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Background Airway inflammation is considered to be important in asthma but is relatively inaccessible to study. Less Airway inflammation is a major factor in the pathogenesis of asthma. Mast cell and eosinophil infiltration, epithelial damage, and mucus production are characteristic features.' Direct examination of the inflammatory response should help to improve understanding of the pathogenesis and treatment of asthma.In patients with stable asthma bronchial biopsy and bronchoalveolar lavage have been used to study airway inflammation2' but discomfort, inconvenience, and risks limit their use. Examination of sputum is a less invasive alternative,5 but sputum cannot always be produced spontaneously. When sputum is not otherwise available induced samples may allow secretions from the lower airways to be sampled.Sputum induction by inhalation of hypertonic saline has been successfully used to diagnose Pneumocystis carinii pulmonary infections in patients infected with HIV.'We adapted this method for use in asthmatic subjects and examined (a) the success rate and safety of the method, (b) the reproducibility of cell counts, and (c) the differences in cell counts between normal and asthmatic subjects. Methods SUBJECTSSeventeen normal subjects and 17 subjects with asthma were selected from among the staff (adults) and asthmatic patients and their siblings (adults or children) at the clinics of the Firestone Regional Chest and Allergy Unit and the Health Sciences Centre. All were nonsmokers or ex-smokers of more than five years. None had spontaneous sputum or symptoms of a respiratory tract infection, or had been exposed to a seasonal allergen within the last month. The normal subjects had no past or current symptoms of asthma, a forced expiratory volume in one second (FEVI) >80% of predicted values,9 a ratio of FEV, to vital capacity >70%, and normal airway responsiveness to methacholine (provocative concentration of methacholine causing a 20% fall in FEV, (PC20) >8 mg/ml)'0 (table 1). The asthmatic subjects had a history of episodic dyspnoea with wheeze in the previous six months and a PC20 methacholine <8 mg/ml (15 patients) or a spontaneous variability in peak expiratory flow rate (PEF of >20% (two patients). All were taking an inhaled 2 agonist when needed; 15 were treated with inhaled corticosteroid (daily dose 200-3000 Mg) and one with prednisone 5 mg daily. Although asthma was stable in all subjects, control of the condition was good" in only five subjects; the remaining 12 had more asthmatic symptoms

High-intensity warfarin was not superior to moderate-intensity warfarin for thromboprophylaxis in patients with antiphospholipid antibodies and previous thrombosis. The low rate of recurrent thrombosis among patients in whom the target INR was 2.0 to 3.0 suggests that moderate-intensity warfarin is appropriate for patients with the antiphospholipid antibody syndrome.

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.

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