be required to safeguard the health of consumers without creating the perception of excessive chlorination close to service reservoirs. Cascade loop control involving feed forward control (in proportion to flow rate) and additional feedback control of dose rate (based on a chlorine residual monitor). The chlorine residual level downstream of mechanical mixing and/or chlorine contact time is compared with a desired residual set point value. To determine the preferred strategy for their applications the operator needs an appreciation of the following the instrumentation required for each control strategy, the desired residual dosage and control the particular site constraints such as the availability and effectiveness of contact tank volumes and/or mixing devices, the range and variability of flowrates and chlorine demands the required routine maintenance required Manual on-off control should never be used for chlorination of drinking water where waters originate from a surface water source or from a groundwater source subject to surface water contamination e,g. Exception may be made only where the flow is constant and there is a consistently low and stable chlorine demand such as from an unpolluted groundwater aquifer source. Flow proportional control may be appropriate for booster chlorination application on pumped systems where a pre determined dose is required and where treated water quality is consistently good or chlorine demand is not variable. However if there is a long contact time prior to residual monitoring, feed back control may not provide a satisfactory response to variable water demand conditions. In addition when using bulk delivered hypochlorite (which can deteriorate over time) or particularly hypochlorite generated by on-site electrolytic technology (where chlorine content may vary depending on operating conditions at generation), flow proportional control without residual monitoring is not recommended. Flow proportional control with residual monitoring feedback to adjust the dosing rate is suitable for systems where the water demand of the system at the point of dosage stays relatively constant but where the chlorine demand of the water or the chlorine content of the dosed solution is potentially variable. For most primary and secondary disinfection installations flow proportional dosing in tandem with residual monitoring control is the most common control strategy used. Water Treatment Manual: Disinfection Residual feedback control systems can also be used on inline chlorine booster stations but only where there is adequate mixing between the dosing point and the sampling point for the chlorine residual analyser. Homogeneous mixing of added chlorine is required to prevent inaccurate chemical dosage control due to inconsistently mixed chlorine solution at the sampling point. Where this mixing is not achievable hydraulically within the pipe manifold, static mixers should be used. Where such static mixers are used they should be accompanied by testing verification to prove that proper mixing is achievable to comply with any site installation constraints. While flow proportional control of chlorine dose is an integral part of the most commonly used dosing strategies, it is important to consider the effects of flow variation on Ct and contact tank performance. In principle, a change in flow rate, with a consequent increase or decrease in contact time (t), should be accompanied by an inversely proportional change in chlorine residual (C) to maintain the target Ct. However, the adjustment of chlorine concentration (C) to compensate for larger flows (i.
At therapeutic dosages cheap malegra dxt 130 mg with visa, fentanyl usually does not exert major effects on the cardiovascular system discount generic malegra dxt canada. Histamine assays and skin wheal testing in man indicate that clinically significant histamine release rarely occurs with fentanyl administration cheap malegra dxt online visa. Assays in man show no clinically significant histamine release in dosages up to 50 mcgm/kg. Most evidence indicates that fentanyl produces little or no change in myocardial contractility, although a few investigators have reported a negative inotropic effect. Virtually all hemodynamic variables, including heart rate, arterial blood pressure, cardiac output, systemic and pulmonary vascular resistance, and pulmonary artery occlusion or wedge pressure, remain unchanged after large (anesthetic) doses of fentanyl. Anesthetic induction with fentanyl is associated with the least change in mean arterial pressure and myocardial performance. While sufentanil does not produce hemodynamic instability, it does cause myocardial depression. Perhaps fentanyl is preferred over sufentanil in patients with poor left ventricular function. On the other hand, other investigators have found better hemodynamic stability, less hypotension, and less ventricular stroke work after sufentanil than after fentanyl in patients undergoing valvular heart surgery. Hypotension after fentanyl is often related to associated bradycardia and can be prevented or treated with anticholinergics, ephedrine, or even pancuronium. Patients with high sympathetic tone are more likely to experience hypotension after fentanyl. Sufentanil Sufentanil, which is 7 to 10 times as potent as fentanyl, causes hypotension with equal or greater frequency as compared with the latter. Since sufentanil is available in concentrations