From the Top at Carnegie Hall Term Paper Example | Topics and Well Written Essays - 250 words

From the Top at Carnegie Hall - Term Paper Example â€Å"We learn that no matter how far from home we are, we always have a home in the things we love†. These are the lines that struck me in the episode; Music is where the heart is. The three young musicians who have their own stories of ups and downs led them where they are right now. In the case of Ronald Joseph for instance, his terrible experience from Hurricane Katrina did not stop him from pursuing his delight. Like what his teacher said, â€Å"You owe it to Katrina†. Oftentimes, the bad things in life are the process of something good that is about to come. For the second part of the episode, 17-year old violist Allyson Tomsky had a different means of showing her enthusiasm. Her love for both music and for her hometown greatly contributed in becoming who she really is. Playing in the streets of New York as one of her practices is indeed a unique way of showing and sharing the talent that she has. Lastly is 14-year old Jazz singer, Nikki Yanofsky who at a very you ng age possessed a very powerful voice and a great confidence toward the thing that she loved. This episode portrayed only but one thing, that as long as we love what we do, we are happy and we’ll always be contented. There will always be the sense of fulfillment no matter what the odds are. Another episode, Family Ties revealed the role of family in shaping and building the vision of our youth.

The Ability to Enjoy What One Does Personal Statement - 2

The Ability to Enjoy What One Does - Personal Statement Example The profession calls for individuals with the ability to nurture the growth and address the issues of people, their physical ailments, psychological issues, intellectual problems, and also the emotional and spiritual well being of the people. As a helping enthusiast and a lover of life, I realize that a number of people require support and assistance to help them be able to enjoy life and not abuse the greatest gift that God has given us. I believe that each one of us has the rights to be able to enjoy this gift and it is essential that we assist others who have issues and problems. One of the most essential groups of people who require help and assistance are the youth and children. My biggest strength is that I love working with people especially children and youth, who have their entire lives in front of them to live and cherish. I believe that we get to live just once hence we should use this to bring out the best in ourselves as well as others around us. Having been in the teaching profession for five full years, along with the experience of working with people with substance abuse traits, I have come across a number of students and individuals who have a very strong and bright life ahead but need the nurturing and assistance to be able to recognize and cherish it. I would love to have a career in the helping professions as I feel it is my responsibility to reach out to as many people and try and help them in any way possible to help them recover and regain out of the issues and troubles of life. This could mean not only psychological but also physical, intellectual, emotional and even spiritual. I believe that if in the current world, all of us turn only towards making money and being successful ourselves with no care and affection towards others in the world, the world will come to an end very soon.  

Economic factors affecting food choice Essay Example for Free

Economic factors affecting food choice Essay The aim of this research is to find the economic factors that affect a person’s food choice for example the amount of disposable income, family size and spending patterns. This then helps us to decide a suitable dish for our chosen practical. This research helps understand the relationship between quality of diet and disposable income and how are eating patterns have changed from the past. Disposable income The amount of money left after tax and other deductions have been made is called the disposable income. The amount of money spent on food cooked at home has declined even though the disposable income has risen since the 1980s. Disposable income affects the food you eat because you tend to eat out more frequently, spend more money on premium ranges of ready prepared foods and shop at more expensive supermarkets and specialist shops if you have more disposable income. However families with less disposable income tend to spend more on convenience foods and snack foods. It takes careful budgeting and shopping around for cheaper prices to provide healthy meals for low income families. Family size and spending patterns Family size also affects how much you spend on food because declining family size and an increase in single person household has led to a change in patterns of spending on food as couples and single adult households spend more per person on food. Whereas due to larger families having young children with smaller appetites less is spent per person on food, also because less food is wasted in larger families. Larger families may also buy in bulk or shop around for cheaper prices or offers such as three for the price of two and buy one get one free. There is an increase in single person households because of an ageing population where there are more elderly people than young people in a population and due to more young, single people living alone.

