Asthma and America's Next Top Model: Difference between pages

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'''''America’s Next Top Model''''' is a [[reality television]] show which pits [[contestant]]s against each other in a variety of competitions to determine who will win a [[model (person)|modeling]] [[contract]] with [[makeup]] manufacturer [[Covergirl]]. [[Supermodel]] [[Tyra Banks]] hosts and produces the show.

{{DiseaseDisorder infobox |

Name = Asthma |

ICD = J45-J46 |

ICD9 = 493 |

}}

The debut season of the show premiered on the [[UPN]] network in [[2003]]. On it, 10 female contestants were placed in a [[New York City]] apartment. Spanning a wide variety of women of various races, heights and body sizes, they had been whittled down from a pool of thousands to compete against one another in various contests designed to simulate the extreme demands placed on professional models. Each week one contestant was eliminated by a panel of judges: Banks herself, clothing designer [[Kimora Lee Simmons]], [[Beau Quillian]], and [[Janice Dickinson]], who bills herself as the world's first supermodel. By the next season, only Tyra and Janice remained judges, but the others are now ex-model/fashion photographer [[Nigel Barker]] and fashion editor/stylist [[Nolé Marin]]. After season four, Janice, amid rumors of personality conflicts with some other judges, and Marin were replaced by [[Twiggy]] and "Miss" [[Jay Alexander]] (Alexander had been involved with the runway and various photo shoots since the first season).

'''Asthma''' is a chronic inflammatory condition in which the [[lung|airways]] develop increased responsiveness to various stimuli. Patients are usually symptom-free until exposed to the stimulus, causing a reversible narrowing of the airways. It is characterized by [[bronchus|bronchial]] hyperresponsiveness (BHR), [[inflammation]], mucus production and intermittent airway obstruction. A person with asthma may experience recurrent episodes of wheezing, [[dyspnea|shortness of breath]], chest tightness, and cough, particularly after exposure to an allergen, cold air, exercise, or emotional [[stress (medicine)|stress]]. The symptoms of asthma, which can range from mild to life-threatening, can be controlled with a combination of drugs and lifestyle changes.

The show has also produced a [[male model]] copy-cat show on the [[Bravo (television network)|Bravo]] network, called ''[[Manhunt (reality television series)|Manhunt]]''. It's hosted by [[Carmen Electra]].

Public attention has become focused on asthma recently due to its rapidly increasing [[prevalence]] in the developed world, affecting up to 1 in 4 urban children. Susceptibility to asthma can be explained in part by [[genetics|genetic]] factors, but no clear pattern of [[inheritance]] has been found so far. Asthma is a complex disease, influenced by multiple [[genetics|genetic]], developmental, and environmental factors, all interacting to produce the overall condition.

==Epidemiology Season 1 ==

Asthma patients mostly present during childhood. The [[incidence]] of asthma seems to be increasing worldwide; asthma is more common in affluent countries, and more common in higher socioeconomic groups within countries.

The show takes on a reality show style of format in that we not only see these competitions but the effects they have on the participants, as well as the drama of their day to day lives while participating. This included several contestants who were devout [[Christian]]s and disapproved of [[homosexuality]], to the dismay of [[lesbian]] contestant [[Ebony Haith]]. [[Elyse Sewell]], who was in the top three, is probably the most memorable contestant. The extremely intelligent double major expressed her liberal views proudly, which gave her edginess, but her acerbic tongue that dripped with condescension towards others of differing views or who weren't as gifted mentally, brought a wary eye upon her by the show's judges. It also didn't help that she undercut the touted premise throughout the show that modeling was "hard" as she breezed through set up challenges and the rigors of modeling using sheer wit. Elyse did earn a huge following that has lasted well after the show for said views and attitude, but she proved on the show that innate intelligence can get you very far and is probably most responsible for her continued success as a model. In a dramatic 2 hour season finale, Elyse and the eventual winner [[Adrianne Curry]] were both selected as the bottom two, allowing fellow contestant Shannon to advance automatically to the finals. The former was later booted out of the competition due to her "know'all" attitude. The winner of the first season was [[Adrianne Curry]], an [[Illinois]] woman with a thick accent who had been pursuing modeling since her early teens, and till today, the judges felt that Adrianne was indeed the rightful winner that outshone's Shannon's superior All-American beauty.

==Signs and symptoms ==

The main symptom of asthma is wheezing, caused by obstruction of the airways. A cough, sometimes with clear [[sputum]], may also be present. The symptoms are variable, often with rapid onset, and are commonly associated with the triggers listed above. Symptoms can be worse during the night or upon waking. Asthma sometimes occurs with [[acid indigestion]], especially amongst older patients.