similar to those of fentanyl (50 mg/ml) one obvious possible cause of hypotension is relative overdose. Sufentanil does not produce increases in plasma histamine but does cause vagal‐induced bradycardia. As with fentanyl, mild to no depression of cardiac index and pump function is usually observed after sufentanil in humans. Ablation of sympathetic tone and enhanced parasympathetic tone are the most likely mechanisms for sufentanil‐associated hypotension. Sufentanil‐induced hypotension may also be mediated by a direct depression of vascular smooth muscle. Several studies suggest that sufentanil not only is more potent than fentanyl but also is closer to a "complete anesthetic. It is found that sufentanil (5 mg/kg) produces lower mean arterial blood pressures than fentanyl (25 mg/kg) during induction of anesthesia in patients undergoing coronary artery surgery. It has been also shown that although sufentanil (15 mg/kg) attenuated the hemodynamic response to endotracheal intubation better than fentanyl (75 mg/kg), it impaired myocardial function and depressed systolic blood pressure more. Side effects include respiratory depression, which will manifest itself as a gradual slowing of breathing and increased intracranial pressure. Buprenorphine is a thebaine derivative, which is similar to morphine in structure but approximately 33 times as potent. Buprenorphine is a partial mu‐receptor agonist and also binds to delta and kappa receptors, but its activity at the latter two sites is relatively insignificant. The metabolites of buprenorphone, buprenorphone‐3‐glucuronide, and norbuprenorphine are significantly less potent and have lower affinities for the mu receptor. Their accumulation in patients with renal failure is unlikely to cause significant pharmacologic activity. Higher doses do not produce further respiratory depression and may actually result in increased ventilation (predominance of antagonistic actions). Nonetheless, at some doses respiratory depression is impressive after buprenorphine. Dopram should be administered if Narcan does not reverse the respiratory depression. Like the other agonist‐antagonist compounds, buprenorphine is not acceptable as a sole anesthetic, and its receptor kinetic profile restricts its usefulness if other mu‐receptor agonists are used concurrently. On the other hand, in large doses buprenorphine might be of value as an alternative to methadone for maintenance therapy in opiate addicts. Opioid withdrawal symptoms develop slowly (5 to 10 days) after buprenorphine is discontinued following chronic use. In contrast to other opioid compounds (antagonists, agonists, and agonist‐antagonists) buprenorphine produces minimal effects in methadone‐maintained opioid abusers. Naloxone Description: Narcan, a narcotic antagonist, is a synthetic congener of oxymorphone. Its duration of action is approximately 4 hours; therefore, it may need to be administered more than once. When using Narcan against Buprenex you may need to use 10X the normal dose Usage: To reverse the effects of possible overdose of narcotics. Note that Naloxone is not effective against respiratory depression due to non‐opioid drugs. Given prior to and following surgery for 48 hours, often in conjunction with other analgesics. Often it is convenient to use children’s Tylenol because of the smaller number of milligrams per tablet. Other Drugs Antibiotics Antibiotics are substances produced by various species of microorganisms (bacteria, fungi, actinomycetes) that suppress the growth of other microorganisms and eventually may destroy them. However, common usage often extends the term antibiotics to include synthetic antibacterial agents, such as the sulfonamides and quinolones, which are not products of microbes. Hundreds of antibiotics have been identified, and many have been developed to the stage where they are of value in the therapy of infectious diseases. Antibiotics differ markedly in physical, chemical, and pharmacological properties; antibacterial spectra; and mechanisms of action. For the maintenance of implants Agents of the first category will only be always selected for use by the designated veterinarian. No person in the laboratory should ever administer antibiotics to the monkeys without previously consulting the veterinarian. Specific agents of the other two categories are routinely used for the maintenance of implants, or before and after the surgery. The following describes the properties, dosages, and types of administration of the antimicrobial drugs used in the lab: Ampicillin Description: Ampicillin is a semisynthetic penicillin derived from the basic penicillin nucleus, 6‐amino‐penicillanic acid. Ampicillin is not only bactericidal against the gram‐positive organisms usually susceptible to penicillin G, but also against the gram‐negative bacteria. It is, however, ineffective for organisms which produce penicillinase, including the penicillin G resistant strains of staphylococci. We use it for the treatment of skin and skin‐structure infections caused by beta‐lactamase producing strains of Staphylococcus aureus, E. It can be also given for infections caused by meningococcus, pneumococcus, gonococcus. Ampicillin should be used if the susceptibility test shows sensitivity of the cultured pathogens to this drug. Bacitracin Ophthalmic Ointment Description: Bacitracin zinc (or polymyxin B sulfate) ophthalmic ointment is a sterile antimicrobial ointment for ophthalmic use.