Iraq War Essay Example for Free

Iraq War Essay The American government took the controversial decision of waging a war against Iraq. The circumstances and the motives of the American government indicate that the war on Iraq was unwarranted and cannot be justified although the American government has put forward a few reasons for waging this war. The logic and evidence does not support such contentions by the American government. The American government has failed to justify its unilateral decision of declaring war against Iraq. In the year 2002, the American President revealed his plan of attacking the Iraqi regime as it was thought that Iraq was in the process of emerging as the greatest threat to the American security. This decision was apparently taken on the basis of the intelligence information that the US government obtained concerning Iraq’s nuclear program. However, it is interesting to note that this intelligence information was kept secret until 2002. The major reason for this war was the terrorist attack of the World Trade Center in the year 2001. Obviously, this attack had left Americans at a state of shock as the successful terrorist attack demonstrated to the whole world that American security is at stake and that American military and intelligence power is not that efficient. (Powers 1) The knee jerk reaction resulted in the decision to chalk out the proper plans to prevent the future attacks of the American territory. However, it is interesting to note that the American government could not obtain even the simple majority of the members of the UN Security Council. This clearly indicates that the United Nations did not wholeheartedly support the Iraqi venture initiated by the American government. The close allies such as France and Germany could not be convinced of the need for this war project as these countries felt that there was no need for any fresh attack on the Iraqi territory as after 1991 this region was left in almost depleted state. The President was able to only convince the United States Congress as the members of the Congress did not question the necessity of a war on Iraq. The Congress members did not even participate in the debate regarding the Iraqi war. This shows that the American government could not convince the world leaders that Iraq was up to some fresh mischief in the form of the production of armaments having the capacity to destroy the world population. These details indicate that the American government has been alienated by other important powers which have not accepted the evidence presented by America that Iraq was emerging as another center of terrorist activities. (Powers 2) The main argument of the proponents of war was that Saddam Hussein possessed various dangerous weapons such as nuclear arsenals and chemical weapons which could have been used to destroy the enemy countries. The proponents of war asserted that the past history of Saddam showed that he was an aggressor. Their another contention is that Saddam Hussein had connections with the Islamic terrorist organizations and the leaders such as Osama bin Laden who had played an important role in the WTC attack. (Mearsheimer and Walt 1) These are the three reasons given by war supporters to justify the US aggression on Iraq. However, the proponents of war are not able to prove that Hussein really possessed Weapons of Mass Destruction (WMD). The UN inspections did not reveal that Iraq actually possessed or had the potential of building huge base of WMD which could have been used for destructive purposes. The War mongers were aware of the fact that their action would lead to huge expenses to the American treasury and that this war would result in the alienation of America in the world politics. Even then they insisted that war was inevitable as one could not afford to ignore the possession of nuclear arsenals in the hands of the Iraqi leadership. In reality, the US had the power to contain the alleged Iraqi aggression. The argument that war was inevitable rests on the faulty logic. The war supporters are not able to come up with substantial proof to suggest that Saddam had seriously pursued the plan of destroying his enemy countries. (Mearsheimer and Walt 4) However, in this context one should remember that after the Gulf war the allied forces had obtained entry into Iraq and they had used their energy to reduce the military power of Iraq. The Gulf war debacle was sufficient to deplete the Iraqi resources. Perhaps the American government needed to make a strong statement against Islamic terrorists after the September 11 attack. This resulted in the declaration of war on Iraq. This can be considered as the face saving attempt made by the American government. The newspapers have reported information from CIA documents which contradicted the statements made by the President Bush who asserted that Iraq was trying to produce nuclear arsenals as the Iraqi officials had approached South Africa to obtain materials needed for producing nuclear weapons. However, CIA expressed doubt regarding this report that Iraq was trying to obtain nuclear weapon materials from South Africa. Another contention of the President was that the Iraqi officials refused entry of the weapon inspectors into Iraqi regions. However, there are evidences which refute this allegation. In reality, as the newspapers reported, the Iraqi government