== Season 2==

[[Sign (medicine)|Signs]] of asthma are wheezing, rapid breathing, expiratory phase of breathing longer than inspiratory, using accessory muscles of respiration - shown as in-drawing of tissues between ribs and above the [[sternum]] and [[clavicle]]s, over-inflation of the chest, and [[rhonchus|rhonchi]] (wheezy noises heard with a stethoscope). During severe attacks the asthma sufferer may be cyanosed (blue), may have [[chest pain]] and can lose [[consciousness]]. Between attacks a person with asthma may show no symptoms of the disease at all.

The second season of the show, in [[2004]], featured 12 contestants this time. Though the format was the same, the production took several different angles on how the show was presented. The judges were often much more harsh in their criticism of the contestants. In particular, one contestant, Catie Anderson, was repeatedly told that she looked or acted like a [[prostitute]]. The contests in this season were also more sexual: the first one required contestants to pose nude in body paint, something that plus-size contestant Anna Bradfield opted out of, causing her to be eliminated first. There was also a lesbian-erotic photo shoot towards the end of the show where the remaining four contestants posed nude in seductive positions in pairs of two.

==Diagnosis==

In most cases, the physician can make the [[diagnosis]] on the basis of the history of typical symptoms and examination signs. Whilst measurement of airway function is possible for adults, most new cases are diagnosed in children who are unable to perform such tests. Hence:

*Diagnosis in Children is based upon careful history taking and subsequent improvement with an inhaled bronchodilator medication.

:It will be suspected particluarly if a family history of asthma, or suffer from [[eczema]] (suggesting a general [[atopy]] condition)

*Adults may perform [[peak flow meter]] testing of [[diurnal]] [[Circadian rhythm|variation]] and/or measure the reversibility with inhaled bronchodilator medication as being greater than 15%.

The second season also spawned a clear-cut "hated" character in the form of Camille McDonald. While it is not uncommon for a "bad" character to emerge on a reality show, Camille's race came into play when it was pointed out by critics and the [[NAACP]] that many reality shows airing at this time seemed to peg the black female character as the one to dislike. Camille did make it into the final five, however, and in so doing ousting other more promising model hopefuls, including Catie and the Muslim-originated Sara. The second season also featured Mercedes Scelba-Shorte, a young woman whose struggle with [[lupus erythematosus|lupus]] was detailed on the show. She fought against it to become one of the last two finalists.

If the diagnosis is in doubt, or [[Chronic obstructive pulmonary disease]] is suspected, then more formal [[spirometry|pulmonary lung function testing]] may carried out. Testing a baseline and after exercise may be helpful. Very occasionally specialised tests after inhalation of [[methacholine challenge test|methacholine]], or less commonly [[histamine]], may be performed. Other tests (for example [[chest X-ray]] or chest [[CT scan]]) may be required to exclude the possibility of other lung diseases after pulmonary function testing has been obtained.

Another contestant of note was [[Shandi Sullivan]], a lithe, blonde cashier from [[Kansas City, Missouri]]. Shandi began the show as a very mousy and poorly dressed girl in glasses with absolutely no flare at all for the catwalk, but by the end she had transformed into an extremely skilled model and ravishing beauty. Shandi provided an infamous moment when in one episode she cheated on her boyfriend, Eric, while in [[Italy]]. The scene when she called her boyfriend to inform him of her infidelity was shown on various other programs. She made it into the top three.

Once the diagnosis is made, [[peak flow meter]] testing can be used to monitor the severity of the disease.

The winner of the cycle was [[Yoanna House]], a fashionista who had lost 40 pounds (18 kg) in order to realise her dreams of being a model. Yoanna proved that one with physical disadvantages (she was overweight and had a slightly limp shoulder) need not bow down to outside contention should you believe in yourself.

In addition, many people with asthma have allergies. Positive [[allergy]] tests support a diagnosis of asthma and may help in identifying avoidable triggers of symptoms. In addition, some people with asthma have been diagnosed with [[gastroesophageal reflux disease]] (GERD in US, GORD in UK) and immune related disorders including atopic dermatitis.

==Pathology Season 3 ==

[[Image:Asthmacausesillusa.gif|right]]

In essence, asthma is an [[inflammatory]] disorder of the [[bronchial]] airways. The inflammation leads both to some narrowing of the airway as well as excess [[mucus]] production (hence the cough). The hypersensitisation means trigger factors may cause the bronchi to contract into spasm ("asthma attack").

