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The predictors of autopsy and the accuracy of European short list (E) codes of respiratory diseases lack recent knowledge.A 10% random sample (n=6811) of inhabitants of Bergen, Norway, aged 20–70 years, was invited to participate in a survey in 1965–1971 (participation rate 83%).By December 31, 2005, 4387 (64%) participants had died and 1163 (27% of the deceased) had been given an autopsy. Causes of death were tuberculosis (E02, 0.2%), lung malignancy (E15, 3.5%), influenza (E38, 0.2%), pneumonia (E39, 6.5%) and chronic lower respiratory diseases (E40, 3.2%). Male sex, early deaths in the surveillance period and E15 were positive predictors of an autopsy examination, whereas old age and E39 were strong negative predictors. Among those referred for apost mortemexamination, the cause of death was verified as tuberculosis in 0.3%, lung cancer in 8.1%, acute pneumonia in 2.0% and chronic obstructive lung diseases in 4.9%. Cohen’s kappa coefficients (E codesversusautopsy) were 0.91 (95% CI 0.86–0.96) for E15, 0.37 (95% CI 0.20–0.54) for E39 and 0.65 (95% CI 0.54–0.76) for E40.These findings matter when deaths from respiratory diseases are used as end-points in epidemiological association studies and clinical trials.

Prediction bias in spirometry reference equations can arise from combining equations for different age groups, rounding age or height to integers or using self-reported height. To assess the bias arising from these sources, the fit of 13 prediction equations was tested against the Global Lungs Initiative (GLI) dataset using spirometric data from 55,136 healthy Caucasians (54% female). The effects on predicted values of using whole-year age versus decimal age, and of a 1% bias in height, were quantified. In children, the prediction bias relative to GLI ranged from -22% to +17%. Switching equations at 18 yrs of age led to biases of between -846 (-14%) and +1,309 (+38%) mL. Using age in whole years rather than decimal age introduced biases from -8% to +7%, whereas a 1% overestimation of height introduced bias that ranged from +1% to +40%. Bias was greatest in children and adolescents, and in short elderly subjects. Using a single spirometry equation applicable across all ages and populations reduces prediction bias. Measuring and recording age and height accurately are also essential if bias is to be minimised.

The aim of our study was to examine sex-specific associations between different aspects of socioeconomic status (SES) (educational level, occupational status, income) and lung function in a general adult population. In the Hordaland County Cohort Study, 1,644 subjects aged 26-82 yrs at baseline answered questionnaires and performed post-bronchodilator spirometry both in 1996-1997 and in 2003-2006. We performed adjusted linear regression analysis on the effect of SES on decline in forced experimental volume in 1 s (FEV(1)), forced vital capacity (FVC) and FEV(1)/FVC. Mean annual decline in FEV(1) from baseline to follow-up was 57 mL (se 1.3) and 48 mL (se 1.0) for males and females, respectively. Males had a larger decline in FVC than females, while females had a larger decline in FEV(1)/FVC. Lower education and low occupational status were associated with larger male lung function decline. SES did not affect female lung function decline. However, marital status was a significant predictor; unmarried females had less decline than both married and widowed females in both FEV(1) (adjusted mean annual difference 8 mL and 16 mL) and FVC (adjusted mean annual difference 8 mL and 18 mL). Low SES was associated with increased lung function decline in males. For females, marital status was more important.

We investigated how quantitative high-resolution computed tomography (HRCT) measures of emphysema and airway wall thickness (AWT) vary with sex, age and smoking history. We included 463 chronic obstructive pulmonary disease (COPD) cases and 431 controls. All included subjects were current or ex-smokers agedor = 40 yrs, and all underwent spirometry and HRCT examination. The HRCT images were quantitatively assessed, providing indices on lung density and airway dimensions. The median (25-75th percentile) %LAA950 (% low-attenuation area-950 HU) was 8.9 (3-19) and 4.7 (1-16) in male and female COPD cases, respectively, and 0.71 (0.3-1.6) and 0.32 (0.1-0.8) in male and female controls, respectively. %LAA950 was higher in ex-smokers and increased with increasing age and with increasing number of pack-years. The mean+/-SD standardised AWT was 0.504+/-0.030 and 0.474+/-0.031 in male and female COPD cases, respectively, and 0.488+/-0.028 and 0.463+/-0.025 in male and female controls, respectively. AWT decreased with increasing age in cases, and increased with the degree of current smoking in all subjects. We found significant differences in quantitative HRCT measures of emphysema and AWT between varying sex, age and smoking groups of both control and COPD subjects.

The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10-yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n=423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.

