Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Deprecated: preg_replace(): The /e modifier is deprecated, use preg_replace_callback instead in /home/alerpma/public_html/libraries/rokcommon/RokCommon/Service/ContainerImpl.php on line 454

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/rokextender/rokextender.php on line 32

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/rokgallery/rokgallery.php on line 22

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/rokgallery/rokgallery.php on line 23

Strict Standards: Non-static method RokCandyHelper::getMacros() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/plugins/system/rokcandy/rokcandy.php on line 28

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/administrator/components/com_rokcandy/helpers/rokcandy.php on line 13

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/administrator/components/com_rokcandy/helpers/rokcandy.php on line 14

Strict Standards: call_user_func_array() expects parameter 1 to be a valid callback, non-static method RokCandyHelper::getUserMacros() should not be called statically in /home/alerpma/public_html/libraries/joomla/cache/controller/callback.php on line 159

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/administrator/components/com_rokcandy/helpers/rokcandy.php on line 24

Strict Standards: Non-static method RokCandyHelper::getTemplateOverrides() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/administrator/components/com_rokcandy/helpers/rokcandy.php on line 18

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/administrator/components/com_rokcandy/helpers/rokcandy.php on line 41

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/administrator/components/com_rokcandy/helpers/rokcandy.php on line 42

Strict Standards: call_user_func_array() expects parameter 1 to be a valid callback, non-static method RokCandyHelper::readIniFile() should not be called statically in /home/alerpma/public_html/libraries/joomla/cache/controller/callback.php on line 159

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/jcemediabox/jcemediabox.php on line 331

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/jcemediabox/jcemediabox.php on line 136

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/rokbox/rokbox.php on line 51

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/rokcandy/rokcandy.php on line 67

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/rokcandy/rokcandy.php on line 37

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/gantry.php on line 421

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Declaration of LikeWhereClause::testRow() should be compatible with WhereClause::testRow($row, $rowSchema = NULL) in /home/alerpma/public_html/libraries/gantry/core/gantryflatfile.class.php on line 662

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/gantry.php on line 188

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/gantry.php on line 189

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Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 1085

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/includes/application.php on line 536

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 1085

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Declaration of GantryParamProcessorAlias::postLoad() should be compatible with GantryParamProcessor::postLoad(&$gantry, $param_name, &$param_element, &$data, $value) in /home/alerpma/public_html/libraries/gantry/core/params/processors/alias.php on line 17

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/utilities/gantrycache.class.php on line 70

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 321

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 324

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 337

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/includes/application.php on line 536

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 337

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantrySessionParamOverride::populate() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 1239

Strict Standards: Non-static method GantryCookieParamOverride::populate() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 1240

Strict Standards: Non-static method GantryMenuItemParamOverride::populate() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 1243

Strict Standards: Non-static method GantryMenuItemParamOverride::_populateSingleItem() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/params/overrides/gantrymenuitemparamoverride.class.php on line 36

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/params/overrides/gantrymenuitemparamoverride.class.php on line 54

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/includes/application.php on line 536

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/params/overrides/gantrymenuitemparamoverride.class.php on line 54

Strict Standards: Non-static method GantryMenuItemParamOverride::_populateSingleItem() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/params/overrides/gantrymenuitemparamoverride.class.php on line 36

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/params/overrides/gantrymenuitemparamoverride.class.php on line 54

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/includes/application.php on line 536

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/params/overrides/gantrymenuitemparamoverride.class.php on line 54

Strict Standards: Non-static method GantryUrlParamOverride::populate() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 1246

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 1053

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/features/inactive.php on line 31

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/includes/application.php on line 536

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/features/inactive.php on line 31

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/features/pagesuffix.php on line 38

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/includes/application.php on line 536

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/features/pagesuffix.php on line 38

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/plugins/system/rokgallery/rokgallery.php on line 53
Medicamentos Inhalados Para el ASMA

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryModulesRenderer::display() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 680