had offered their cooperation with the weapon inspectors. There is also evidence to suggest that even before the beginning of war the American government obtained the information that Iraq did not approach South Africa to obtain nuclear weapon materials. This shows that the Bush administration had deliberately misinterpreted the intelligence reports in order to obtain the support of the Congress members for this war. In spite of these contradictions Bush has defended his action of invading Iraq without any major reason. (Priest and Milbank A01) There are evidences to state that the US decision to attack Iraq has backfired and it has not contributed to the improvement of the US image in the international political arena. The Iraq venture has resulted in the protest by the governments and people belonging to different nations in the world which did not find any necessity for this war. (Martin 3) The main reason for this protest against the war is that this war was unjust. The extreme action taken by the US forces against the innocent Iraqi civilians has come under public criticism. This shows the world public opinion has not supported the idea of the US led campaign against Iraq. This war has enraged the Muslim nations and this may contribute to increase in the activities of the Muslim terrorist organizations leading to the loss of lives in different parts of the world. There is no evidence to state that the US government obtained the support of the majority of the Americans for this war. The Iraq war has contributed to the creation negative image of Bush not only in the world politics but also in the US. In this sense, this war has not benefited the US people. Instead of increasing the security of Americans, this war has increased the possibility of terrorist attack on the innocent American population. (Martin 4) Works Cited Bracknell, Major Rob. â€Å"Euro-bashing as Good Sport†. Naval War College Review. 58. 2, (2005): 139-142. Available at https://www.brookings.edu/

Priestleys purpose Essay Example for Free

Priestleys purpose Essay Unlike Gerald, Priestley describes Eric in the opening stage directions as not quite at ease. He has been expensively educated, and yet he is a disappointment to Birling: he and Gerald joke behind his back (p.10), and his father patronises him (p.12). He is kept out of the information about his fathers possible knighthood, and when he really needed help he felt his father was not the kind of father a chap could go to when hes in trouble (p. 54). His drinking is an open secret within the family (though Mrs Birling chooses not to admit it to herself), and suggests that he lacks self-discipline. This is borne out by the behaviour that is revealed in the course of the play: he forced himself into the girls lodgings despite her protests, drunk and in that state when a chap easily turns nasty (p.52), has made her pregnant, and has stolen money from his father. But he also has an honesty that others lack. He is the only one to respond spontaneously to details of the girls death (p.11), and when he is forced to admit how he behaved towards her he has a strong sense of guilt because the consequences of what he did are so serious. We also believe him when he tells Birling that he would have let the girl stay at the factory (p.16) but Eric throughout the play is shown to be naive, even if his heart is often in the right place. (Stealing Birlings money, even though a crime in law, might be another example of this.) He does not have the realistic outlook necessary to make a success of his life. He is also shown to be immature, regarding the girl as a good sport (p.52), although she treated him as a child. Like every character accused by the Inspector, he is shown to be a hypocrite he is disgusted by the fat old tarts round the town (p.52), yet by this stage in her life, the girl is also a prostitute, though it is not clear whether Eric realises this.  He appears to have learnt very little from his privileged education, yet he has been impressed by the Inspector. At the end, like Sheila, he refuses to pretend things are like they were before, and is frightened by the fact that the older generation appear not to have learnt anything. He wants his parents to admit their mistakes as freely as he has admitted his. Though he is not a particularly pleasant character, we may feel that he is sincerely ashamed of his behaviour and is capable of changing for the better. Sheila  Priestley describes Sheila in the opening stage directions as a pretty girl and very pleased with life later, however, her prettiness is revealed as vanity and her happiness is shown to be selfish, bought at the price of the girls job.  