TNF and congestive heart failure: On the other hands, small airway obstruction and the airway hyper-responsiveness are reported in patients with CHF.4-7 There are several mechanisms such as interstitial edema and airway mucosal vasodilatation, and also vagotonia which result in decreased airway cross-section and airway hyper-responsiveness in CHF.8,9 Inhaled glucocorticoids can reduce the airway obstruction, so the inflammatory mediators such as arachidonic acid metabolites, platelet-activating factor, TNF, IL1 and IL6 may play a role in bronchial hyper-responsiveness.