Carta al Director
Corticoides inhalados en enfermedad pulmonar obstructiva crónica: algunas consideraciones
Inhaled corticosteroids in chronic obstructive pulmonary disease: Some considerations
Adolfo Baloira Villar
, Marta Núñez Fernández, Abel Pallarés Sanmartín
Corresponding author
Servicio de Neumología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
Read
13530
Timeswas read the article
2662
Total PDF
10868
Total HTML
Share statistics
array:24 [ "pii" => "S0300289615002549" "issn" => "03002896" "doi" => "10.1016/j.arbres.2015.06.004" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1214" "copyright" => "SEPAR" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:229" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5071 "formatos" => array:3 [ "EPUB" => 122 "HTML" => 4030 "PDF" => 919 ] ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S1579212916000288" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.02.003" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1214" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:229" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1676 "formatos" => array:3 [ "EPUB" => 120 "HTML" => 1088 "PDF" => 468 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease: Some Considerations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "229" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Corticoides inhalados en enfermedad pulmonar obstructiva crónica: algunas consideraciones" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Adolfo Baloira Villar, Marta Núñez Fernández, Abel Pallarés Sanmartín" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Adolfo" "apellidos" => "Baloira Villar" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Núñez Fernández" ] 2 => array:2 [ "nombre" => "Abel" "apellidos" => "Pallarés Sanmartín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289615002549" "doi" => "10.1016/j.arbres.2015.06.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615002549?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000288?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000004/v2_201604010234/S1579212916000288/v2_201604010234/en/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S0300289615003671" "issn" => "03002896" "doi" => "10.1016/j.arbres.2015.08.008" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1253" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2016;52:227-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3135 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 2274 "PDF" => 742 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Rinoconjuntivitis y asma ocupacional en una trabajadora de una fábrica de muebles" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "227" "paginaFinal" => "228" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Rhinoconjunctivitis and occupational asthma in a furniture factory worker" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 784 "Ancho" => 1646 "Tamanyo" => 101549 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Prueba de provocación bronquial con harina de centeno.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elisa Gómez-Torrijos, Yesica Mendez Núñez, Rosa García Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elisa" "apellidos" => "Gómez-Torrijos" ] 1 => array:2 [ "nombre" => "Yesica" "apellidos" => "Mendez Núñez" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "García Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212915003298" "doi" => "10.1016/j.arbr.2015.10.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003298?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615003671?idApp=UINPBA00003Z" "url" => "/03002896/0000005200000004/v1_201603270531/S0300289615003671/v1_201603270531/es/main.assets" ] "asociados" => array:2 [ 0 => array:18 [ "pii" => "S0300289614004323" "issn" => "03002896" "doi" => "10.1016/j.arbres.2014.11.001" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1072" "copyright" => "SEPAR" "documento" => "article" "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2015;51:193-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 12095 "formatos" => array:3 [ "EPUB" => 139 "HTML" => 9235 "PDF" => 2721 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo especial</span>" "titulo" => "Documento de consenso «Uso adecuado de los corticoides inhalados en la enfermedad pulmonar