Her first reaction to the news of the girls death is superficial she seems upset that it has spoiled her evening and Ive been so happy tonight (p.17), and is interested only in whether she was young and pretty. But, unlike her parents, she quickly comes to see her as an individual: these girls arent cheap labour theyre people (p.19), she tells Birling. She becomes agitated (p.20) as she realizes her own part in the girls death, and like Gerald later in the play runs out of the room. However, unlike her fiancà ¯Ã‚ ¿Ã‚ ½, she returns to accept her guilt rather than to find a way round it. We sense at the start of the play that there is an unresolved tension in her relationship with Gerald; they are actually very different people. But it is Sheila who grows up in the course of the play: at the start she is playful and attention-seeking; at the end, she is thoughtful and reflective. By contrast, Gerald is revealed to be a moral coward, unable to accept the wrongness of his behaviour and taking comfort from the fact that no-one seems to have died after all. Like Birling, she readily admits to having met the girl. But her father admits this because he is unable to see that he has done anything wrong; Sheila, on the other hand, admits this because she is genuinely ashamed (p.23) and is trying to tell the truth (p.23). Of all the characters, hers is the only confession that does her credit Mrs Birling is first obstructive then defiant, and Gerald and Eric both confess at a point when they know they have been already found out. She is guilty of the sins of pride and envy she complained about the girl because she thought she was laughing at her, and because she was a very pretty girl too I couldnt be sorry for her (p.24). Although she asks how could I know what would happen afterwards (p.24), she does not try to escape from the blame. Priestley uses her as an example of someone who is vain and thoughtless, but not heartless: she is genuine when she says if I could help her now I would (p.24). But he intends the audience to learn the lesson that good intentions are no good if they come too late; Sheilas predicament is a warning to us.  Sheila herself warns both Gerald and Mrs Birling not to try to build up a kind of wall between us and that girl (p.30). Once she has admitted her own guilt, her rà ¯Ã‚ ¿Ã‚ ½le in the rest of the play is to show others the importance of admitting the truth. She becomes disillusioned and hurt by what she learns about the rest of her family particularly Gerald, whom she now addresses bitterly (p.33) and with sharp sarcasm and irony (p.38) but when he has finally told the truth, she respects him rathermore than Ive ever done before (p.40). Facing up to our faults, Priestley suggests through Sheila, is painful, but not to do so makes things worse in the long run, as she says. This is part of Priestleys purpose in the play: to make us feel the urgency of rethinking the responsibility we bear towards our fellow men before it is too late.  Sheila emphasizes the importance of everyone learning from the Inspectors visit. She and Eric are the only characters who are not concerned whether Goole was a real Inspector she says it doesnt make any real difference (p.59), because she acknowledges her behaviour was morally wrong, whether or not it was legally wrong and whether or not it actually resulted in a girls death. By the end of the play, she has begun to have some understanding of what the Inspector is doing, so that she is able to see the world, and her responsibility, according to his values instead of those of her family. This is why she can see the trap her mothers arrogance is creating, and why she tries to stop her mother from exposing and condemning the childs father. It is only she and Eric, the two youngest and more impressionable characters (p.30) who, in Priestleys eyes, have profited sufficiently from the lessons on stage in front of them not to repeat their mistakes a second time as he hopes the audience will have too

The friendship that exists with Stephen and Keith Essay Example for Free

The friendship that exists with Stephen and Keith Essay In the first chapter of Michael Frayns novel Spies, amongst the limited amount of characters introduced, is Keith. The reader is given no background knowledge about him, only that Does he ever think about the things that happened that summer? meaning that Keith is a significant person as it is implied that he shared the narrators (revealed as Stephen in chapter 2) experience that particular, somewhat haunting summer. However in Chapter 2 a lot more information is given about Keith and details about the depth of friendship between Keith and Stephen begin to emerge. In Chapter 2, one of the first memories Stephen comes to is that of his house. in spite of the fact that its attached to No.3- the only semidetached pair in the Close, indicating that Stephen is somewhat the odd one out, when he says only, and almost uncomfortable about admitting to this. He then goes on to describe his ghastly neighbours who were even more shameful than his house, and how they brought us down with them., and he then goes on to expresses his distress about being attached to the undesirables. Also that he was still somewhat faintly embarrassed about it despite all the years that had past. Throughout this chapter, Stephen implies to the reader how his house was neglected, and never tended to, and this could easily link to his and his parents relationship with each other. Next, Stephen then describes how he doesnt need to open the front gate because its already, rotted drunkenly away from the top hinge, as he makes his way to Keiths house, however, once arriving there, he goes through the White wicket gate on its well oiled hinges and closes it carefully behind him. The keywords here are white suggesting purity (unlike the rot on Stephens gate), and carefully as Stephen obviously feels he should treat Keiths gate with respect, even if he has no regard for his own, as it has been so well maintained. Immediately the gates highlight the contrast between Keith and