Background: Inhaled corticosteroids (ICS) provide short term benefits in asthma but the long term effects are still unknown. Methods: 281 patients diagnosed with moderate to severe asthma in 1963-75 were re-examined in 1991-9. Information was collected on forced expiratory volume in 1 second (FEV 1 ), bronchial hyperresponsiveness, atopy, smoking, use and dosage of oral and ICS. Patients were included in the analyses if they had at least three FEV 1 measurements during two consecutive years after the age of 30 and used ICS during follow up. Results: Analyses were performed on 122 patients. During a median follow up period of 23 years, 71 men and 51 women had on average 37 and 40 individual FEV 1 measurements, respectively. Linear mixed effect models showed that men had a mean annual decline in FEV 1 of 20.6 ml/year less after ICS initiation than before (p = 0.011), and in women the decline in FEV 1 was 3.2 ml/year less (p = 0.73). In individuals with ,5 pack years of smoking the decline in FEV 1 was 36.8 ml/year less after ICS institution in men (p = 0.0097) and 0.8 ml/year less in women (p = 0.94), the difference between the sexes being significant (p = 0.045). These effects were not observed in those with >5 pack years smoking. A higher daily dose of ICS was associated with a smaller decline in FEV 1 in men (p = 0.006), an effect not observed in women. Conclusion: Treatment with ICS in adult patients with moderate to severe asthma was associated with a reduction in the decline in FEV 1 over a 23 year follow up period in men who had smoked ,5 pack years. This effect was dose dependent and was not present in women or in men with >5 pack years of smoking at follow up. The lack of effect of ICS on the decline in FEV 1 in women needs further study.

These findings suggest that a variant in ADAM33 is not only important in the development of asthma but also in disease progression, possibly related to enhanced airway remodelling.

Aim.  This paper reports an investigation of the diagnostic accuracy of the Care Dependency Scale (CDS). Background.  Assessment tools can be described in terms of diagnostic accuracy, or the ability to correctly classify subjects into clinically relevant subgroups. Diagnostic accuracy can be determined by several techniques as sensitivity, specificity, receiver operating curve analysis and likelihood ratios. Method.  A cross‐sectional design was used with data from 237 patients from two studies. Data were collected using a questionnaire consisting of the CDS and the Barthel Index (BI). The CDS is a relatively new instrument and should be validated by comparison against an established gold standard, in this case the BI. Measures to quantify the validity of diagnostic tests, such as sensitivity, specificity, positive and negative predictive values, prevalence and likelihood ratios were calculated. In addition, the receiver operating characteristics (ROC) curve analysis was used to report the test accuracy of the CDS and to determine an appropriate cut‐off point for care dependency detection. Findings.  The prevalence in the sample study was very high (84%). The area under the ROC curve for the CDS was 0·81, which indicates moderate diagnostic accuracy. Patients with a CDS sumscore ≤68 (rule‐out cut‐off point) were classified as care dependent, all others as independent. The determination of the appropriate cut‐off point was based on sensitivity (0·85) and positive predictive valued (0·90). Conclusion.  The CDS may be used for to estimate care dependency among hospital patients with various conditions.

In an international study, psychometric properties of the Care Dependency Scale (CDS) were examined by analysing data gathered in Dutch, Canadian, Italian and Norwegian nursing homes. For that purpose, from these countries a convenience sample was developed consisting of 525 patients with dementia. The English, Italian and Norwegian research instruments were translations of the original Dutch CDS. Psychometric evaluations of the CDS were carried out for each country separately as well as for the four countries combined. High alpha coefficients between 0.94 and 0.97 were calculated. Subsequent test-retest and inter-rater reliability revealed moderate to substantial Kappa values. Factor analysis resulted in a one-factor solution. The scalability of the CDS was demonstrated by means of Mokken scale analysis. One of the main outcomes of the cross-cultural comparison was that the findings in the four countries show more similarities than differences, so that the scale can be used appropriately in nursing home practice.

In view of the associations of "a disintegrin and metalloprotease" (ADAM) with respiratory diseases, we assessed the expression of various ADAMs in human lung tissue. Lung tissue was obtained from nine individuals who underwent surgery for lung cancer or underwent lung transplantation for emphysema. Also, 16HBE 14o-(human bronchial epithelial) and A549 (alveolar type II epitheliumlike) cell lines were used. Immunohistochemistry was performed with antibodies recognizing different ADAM domains. The ADAMs were typically distributed over the bronchial epithelium. ADAM8 and ADAM10 were expressed diffusely in all layers of the epithelium. ADAM9, ADAM17, and ADAM19 were predominantly expressed in the apical part of the epithelium, and ADAM33 was predominantly and strongly expressed in basal epithelial cells. In smooth muscle, ADAM19 and ADAM17 were strongly expressed, as was ADAM33, though this expression was weaker. ADAM33 was strongly expressed in vascular endothelium. All ADAMs were generally expressed in inflammatory cells. The typical distribution of ADAMs in the lung, especially in the epithelium, is interesting and suggests a localized function. As most ADAMs are involved in release of (pro-) inflammatory mediators and growth factors, they may play an important role in the first line of defense and in initiation of repair events in the airways.

This paper describes the results of a study determining construct validity aspects of the Nursing Care Dependency (NCD) Scale. This 15-item instrument has been developed recently for the assessment of the care dependency of dementia or learning-disabled inpatients. Data was collected for 450 dementia and 203 learning-disabled patients using the NCD instrument. Factor analysis of the NCD instrument resulted in one Factor. With Mokken scale analysis an H-coefficient of 0.75 was found, which implied a strong hierarchical scale. Cronbach's alpha coefficients (0.97) were high enough to use the NCD instrument in clinical practice, at both group and individual levels.

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Background Emphysema and small airway disease both contribute to chronic obstructive pulmonary disease (COPD), a disease characterised by accelerated decline in lung function. The association between the extent of emphysema in male current and former smokers and lung function decline was investigated. Methods Current and former heavy smokers participating in a lung cancer screening trial were recruited to the study and all underwent CT. Spirometry was performed at baseline and at 3-year follow-up. The 15th percentile (Perc15) was used to assess the severity of emphysema. Results 2085 men of mean age 59.8 years participated in the study. Mean (SD) baseline Perc15 was À934.9 (19.5) HU. A lower Perc15 value correlated with a lower forced expiratory volume in 1 s (FEV 1 ) at baseline (r¼0.12, p<0.001). Linear mixed model analysis showed that a lower Perc15 was significantly related to a greater decline in FEV 1 after follow-up (p<0.001). Participants without baseline airway obstruction who developed it after follow-up had significantly lower mean (SD) Perc15 values at baseline than those who did not develop obstruction (À934.2 (17.1) HU vs À930.2 (19.7) HU, p<0.001). Conclusion Greater baseline severity of CT-detected emphysema is related to lower baseline lung function and greater rates of lung function decline, even in those without airway obstruction. CT-detected emphysema aids in identifying non-obstructed male smokers who will develop airflow obstruction.