The third season of the show debuted in fall 2004 and was criticized by some for focusing far more on "drama" than on modeling ability. Amanda Swafford, who was legally blind, broke ground by making it to the final three due to her stunning photos produced consistently week after week. However, the final two were Yaya Da Costa Johnson and [[Eva Pigford]], who went head-to-head in a very elegant Japanese fashion show. Both women were African-American, while no black woman had previously won (Mercedes, a mixed race competitor (half African-American) had been a finalist in Season 2). Eva was declared the winner.

Clues to the understanding of the mechanisms causing asthma are its known risk factors {{ref|PatientsPlus}},

*Personal or family history of asthma or [[atopy]]

*Triggers e.g. pollens, animal dander, dust, exercise, viruses, chemicals, irritants and smoke.

*Prematurity and low birth weight

*Viruses in early childhood

*Maternal smoking

*Reduced in breast fed babies.

*Male sex in asthma in prepubertal children

*Female sex for persistence of asthma into adulthood

and typical triggers of asthma attacks include:

*inhaled [[allergen]]s such as [[house dust mite]] and [[cockroach]], [[pollen|grass pollen]], [[mould]] spores and pet [[epithelium|epithelial cells]].

*cold air

*[[exercise]]

*respiratory infection

*emotional stress

*[[aspirin]] & similar medications ([[NSAID]])

Season 3 of the popular reality TV series proved to shatter many ANTM records. Among them was for the inclusion of the first blind contestant (as mentioned above to be Amanda), the contestant who survived the most number of eliminations, that is, to be second to last most numerously (Ann, a total of 4 times) and the contestant who won the most number of reward challenges (Yaya, with a total of 5). It also featured the first openly acclaimed plus-sized model in Toccara, a 180 pound model hoping to break the industry. She made it to an impressive seventh place. Finally, it was the first African-American winner and runner-up pair in the show's history. Furthermore, Eva is the youngest winner of these reality TV shows series at the age of 18 (in fact she was still 17 when she first came for auditions).

===Mechanisms===

Primary exposure to a foreign antigen, such as pollen or cigarette smoke, can trigger the development of asthmatic symptoms. Once an inhaled antigen becomes trapped in the [[bronchial tubes|airway]], it is [[protease|enzymatically]] degraded into shorter [[peptide]]s by [[antigen presenting cell]]s (APCs) such as [[dendritic cell]]s. APCs take the [[peptide]]s derived from the antigen, and express them on the [[cell membrane|cell surface]] in the binding groove of the class II [[Major Histocompatibility Complex|major histocompatiblity complex]] (MHC) molecule. Now located on the cell surface, the antigen-MHC complex is presented to [[T cell]]s, which express a receptor specific for the MHC II peptide.

Many today still consider Yaya as the better competitor, attributed to her profound determination and her amazing consistency throughout the season. Eva was also notoriously noted for her frequent fighting within the loft that the girls stayed in, particularly with Amanda and her self-dubbed "friend" Ann, although Yaya and fellow contestant Norelle didn't really get along very well too.

Presented with the antigen-MHC II complex, [[T helper cell|T helper 0 (T_H0) cells]] become activated and begin to differentiate into either T helper type 1 (T_H1) or T helper type 2 (T_H2) cells. The selective differentiation of T_H0 cells has profound consequences for the immune system: T_H1 cell production leads to [[cell-mediated immunity]], while the production of predominantly T_H2 cells provides [[humoral immunity]]. The resulting balance of T_H1 or T_H2 cells is a crucial variable in the development of asthma. Studies indicate that the dominance of the T_H2 cell type appears to be necessary for the development of asthma. In one study, [[knockout mouse|mice]] that lack the ability to create T_H1 cells displayed an asthma-like [[phenotype]] (Finotto and Glimcher, 2004). The variables that decide T_H1 vs. T_H2 cell fate are not well understood, but depend on many factors, including childhood exposure to infectious agents and the [[cytokine]]s elicited by those agents.

Mid season, they flew off to Tokyo Japan, where Nicole was first axed due to her inability to master basic Japanese. This was soon followed by Norelle, Ann and Amanda, leaving Yaya and Eva in a closely contested final that even Tyra Banks was tearing when she anounced the winner to be Eva.