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/features/systemmessages.php on line 26

Strict Standards: Only variables should be passed by reference in /home/alerpma/public_html/libraries/gantry/core/renderers/gantrymodulesrenderer.class.php on line 81

Strict Standards: Only variables should be passed by reference in /home/alerpma/public_html/libraries/gantry/core/renderers/gantrymodulesrenderer.class.php on line 82

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Non-static method GantryLoader::import() should not be called statically in /home/alerpma/public_html/libraries/gantry/gantry.php on line 40

Strict Standards: Non-static method GantryModulesRenderer::display() should not be called statically, assuming $this from incompatible context in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 680

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

Strict Standards: Only variables should be passed by reference in /home/alerpma/public_html/libraries/gantry/core/renderers/gantrymodulesrenderer.class.php on line 81

Strict Standards: Only variables should be passed by reference in /home/alerpma/public_html/libraries/gantry/core/renderers/gantrymodulesrenderer.class.php on line 82

Strict Standards: Only variables should be assigned by reference in /home/alerpma/public_html/libraries/gantry/core/gantry.class.php on line 489

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medicamentos asmaLas personas con asma tienen las vías respiratorias inflamadas, que se contraen, lo cual dificulta la respiración. Los medicamentos antiinflamatorios para el asma reducen los síntomas al tratar la inflamación.

Los broncodilatadores son medicamentos que ayudan a aliviar la contracción del músculo dentro de las vías respiratorias inflamadas. A menudo, la inhalación es la forma más efectiva de administrar un medicamento para tratar el asma. Su principal ventaja es que se administran directamente en el área problemática: los bronquios y bronquiolos, y el menor número de efectos colaterales en comparación con muchos medicamentos que se toman oralmente o se inyectan.

Clases de medicamentos que se inhalan

Entre los principales medicamentos para el asma que vienen para inhalar se tiene:

•Los corticosteroides inhalados, también llamados glucocorticosteroides, son antiinflamatorios muy efectivos que se vienen usando exitosamente para tratar el asma desde hace más de medio siglo. Estos esteroides no tienen nada que ver con los esteroides anabólicos mal utilizados por algunos atletas para mejorar su rendimiento. Estos medicamentos esteroides inhalados reducen la inflamación de las vías respiratorias, la producción de moco, la hipersensibilidad, la hinchazón y la contracción de los conductos bronquiales. Es importante continuar tomando los corticosteroides inhalados, tal como han sido prescritos, aunque usted se sienta bien, porque la inflamación es constante, incluso cuando usted no la nota y la medicación ayuda a prevenir las exacerbaciones asmáticas. Algunos ejemplos de corticosteroides inhalados son: beclometasona, budesonida, flunisolida, fluticasona y triamcinolona. Es importante enjuagar la boca, hacer gárgaras y escupir el agua del lavado luego de cada dosis de esteroides inhalados.

•Los broncodilatadores, también llamados beta2 agonistas, son medicamentos no esteroides relacionados con la adrenalina y se usan como remedios de "rescate" para aliviar de inmediato los síntomas de asma. Entre éstos se incluye el albuterol y el levalbuterol, el pirbuterol y la terbutalina. Algunas veces se abusa de estos medicamentos inhalados. La utilización de más de un inhalador por mes o necesitar más de 3 ó 4 inhalaciones diarias debe ser causa de preocupación. Esto indica que la inflamación subyacente no está bien controlada y usted debe consultar a su médico para que ajuste el tratamiento. El salmeterol y el formoterol son broncodilatadores beta2 agonistas que se usan junto con los medicamentos antiinflamatorios sobre una base regular (diaria), no cuando es necesario.

•Los medicamentos antiinflamatorios no esteroides, como la cromolina o el nedocromil, reducen la inflamación y previenen los síntomas de asma. Estas drogas son extremadamente seguras pero son menos efectivas que los corticosteroides inhalados.

