Asthma Medications:
Medications for treating asthma come in different categories: 1. Quick Relievers (also called Rescue Medications):
These medications are inhaled bronchodilators. They act quickly to open the airways narrowed by asthma.
Anybody with asthma will need a quick reliever and should have access to this medication at all times.
Some quick relievers are:

Side effects of short acting bronchodilators may include shakiness and increased heart rate. Using a
chamber/spacer to administer these medications may reduce these symptoms.
Quick reliever inhalers need to be “primed” by spraying the inhaler into the air three times if not used for 2 weeks or longer. 2. Long-Term Controllers (Preventative Medications):
These medications are recommended for all patients who have symptoms more than two days a week.
They are used daily to control symptoms of asthma and should be taken even if you or your child feels
fine. Controller medications do not work immediately; their benefit occurs gradually.
There are many different controller medications.
Inhaled Corticosteroids
The most preferred category is the inhaled corticosteroids (ICS). They are not anabolic steroids taken illegally by some athletes. The inhaled corticosteroids work directly in the airways by preventing inflammation and swelling in the airways. Inhaled corticosteroids are the most effective long-term control therapy for persistent asthma. Some inhaled corticosteroids are: • Pulmicort® (Budesonide)
Flovent® (Fluticasone)
QVAR® (Beclomethasone)
Asmanex® (Mometasone)
Common side effects of inhaled corticosteroids include: oral candidiasis (thrush) and hoarseness of throat. Thrush can be greatly reduced by rinsing your child’s mouth and/or brushing teeth or using a mouthwash after each use. Using a spacer may reduce hoarseness of throat. In addition, a child’s vertical growth rate can be affected by inhaled steroids. Vertical growth may slow down in the first years of treatment; however their final adult height will be unchanged. Vertical growth, however, can also be affected by uncontrolled inflammation due to uncontrolled asthma. Singulair®(Montelukast)
• Sometimes used alone to treat mild asthma • Available in sprinkles, chews and pill form • May be helpful to treat seasonal allergies (allergic rhinitis) and exercise induced asthma Combination medications (have both an inhaled steroid and long term bronchodilator)
Advair® (Flovent and Serevent)
Symbicort® (Pulmicort and Foradil)
3. Oral Steroids (Prednisone/Prednisolone)
• Used for severe asthma flares ro decrease inflammation quickly. • Oral Prednisone is a systemic steroid, which means it goes directly into the bloodstream, unlike inhaled steroids which go straight into the lungs and very little gets absorbed into the blood stream. • Possible side effects are: behavior changes, increased appetite, trouble falling asleep, elevated blood sugars. Longer courses (greater than 3 months) of oral steroids can cause growth suppression, weight gain, bone-thinning, and muscle weakness. • According to the American Lung Association, “a short course of systemic corticosteroids for less than two weeks is rarely associated with significant side effects.” • Reduce the problem of coordinating the actuation of the metered dose inhaler with inhalation. • Easier to use; can use with a face mask for small children. • Face masks come in multiple sizes, need proper fitting mask. • Decreases the amount of medication swallowed and side effects. • Transition from mask to mouthpiece at approximately age 5. (need to be able to hold breath for A- Inhaler without spacer B- Inhaler with spacer
Spacer Technique
1. Remove cap and insert inhaler into spacer.
2. Shake the inhaler and spacer.
3. Put the mouthpiece in your mouth.
4. Press down on the inhaler one time.
5. Breathe in slowly through mouth. Take slow, deep inhalation (3 to 5 seconds) followed by a 10 second
breath hold, if possible.
6. Wait one minute between puffs.



VIEUX-MONTRÉAL LUGAR A LA MEMORIA, MEMORIA DEL LUGAR Presentada por el Arquitecto Mario Brodeur, Consultor en patrimonio De los 25 espacios exteriores públicos catalogados en el Quartier Historique du Vieux- Montréal, algunos datan de mas de 300 años. Desde la declaración de “arrondissement historique” de ese barrio en 1964, todos esos espacios fueron objeto de importantes

Curriculum vitae

CURRICULUM VITAE THOMAS K. HUISMAN, M.D. PERSONAL DATA BIRTH DATE: BUSINESS ADDRESS: Chiaramonte, Huisman and Zorn Urology, LLC (CHZ Urology, LLC) 7501 Surratts Road, Suite 308 Clinton, Maryland 20735 Wife: Susan (Married 1981) Son: Christopher (Born 1988) Daughter: Jennifer (Born 1990) EDUCATION RESIDENCY: Reservoir Road Washington, D.C. 1977-1981 SUMMARY OF CAREER:

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