obstructiva crónica»" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "193" "paginaFinal" => "198" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "«Correct Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease»: A Consensus Document" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bernardino Alcázar Navarrete, Ciro Casanova, Marc Miravitlles, Pilar de Lucas, Juan Antonio Riesco, José Miguel Rodríguez González-Moro" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Bernardino" "apellidos" => "Alcázar Navarrete" ] 1 => array:2 [ "nombre" => "Ciro" "apellidos" => "Casanova" ] 2 => array:2 [ "nombre" => "Marc" "apellidos" => "Miravitlles" ] 3 => array:2 [ "nombre" => "Pilar" "apellidos" => "de Lucas" ] 4 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Riesco" ] 5 => array:2 [ "nombre" => "José Miguel" "apellidos" => "Rodríguez González-Moro" ] 6 => array:1 [ "colaborador" => "en nombre del Grupo de Trabajo «Documento de consenso sobre el uso adecuado de los corticoides inhalados en la EPOC»" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212915000208" "doi" => "10.1016/j.arbr.2015.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000208?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614004323?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000004/v2_201503280455/S0300289614004323/v2_201503280455/es/main.assets" ] 1 => array:19 [ "pii" => "S0300289616301296" "issn" => "03002896" "doi" => "10.1016/j.arbres.2016.04.014" "estado" => "S300" "fechaPublicacion" => "2016-10-01" "aid" => "1390" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:540" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4085 "formatos" => array:3 [ "EPUB" => 109 "HTML" => 3182 "PDF" => 794 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Corticoides inhalados, eosinófilos y exacerbaciones de la enfermedad pulmonar obstructiva crónica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "540" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Inhaled corticosteroids, eosinophils and chronic obstructive pulmonary disease exacerbations" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Golpe, Irene Martín-Robles, Pilar Sanjuán-López" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "Golpe" ] 1 => array:2 [ "nombre" => "Irene" "apellidos" => "Martín-Robles" ] 2 => array:2 [ "nombre" => "Pilar" "apellidos" => "Sanjuán-López" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212916301707" "doi" => "10.1016/j.arbr.2016.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301707?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616301296?idApp=UINPBA00003Z" "url" => "/03002896/0000005200000010/v3_201609300128/S0300289616301296/v3_201609300128/es/main.assets" ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Corticoides inhalados en enfermedad pulmonar obstructiva crónica: algunas consideraciones" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Sr. Director:</span>" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "229" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Adolfo Baloira Villar, Marta Núñez Fernández, Abel Pallarés Sanmartín" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Adolfo" "apellidos" => "Baloira Villar" "email" => array:1 [ 0 => "adolfo.baloira.villar@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Núñez Fernández" ] 2 => array:2 [ "nombre" => "Abel" "apellidos" => "Pallarés Sanmartín" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Inhaled corticosteroids in chronic obstructive pulmonary disease: Some considerations" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemos leído con gran interés el documento de consenso sobre el uso de corticoides inhalados (CI) en enfermedad pulmonar obstructiva crónica (EPOC), publicado en la revista <span class="elsevierStyleSmallCaps">Archivos de Bronconeumología</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>, y nos gustaría hacer algunas consideraciones.</p><p id="par0010" class="elsevierStylePara elsevierViewall">El uso de corticoides inhalados en EPOC constituye un tema de debate, existiendo un buen número de trabajos tanto a favor como en contra. La principal indicación, que además alcanza un porcentaje de acuerdo del 100% en el documento de consenso, es el paciente con fenotipo mixto EPOC/asma, pero el problema es cómo definir este fenotipo<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>. Un diagnóstico previo de asma parece ser el mejor criterio. Ello implica asumir que ese diagnóstico es correcto, algo que posiblemente no sea cierto en algunos/bastantes casos.