Show your doctor or pharmacist how you use your inhalers You are being exposed to a trigger purchase malegra dxt with paypal. Read the Asthma Basics Booklet called Triggers for information about things that can make your asthma worse buy malegra dxt 130 mg on-line. Talk to your doctor about allergy tests You are not using your controller medication regularly order 130mg malegra dxt otc. Use your controller medication every day You may have something other than asthma, such as an infection, and you may need another different medication, in addition to your asthma medication One indicator of poor asthma control = needing your reliever inhaler 4 or more times a week because of breathing problems 5 Medications: Asthma Basics Booklet Controller medications Having asthma means having long-term inflammation in your airways. Avoiding your asthma triggers by modifying your environment is the best way to help reduce this swelling (see the Asthma Basics Booklet called Triggers), but it is often not enough to achieve and maintain good asthma control. Regular use of a controller medication, will treat the persistent inflammation of the airways. Inflamed airway and mucus Regular use of controller medicine Normal airway = normal function 6 © Asthma Society of Canada Controllers: Inhaled Corticosteroids Inhaled corticosteroids have an anti-inflammatory effect on the airways. When used regularly, inhaled corticosteroids reduce inflammation and mucus in the airways, making the lungs less sensitive to triggers. Everyone with asthma, including mild asthma, benefits from regular use of inhaled corticosteroids. When your asthma is poorly controlled, your doctor may prescribe an inhaled corticosteroid. It can take days or weeks for the inhaled corticosteroid to reduce the inflammation in your airways, so be patient. The longer you are using it, the less you will need to use your reliever medication. The common side effects of inhaled corticosteroids are hoarse voice, sore throat and mild throat infection called thrush (yeast infection). Rinsing out your mouth with water after every dose of inhaled corticosteroids will also help reduce these side effects. If your asthma is not well controlled with one controller medication, another may be added to your current treatment. Continue taking your inhaled corticosteroid while taking the “add on” medications; the medications are meant to work together. Some of the side effects of Combination Medications include hoarseness, throat irritation, and rapid heart beat. Combination medication First choice Add-on Combination therapy therapy therapy Long-acting Corticosteroid bronchodilater Two medications (reduces (relieves airway in one device inflammation) constriction) 9 Medications: Asthma Basics Booklet Reliever Medication Short-acting bronchodilators are called "relievers" or "rescue medications". They provide temporary relief of bronchospasm by relaxing the muscles that have tightened around the bronchiole tubes. Most bronchodilators open the airway and help restore normal breathing within 10 to 15 minutes. If you need it 4 or more times a week for relief your asthma is not well controlled. Your doctor may prescribe one or more controller medications or may change the dose or type of controller that you are currently using to get the asthma under control. Tell your doctor if you need your reliever 4 or more times per week 10 © Asthma Society of Canada Relievers can be used for short-term prevention of exercise-induced asthma. Some of the side-effects of short-acting bronchodilators are headache, shaky hands (tremor), nervousness and fast heartbeat. Muscles around airway tighten Reliever Muscles relaxed 11 Medications: Asthma Basics Booklet Medication: Questions & answers What is the difference between corticosteroids and anabolic steroids? When your doctor prescribes an inhaled corticosteroid, he is giving a very small amount of this same hormone, to reduce the amount of inflammation in the airways. Some people worry that the more asthma medication they take or the longer they take it, the more they will need it. Many people do not take their medications because they think they can tolerate their asthma symptoms. Their poorly controlled asthma may lead to: Decreased quality of life (exercise, sleep) Higher risk of severe, life-threatening asthma attacks Permanent damage to the lungs My doctor wants me to use a corticosteroid inhaler. The dose of the corticosteroid inhaler is in micrograms, which is one millionth of a gram. Corticosteroids in a tablet form are in grams, a much higher dose than in the inhaler. Corticosteroid tablets are used when a larger dose is needed to get the asthma under control. Mild asthma may still cause regular symptoms, limit your quality of life and cause long-term inflammation in your airways that may lead to permanent damage of your lungs. So, people with "mild, persistent" asthma will most likely be treated with a low dose of daily controller medication. Six out of ten people with asthma have poor asthma control and do not take their symptoms seriously. If you are having regular asthma symptoms, then your asthma is not well controlled, and you are at risk of having a severe asthma attack. It is very important for your baby’s health to maintain excellent asthma control throughout the pregnancy. Asthma medications are well tolerated in pregnancy but it is a good idea to discuss all your medications with your doctor. When your asthma is under control talk to your doctor about adjusting the dose of your medications. There is no evidence of any benefit from the unconventional therapies for asthma, such as acupuncture, chiropractic, homeopathy, naturopathy, osteopathy and herbal remedies. If you decide to use unconventional therapies, tell your doctor and keep taking your asthma medications. Before starting a new medication, always ask if it is okay for people with asthma to use. Inhaled corticosteroids are the most effective prescribed medication for most patients with asthma. Inhaled corticosteroids at the doses they are currently recommending for asthma have not been shown to cause weak bones, growth suppression, weight gain and cataracts. Inhaled corticosteroids are much less likely to cause these side effects, but they can cause throat irritation and hoarseness. When corticosteroids are taken in higher doses, such as in a tablet form, for long periods of time, they can cause weak bones and growth suppression. When you decide to take any medication, you must weigh the possible risks of taking medication against the benefits. Low amounts of inhaled corticosteroids are generally considered to be the best option and are used by many people for asthma control. Inhaled asthma medications go directly to the site of inflammation and constriction in the airways instead of travelling through the bloodstream to get there. Inhaled medications only work if they get to the airways, so learn how to use your inhaler properly (see pages 18 to 21). Many people do not use their inhalers properly, so the medication does not reach their airways. It is very important that you show your doctor, pharmacist or asthma educator how you use your inhaler to make sure the medication is getting to your lungs, where it’s needed.