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8 9 In addition, such association between lower lung function and impaired glucose metabolism was also demonstrated in Western populations with higher BMI but lower smoking prevalence, and the association had been shown to be independent of smoking or obesity (refs. 1 6, for review ref. 7).
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Like Burrows we did not find any association between atopy and lower lung function with age.
There is epidemiological evidence showing an association between T2DM and MS with lower lung function in adults [ 24, 25].
The relationship between higher levels of inflammatory biomarkers and lower lung function in the present study are in accordance with what has been found in many previous investigations [ 11, 16- 19, 26- 29].
An alternative explanation is that higher serum highly sensitive CRP is a biomarker for lower lung function and that the apparent associations between coagulation pathway activity and lung function that we have observed are in part a consequence of confounding.
Indeed, obesity is associated with high CRP and fibrinogen [28] and lower lung function [29] and may provide another link between systemic inflammation and low lung function.
Increased in susceptibility to thrombotic disease may be associated with lower lung function.
As air pollution is also a risk factor for lower lung function in children [20] it may impact on lung function by a vascular mechanism in addition to its direct toxic effects on the lungs.
These data thus suggest that higher systemic clotting pathway activity may be a modifiable risk factor for lower lung function.
Our original hypothesis was that higher levels of activation of blood coagulation would be associated with lower lung function.
There were no significant differences between subjects randomized to placebo and those randomized to esomeprazole, though the placebo group tended toward lower lung function, more frequent exacerbations and lower body mass index (BMI) (Table 1).
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