Socio-economic status (SES) is related to increased risk of airway disease in terms of forced expiratory volume in one second (FEV1) and forced vital capacity. No data are available as to what extent SES predicts alveolar function in a general population. In this cross-sectional study, 1,275 subjects aged 18–73 yrs underwent pulmonary testing, including the single-breath carbon monoxide transfer capacity of the lungs ( T L,CO). Educational level was used as an index for SES. Mean±sd T L,CO % predicted was 97% among those with primary school education, 99% among those with secondary school education and 104% among those with a university degree. In a multiple linear regression analysis, adjusting for age, height, haemoglobin, carboxyhaemoglobin, smoking habits, occupational exposure, FEV1 and body mass index, T L,CO was significantly related to educational level in males but not in females. Occupational exposure was not significant. In this study, socio-economic status was found to be an independent determinant of T L,CO. Even in an affluent country such as Norway, socio-environmental risk factors may differ based on individuals' SES. Such risk factors may, for instance, be higher exposure to airborne pollutants, poorer housing conditions, or lower consumption of fruit and vegetables. Further exploration is called for.

Few studies have estimated the remission rates of respiratory symptoms in general populations. No community cohort studies have examined the impact of smoking cessation and previous dust or fumes exposure on the remission of respiratory symptoms. In the Hordaland County Study, an 11-yr community cohort (1985-1996/1997) from Western Norway, data from 2,819 subjects were used to examine the remission of six respiratory symptoms. The measured cumulative remission varied from 42.3% for morning cough to 58.4% for chronic cough. Smoking cessation was a significant predictor of remission of the cough symptoms and wheezing, with odds ratios (OR) (95% confidence intervals (CI)) varying from 2.2 (1.3-3.7) for wheezing to 6.2 (3.5-11.2) for morning cough, after adjustment for sex, age, pack-years smoked, previous dust or fumes exposure, and educational level. In those not previously exposed to dust or fumes, the adjusted OR (95% CI) for the remission of morning cough, phlegm cough, dyspnoea grade 2, attacks of dyspnoea and wheezing varied from 1.5 (0.9-2.5) for attacks of dyspnoea to 2.1 (1.1-3.9) for dyspnoea grade 2, as compared to those previously exposed to dust or fumes. This study suggests a beneficial effect of smoking cessation and an adverse effect of occupational exposure on the remission of respiratory symptoms.

Studies have indicated that females are more vulnerable to the deleterious effect of tobacco smoking than males. The current study aimed to investigate the associations between tobacco smoking and reported respiratory symptoms, self-rated health, and lung function by sex. In 1995-1997 65,225 subjects aged > or = 20 yrs (71% of invited) attended for screening within the Nord-Trondelag Health Study. Among these, 10,941 subjects selected randomly or because they reported having asthma or asthma-related symptoms, participated in the Bronchial Obstruction in Nord-Trondelag study consisting of spirometry and a personal interview. Tobacco smoking was associated with increased prevalence of respiratory symptoms, reduced lung function, and lower score on global self-rated health (SRH). Adjusted for smoking burden and lung function, females had a higher risk for reporting respiratory symptoms and lower SRH compared with males. Further, smoking burden was associated with a larger relative reduction in expiratory lung function in females than in males. Females reported more symptoms and lower self-rated health compared with males with similar smoking burden. Even if smoking in females was associated with a larger reduction in per cent predicted lung function compared with males, this does not fully explain the higher symptom prevalence in females.

There has been an increase in asthma prevalence among children. Little evidence is available regarding long-term changes in asthma prevalence in adults. Two cross-sectional studies were performed among adults aged 15-70 yrs in Oslo, Norway, in 1972 and again in 1998-1999 (n=39,998). A postal self-completed questionnaire was used. Exactly the same questions and survey methods were used in both studies. In 1998-1999, additional telephone follow-up was included for postal nonresponders. The crude prevalence of ever having had a doctor's diagnosis of asthma increased from 3.4 to 9.3%. The prevalence of wheezing increased from 17.8 to 25.8% and attacks of breathlessness from 12.6 to 16.7%. After controlling for smoking, the risk of asthma among those aged40 yrs had tripled. The increase in asthma was 50% greater in females than males. The prevalence of symptoms increased less than asthma diagnosis. Wheezing increased by 50% in those aged40 yrs, with smaller increases at greater ages. The increase in symptoms was seen among both asthmatics and nonasthmatics. There has been a large increase in the prevalence of asthma diagnosis and asthma-like symptoms in adults. The increase is less pronounced among those aged40 yrs.