</p><p id="par0015" class="elsevierStylePara elsevierViewall">La presencia de exacerbaciones frecuentes es la otra indicación más aceptada. Diversas revisiones han puesto en duda la relevancia clínica que tiene para el paciente la modesta mejoría conseguida. Nos ha llamado la atención el significativo cambio entre la primera y segunda ronda de preguntas en el porcentaje de acuerdo sobre añadir un CI a un paciente con frecuentes exacerbaciones independientemente del valor del FEV<span class="elsevierStyleInf">1</span> (54 vs. 92%). Probablemente esto traduce las dudas de los participantes, incrementadas posiblemente por los estudios Withdrawal of Inhaled Steroids during Optimized Bronchodilator Management (WISDOM) e Indacaterol: Switching Nonexacerbating Patients with moderate COPD from Salmeterol/Fluticasone to Indacaterol (INSTEAD). Aunque el resultado final se toma como consenso, quizá un cambio tan marcado merecería una reflexión.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Otro aspecto reseñable es la falta de acuerdo en retirar CI en función de la presencia de eosinofilia. Existe evidencia creciente sobre el papel predictor de agudizaciones en la EPOC de una concentración elevada de eosinófilos sanguíneos. Un estudio reciente mostró que la reducción de exacerbaciones con fluticasona/vilanterol respecto a vilanterol solo era significativa cuando la eosinofilia sanguínea era ><span class="elsevierStyleHsp" style=""></span>2%, y se hacía mucho más evidente cuando superaba el 6%<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>. No parece que los integrantes del consenso estén muy seguros del efecto positivo de los CI en exacerbaciones de origen infeccioso, dado que el acuerdo fue del 37,5% en primera ronda y del 52% en segunda. Bafadhel et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>, indican que las agudizaciones no infecciosas tendrían como principal biomarcador la eosinofilia sanguínea, correlacionándose con la respuesta a los esteroides durante la agudización.</p><p id="par0025" class="elsevierStylePara elsevierViewall">En nuestra opinión, coincidiendo con Ernst et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>, actualmente el mejor marcador de respuesta favorable al tratamiento con CI en EPOC es la presencia de eosinofilia. Necesitamos más biomarcadores que permitan determinar que otros tipos de pacientes con esta enfermedad tan heterogénea podrían beneficiarse del tratamiento a largo plazo con CI.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso «Uso adecuado de los corticoides inhalados en la enfermedad pulmonar obstructiva crónica»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Alcázar Navarrete" 1 => "C. Casanova" 2 => "M. Miravitlles" 3 => "P. de Lucas" 4 => "J.A. Riesco" 5 => "J.M. Rodríguez González-Moro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2014.11.001" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2015" "volumen" => "51" "paginaInicial" => "193" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25540900" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The asthma COPD overlap syndrome (ACOS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Bujarski" 1 => "A.D. Parulekar" 2 => "A. Sharafkhaneh" 3 => "N.A. Hanania" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11882-014-0509-6" "Revista" => array:5 [ "tituloSerie" => "Curr Allergy Asthma Rep" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25712010" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: A secondary analysis of data from two parallel randomised controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Pascoe" 1 => "N. Locantore" 2 => "M.T. Dransfield" 3 => "N.C. Barnes" 4 => "I.D. Pavord" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2213-2600(15)00106-X" "Revista" => array:6 [ "tituloSerie" => "Lancet Respir Med" "fecha" => "2015" "volumen" => "3" "paginaInicial" => "435" "paginaFinal" => "442" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25878028" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute exacerbations of chronic obstructive pulmonary disease: Identification of biologic clusters and their