One cytokine secreted by T_H2 cells, IL-4, combined with the action of other cytokines, induces synthesis of [[IgE]], an allergen-specific antibody, by antigen-stimulated [[B cells]]. [[IgE]] binds allergens, and then binds receptors on [[mast cells]], [[basophil]]s, and [[eosinophil]]s in the airway epithelium. Subsequent exposure of the same antigen to these cells in the airway epithelium initiates the acute phase reaction of asthma. Stimulated [[mast cell]]s in the airway release preformed granules of mediators such as [[histamine]], [[eicosanoids]], and [[cytokines]]. It is these molecules which are responsible for the symptoms of asthma. They affect the [[mucosa]] of the airways, increasing mucosal edema, mucus production, [[smooth muscle]] constriction, and recruit other immune cells, excacerbating the reaction.

== Season 4 ==

The late phase of an asthmatic reaction is characterized by an influx of inflammatory and immune cells over the next several hours after antigen exposure. These cells, particularly [[eosinophil]]s, secrete a series of [[cytokines]], [[leukotrienes]], and [[polypeptide]]s which contribute to hyperresponsiveness, mucus secretion, bronchoconstriction, and sustained inflammation.

For the next installment, which ran in spring [[2005]], the ___location was moved from [[New York City]] to [[Los Angeles]], but with the girls living on a set which resembled NYC. One of the most memorable contestants in season four was Tiffany Richardson, who initially had made it into the semifinals in cycle three but had gotten into a fight with a woman who poured beer on her weave in a bar. She was accepted as a finalist for cycle four with a calmer and more mature attitude, though her defeatist outlook caused her to be eliminated from the game. In what was generally considered a lackluster season, one of the most talked-about moments occurred after a double elimination ceremony which removed Tiffany and another contestant, Rebecca Epley. Tiffany laughed and joked on her way out, prompting Tyra to scream "BE QUIET!!!!" and have a meltdown over how they had given Tiffany a chance and she had let them down.

===Pathogenesis===

The fundamental problem in asthma appears to be [[immunology|immunological]]: young children in the early stages of asthma show signs of excessive inflammation in their airways. [[Epidemiology]] gives clues to the [[pathogenesis]]: the incidence of asthma seems to be increasing worldwide; asthma is more common in more affluent countries, and more common in higher socioeconomic groups within countries.

Rebecca too gave the judges a scare a couple of episodes earlier. During evaluation, she collapsed and literally fainted right before the judges. It was due to a childhood medical relapse, and although not life threatening, it was inconvenient. The judges admired her courage to come back for evaluation after her discharge and she made it to the next round.

One theory is that asthma is a disease of hygiene. In nature, babies are exposed to [[bacteria]] soon after [[birth]], "switching on" the T_H1 [[lymphocyte]] cells of the [[immune system]] which deal with bacterial infection. If this stimulus is insufficient (as perhaps in modern clean environments) then T_H2 cells predominate, and asthma and other allergic diseases may develop. This "[[Hygiene hypothesis]]" may explain the increase in asthma in affluent populations. The T_H2 lymphocytes and eosinophil cells which protect us against [[parasite]]s and other infectious agents are the same cells responsible for the allergic reaction. In the developed world these [[parasite]]s are now rarely encountered but the immune response remains and is wrongly triggered in some individuals by certain allergens.

The season also included Michelle Deighton, a [[bisexuality|bisexual]] wrestler who was considered by some to be awkward and masculine in person, but who nevertheless turned out to be one of the most versatile and photogenic contestants. During the show she contracted [[impetigo]], which at one point was mistaken to be a flesh-eating virus by several of the other girls (partly upon "confirmation" from fellow contestant Noelle's mom that it would cause certain death). She managed to make it into the sixth place before being eliminated.

Another theory correlates the rise of asthma with increasing [[air pollution]]. Though it is well known that substantial exposures to certain industrial chemicals can cause acute episodes of asthma, it has not been proven that air pollution is responsible for the development of asthma. In Western Europe, most atmospheric pollutants have fallen significantly in the last forty years while the prevalence of asthma has risen.

Another memorable character was janitor turn model Lluvy. In the fourth episode, where the final twelve remaining girls had to take a Zodiac calendar spread, Lluvy's Pisces shot was commented by Tyra as "the worst photo in the history of America's Next Top Model". Expectedly, Lluvy was very distressed by this, but she still managed to hang on as Brandy was eliminated due to her bad attitude. (In fact, Lluvy holds the record for the girl who appeared the most times consecutively in the bottom 2, a total of three times in a row!)

