In a sample of the general population, people who identified themselves as having asthma had substantially greater declines in FEV1 over time than those who did not.

Objective: To evaluate whether measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) can be used to differentiate patients with normal and reduced left ventricular ejection fraction (LVEF) in an unselected consecutive group of hospital inpatients. Setting: City general hospital, Copenhagen, Denmark. Patients and design: During a 10 month period 2230 admissions to a city general hospital (80% of targeted patients) had an echocardiographic evaluation of left ventricular function, a comprehensive clinical evaluation, and blood analysis of N-terminal-pro-brain natriuretic peptide (NT-proBNP) within 24 hours of admission. Exclusions resulted from lack of informed consent or failure to obtain the required evaluations before death or discharge from hospital. Echocardiography was unsatisfactory in 37 patients, so the final number studied was 2193. Results: A raised NT-proBNP (> 357 pmol/l) identified patients with an LVEF of < 40% (n = 157) with a sensitivity of 73% and a specificity of 82%. The negative predictive value of having an NT-proBNP concentration below 357 pmol/l was 98%. Concentrations of NT-proBNP increased with increasing age and with decreasing LVEF (p < 0.05). A predicted concentration of NT-proBNP (corrected for age, sex, and serum creatinine) was determined for each patient. In patients with an NT-proBNP value less than predicted, the probability of having an LVEF of > 40% was more than 97%. This probability rapidly decreased to 70% as the measured NT-proBNP increased to 150% of the predicted value. Conclusions: A single measurement of NT-proBNP at the time of hospital admission provides important information about LVEF in unselected patients.

The natural history of lung function in diabetes is unknown due to the lack of longitudinal observations. The decline of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was studied over 15 yrs in the 17,506 adult participants of The Copenhagen City Heart Study, which included 266 individuals with diabetes.Multiple linear regression and a mixed-effects model were used, taking into account correlation between repeated measurements and adjusting for relevant confounders. In both sexes, FEV1 and FVC were consistently lower in diabetic individuals, compared with healthy individuals, with an average reduction of y8% of the predicted value. Longitudinal analyses showed that the decline of FEV1 and FVC in diabetic individuals was similar to that observed in nondiabetic subjects.It was concluded that although diabetic subjects have, on average, a lower forced expiratory volume in one second and forced vital capacity than individuals without diabetes, this deficit seems not to be progressive in the long term. These observations may be of importance with regard to diabetes treatment with inhaled pulmonary insulin, which is likely to become available within a few years.

Background-Recent evidence suggests a role for hormonal factors in the aetiology of asthma. Methods-Data from a large study of women selected from the general population were used to relate treatment with oral hormonal contraceptives (OCP) and postmenopausal hormone replacement therapy (HRT) to the following asthma indicators: self-reported asthma, wheezing, cough at exertion, and use of medication for asthma. The study sample comprised 1536 premenopausal and 3016 postmenopausal women who participated in the third round of the Copenhagen City Heart Study in 1991-4. A total of 377 women were taking OCP (24.5% of premenopausal women) and 458 were on HRT (15.2% of postmenopausal women). Results-In premenopausal women 4.8% reported having asthma. The prevalence of self-reported asthma, wheeze, use of asthma medication, and cough at exertion was not significantly related to use of OCP. In postmenopausal women the prevalence of self-reported asthma was 6.2%. A weak but consistent association was observed between HRT and self-reported asthma (OR 1.42 (95% CI 0.95 to 2.12)), wheeze (OR 1.29 (95% CI 1.02 to 1.64)), cough at exertion (OR 1.34 (95% CI 1.01 to 1.77)), and use of asthma medication (OR 1.45 (95% CI 0.97 to 2.18)). Conclusions-In this study of the general population no relationship was found between the use of OCP and asthma. Although an association was observed between HRT and asthma and asthmalike symptoms, this was relatively weak and it is concluded that there is no necessity to change present prescription practice. (Thorax 2001;56:613-616)