Characterizing Flocculated Mineral Sediments with Acoustic Backscatter, Using Solid and Hybrid Scattering Models.

This study investigated the performance of an acoustic backscatter system (ABS) for the in situ particle characterization of complex wastes. Two sediments were used: a fine, milled calcite that was flocculated with anionic polyacrylamide and naturally flocculated pond sludge. Particles were initially measured independently by light-based techniques to gain size, the coefficient of variation (COV), and fractal dimensions. For acoustic experiments, a bespoke, high-fidelity ABS was employed with 1, 2.25, and 5 MHz probes and a recirculating mixing tank. Initially, the concentration independent attenuation and backscatter coefficients were measured for each system using a robust calibration procedure at multiple concentrations. Comparisons of the total scattering cross-section (χ) and form function (f) were made between the experimental data and two semiempirical models: a Solid Scattering model and a Hybrid model (where the effects of bound fluid are incorporated). Experimental data compared more closely to the Solid Scattering model, as it was assumed scattering was dominated by small, bound "flocculi" rather than the macroscopic structure. However, if the COV was used as a fit parameter, the hybrid model could give equally accurate fits for a range of input aggregate sizes, highlighting that important size and structure information can be gained from the acoustic models if there is some a priori system data. Additionally, dual-frequency inversions were undertaken to measure concentration profiles for various frequency pairs. Here, the lowest frequency pair gave the best performance (with accurate measurements in the range of 2-35 g·L-1) as interparticle scattering was lowest.

Frontal Mucopyocoele Presenting With Recurrent Periorbital Cellulitis: A Delayed Diagnosis.

Periorbital cellulitis is an uncommon presentation to primary care and the emergency department. With multiple aetiologies, it is crucial that an appropriate history and examination are applied to identify the primary cause and initiate therapy in a timely manner. We present a 30-year-old male who presented with recurrent periorbital cellulitis treated repeatedly with antibiotics without consideration of the origin of the infection. Subsequent investigations discovered a widely dehiscent mucopyocoele of the frontal sinus that had been unrecognised and untreated. Once identified, the patient underwent functional endoscopic sinus surgery to clear the mucopyocoele and improve the drainage of the frontal sinus. Symptoms have not recurred since the surgical intervention. A poor understanding of the aetiologies of periorbital cellulitis and the related anatomy likely played a role in his delayed definitive management. Clinicians should be aware that in a patient presenting with periorbital swelling and erythema, consideration should be given to the possibility of underlying sinonasal pathology.

First observation of radiolytic bubble formation in unstirred nano-powder sludges and a consistent model thereof.

Experiments involving the irradiation of water contained within magnesium hydroxide and alumina nanoparticle sludges were conducted and culminated in observations of an increased yield of molecular hydrogen when compared to the yield from the irradiation of bulk water. We show that there is a relationship linking this increased yield to the direct nanoscale ionization mechanism in the nanoparticles, indicating that electron emission from the nanoparticles drives new radiative pathways in the water. Because the chemical changes in these sludges are introduced by irradiation only, we have a genuinely unstirred system. This feature allows us to determine the diffusivity of the dissolved gas. Using the measured gas production rate, we have developed a method for modelling when hydrogen bubble formation will occur within the nanoparticle sludges. This model facilitates the determination of a consistent radiolytic consumption rate coinciding with the observations of bubble formation. Thus, we demonstrate a nanoscale radiation effect directly influencing the formation of molecular hydrogen.

Management of non-traumatic epistaxis in adults in the emergency department.

BACKGROUND/AIMS: Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions. METHODS: The study was an interrupted time series analysis over 29 months and included 903 participants. A pathway for the management of adults with non-traumatic epistaxis was designed and implemented in a university teaching hospital with an emergency department annual attendance rate of 105 495 in 2019-20. RESULTS: The pathway led to a 14-minute longer stay in the emergency department, a 5% increase in emergency department breaches, an 8.2% reduction in admissions, a 3.6% reduction in emergency ambulance transfers, a 14.1% increase in nasal cautery and a 3.2% reduction in nasal packing. CONCLUSIONS: The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.

Flotation using sodium dodecyl sulphate and sodium lauroyl isethionate for rapid dewatering of Mg(OH)2 radwaste suspensions.

