Asthma, a chronic inflammatory disease of the airways, affects nearly 25 million Americans. The vast majority of these patients suffer from exercise-induced bronchoconstriction (EIB), a complication of asthma. Although traditionally treated pharmacologically, nutritional strategies provide a promising alternative for managing EIB as the prevalence of asthma may be due in part to changes in diet. Our objective was to determine the effects of novel nutritional strategies on hyperpnea-induced bronchoconstriction (HIB) in asthmatic individuals. HIB uses rapid breathing to identify EIB in a research or clinical setting. Fish oil, a combination of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docsahexaenoic acid (DHA), has been shown to be effective in suppressing EIB. However, its use in combination with other nutritional supplements, the optimal fish oil formula, and its effect on smooth muscle contractility have not been fully explored. An in vivo study (study 1) was conducted in individuals with both asthma and HIB to determine whether a combination of fish oil and vitamin C was more effective than either one alone in alleviating HIB. Pulmonary function was significantly improved with both fish oil and the combination treatment but not with vitamin C alone. In study 2, individuals with both asthma and HIB were supplemented with DHA alone since the optimal formula for fish oil has yet to be ascertained; previous in vitro studies have suggested DHA may be the more potent omega-3 fatty acid in fish oil. However, no significant changes in pulmonary function or airway inflammation were seen with DHA supplementation. For study 3, canine airway smooth muscle tissue was treated with fish oil to determine the in vitro effect of fish oil on smooth muscle contractility. Acute treatment with fish oil relaxed smooth muscle strips that had been contracted with 5-hydroxytryptamine. These minor relaxations in smooth muscle tension with fish oil may represent significant changes at the level of the smaller airways. These studies have confirmed that fish oil represents a viable treatment modality for asthmatic individuals with EIB and suggest that fish oil may influence airway smooth muscle contractility.

The purpose of this study was to conduct a systematic review of the scientific medical literature to identify, appraise, and synthesize the evidence for the health effects of omega-3 fatty acids on asthma. Asthma is a chronic inflammatory disorder of the airways leading to airways hyper-responsiveness and associated symptoms such as wheezing and coughing, and is also typically associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammatory process is a complex one, involving a multitude of cell types and activities marking the early and late phase asthmatic responses. There are important issues requiring careful consideration in diagnosing asthma, including the need to distinguish it from transient wheezing disorders in children, especially under the age of 5 years, and also from chronic obstructive pulmonary disorder, especially in older adults who are current or ex-smokers. Various strategies have been developed to manage asthma. Since airway inflammation is multifactorial, involving various cell types and mediators, the drugs used to decrease inflammation may act at several different steps in the inflammatory process. Agents that modify the asthma process, with some influencing inflammation, include: beta-2 adrenergic agonists, corticosteroids, leukotriene modifiers, mast-cell stabilizing agents, and theophylline. Considerable interest in the possible value of omega-3 fatty acid supplementation in asthma was sparked by Horrobin's hypothesis that the low incidence of asthma in Eskimos stems from their consumption of large quantities of oily fish, rich in omega-3 fatty acids. Additional impetus for research came from observations that omega-3 fatty acids' possible protective, or even therapeutic, effect might be afforded by their impact on mediators of inflammation thought to be related to the pathogenesis of asthma.

"They asked if the sneezles came after the wheezles, or if the first sneezle came first. " It has been nearly 25 years since the first edition of this textbook was published. During that time, we have witnessed an enormous improvement in the understanding of the basic pathophysiology of asthma and, more importantly, better treatment options. However, and with regret, the incidence and prevalence of asthma during this 25 year period increased significantly. Recent studies from the NIH highlight this point and illustrate that despite improved care and diagnosis, mortality continues to rise. In fact, asthma remains the most common chronic childhood illness and is among the most common chronic adult diseases. Despite improved medications, increased awareness, and a better understanding of the pathophysiology of this disease, mortality and morbidity continue to rise. Both international and national consensus positions have been published that offer guidance on treatment approaches. The importance of the primary care physician and provider cannot be overestimated in the appropriate diagnosis and management of this disease. The management options in asthma are changing rapidly with the advent of new drugs and approaches. The recent introduction of the leukotriene inhibitors has added an entirely new class of anti-inflammatory agents in the treatment of asthma. The potential of even newer approaches, including cellular modulation of the asthma patient with specific anti-IgE antibodies, opens up exciting possible treatments.

Written by outstanding authorities from all over the world, this comprehensive new textbook on pediatric and neonatal ventilation puts the focus on the effective delivery of respiratory support to children, infants and newborns. In the early chapters, developmental issues concerning the respiratory system are considered, physiological and mechanical principles are introduced and airway management and conventional and alternative ventilation techniques are discussed. Thereafter, the rational use of mechanical ventilation in various pediatric and neonatal pathologies is explained, with the emphasis on a practical step-by-step approach. Respiratory monitoring and safety issues in ventilated patients are considered in detail, and many other topics of interest to the bedside clinician are covered, including the ethics of withdrawal of respiratory support and educational issues. Throughout, the text is complemented by numerous illustrations and key information is clearly summarized in tables and lists.

Untoward reactions to environmental chemicals, particularly when a subject reports difficulties with exposures to chemicals of diverse classes involving more than one organ system, have been poorly understood and an area of great controversy. Studies of airway inflammation induced by respiratory irritants have established neurogenic inflammation as the mechanism for irritant asthma and rhinitis. Remodeling of the airway after an acute irritant exposure can lead to a heightened sensitivity to irritants that persists. Recognition that rhinitis, while sometimes regarded as a trivial disease, is associated with extra-airway manifestations such as fatigue and disturbances of sleep, mood, and cognition, further elucidates how chemical exposures can be serious for susceptible individuals. This book reviews current scientific understanding of irritant airway inflammation and related conditions, including cardiovascular effects of particulate exposures, airborne contact dermatitis and irritant dermatitis, and the brain as a target organ for both allergic and irritant reactions. It is essential reading for physicians and other healthcare workers caring for patients with environmental intolerances. Allergists, toxicologists, occupational and environmental physicians, and pulmonologists will find the materials particularly valuable. Patients and advocates for those with chemical intolerances will also find the book of interest.

A modern quantitative study of lung mechanics, relating mathematical modeling and engineering principles to lung function, structure, mechanics, and disease.