The aim was to examine the relationship of serum inflammatory markers to the level of single-breath diffusing capacity of carbon monoxide (TL,CO).A stratified sample (n=1,121) of a Norwegian general population aged 18–73 yrs was examined. The inflammatory markers measured were calprotectin, a prominent protein in the cytosol fraction of neutrophil granulocytes, and α1-antitrypsin (α1-AT), the major inhibitor of neutrophil elastase in the lower respiratory system. Both markers have increased circulating levels in the course of an acute inflammatory reaction.Subjects with a TL,CO1-AT (p=0.003) and calprotectin (pL,CO>100%. In multiple linear regression analyses, α1-AT was still significantly associated withTL,COafter adjusting for sex, age, smoking habits, haemoglobin, carboxyhaemoglobin, forced expiratory volume in one second and alveolar volume. In a similar analysis, no significant overall association was found between calprotectin and TL,CO, but in a stratified analysis, calprotectin was significantly related to TL,COin females. However, no significant sex interaction in the relationship between the inflammatory markers and TL,COwas found.The findings suggest that increased levels of α1-antitrypsin and of calprotectin are risk factors for decreased diffusing capacity of carbon monoxide.

Reduced single-breath transfer factors of the lung for carbon monoxide are seen in a number of conditions. The hypothesis of the present study was that self-reported respiratory symptoms differ in their prediction of TL,CO level in a general population in Norway. A cross-sectional survey of a general population sample in Norway, made up of 1,275 subjects aged 18-73 yrs, was conducted in 1987-1988. The attendees (84% response rate) filled in a questionnaire on respiratory symptoms and underwent standardized spirometric and TL,CO measurements and clinical examination. Associations between TL,CO and respiratory symptoms were assessed using multiple regression models. Tests for interaction were used to examine whether these associations varied with sex, age and smoking habits. Data from 1,221 subjects were analysed. Both males and females who reported respiratory symptoms had significantly lower TL,CO after adjusting for age and height. In a multiple linear regression analysis of TL,CO, adjusting for sex, age, height and smoking habits, the symptoms for which statistical significance was attained, were morning cough, chronic cough and breathlessness. However, only the breathlessness score was independently associated with the TL,CO (-0.42 mmol x min(-1) x kPa(-1) per breathlessness score unit) after adjusting for other respiratory symptoms, and the relationship was stronger in males than in females. In this study, the strongest predictor for a decreased single-breath transfer factor of the lung for carbon monoxide was the presence of self-reported breathlessness, regardless of age, smoking habits and height.

There is evidence that the origin of obstructive lung disease may be traced back to foetal life. The associations between birth characteristics and asthma symptoms were studied in a random population sample of young Norwegian adults. Respiratory symptoms were recorded in a population-based questionnaire survey. The records of all subjects aged 20-24 yrs were linked with the Medical Birth Registry of Norway. Of 868 subjects born in Norway, there were 690 (79%) responders. The associations between asthma symptoms and birth characteristics were analysed by logistic regression, adjusted for possible confounding factors. Asthma symptoms in young adults were inversely associated with birth weight (odds ratio (OR)wheeze=0.82; 95% confidence interval (CI)=0.69-0.96x500 g increase in birth weight(-1))), and after adjustment for gestational age, birth length, parity and maternal age (ORwheeze=0.69; 95% CI=0.50-0.95x500 g increase in birth weight(-1)). The association did not vary according to adult smoking habits or atopic status and remained when premature and low weight births were excluded (ORwheeze=0.73; 95% CI=0.60-0.90x500 g increase in birth weight(-1)). The association was consistent for all asthma symptoms. Adjusted for birth weight, asthma symptoms were further associated with low gestational age, high birth length and low maternal age. In a random sample of young adults, asthma symptoms were strongly associated with low birth weight, an association driven by the full-term births within the normal birth weight range. The findings show that the risk for adult asthma is partly established early in life and suggest that poor intrauterine growth is involved in the aetiology of asthma.

It is still unclear whether the reported increase in the prevalence of asthma is real or due to changes in diagnostic criteria. The objectives of this study were to compare the prevalence of diagnosed asthma with the prevalence of respiratory symptoms, and to compare the association between asthma and other atopic diseases in 1981 and 1994. The study populations comprised randomly selected school classes in Oslo in 1981 (n=1,772) and 1994 (n=2,577). The main outcomes in these comparable cross-sectional studies of children, 6-16 yrs of age, were parent-reported prevalence of diagnosed asthma, respiratory symptoms, eczema and hay fever. The questionnaire was identical in 1981 and 1994. The response rates were 94% (1,674 out of 1,772) in 1981 and 85% (2,188 out of 2,577) in 1994. The lifetime prevalence of asthma increased from 3.4% in 1981 to 9.3% in 1994; odds ratio (OR) 2.9 (95% confidence interval (95% CI) 2.1-4.0) comparing 1994 to 1981. The prevalence of occasional wheezing increased from 9.0 to 10.8%; OR 1.2 (95% CI 1.0-1.5), and attacks of wheezing from 3.7 to 6.8%; OR 1.8 (95% CI 1.3-2.5). Survival analyses for 3 year birth cohorts showed that asthma was more readily diagnosed in the latest birth cohort (1985-1988). The association between asthma and other atopic diseases decreased during the period under study. The increase in diagnosed asthma and respiratory symptoms supports a true increase in asthma. However, the larger increase in diagnosed asthma than wheezing and a reduced association between asthma and other atopic diseases suggest that the increase in asthma may be explained, in part, by changes in diagnostic criteria.