Mg(OH)2 suspensions were floated utilising sodium dodecyl sulphate (SDS) and sodium lauroyl isethionate (SLI) collectors, for rapid dewatering of radwaste suspensions. Freundlich adsorption isotherms were first used to compare the adsorption densities of SDS and SLI on Mg(OH)2 surfaces, to determine the maximum monolayer coverage capacity, and were found to be 0.11 µmol m-2 at a dosed concentration of 172 µM for SDS and 0.05 µmol m-2 at a dosed concentration of 188 µM for SLI. The natural and salt induced coagulation kinetics of Mg(OH)2 were examined using static light scattering, where the influence of collector adsorption on particle size distributions was also investigated, to probe potential hydrodynamic limitations of flotation. Particle stabilised foam formation was then characterised using a Bikerman column test, where the dynamic foamability indices (DFIs) of SDS and SLI were determined to be 49 × 103 s L mol-1 and 321 × 103 s L mol-1 respectively. Flotation performance was measured, and a collection efficiency factor used to compare the solid-liquid separation ability of mixed 2.5 vol% suspensions with SDS or SLI, as well as MIBC frother. Optimal performance aligned with collector concentrations relating to predicted maximum monolayer coverage, and whilst both surfactants were effective, SDS systems performed better than SLI in all metrics. Recoveries of >80% of the Mg(OH)2 wastes were achieved, whilst only transferring 35% of the water mass at the optimum SDS dosed concentration of 82 µM, likely due to its denser surface adsorption and minimised lamella water entrainment.

Sediment Microstructure and the Establishment of Gas Migration Pathways during Bubble Growth.

Soft sediments exhibit complex and varied deformation behavior during in situ bubble growth; however, the sediment microstructure is often neglected when predicting bubble networking or fracture propagation dynamics. This study considers three chemically similar Mg(OH)2-rich sediments, which differ slightly in their particle size distributions and morphologies but exhibit significant differences in their porosity, stiffness, and pore throat dimensions at equivalent yield strengths. At low yield strengths, microstructure greatly influenced the size distribution and connectivity of spherical bubble populations, with narrow sedimentary pore throats promoting coarser bubbles with diminished connectivity. Increased connectivity of the bubble population appeared highly significant in limiting bed expansion, either by establishing pathways for gas release or by dissipating excess internal bubble pressure, thereby diminishing further growth. During in situ gas generation, each sediment demonstrated a critical fracture strength, which demarcated the populations with high void fractions (0.27 < ν < 0.4) of near-spherical bubbles from a fracturing regime supporting reduced void fractions (ν ≈ 0.15) of high aspect ratio cracks. However, critical fracture strengths varied significantly (in the 60-1000 Pa range) between sediments, with coarser-grained and higher porosity sediments promoting fracture at lower strengths. Fracture propagation greatly enhanced the connectivity and diminished the tortuosity of the void networks, thereby augmenting the continuous gas release flux.

Localized Sinonasal Amyloidosis.

Localized amyloidosis involving the nasal mucosa is rare, with only 38 published cases reported to date. We report a case of amyloidosis localized to the sinonasal tract. A 61-year-old man presented with a 1-year history of left-sided nasal obstruction. Endoscopic examination and computed tomography revealed the presence of a nasal mass originating from the left inferior turbinate. The patient subsequently underwent an examination under anesthesia and an excision biopsy of the nasal mass. Histology confirmed amyloidosis with no immunospecific stains. Systemic amyloidosis testing was negative, leading to a diagnosis of localized sinonasal amyloidosis of nonamyloid A (AA) subtype. To our knowledge, this is the second reported case of non-AA subtype of the sinonasal tract. The patient was managed conservatively and is currently under close follow-up.

A new technique using fibrin glue in the management of auricular hematoma.

: This study aims to describe a new technique for the management of auricular hematoma using fibrin glue. Five difficult cases of auricular hematoma were managed using this technique, including 2 recurrent and 3 delayed presentations. After skin preparation and local anesthetic, an incision was made, the hematoma was evacuated, and the cavity was washed out with saline. Fibrin glue was applied liberally; a dental roll pressure dressing was applied and secured with a prolene bead suture. The patients were given a course of oral antibiotic and reviewed after 5 days for removal of the external dressing. They were later assessed to exclude re-accumulation of the hematoma. All patients had complete resolution of the hematoma without re-accumulation; they were satisfied with the cosmetic results and experienced no complications. This case series provides evidence that fibrin glue is effective in the management of auricular hematoma. Larger studies may provide further evidence of the effectiveness of this new technique.

Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial.

BACKGROUND: Chronic rhinosinusitis (CRS) with nasal polyposis is common. The long-term efficacy and safety of approaches to medical management are not well-known. OBJECTIVE: To evaluate the efficacy and safety of a 2-week regimen of oral steroid therapy followed by 26 weeks of sequential topical steroid maintenance therapy. DESIGN: Parallel randomized trial with computer-generated block randomization and central allocation. Patients and investigators were blinded to group assignment. (ClinicalTrials.gov registration number: NCT00788749) SETTING: A specialty rhinology clinic in Tayside, Scotland. PATIENTS: 60 adults with CRS and moderate-sized or larger nasal polyps who were referred by their primary physicians for specialty care. INTERVENTIONS: Patients were randomly assigned in a 1:1 ratio to receive oral prednisolone, 25 mg/d, or placebo for 2 weeks, followed in both groups by fluticasone propionate nasal drops, 400 µg twice daily, for 8 weeks and then fluticasone propionate nasal spray, 200 µg twice daily, for 18 weeks. MEASUREMENTS: Polyp grading (primary outcome), hyposmia score, quality of life, symptoms, nasal patency, adrenal function, and bone turnover. RESULTS: The mean decrease in polyp grade from baseline to 2 weeks was 2.1 units (SD, 1.1) in the prednisolone group and 0.1 unit (SD, 1.0) in the placebo group (mean difference between groups, -1.8 units [95% CI, -2.4 to -1.2 units]; P < 0.001). The difference between groups was -1.08 units (CI, -1.74 to -0.42 unit; P = 0.001) at 10 weeks and -0.8 unit (CI, -1.8 to 0.2 unit; P = 0.11) at 28 weeks. The mean decrease in hyposmia score from baseline to 2 weeks was 31.12 mm (SD, 30.1) in the prednisolone group and 1.41 mm (SD, 30.6) in the placebo group (mean difference between groups, -28.33 mm [CI, -42.71 to -13.96 mm]; P = 0.002). The difference between groups was -16.06 mm (CI, -30.99 to -1.13 mm; P = 0.03) at 10 weeks and -12.13 mm (CI, -30.55 to 6.29 mm; P = 0.19) at 28 weeks. Prednisolone therapy resulted in transient suppression of adrenal function and increase in bone turnover after 2 weeks, with a return to baseline at 10 and 28 weeks. LIMITATIONS: Patients were referred from primary care to a single-center rhinology clinic, which limits the generalizability of results. Serial measurements of surrogates of nasal inflammation (such as nitric oxide or cytokine levels) were not performed. CONCLUSION: Initial oral steroid therapy followed by topical steroid therapy seems to be more effective over 6 months than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients referred for specialty care of CRS with at least moderate nasal polyposis. PRIMARY FUNDING SOURCE: Chief Scientist Office, Scotland; National Health Service Tayside Small Grants Scheme; and an Anonymous Trust grant from University of Dundee.

The effect of functional endoscopic sinus surgery on nasal spray distribution to the middle meatus in patients with rhinosinusitis.

BACKGROUND: Because the principle behind functional endoscopic sinus surgery (FESS) recognizes the middle meatus as essential for the control of the disease, the effect of the operation in the distribution of drugs in the same area should be of similar importance. This study was designed to clarify whether nasal drug delivery is improved in patients after FESS. The study involved a prospective assessment within subject comparison. The subjects were 20 adult (>18 years old) patients on the waiting list for FESS. It was conducted within two teaching hospitals in the East of Scotland. METHODS: A novel method was used, positioning a neurosurgical patty in the middle meatus and assessing blue dye nasal spray absorption on a 4-point scale. RESULTS: A significant improvement was observed in the distribution of the indicator in the middle meatus postoperatively. Seventy percent of the patients showed improvement in the drug distribution after FESS. The median result for absorption score was 2 preoperatively (<50%) and 3 postoperatively (>50%). The difference was statistically significant (p<0.001). CONCLUSION: The distribution of nasal drugs is improved in the middle meatus after FESS. This can have important clinical applications that can benefit patients in otolaryngology as well as other disciplines.