Stephen, however the contrast then grows as the reader is introduced to Keiths house, which is perceived as neat, flawless and perfection by Stephen. This is because Keiths house is exactly the opposite of Stephens, and the unlikely forming of friendship of these two boys is defiantly presented with the differences of lifestyle and houses. Another key point used in the presentation of friendship between Stephen and Keith is the boys appearance. Stephen is described as grubby, with one of his grey socks slipping down his leg into a thick concertina. The narrator (older Stephen) asks the rhetorical question What do I feel about him as I watch him now?, and then goes on to answer this himself claiming his appearance to be unsatisfactory. Keith is then bought into the story, and his appearance, like the houses, is the exact opposite of Stephen; His shirt, though, not to short, his shorts are not to long. Also he is described as neat compared to his unsatisfactory friend. However the most significant thing about the boys appearances is their uniform. The narrator describes how once seeing Keith, he no longer views himself as monochrome or slightly ashamed of his younger self. This is purely down to the fact that he can now see both their belts. The boys each have a different colour belt; Stephens being green whereas Keiths is yellow. The reader then learns why, as well as some more background information on Stephen and Keith. Were socially colour coded for ease of reference. Meaning that being green is the colours of a wrong school. This tells the reader that the boys do not go to school together, and Keith goes to a much higher rated school in the society around them. From this alone the reader can gain a better understanding of the social differences between the two boys, the houses also lead to the fact that Keith is a great deal wealthier than Stephen. Moving on to the games room in Keiths house, it is immediately clear of the presentation of the social differences once again, His playroom was well ordered as the rest of the house, from this we can once again confirm that Keith is a great deal better off than Stephen, All Keiths toys are his own. Not only this, but the reader can begin to figure out the boys individual personalities- Stephen is care-free and entirely not phased by his appearance, where as Keith is a very neat, and well organised personality. Once again, complete opposites, which is what the narrator wants to show to the reader. Not only do objects, and clothes define the differences in Stephens and Keiths relationship, but both their parents do as well. For example Keiths mum, is very similar to Keith as she takes pride in her appearance, she raises her perfectly plucked eyebrows. His father is also similar to the glamorised perfect family image that Stephen is creating, as he spends most of his time trimming, pruning, and perfecting things such as the garden. Not only this, but the relationship between parents and child seems to be quite strong, as they put the same amount of effort and love into their property and appearance as they do with Keith. He even has various pet names such as old chap or old bean, and his mother seem to always want to know what Keith is doing/ up to. But, when Stephen goes on to describe his family, once again, completely different, and the parents reflect their child, as Stephens dad is described to be unsatisfactory as Stephens, not only this, but his parents have no pet names for him, or seem to particularly care where he is going. The conflicting backgrounds of the boys dont seem to affect their relationship in the slightest. To summarise, although the author presents the boys to be of entirely different backgrounds, wealth, and social status, he makes it known to the reader that these are the foundations on which the boys friendship is built on. Being different to each other only draws them closer together. For instance, Keith calls the shots, but Stephen is still astonished and proud that Keith even wants to be his friend (as he is so ashamed of himself and his family) so doesnt feel resentful in the slightest, He was the officer corps in our two man army. I was the Other Ranks- and grateful to be so. Although Stephen may envy Keiths lifestyle, he certainly doesnt hold any judgement towards him, and is glad that he gets to share an experience of how the other half lives. Despite the various class/economical clashes, the boys are still great friends, and seem to follow suit that opposites do attract.

Recurrent Airway Obstruction in Horse: Case Study Report

Recurrent Airway Obstruction in Horse: Case Study Report A 12-year-old Thoroughbred gelding was examined for a cough whilst being stabled over the winter. There was limited available turnout so the horse remained stabled on shavings in a stable barn. The horse was fed dry hay. There was no previous history of coughing. The clinical examination was unremarkable. The owner described an intermittent dry cough occurring at rest and exercise. At this time the owner was advised to introduce environmental changes to reduce dust exposure. The horse was moved to a stable away from the hay store and started on soaked hay. An inflammatory blood profile was taken which revealed no abnormalities. Despite implementation of environmental changes the cough persisted. The horse was re-examined two months later at the clinic. On