==Treatment==

Triggers such as pets and [[aspirin]] should be identified and managed. Whilst occasional symptom relievers may be used, a stepwise use of additional preventer medications is also used.{{ref|SIGN}}

Other interesting characters included Brittany, a tomboyish, sometimes overly alcoholic, model who was best friends with fellow contestant Keenyah for most of the whole show, until the former got fed up with the latter's "hypocritical" attitude in South Africa. This led to a complete argument explosion whereby Brittany yelled a loud and shocking "SHUT UP!" into Keenyah's face. The quarrel spread all the way back to the loft when Keenyah further provoked Naima. Brittany was eliminated the next day as the quarrel clearly took its toll in the pre-evaluation contest.

===Relievers===

Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting [[bronchodilator]]s. Ordinarily these are provided in pocket-sized metered-dose inhalers. In younger sufferers who may have difficulty with the coordination necessary to use inhalers or with poor ability to hold their breath for 10seconds afterwards (particularly the elderly), a device called an [[asthma spacer]] is used. These are enclosed plastic cylinders that mixes the medication with air, to a simple tube that allows for a lesser dilution. For a minority of patients with severe asthma a [[nebulizer]], which provides a larger dose to the patient, is sometimes needed.

Christina, another contestant who made it to fifth place, was a very strong contender, whom the judges commented as the girl who took some of the best pictures in the season (this was said too for Kahlen and Michelle). However, Christina just couldn't get past her "cold" persona and was ousted as such.

* Short-acting selective [[adrenergic receptor|beta₂-adrenoceptor]] agonists ([[albuterol]] (salbutamol), levalbuterol, [[terbutaline]], bitolterol, pirbuterol, procaterol, fenoterol, bitolterol, reproterol)

* Older, less selective [[adrenergic receptor|adrenergic agonists]] such as inhaled [[epinephrine]] and [[ephedrine]] tablets - both of which, unlike other medications, are available over the counter in the US under the [http://www.primatene.com Primatene] brand

In the season finale of Cycle 4, which was located in [[South Africa]], Keenyah, Kahlen, and Naima competed to win the top spot. Keenyah was the first to go because the judges felt Kahlen was a stronger model. Kahlen and Naima faced off in the final runway walk in which the runway was partially under water. The judges had a hard time choosing between the two potentials. They explained that Kahlen's pictures had been stronger during the competition, but Naima had a better and stronger finish in the final stretch. In the end of what was supposedly the longest deliberation ever, the judges chose Naima as America's Next Top Model.

====Long acting relievers====

Long acting bronchodilators ('''LABD''') give a 12 hour effect and are used to give a smoothed symptomatic effect during the day (used morning & night). Whilst patients report improved symptom control, they do not replace the need for routine preventers and their slow onset of action means tha short-acting dilators may still be required.

* Long-acting [[adrenergic receptor|beta₂-adrenoceptor]] agonists ([[salmeterol]], [[formoterol]], [[bambuterol]], sustained-release oral [[albuterol]])

Especially the third and fourth seasons of the shows have been criticised for having contestants chosen more for their potential to be reality TV personalities than actual modelling abilities. The show has constantly featured contestants that would generally be too old to start out in the modeling business or not tall or thin enough to do [[runway]] work. The later seasons have also been criticised for deviating further from high fashion into a more [[commercial]] territory. Nevertheless, the show remains one of the highest rated shows on UPN and a fifth and a sixth season have been commissioned.

===Preventive===

Current treatment protocols recommend an inhaled [[corticosteroid]] (to suppress [[inflammation]] and reduce the swelling of the lining of the airway) for anyone who has frequent (greater than twice a week) or severe symptoms. If symptoms persist, additional preventive drugs are added until the patient's asthma is controlled.

== America's Next Top Model Records ==

* Inhaled [[corticosteroid]]s ([[fluticasone]], [[budesonide]], [[beclomethasone]], [[mometasone]], [[flunisolide]], [[triamcinolone]])

* Antimuscarinics/anticholinergics (ipratropium, oxitropium) have a mixed reliever and preventer effect

* [[Leukotriene]] modifiers ([[montelukast]], [[zafirlukast]], [[pranlukast]], [[zileuton]])

* [[Mast cell]] stabilizers ([[cromoglicate]] (cromolyn), [[nedocromil]])

* [[Antihistamine]]s are often used to treat allergic symptoms which may underlie the chronic inflammation. In more severe cases, [[hyposensitization]] ("allergy shots") may be recommended.

* [[Omalizumab]], an [[immunoglobulin E|IgE]] blocker, can help patients with severe allergic asthma that doesn't respond to other drugs. However, it is phenomenally expensive and must be injected.