Comparative safety and efficacy of 2 formulations of fluticasone aqueous nasal spray in persistent allergic rhinitis.

BACKGROUND: There are few data on the clinical equivalence of different nasal corticosteroids in persistent allergic rhinitis (AR). Studies measuring plasma concentrations after a single dose may not predict relative systemic bioactivity at steady state. OBJECTIVE: To compare a test formulation of fluticasone propionate with the innovator using a noninferiority design. METHODS: Twenty-three patients with persistent AR were randomized to completion in a double-blind, placebo-controlled, crossover manner to receive the formulations at 200 microg/d for 4 weeks, with baselines measured after 2-week run-in and washout periods. The primary outcome measure was the Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) score. RESULTS: Both formulations produced significant improvements in MiniRQLQ scores as change from baseline (P < .001), with a nonsignificant mean difference (test vs innovator) of -0.06 U (95% confidence interval [CI], -0.41 to 0.52 U) and the lower bound of the 95% CI being above the predefined noninferiority limit of -0.7 U. Both formulations produced significant improvements in peak nasal inspiratory flow rates as change from baseline (P < .01), with a nonsignificant mean difference of 0.5 L x min(-1) (95% CI, 9.8 to 10.8 L x min(-1)). There were also significant reductions in total nasal symptom scores (P < .01), with a nonsignificant mean difference of 0.4 U (95% CI, 0.3 to 1.1 U). No significant suppression of the 10-hour overnight urinary cortisol to creatinine ratio was seen with either formulation. CONCLUSIONS: The test formulation was noninferior to the innovator for the primary outcome of MiniRQLQ score. The secondary efficacy and safety end points also support the interchangeability of the 2 formulations.

Malignant tumors of the ear and temporal bone: a study of 27 patients and review of their management.

OBJECTIVE: To evaluate the management of patients with malignant tumors of the ear and temporal bone. DESIGN: Retrospective analysis of data. SETTING: Radcliffe Infirmary, Oxford, United Kingdom. PARTICIPANTS: Twenty-seven patients were classified into two groups according to the site of origin of the tumor: (1) superficial (17 tumors): tumors arising from the skin of the pinna, parotid, and temporomandibular joint area; (2) deep (10 tumors): tumors arising in the ear canal and temporal bone. MAIN OUTCOME MEASURES: Treatment modality, complications, recurrence rate, disease-free interval, and survival. RESULTS: The mean follow-up period was 25 months (0 to 60), and the median overall survival 46 months (0 to 102). Complications occurred in 6 patients (22%). The 3-year survival was 38% (95% confidence interval [CI], 19 to 58%), and the 5-year survival 19% (95% CI, 3 to 35%). CONCLUSIONS: There were insufficient data to demonstrate any difference in survival or disease-free interval related to the site of tumor origin (superficial versus deep tumors). There were independent differences in survival in favor of both performing parotidectomy and using postoperative radiotherapy, but neither reached significance at the 0.05 level.

Respirable dose delivery of fluticasone propionate from a small valved holding chamber, a compact breath actuated integrated vortex device and a metered dose inhaler.

AIMS: To compare the respirable dose delivery of the hydrofluroalkane fluticasone propionate (HFA-FP) via an optimally prepared Aerochamber Plus spacer (AP), via a Synchro-Breathe (SB) device, and pMDI Evohaler (EH). METHODS: Seventeen mild to moderate asthmatics completed the study using a randomized, double-blind, double-dummy, three way crossover design. Single doses of placebo or HFA-FP 2.0 mg were administered via the EH, AP, and SB devices. The overnight urinary cortisol : creatinine ratio (OUCC) was measured at baseline and after each dose. RESULTS: Significant suppression of OUCC occurred from baseline with AP and SB but not EH devices (geometric mean fold suppression, 95% CI): AP: 3.18 (2.29, 4.36), P < 0.001; SB: 1.79 (1.31, 2.40), P = 0.001; EH: 1.12 (0.69, 1.44), p = 0.37 (equating to 68%, 45% and 9% falls, respectively). Significant differences in OUCC between devices were as follows: (geometric mean fold difference, 95% CI): AP vs. EH. 2.83 (2.09, 3.82), P < 0.001; AP vs. SB: 1.78 fold (1.21, 2.60), P = 0.003; SB vs. EH: 1.59 (1.09, 2.31), P = 0.013 (equating to 65%, 44% and 37% differences, respectively). CONCLUSIONS: The use of an optimally prepared AP spacer and breath actuated SB device, when compared with pMDI, significantly increased the respirable dose of HFA-FP.