this occasion the horse presented with a bilateral mucopurulent nasal discharge and persistent cough. The horse was tachypneic (25 breaths per minute) with increased abdominal effort; the remainder of the clinical examination was unremarkable. A re-breathing examination was performed to aid auscultation of abnormal lung sounds; there were no adventitious sounds and the trachea was normal on auscultation. Problem list Intermittent cough at exercise and at rest Mucopurulent nasal discharge Recurrent episodes Tachypneic Differential Diagnosis List Recurrent airway obstruction (RAO) Inflammatory airway disease Viral infection Bronchopneumonia Pulmonary neoplasia Lungworm The signalment and history alongside the clinical signs of coughing, nasal discharge, laboured respiratory effort and exercise intolerance in the absence of pyrexia, suggested RAO. An endoscopic examination of the upper and lower airways to assess tracheal secretions and to obtain a fluid sample for a tracheal wash was performed. Endoscopy revealed inflammation of the pharyngeal recess, mild lymphoid hyperplasia, erythema of the trachea and a thickened carina. The tracheal wash (TW) sample was mucoid. The cytology report from the TW indicated chronic irritation and inflammation however the cell populations were unable to indicate a specific underlying aetiology. Neutrophillic inflammation was not a strong feature; however low-moderate levels of macrophages and Curschman spirals were present, both of which can be associated with RAO. Bacterial culture yielded a scant growth of Enterobacter spp and Pasteurella spp sensitive to trimethoprim sulphonamides; treatment for a possible bacterial tracheitis was initiated alongside a mucolytic for the mucus present in the airway. Dembrexine hydrochloride (Sputolosin, Boerhinger Ingleheim) (0.3mg/kg q12h PO) and trimethoprim sulfadiazine (Trimediazine Plain, Vetquinol) (30mg/kg q12h PO) were administered for 10days followed by re-examination. A Broncho alveolar lavage (BAL) was advised in order to determine the presence of lower airway inflammation specifically; however the horse was improving and the client declined at this time. Improvement was seen initially however after 5months following initial presentation the cough and nasal discharge resumed. The clinical examination was again unremarkable. A thick muco-purulent TW sample was obtained which revealed marked neutrophilic inflammation >95% of the nucleated cells and a negative bacterial culture. These results were consistent with RAO and as a result treatment for RAO was initiated. Inhaled salbutamol (400ug q12h) followed 5minutes later by beclomethasone (3000ug q12h) for 6weeks. This was administered using a MDI and an AeroHippus, Equine Aerosol Chamber (Trundell Medical). A decision was made to perform a BAL 6weeks later to assess response to treatment. On re-examination the nasal discharge had ceased with a residual cough only at exercise. The BAL sample at this time revealed A residual cough persisted despite being on continuous treatment. As a result a Flexineb nebuliser was trialled. Dexamethasone was used as the inhaled agent; 0.5ml sterile water with 0.5ml dexamethasone (Dexadresson, Intervet) once daily for two weeks and then every other day for two weeks. Discussion RAO is a common disease of older usually stabled horses. Hotchkiss et al, 2007 reported an estimated disease prevalence of 14% in the UK (Hotchkiss et al, 2007). The history, signalment and clinical signs presented in this case supported a diagnosis of RAO (Leclere et al, 2011). The clinical signs most likely represent hypersensitivity/exaggerated response to inhaled pro-inflammatory agents such as hay dust, moulds, spores, forage mites, endotoxins and inorganic components which cause significant distal airway inflammation in susceptible horses (Robinson and Chairperson, 2001). The relative importance of these allergens in the aetiopathogenesis of RAO is difficult to determine; it’s likely all contribute through an additive and/or synergistic mechanism (Pirie et al, 2003). Endoscopic examination revealed excess mucus as a result of neutrophilic inflammation and a blunted carina due to oedema and remodelling (Koblinger et al, 2011). Changes within the airway result from mucus metaplasia, smooth muscle hypertrophy and fibrosis. Bronchospasm of the airway alongside mucus and neutrophil accumulation leads to obstruction (Robinson et al, 2000). The initial treatment with a mucolytic, dembrexine hydrochloride (Sputolosin, Boerhinger Ingleheim) initially provided improvement in clinical signs by fragmenting the sputum fibre network so reducing mucus viscoelasticity (Matthews, Hackett and Lawton, 1988). The owner was reluctant to perform a BAL initially due to the increased stress to the horse. The initial TW cytology couldn’t confirm a diagnosis despite the presence of Curschmann’s spirals which can indicate RAO (Reed and Bayly, 1998). Although it’s important to interpret culture results in light of cytology and clinical signs, paying less attention to scanty mixed growths of bacteria, the culture results were used to direct initial treatment for a possible bacterial tracheitis (McGorum, 2007). In this case where the clinical signs and signalment supported RAO a BAL alongside the TW would have provided a more reliable diagnosis. A BAL is more representative of the lower airways as