* If chronic acid indigestion ([[Gastroesophageal reflux disease|GERD]]) contributes to a patient's asthma, it is necessary to treat it as well or it will restart the inflammatory process.

Cycle 1 Champion: Adrianne Curry

===Advanced===

When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:

* Systemic steroids, oral or injected ([[prednisone]], [[prednisolone]], [[methylprednisolone]], [[dexamethasone]], [[hydrocortisone]])

* [[Oxygen]] to alleviate the hypoxia (but not the asthma ''per se'') that is the result of extreme asthma attacks{{fn|3}}

* Other bronchodilators that are occasionally effective when the usual drugs fail:

** Non-specific beta-agonists, injected or inhaled ([[epinephrine]], [[isoetharine]], [[isoproterenol]], [[metaproterenol]])

** Anticholinergics, IV or nebulized, with systemic effects ([[glycopyrrolate]], [[atropine]])

** Methylxanthines ([[theophylline]], [[aminophylline]])

** Inhalation anesthetics that have a bronchodilatory effect ([[isoflurane]], [[halothane]], [[enflurane]])

** The dissociative anesthetic [[ketamine]], often used in [[endotracheal tube]] induction

** Magnesium sulfate, IV

* Intubation and mechanical ventilation, for patients in or approaching respiratory arrest

Cycle 2 Champion: Yoanna House

==Prognosis==

Approximately half of the children that suffer of asthma during their childhood, won't have any symptoms anymore when they are adults. Thanks to corticosteroids most patients can live their lives without many [[disabilities]].

Cycle 3 Champion: Eva Pigford

== References ==

* {{note|PatientPlus}} Diagnosing Childhood Asthma in Primary Care, Patient UK [http://www.patient.co.uk/showdoc/40024499/ PatientPlus article written for doctors]

* {{note|SIGN}} British guideline on the management of asthma - Scottish Intercollegiate Guidelines Network (SIGN) [http://www.sign.ac.uk/guidelines/fulltext/63/index.html Online] [http://www.sign.ac.uk/pdf/sign63.pdf Full PDF] [http://www.sign.ac.uk/pdf/qrg63.pdf Summary PDF]

* Asthma Prevention Program of the National Center for Environmental Health Center for Disease Control and Prevention. Asthma At-A-Glance. 1999.

* Finotto S, Glimcher L. “T cell directives for transcriptional regulation in asthma.” Springer Semin. Immunopathology 2004, 25(3-4):281-94. PMID 15007632.

* Inwald D, Roland M, Kuitert L, McKenzie SA, Petros A. ''Oxygen treatment for acute severe asthma.'' BMJ 2001;323:98-100. PMID 11451788.

* Jenkins C, Costello J, Hodge L. ''Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice.'' [[British Medical Journal|BMJ]] 2004;328:434. PMID 14976098.

* Lilly CM, “Diversity of asthma: Evolving concepts of pathophysiology and lessons from genetics.” J Allergy Clin Immunol 2005, S526-31. PMID 15806035.

* Maddox L, Schwartz DA. “The Pathophysiology of Asthma.” Annu. Rev. Med. 2002, 53:477-98. PMID 11818486.

* Mujica VR, Rao SS. ''Recognizing atypical manifestations of GERD; asthma, chest pain, and otolaryngologic disorders may be due to reflux.'' Postgrad Med J 1999;105:53-55. PMID 9924493.

* Asthma Prevention Program of the National Center for Environmental Health Center for Disease Control and Prevention. Asthma At-A-Glance. 1999.

Cycle 4 Champion: Naima Mora

== External links ==

*[http://www.atsdr.cdc.gov/HEC/CSEM/asthma/ Case Studies in Environmental Medicine (CSEM) - Environmental Triggers of Asthma]

*[http://www.nlm.nih.gov/medlineplus/asthma.html MedLine Plus - Asthma]

*[http://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.View..ShowTOC&rid=asthma.TOC&depth=10 NIH Guidelines for the Diagnosis and Management of Asthma ]

First White Winner: Adrianne (Cycle 1)

[[Category:Asthma|*]]

First Black Winner: Eva (Cycle 3)

[[cy:Asthma]]

[[da:Astma]]

First Mixed-Parentage Winner: Naima (Cycle 4 - Black-Irish & Black-Mexican Indian)

[[de:Asthma bronchiale]]

[[es:Asma]]

First White Runner-Up: Shannon (Cycle 1)

[[fr:Asthme]]