Removing nasal valve obstruction in peak nasal inspiratory flow measurement.

BACKGROUND: Peak nasal inspiratory flow (PNIF) measurements are used to evaluate nasal obstruction and as a surrogate for disease activity in allergic rhinitis and other nasal complaints. This measurement can give erroneous results when forced inspiration leads to nasal valve collapse. OBJECTIVE: To determine the effects of 2 different nasal stents (Sinuscone and Nozovent) on valve collapse and repeatability of PNIF measurements. METHODS: Repeated measurements of PNIF were obtained in 74 individuals with and without 2 different nasal stents: Sinuscone and Nozovent. RESULTS: The mean (95% confidence interval) improvement in PNIF was 1.7 L/min (-2.4 to 5.8 L/min; P = .42) with Nozovents and 25.4 L/min (11.4 to 39.4 L/min; P = .001) with Sinuscones. The PNIF coefficient of variation for repeatability was 11.6% without stents, 16.0% using Nozovents, and 10.4% using Sinuscones. CONCLUSIONS: Sinuscones, but not Nozovents, significantly improved PNIF. Repeatability of PNIF measurements was worse with Nozovents and only marginally improved with Sinuscones.

An in vivo and in vitro comparison of inhaled steroid delivery via a novel vortex actuator and a conventional valved holding chamber.

BACKGROUND: Valved holding chambers improve delivery of inhaled corticosteroids to the lung but are bulky in design. A novel compact vortex actuator device has therefore been developed. OBJECTIVES: To compare the in vitro and in vivo performance of a novel compact vortex actuator (the Neohaler [NH]) vs a conventional small-volume valve holding chamber (the AeroChamber Plus [AP]. METHODS: Seventeen asthmatic patients completed the study per protocol, receiving 4 weeks each of 100 microg/d (50-microg formulation) or 400 microg/d (100-microg formulation) of hydrofluoroalkane beclomethasone dipropionate via the NH or AP devices in a randomized crossover, double-blind, double-dummy, placebo-controlled design. The doubling dilution (dd) shift in methacholine provocation concentration that caused a decrease in forced expiratory volume in 1 second of 20% (primary outcome) was used to evaluate anti-inflammatory effects and adrenal function to measure systemic exposure. The fine particle (<4.7 tm) dose was evaluated using an Andersen Cascade Impactor. RESULTS: A total of 100 microg of hydrofluoroalkane beclomethasone dipropionate via the NH and AP produced 0.95-dd (95% confidence interval [CI], 0.44-1.45; P = .006) and 0.45-dd (95% CI, -0.16 to 1.06; P = .83) improvements from baseline in methacholine provocation concentration that caused a decrease in forced expiratory volume in 1 second of 20%, respectively, with no statistically significant difference between devices: 0.50 dd (95% CI, -0.25 to 1.24; P = .18). At 400 microg/d, 1.08-dd (95% CI, 0.49-1.67; P = .006) and 0.85-dd (95% CI, 0.32-1.39; P = .02) improvements were found for the NH and AP, respectively, with a 0.23-dd difference (95% CI, -0.28 to 0.74; P = .36) between devices. No adrenal suppression occurred with either device. The in vitro fine particle dose was 39.1 microg for the NH and 39.0 microg for the AP with the 100-microg formulation and 26.0 g and 25.2 microg, respectively, with the 50-microg formulation. CONCLUSIONS: Delivering hydrofluoroalkane beclomethasone dipropionate via the NH and AP attenuates asthmatic airway inflammation to a comparable degree and produces a similar in vitro fine particle dose profile.

Simvastatin does not exhibit therapeutic anti-inflammatory effects in asthma.