it allows elucidation of the cellular response to lung injury (Derksen et al, 1989). Macrophages and lymphocytes are the predominant cell populations in BAL in normal horses whereas RAO is characterised by a non-septic inflammatory reaction, >25% neutrophils of the total nucleated cel l count (Robinson, 2001). Management of this disease involves three principles; environmental control to reduce allergens, corticosteroids to reduce inflammation and bronchodilators to relieve respiratory distress (Durham, 2001). It can be difficult to persuade owners that environmental changes are as important as medical treatment. In many cases clinical remission can be achieved by moving horses to either pasture or an indoor low-airborne dust environment (Vandenput et al, 1998). Green pasture is the best option to reduce clinical signs and horses should remain outdoors at all times with a supplementary pelleted diet; this was not practicable in this case (Jackson et al, 2000). The limited available turnout during winter made management problematic. Bedding on rubber matting in conjunction with cardboard and shredded paper provides the lowest dust levels for a stabled horse (Tanner et al, 1998). In most horses with RAO the main source of dust is from hay and bedding; in this case the horse had originally be en stabled adjacent to the hay barn. Soaking hay reduces the dust challenge however not sufficiently to resolve symptoms of RAO (Clements and Pirie, 2007). Treatment is based around a combination of bronchodilators and corticosteroids. Bronchodilators aim to alleviate respiratory distress associated with bronchospasm. Clenbuterol a B2 adrenergic agonist is most commonly administered orally to effect (Erichsen et al, 1994). In addition to its bronchodilator effect, clenbuterol has also been shown to have an anti-inflammatory effect (Lann et al, 2006). The efficacy of inhaled B2 adrenergic agonists has also been recognised, inducing a rapid, significant bronchodilation in horses demonstrating RAO (Bertin et al, 2011). Due to the effectiveness found with inhaled agents in human patients, this route was investigated in horses. By using bronchodilators prior to administration of corticosteroids a deeper penetration of inhaled drug can be achieved (Rush et al, 1998). The horse’s demeanour in this case made him suitable for inhaled medications and he tolerated treatment well. The advantage of inhaled corticosteroids is that a higher concentration of drug can be administered locally to the airways leading to a rapid onset of action, reducing the dose required and the subsequent side effects associated with corticosteroids (Duvvier et al, 1997). In severe cases systemic steroids are used initially to improve lung function as inhaled steroids require good pulmonary distribution to be effective (Ammann et al, 2008). MDI are not licensed for horses and therefore they were used with due consideration of the cascade and the owners informed consent for the use of off-label medications according to Section 4.17 of the Supporting Guidance to the RCVS Code of Professional Conduct (RCVS, 2014). They are most efficient and effective when used with a ‘spacer’ which directs flow of the drug through a one way valve which opens on inspiration. The AeroHippus EAC, (Trundell Medical) is designed to be used with a MDI. The presence of the Flow-Vu ® indicator enables owners to count the number of breaths the horse has taken through the chamber and ensures a satisfactory seal, both of which aid the correct and optimal delivery of the drug to the lungs (Trundell Medical International, 2015). Nebulisers can also be used to distribute aerosol medication. Nebulisation has been shown to improve drug concentration in the lungs while minimising systemic concentrations and potential toxicity (Sustronck et al, 1995). Fultz et al (2014) demonstrated that delivery via nebulization can increase the concentration of a drug in the pulmonary epithelial lining fluid (PELF) (Fultz et al, 2014). A Flexineb nebuliser was tried with this case due to its chronic nature and the clinical signs subsequently resolved. Although the mainstay of treatment is corticosteroids, recurrence of clinical signs will recur within 3days of treatment cessation if environment improvements are not made (Jackson et al, 2000). There is evidence of persistent chronic peripheral airway obstruction, in the absence of neutrophilic airway inflammation, even when RAO cases are maintained in a low dust environment. This supports the evidence for development of irreversible ultrastructural changes in the lung induced by prolonged repeated exacerbation, but also low grade airway inflammation (Miskovic et al, 2007). In these cases thoracic radiographs should be used to rule out irreversible lung pathology (Lavoie et al, 2004). Bibliography Ammann, V., Vrins, A. and Lavoie, J. (1998). Effects of inhaled beclomethasone dipropionate on respiratory function in horses with chronic obstructive pulmonary disease (COPD). Equine Veterinary Journal, 30(2), pp.152-157. Bertin, F., Ivester, K. And Couà «til, L. (2011). Comparative efficacy of inhaled albuterol between two hand-held delivery devices in horses with recurrent airway obstruction. Equine Veterinary Journal, 43(4), pp.393-398. Clements, J. and Pirie, R. (2007). Respirable dust concentrations in equine stables. Part 2: The benefits of soaking hay and optimising