[[he:אסטמה]]

First Black Runner-Up: Mercedes (Cycle 2)

[[hu:Asztma]]

[[ia:Asthma]]

Furthest Advancing Asian: April (Cycle 2 - 4th Place)

[[it:Asma]]

[[ja:喘息]]

Furthest Advancing Black-Black Pair: Eva & Yaya (Cycle 3 - 1st & 2nd Place)

[[ko:천식]]

[[nn:Astma]]

Oldest Champion: Yoanna (Cycle 2 - 23 years)

[[nl:Astma]]

[[pl:Astma oskrzelowa]]

Youngest Champion: Eva (Cycle 3 - 19 years)

[[ru:Бронхиальная астма]]

[[sv:Astma]]

Shortest Champion: Eva (Cycle 3 - 5'7")

[[tr:Astım]]

[[wa:Coûtresse d' alinne]]

Tallest Champion: Yoanna (Cycle 2 - 5'11")

[[zh-min-nan:He-ku]]

Oldest Contestant: Robin (Cycle 1 - 28 years)

Youngest Contestants: Heather(Cycle 2) and Ebony (Cycle 5) (both were right out of highschool during their seasons

First Disabled Contestant: Amanda (Cycle 3 - Legally Blind (Retinitis Pigmentosa)/Night Blindness)

Most Asian-Originated Contestants: April(Japan), Jenascia(Philippines) & Sarah(Iran) (all from Cycle 2)

Most African-American Contestants: Eva, Yaya, Toccara and Kelle (all from Cycle 3)

First Latin-American Originated Contestant: Giselle (Cycle 1)

First European-Originated Contestant: Brita Petersens (Cycle 4)

Heaviest Contestant: Toccara (Cycle 3 - 180 pounds)

Lightest Contestants: Elyse (Cycle 1), Amanda & Magdalena (Cycle 3) & Shandi (Cycle 2), all 115 pounds

Shortest Contestants: Eva (Cycle 3), Jenascia (Cycle 2) & Cassandra (Cycle 5) all 5'7"

Tallest Contestants: Ann, Kelle (Cycle 3), Xiomara, Yoanna (Cycle 2), Brittany, Keenyah (Cycle 4) & Diane (Cycle 5), all 5'11"

Most Reward Challenges Won: Yaya (Cycle 3 - 5 in total)

Most Reward Challenges Won Consecutively: Yaya (Cycle 3 - 5 times in a row)

First contestant to ever win CoverGirl of the Week from start to finish: Naima (Cycle 4 winner of ANTM)

Total Escapes From Elimination: Ann (Cycle 3 - 4 times in bottom 2 without getting ousted)

Consecutive Bottom 2 Appearances: Lluvy (Cycle 4 - 3 times in a row)

Worst Photo In History: Lluvy (Cycle 4 - Pisces Photo)

Most "First Called Out For Safety": Amanda (Cycle 3 - 4 times in total)

First Contestant To Quit The Game: Cassandra (Cycle 5)

First Publicly Announced Lesbian Contestant: Ebony (Cycle 1)

First Publicly Announced Bisexual Contestant: Michelle (Cycle 4)

First Contestant To Contract Disease During The Show: Michelle (Cycle 4 - she came down with impetigo)

First Contestant Who Tyra Banks Shouted At: Tiffany (Cycle 4)

First Double Elimination: Rebecca & Tiffany (Cycle 4)

First Contestant To Faint In The Show: Rebecca (Cycle 4 - before the panel of judges)

First Contestant Whose Loved One Died While Filming: Kahlen (Cycle 4 - her best friend from high school died)

First Contestant To Refuse Taking A Photo Shoot: Robin & Shannon (Cycle 1)

First Contestant To Arrive Late For A Photo Shoot: Jenascia (Cycle 2)

First Contestant To Verbally Request To Leave Competition: Nicole (Cycle 1)

Most Frequently Appeared Name For Contestants: Nicole (Cycles 1, 3 & 5) and Sarah (Cycles 2, 4 & 5)

Most diverse racial mix: Cycle 2 (Whites: Other Races = 6:6)

First fake double elimination/time no contestant was eliminated in a regular episode - Episode 8, Cycle 5 (Nicole and Jayla)

Unique Parentage:

1) Giselle (Cycle 1 - Mexican)

2) Yoanna (Cycle 2 - Canadian American/Mexican)

3) April (Cycle 2 - German/Japanese-Irish/Welsh)

4) Camille (Cycle 2 - Jamaican)