biomarkers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Bafadhel" 1 => "S. McKenna" 2 => "S. Terry" 3 => "V. Mistry" 4 => "C. Reid" 5 => "P. Haldar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201104-0597OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "184" "paginaInicial" => "662" "paginaFinal" => "671" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21680942" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled corticosteroids in COPD: The clinical evidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Ernst" 1 => "N. Saad" 2 => "S. Suissa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00128914" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "525" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25537556" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000004/v1_201603270531/S0300289615002549/v1_201603270531/es/main.assets" "Apartado" => array:4 [ "identificador" => "49740" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Carta al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005200000004/v1_201603270531/S0300289615002549/v1_201603270531/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615002549?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 7 | 16 |
| 2024 October | 58 | 21 | 79 |
| 2024 September | 74 | 14 | 88 |
| 2024 August | 112 | 38 | 150 |
| 2024 July | 62 | 19 | 81 |
| 2024 June | 99 | 23 | 122 |
| 2024 May | 92 | 22 | 114 |
| 2024 April | 66 | 22 | 88 |
| 2024 March | 82 | 16 | 98 |
| 2024 February | 47 | 23 | 70 |
| 2023 March | 39 | 6 | 45 |
| 2023 February | 191 | 20 | 211 |
| 2023 January | 151 | 34 | 185 |
| 2022 December | 134 | 22 | 156 |
| 2022 November | 233 | 46 | 279 |
| 2022 October | 234 | 36 | 270 |
| 2022 September | 218 | 36 | 254 |
| 2022 August | 211 | 49 | 260 |
| 2022 July | 188 | 53 | 241 |
| 2022 June | 146 | 40 | 186 |
| 2022 May | 165 | 41 | 206 |
| 2022 April | 144 | 65 | 209 |
| 2022 March | 167 | 48 | 215 |
| 2022 February | 144 | 32 | 176 |
| 2022 January | 130 | 43 | 173 |
| 2021 December | 136 | 41 | 177 |
| 2021 November | 155 | 53 | 208 |
| 2021 October | 165 | 55 | 220 |
| 2021 September | 136 | 55 | 191 |
| 2021 August | 98 | 45 | 143 |
| 2021 July | 113 | 31 | 144 |
| 2021 June | 157 | 51 | 208 |
| 2021 May | 172 | 49 | 221 |
| 2021 April | 362 | 179 | 541 |
| 2021 March | 273 | 41 | 314 |
| 2021 February | 207 | 33 | 240 |
| 2021 January | 187 | 30 | 217 |
| 2020 December | 156 | 40 | 196 |
| 2020 November | 122 | 25 | 147 |
| 2020 October | 175 | 37 | 212 |
| 2020 September | 182 | 32 | 214 |
| 2020 August | 146 | 31 | 177 |
| 2020 July | 143 | 29 | 172 |
| 2020 June | 121 | 20 | 141 |
| 2020 May | 119 | 29 | 148 |
| 2020 April | 130 | 26 | 156 |
| 2020 March | 135 | 22 | 157 |
| 2020 February | 134 | 28 | 162 |
| 2020 January | 164 | 21 | 185 |
| 2019 December | 139 | 24 | 163 |
| 2019 November | 154 | 28 | 182 |
| 2019 October | 152 | 21 | 173 |
| 2019 September | 181 | 24 | 205 |
| 2019 August | 119 | 20 | 139 |
| 2019 July | 134 | 29 | 163 |
| 2019 June | 123 | 17 | 140 |
| 2019 May | 156 | 35 | 191 |
| 2019 April | 89 | 28 | 117 |
| 2019 March | 175 | 29 | 204 |
| 2019 February | 67 | 18 | 85 |
| 2019 January | 70 | 25 | 95 |
| 2018 December | 68 | 24 | 92 |
| 2018 November | 77 | 32 | 109 |
| 2018 October | 100 | 23 | 123 |
| 2018 September | 57 | 14 | 71 |
| 2018 August | 1 | 0 | 1 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 37 | 2 | 39 |
| 2018 April | 76 | 11 | 87 |
| 2018 March | 68 | 6 | 74 |
| 2018 February | 80 | 10 | 90 |
| 2018 January | 89 | 7 | 96 |
| 2017 December | 116 | 8 | 124 |
| 2017 November | 99 | 12 | 111 |
| 2017 October | 48 | 9 | 57 |
| 2017 September | 49 | 11 | 60 |
| 2017 August | 42 | 16 | 58 |
| 2017 July | 49 | 12 | 61 |
| 2017 June | 58 | 17 | 75 |
| 2017 May | 54 | 13 | 67 |
| 2017 April | 59 | 14 | 73 |
| 2017 March | 42 | 15 | 57 |
| 2017 February | 34 | 15 | 49 |
| 2017 January | 47 | 10 | 57 |
| 2016 December | 34 | 23 | 57 |
| 2016 November | 79 | 39 | 118 |
| 2016 October | 83 | 35 | 118 |
| 2016 September | 69 | 31 | 100 |
| 2016 August | 87 | 27 | 114 |
| 2016 July | 114 | 36 | 150 |
| 2016 June | 5 | 0 | 5 |
| 2016 May | 14 | 7 | 21 |
| 2016 April | 303 | 50 | 353 |
| 2016 March | 43 | 37 | 80 |
| 2016 February | 8 | 8 | 16 |
| 2016 January | 4 | 4 | 8 |
| 2015 December | 5 | 6 | 11 |
| 2015 November | 16 | 0 | 16 |
| 2015 October | 9 | 1 | 10 |
Show all
