Background -Corticosteroids suppress disease activity in pulmonary sarcoidosis and their use produces symptomatic, radiographic, and functional improvement. There is, however, uncertainty regarding their effects on the overall natural history of the condition and long term benefit is unproven.Methods -Patients with pulmonary radiographic shadowing due to sarcoidosis were recruited in a multicentre study. Those who, in the first six months after entry to the study, neither required prednisolone for symptoms nor showed radiographic improvement were allocated at six months to receive either long term steroid treat-

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Between 1988 and 2003 there was a downward trend in asthma mortality rate in East Anglia. In 2001-2003, misclassification of deaths attributed to asthma was still common. Most patients who die of asthma have severe asthma. In 81% of cases, behavioural and psychosocial factors contributed to the patient's death. In 80% of deaths the final attack was not sudden, and may have been preventable. Almost all sudden deaths occurred between April and August, suggesting a seasonal allergic cause. In two-thirds of asthma deaths, medical management failed to comply with national guidelines. 'At-risk' asthma registers in primary care may improve recognition and management of 'at-risk' patients.

The selection of initial antimicrobial treatment in a patient with community acquired pneumonia is an important clinical decision. Because this decision is usually made before the results of specific microbiological tests are available, we attempted to determine how well the presenting clinical features would allow prediction ofmicrobial aetiology in 441 adults admitted to hospital with pneumonia. Five of 90 variables available on admission were selected for inclusion in a multivariate discriminant function analysis because of their strong association with one or more of the major aetiological subsets (Mycoplasma pneumoniae, Streptococcus pneumoniae, "other," and undetermined). These variables were age, number of days ill before admission, presence or absence of bloody sputum and of lobar infiltration on chest radiograph, and white blood cell count. The microbial aetiology was correctly predicted by this discriminant function analysis in only 42% of cases, which gives a quantitative estimate of the degree of difficulty encountered in determining the microbial aetiology at the time of admission for pneumonia. When a similar discriminant function analysis was applied to the third of patients in whom the microbial aetiology was never determined, most of these cases were predicted to be due to Streptococcus pneumoniae.

Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.