Objective-To describe the incidence and prognosis of wheezing illness from birth to age 33 and the relation of incidence to perinatal, medical, social, environmental, and lifestyle factors.Design-Prospective longitudinal study. Setting-England, Scotland, and Wales. Subjects-18 559 people born on 3-9 March 1958. 5801 (31%) contributed information at ages 7,11,16,23, and 33 years. Attrition bias was evaluated using information on 14 571 (79%) subjects.Main outcome measure-History of asthma, wheezy bronchitis, or wheezing obtained fiom interview with subjects' parents at ages 7, 11, and 16 and reported at interview by subjects at ages 23 and 33.Results-The cumulative incidence of wheezing illness was 18% by age 7, 24% by age 16, and 43% by age 33. Incidence during childhood was strongly and independently associated with pneumonia, hay fever, and eczema. There were weaker independent associations with male sex, third trimester antepartum haemorrhage, whooping cough, recurrent abdominal pain, and migraine. Incidence from age 17 to 33 was associated strongly with active cigarette smoking and a history of hay fever. There were weaker independent associations with female sex, maternal albuminuria during pregnancy, and histories of eczema and migraine. Maternal smoking during pregnancy was weakly and inconsistently related to childhood wheezing but was a stronger and significant independent predictor of incidence after age 16. Among 880 subjects who developed asthma or wheezy bronchitis from birth to age 7, 50% had attacks in the previous year at age 7; 18% at 11, 10% at 16, 10% at 23, and 27% at 33. Relapse at 33 after prolonged remission of childhood wheezing was more common among current smokers and atopic subjects.Conclusion-Atopy and active cigarette smoking are major influences on the incidence and recurrence of wheezing during adulthood.

SUMMARY In 1973 a survey was conducted among 12 year old children living in a defined area of South Wales. In 1988 the survey was repeated in the same area, again among 12 year old children. Questionnaires were completed for all 965 children in the population sample; peak expiratory flow rates were performed on them all, and repeated (except for five children) after an exercise provocation test. The prevalence of a history of wheeze at any time had increased from 17% to 22%, while that of a history of asthma at any time had increased from 6% to 12%. Current asthma had increased from 4% to 9%, but wheezing in the past year not attributed to asthma had remained at 6%. The exercise provocation tests suggested that both mild and severe asthma had become more common. Increases had also occurred in the frequencies of a history of eczema (from 5% to 16%) and of hay fever (from 9% to 15%). It seems that the prevalence of asthma has risen, and that this cannot be wholly explained by a greater readiness to diagnose the disease.There is some dispute as to whether the prevalence of childhood asthma is rising in Britain. -3 A phenomenal rise has occurred in hospital admission rates,3 but this may be attributable to changes in admission policy. The consulting rates for patients attending -eneral practitioners for asthma have also increased, but this may merely reflect a greater readiness to diagnose asthma in wheezing children. In the absence of serial surveys conducted in the same areas with the same methodology it is not clear whether the prevalence is really changing. This paper describes a survey of 12 year old school children living in the same areas of South Wales in which a similar survey was conducted 15 years before, using the same methodology-that is, questionnaires and exercise provocation tests. Subjects and methodsThe survey was first conducted in 1973 and the findings then have already been published.

C-reactive protein levels are raised in association with a variety of established cardiovascular risk factors. Neither C-reactive protein nor the systemic inflammation it represents appears to play a direct role in the development of ischaemic heart disease.

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Background-A prospective cohort study of 2512 Welshmen aged 45-59 living in Caerphilly in 1979-1983 was used to investigate associations between diet and lung function. Methods-At baseline (phase I) and at five year follow up (phase II), forced expiratory volume in one second (FEV 1 ) was measured using a McDermott spirometer and dietary data were obtained using a semi-quantitative food frequency questionnaire. Results-Good lung function, indicated by high maximum FEV 1 given age and height, was associated with high intakes of vitamin C, vitamin E, -carotene, citrus fruit, apples, and the frequent consumption of fruit juices/squashes. Lung function was inversely associated with magnesium intake but there was no evidence of an association with fatty fish. Following adjustment for confounders including body mass index, smoking history, social class, exercise, and total energy intake, only the associations with vitamin E and apples persisted, with lung function estimated to be 39 ml (95% confidence interval (CI) 9 to 69) higher for vitamin E intakes one standard deviation (SD) apart and 138 ml higher (95% CI 58 to 218) for those eating five or more apples per week compared with non-consumers. Decline in lung function between phases was not significantly associated with the changing intakes of apples or vitamin E. An association between high average apple consumption and slow decline in lung function lost significance after adjustment for confounders. Conclusions-A strong positive association is seen between lung function and the number of apples eaten per week cross sectionally, consistent with a protective eVect of hard fruit rather than soft/citrus fruit. The recent suggestion that such eVects are reversible was not supported by our longitudinal analysis.