the environment in a neighbouring stable. Research in Veterinary Science, 83(2), pp.263-268. Derksen, F., Brown, C., Sonea, I., Darien, B. and Robinson, N. (1989). Comparison of transtracheal aspirate and bronchoalveolar lavage cytology in 50 horses with chronic lung disease. Equine Veterinary Journal, 21(1), pp.23-26. Durham, A. (2001). Update on therapeutics for obstructive pulmonary diseases in horses. In Practice, 23(8), pp.474-481. Duvivier, D., Votion, D., Vandenput, S. and Lekeux, P. (1997). Aerosol therapy in the equine species. The Veterinary Journal, 154(3), pp.189-202. Fairbairn, S., Lees, P., Page, C. and Cunningham, F. (1993). Duration of antigen-induced hyperresponsiveness in horses with allergic respiratory disease and possible links with early airway obstruction. Journal of Veterinary Pharmacology and Therapeutics, 16(4), pp.469-476. Fultz, L., Giguà ¨re, S., Berghaus, L., Grover, G. and Merritt, D. (2014). Pulmonary pharmacokinetics of desfuroylceftiofur acetamide after nebulisation or intramuscular administration of ceftiofur sodium to weanling foals. Equine Vet Journal, [article first published online 5 September 2014] Hotchkiss, J., Reid, S. and Christey, R. (2007). A survey of horse owners in Great Britain regarding horses in their care. Part 1: Horse demographic characteristics and management. Equine Veterinary Journal, 39(4), pp.294-300. Hoffman, A. (2008). Bronchoalveolar Lavage: Sampling Technique and Guidelines for Cytologic Preparation and Interpretation. Veterinary Clinics of North America: Equine Practice, 24(2), pp.423-435. Gerber, V., King, M., Schneider, D. and Robinson, N. (2000). Tracheobronchial mucus viscoelasticity during environmental challenge in horses with recurrent airway obstruction. Equine Veterinary Journal, 32(5), pp.411-417. Jackson, C.A., Berney, C., Jefcoat, A.M. and Robinson, N.E. (2000). Environment and prednisone interactions in the treatment of recurrent airway obstruction (heaves). Equine Veterinary Journal. 32, pp432-438. Koblinger, K., Nicol, J., McDonald, K., Wasko, A., Logie, N., Weiss, M. and Là ©guillette, R. (2011). Endoscopic Assessment of Airway Inflammation in Horses. Journal of Veterinary Internal Medicine, 25(5), pp.1118-1126. Laan, T., Bull, S., Pirie, R. and Fink-Gremmels, J. (2006). The anti-inflammatory effects of IV administered clenbuterol in horses with recurrent airway obstruction. The Veterinary Journal, 171(3), pp.429-437. Lavoie, J., Dalle, S., Breton, L. and Hà ©lie, P. (2004). Bronchiectasis in Three Adult Horses with Heaves. Journal of Veterinary Internal Medicine, 18(5), pp.757-760. Leclere, M., Lavoie-Lamoureux, A. and Lavoie, J. (2011). Heaves, an asthma-like disease of horses. Respirology, 16(7), pp.1027-1046. Matthews, A., Hackett, I. and Lawton, W. (1988). The mucolytic effect of Sputolosin in horses with respiratory disease. Veterinary Record, 122(5), pp.106-108. McGorum, B. (2007). Equine respiratory medicine and surgery. Saunders Elsevier. (5) pp565-590 Miskovic, M., Couà «til, L. and Thompson, C. (2007). Lung Function and Airway Cytologic Profiles in Horses with Recurrent Airway Obstruction Maintained in Low-Dust Environments. Journal Veterinary Internal Medicine, 21(5), p.1060. Pirie, R., Collie, D., Dixon, P. and McGorum, B. (2003). Inhaled endotoxin and organic dust particulates have synergistic proinflammatory effects in equine heaves (organic dust-induced asthma). Clinical Experimental Allergy, 33(5), pp.676-683 Rcvs.org.uk, (2014). 4. Veterinary medicines RCVS. [online] Available at: http://www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/veterinary-medicines/ [Accessed 18 Feb. 2015]. Reed, S. and Bayly, W. (1998). Equine internal medicine. Philadelphia: Saunders. Chapter 9, pp341 Robinson, N.E., Olszewski, M.A., Boehler, D., Berney, C., Hakala, J., Matson, C. and Derksen, F.J. (2000). Relationship between clinical signs and lung function in horses with recurrent airway obstruction (heaves) during a bronchodilator trial. Equine Veterinary Journal. 32, pp393-400. Robinson, N. and Chairperson, W. (2001). International Workshop on Equine Chronic Airway Disease Michigan State University 16-18 June 2000. Equine Veterinary Journal, 33(1), pp.5-19. Rush, B., Raub, E., Rhodes, W. S., et al. (1998). Pulmonary function in horses with recurrent airway obstruction after aerosol and parenteral administration of beclomethasone dipropionate and dexamethasone, respectively. American Journal of Veterinary Research, 59, pp1039-1043 Sustronck, B., Deprez, P., Muylle, E., Vermeersch, H., Vandenbossche, G. and Remon, J. (1995). Evaluation of the nebulisation of sodium ceftiofur in the treatment of experimental Pasteurella haemolytica bronchopneumonia in calves. Research in Veterinary Science, 59(3), pp.267-271. Tanner, M., Swinker, A., Traub-Dargatz, J., Stiffler, L., McCue, P., Vanderwall, D., Johnson, D. and Vap, L. (1998). Respiratory and environmental effects of recycled phone book paper versus sawdust as bedding for horses. Journal of Equine Veterinary Science, 18(7), pp.468-476. Trundell Medical International (2015) AeroHippus. http://www.trundellmed.com/animal-health/aerohippus [4 February 2015] Vandenput, S., Duvivier, D., Votion, D., Art, T. and Lekeux, P. (1998). Environmental control to maintain stabled COPD horses in clinical remission: effects on pulmonary function. Equine Veterinary Journal, 30(2), pp.93-96.