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The identification of Helicobacter pylori as a pathogen associated with gastric disease has led to serological assays that can establish exposure in larger study populations and hence exploration of associations with diseases epidemiologically. The paper by Sze et al,1 is an elegant example of this process. The authors have used the data from the Lung Health Study, which is a large prospective cohort based on a randomised trial of a smoking cessation intervention coupled with an ipratropium inhaler2 that evaluated data on 4765 patients with mild to moderate COPD at baseline, who were followed up for 11 years. The ascertainment of H. pylori status was made serologically after 5 years of follow-up, and then cross-sectional associations and longitudinal changes in lung function over 11 years were examined stratified by H. pylori status. The results are that absolute lung function is lower in individuals with evidence of exposure to H. …
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