Tipos de dispositivos de inhalación

Hay tres tipos básicos de dispositivos para administrar medicamentos inhalados. El más común es el inhalador de dosis medida (IDM), que usa un impelente químico para expulsar el medicamento. Gradualmente, el clorofluorocarbono (CFC) usado en muchos IDM está siendo reemplazado por otros impelentes. Los nebulizadores envían finos rocíos de medicamento a través de un tubo y una mascarilla que cubre la nariz y la boca, usando aire u oxígeno bajo presión. Los inhaladores giratorios y otros inhaladores de polvo seco administran los medicamentos sin usar impelentes químicos.

Independientemente del tipo de aparato de inhalación, la administración efectiva del fármaco a las vías respiratorias inferiores es crítica para que los medicamentos tengan efecto. En el caso de todos los aparatos, la educación y el entrenamiento de los pacientes, la familia y los encargados de velar por la salud y administrar los medicamentos a los pacientes, para que usen estos aparatos de manera adecuada y efectiva es un componente esencial de la terapia. Es de suma importancia, de hecho, corroborar constantemente que se está empleando la técnica de inhalación apropiada, demostrándolo durante las consultas de rutina al médico, por ejemplo, y repitiendo los programas de educación y capacitación si es necesario.

La coordinación de la inhalación de los dispositivos para inhalar varía de lo extremadamente fácil en algunos casos (nebulizadores, por ejemplo) a los extremadamente difíciles (IDM, por ejemplo). Así, una mala respuesta a la terapia puede deberse sencillamente a un problema en la administración del medicamento a inhalar, haciendo que este no llegue en cantidades suficientes, o directamente no llegue, a las vías respiratorias. Existe un dispositivo llamado espaciador que ayuda a dosificar el medicamento inhalado de los IDM.

Los espaciadores ayudan en entregar una mayor cantidad de medicamento directamente hacia las vías respiratorias inferiores, que es a dónde debe llegar, y no se queda en la garganta. Muchos espaciadores encajan en la boca del inhalador; en algunos casos, el envase del medicamento queda dentro del dispositivo. Algunos dispositivos vienen con espaciadores incorporados. Muchos asmáticos, en particular los niños pequeños, pueden tener dificultades para coordinar la inhalación cuando se usa un inhalador de dosis medida. Para ellos, el uso de un espaciador es particularmente recomendado.

También hay IDM que dispensan la droga automáticamente cuando el paciente respira de ellos. La técnica para obtener el medicamento de los inhaladores de polvo seco es distinta y puede parecer más "natural" que cuando se usan IDM. Para los aparatos de polvo seco no se necesitan espaciadores.

Uso de nebulizadores

Los nebulizadores administran con eficacia los medicamentos para el asma en forma de un fino rocío que llega a la boca y la nariz a través de mascarillas de distintos tamaños, adecuadas para niños o adultos, o a través de tubos en forma de T. Su uso tiende a ser bastante fácil y sólo es necesario inspirar y espirar como de costumbre a través de la conexión al nebulizador. El medicamento nebulizado para el asma es particularmente útil en el caso de bebés, niños pequeños y ancianos incapaces de recurrir al IDM. El uso de un nebulizador puede demandar más tiempo y es mucho menos efectivo si el bebé o el niño está llorando.

Uso apropiado de los medicamentos

Su médico le recetará los medicamentos inhalados más convenientes para usted. Si tiene alguna duda sobre los medicamentos inhalados que le han sido recetados o sobre su uso correcto, asegúrese de contactar a su médico. Muchos medicamentos inhalados para el asma han sido diseñados para usarse a diario y mantener las vías respiratorias abiertas, aunque usted no tenga síntomas. Es importante seguir las recomendaciones de su médico para asegurarse de que usted tenga un control óptimo de su asma.


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Contacto


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Email: Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo.
Tel. (507)
503-6373 Paulo
       (507) 503-6367 Manuel



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redes


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