BACKGROUND: Statins lower cholesterol and also exhibit anti-inflammatory properties. In vitro and animal studies have suggested they may be useful for the treatment of a number of inflammatory conditions. OBJECTIVE: To evaluate the in vivo therapeutic potential of simvastatin as an anti-inflammatory agent in patients with asthma. METHODS: Potential signal from treatment effect was optimized by withdrawing all anti-inflammatory treatment for the duration of the study. Participants received 1 month of daily simvastatin and 1 month of daily placebo in a randomized, double-blind crossover trial. A total of 16 patients completed per protocol. Asthmatic inflammation was evaluated by measuring exhaled tidal nitric oxide, alveolar nitric oxide, sputum and peripheral eosinophil count, methacholine hyperresponsiveness, salivary eosinophilic cationic protein, and C-reactive protein. Measurements of dynamic and static lung volumes and of cholesterol were also made. RESULTS: After initial withdrawal of usual asthma medication, there was a 1.43 geometric mean fold increase (ie, 43% difference) in fraction of exhaled nitric oxide (95% CI, 1.15 to 1.78; P = .004). Compared with placebo, simvastatin led to a 0.86 geometric mean fold decrease (95% CI, 0.7 to 1.04; P = .15) in exhaled nitric oxide (ie, a 14% difference), and a -0.18 doubling dilution shift (95% CI, -1.90 to 1.55; P = 1.0) in methacholine hyperresponsiveness. There were no significant differences in other inflammatory outcomes, lung volumes, or airway resistance between simvastatin and placebo. Treatment with simvastatin led to a significant reduction (P < .005) of total and low-density lipoprotein cholesterol. CONCLUSION: There is no evidence to suggest simvastatin has anti-inflammatory activity in patients with asthma. CLINICAL IMPLICATIONS: Simvastatin is not useful for the treatment of asthma.

Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places.

CONTEXT: Scotland prohibited smoking in confined public places on March 26, 2006. OBJECTIVE: To investigate the association of smoke-free legislation with symptoms, pulmonary function, and markers of inflammation of bar workers. DESIGN, SETTING, AND PARTICIPANTS: This prospective observational study was conducted in Tayside, Scotland from February-June 2006. One hundred five nonasthmatic and asthmatic nonsmoking bar workers were initially enrolled, of whom 77 completed the study per protocol. MAIN OUTCOME MEASURES: Respiratory and sensory symptoms, spirometry measurements, serum cotinine levels, peripheral inflammatory cell count, asthma quality-of-life scores, and exhaled nitric oxide levels were evaluated before and after introduction of the smoking ban. RESULTS: For the per-protocol analysis, the percentage of bar workers with respiratory and sensory symptoms decreased from 79.2% (n = 61) before the smoke-free policy to 53.2% (n = 41) (total change, -26%; 95% confidence interval [CI], -13.8% to -38.1%; P<.001) and 46.8% (n = 38) (-32.5%; 95% CI, -19.8% to -45.2%; P<.001) 1 and 2 months afterward. Forced expiratory volume in the first second increased from 96.6% predicted to 104.8% (change, 8.2%; 95% CI, 3.9% to 12.4%; P<.001) and then 101.7% (change, 5.1%; 95% CI, 2.1% to 8.0%; P = .002), and serum cotinine levels decreased from 5.15 ng/mL to 3.22 ng/mL (change, -1.93 ng/mL; 95% CI, -2.83 to -1.03 ng/mL; P<.001) and then 2.93 ng/mL (-2.22 ng/mL; 95% CI, -3.10 to -1.34 ng/mL; P<.001). The total white blood cell and neutrophil count was reduced from 7610 to 6980 cells/microL at 2 months (-630 cells/muL; 95% CI, -1010 to -260 cells/microL; P = .002) and from 4440 to 4030 cells/microL (-410 cells/microL; 95% CI, -740 to -90 cells/microL; P = .03), respectively. Asthmatic bar workers also had less airway inflammation, with a reduction in exhaled nitric oxide from 34.3 parts per billion (ppb) to 27.4 ppb 1 month after the ban (0.8-fold change; 95% CI, 0.67 to 0.96 ppb; P = .04), and Juniper quality-of-life scores increased from 80.2 to 87.5 points (7.3 points; 95% CI, 0.1 to 14.6 points; P = .049). CONCLUSIONS: Smoke-free legislation was associated with significant early improvements in symptoms, spirometry measurements, and systemic inflammation of bar workers. Asthmatic bar workers also had reduced airway inflammation and improved quality of life.