The purpose of this survey was to evaluate the effects of smoking and occupational exposures on the decline in forced expiratory volume in one second (FEV1), and the presence of airflow limitation (FEV1 x100/forced vital capacity (FVC) being < 65) at follow-up. A random sample of 1,933 men aged 22-54 years in Bergen, Norway, were invited into the survey. Smoking habits and measurements of FEV1 were recorded at the initial survey in 1965-1970 (n = 1,591) and at follow-up in 1988-1990 (n = 951). Past or present self-reported occupational exposures to eleven airborne agents (dusts, gases, vapours and fumes) and measurements of FVC were recorded at follow-up only. The decline in FEV1 was associated (p < 0.001) with age, body height and smoking. Smoking cessation reduced the decline to the level of lifetime nonsmokers. Accelerated decline in FEV1 was observed in subjects exposed to sulphur dioxide gas and to metal fumes. The adjusted decline in FEV1 increased progressively in subjects exposed to increasing numbers of occupational agents (test for trend: p < 0.01). Airflow limitation was observed in 9.5% at follow-up, and increased with age and cigarette consumption. In this community follow-up survey in men, smoking and occupational exposures to sulphur dioxide gas, metal fumes and the numbers of specific agents were found to be important predictors for accelerated decline in FEV1.

The relationship of occupational airborne, exposure to respiratory symptoms and asthma was examined using a self-administered questionnaire in a cross-sectional survey of a random sample (n = 4,992 subjects) of the general population aged 15-70 yrs of Hordaland county, Norway. The response rate was 90%. Twenty nine percent of the population had a history of occupational dust or gas exposure, 5% reported having been exposed to asbestos at work, and 4% reported quartz exposure. A history of occupational dust or gas exposure was associated with morning cough, chronic cough, phlegm when coughing, breathlessness on exercise, occasional wheezing and a physician's diagnosis of asthma after adjusting for sex, age, smoking habits and urban-rural area of residence. The adjusted relative odds ratios for the respiratory disorders in subjects exposed to dust or gas ranged from 1.6-1.9. The population attributable risk of occupational dust or gas exposure for the respiratory disorders ranged from 11-19%. The study indicates that respiratory disorders are independently associated with occupational airborne exposure in a Norwegian general population sample.

The Collaborative European Anti-Smoking Evaluation (CEASE) was a European multicentre, randomized, double-blind placebo controlled smoking cessation study. The objectives were to determine whether higher dosage and longer duration of nicotine patch therapy would increase the success rate. Thirty-six chest clinics enrolled a total of 3,575 smokers. Subjects were allocated to one of five treatment arms: placebo and either standard or higher dose nicotine patches (15 mg and 25 mg daily) each given for 8 or 22 weeks with adjunctive moderately intensive support. The 12 month sustained success rates were: 25 mg patch for 22 weeks (L-25), 15.4%; 25 mg patch for 8 weeks (S-25), 15.9%; 15 mg patch for 22 weeks (L-15), 13.7%; 15 mg patch for 8 weeks (S-15), 11.7%; and placebo (P-0) 9.9% (placebo versus 15 mg, p

A method for quantitative recording of psychiatric symptoms has been modified for application to respiratory symptoms such as cough, attacks of breathlessness, wheezing and dyspnoea. The method was evaluated in a survey of 193 subjects without pulmonary disorders and 186 patients with pulmonary disorders. The average time taken to obtain scores for four symptoms was six minutes. Inconsistencies were few when the subjects selected statements about symptoms. Cough score discriminated between groups of healthy persons with various smoking habits. Wheezing score distinguished healthy persons from patients with obstructive lung disease more accurately than cough, attacks of breathlessness and dyspnoea score. Regression analyses showed that per score point of dyspnoea and cough the peak expiratory flow rate decreased by almost 12 and 7% of predicted, respectively.

A 54 yr old man experienced weakness in his legs, ataxia and subsequent urinary retention after a percutaneous fine-needle aspiration of a tumor in the right lower lobe. Clinical neurological examination and electroencephalography revealed signs of a brain stem lesion, probably due to an air embolism to the basilar artery. The symptoms and signs gradually disappeared prior to, as well as after, hyperbaric oxygen treatment. We believe this to be the first case of air embolism after transthoracic puncture with a 23 gauge needle to be reported in medical literature.