5) Sara (Cycle 2 - Iranian[Persian])

6) Jenascia (Cycle 2 - Filipino/Greek/Cherokee Indian/English/Irish/Possibly German)

7) Yaya (Cycle 3 - Caribbean Origins)

8) Norelle (Cycle 3 - Irish American)

9) Julie (Cycle 3 - Indian)

10) Magdalena (Cycle 3 - Panamanian Origins)

11) Naima (Cycle 4 - Black/Irish/Mexican-Black/Welsh)

12) Noelle (Cycle 4 - Black-White)

13) Jayla (Cycle 5 - Italian)

14) Lisa (Cycle 5 - Distant European Origins)

15) Most Successful Modeling Career After Show: Elyse Sewell

16) Only Two Former Strippers: Cassie Grisham (Cycle 3) and Tiffany Richardson (Cycle 4)

17) Homosexual/Bisexual Contestants: Ebony Haith (Cycle 1), Adrianne Curry (Cycle 1), Michelle Deighton (Cycle 4) and Kim Stolz (Cycle 5)

== Contestants ==

Cycle 1 contestants (in order of elimination)

*Tessa Carlson

*Katie Cleary

*Heather Panattoni

*Ebony Haith

*[[Giselle Samson]]

*Kesse Wallace

*Robin Manning

*[[Elyse Sewell]]

*[[Shannon Niquette Stewart]]

*[[Adrianne Curry]]

Cycle 2 contestants (in order of elimination)

*Anna Bradfield

*Bethany Harrison

*Heather Blumberg

*Jenascia Chakos

*Xiomara Frans

*Catie Anderson

*Sara Racey-Tabrizi

*Camille McDonald

*April Wilkner

*[[Shandi Sullivan]]

*[[Mercedes Scelba-Shorte]] (Mercedes Yvette)

*[[Yoanna House]]

Cycle 3 contestants (in order of elimination)

*Magdalena Rivas

*Leah Darrow

*Julie Titus

*Laura Gromment (Kristi)

*Jennipher Frost

*Kelle Jacob

*Cassie Grisham

*[[Toccara Jones]]

*Nicole Borud

*Norelle Van Herk

*Ann Markley

*[[Amanda Swafford]]

*[[Camara Da Costa Johnson]] (YaYa)

*[[Eva Pigford]]

Cycle 4 contestants (in order of elimination)

*[[Brita Petersons]]

*[[Sarah Dankleman]]

*[[Brandy Rusher]]

*[[Noelle Staggers]]

*[[Lluvy Gomez]]

*[[Tiffany Richardson]]/[[Rebecca Epley]] (double elimination)

*Tatiana Dante

*Michelle Deighton

*Christina Murphy

*Brittany Brower

*Keenyah Hill

*[[Kahlen Rondot]]

*[[Naima Mora]]

Cycle 5 contestants (not in order of elimination, some last names not available yet)

{{spoilers}}

*Ashley Black (eliminated 1st)

*Ebony Taylor (eliminated 2nd)

*Cassandra Whitehead (quit - Episode 3)

*Sarah Rhoades (eliminated 3rd)

*Diane Hernandez (eliminated 4th)

*Coryn Woitel (eliminated 5th)

*Kyle Kavanagh (eliminated 6th)

*Bre

*Jayla

*Kim Stolz

*Lisa

*Nicole Linkletter

*Nik

== International versions ==

An Australian version of the show called ''[[Australia's Next Top Model]]'' was broadcast in [[January 2005]]. A second series will be aired early next year. The format was also used for British show ''Make Me A Supermodel'', the first series of which was broadcast in 2005. [[Thailand]] also used this format in a show broadcast in mid-[[2005]] There have been many spin-offs in many countries, mostly European. These countries include Sweden, Norway, Denmark, France, Thailand, Israel, Australia, Germany, Britain, and more. Most recently, supermodel [[Heidi Klum]] is set to host Germany's Next Top Model.

== External link ==

*[http://www.upn.com/shows/top_model/ Official site]

*[http://imdb.com/title/tt0363307/ ''America's Next Top Model''] at the '''[[Internet Movie Database]]'''

*[http://www.realitytvworld.com/americasnexttopmodel/ ''America's Next Top Model''] at '''[[Reality TV World]]'''

*[http://fansofrealitytv.com/forums/forumdisplay.php?f=195/ America's Next Top Model Forum] at Fans Of Reality TV

[[Category:Reality television series]]

[[Category:2000s TV shows in the United States]]

[[Category:UPN network shows]]