Scientific letter
Incidence and Impact of Upper Airway Symptoms in Patients With Chronic Obstructive Pulmonary Disease
Frecuencia e impacto de los síntomas de las vías respiratorias superiores en pacientes con enfermedad pulmonar obstructiva crónica
Avi Kumar, Shekhar Kunal, Ashok Shah
Corresponding author
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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"apellidos" => "Shah" "email" => array:1 [ 0 => "ashokshah99@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Frecuencia e impacto de los síntomas de las vías respiratorias superiores en pacientes con enfermedad pulmonar obstructiva crónica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD), a condition largely caused by smoking, is usually adversely affected.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Associated comorbidities contribute to disease severity and lead to poorer QoL.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Over the last 15 years, awareness of nasal inflammation in COPD has increased,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> and the estimated prevalence of upper airway symptoms vary from 40% to 88%.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–6</span></a> The presence of upper airway symptoms negatively affects the already poor QoL.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5–9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study is to determine the incidence of upper airway symptoms in patients with COPD and its impact on QoL. Newly referred symptomatic smokers over 35 years of age with COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> were included. The incidence of upper airway symptoms was assessed on the basis of the Allergic Rhinitis and its Impact on Asthma<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> workshop report. The study variables were: respiratory symptoms, upper airway symptoms, spirometry with reversibility, peripheral blood eosinophil count, and computed tomography of paranasal sinuses (CT-PNS). CT-PNS was scored in accordance with the Lund-Mackay staging system.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> QoL in patients with upper airway symptoms was assessed using the St. George's Respiratory Questionnaire (SGRQ)<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> and Sino Nasal Outcome Test-22 (SNOT-22) questionnaire.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> Patients were divided into 2 groups: Group 1, COPD with upper airway symptoms; and Group 2, COPD without upper airway symptoms (controls). Radiological sinusitis was defined in accordance with the European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> along with CT-PNS findings. All patients gave their informed, written consent. The study was approved by the institutional research ethics committee. Data were analyzed using SPSS (version 11.5, SPSS, Inc., Chicago, IL). Chi-Square, Student's <span class="elsevierStyleItalic">t</span>-test and Pearson's correlation test were used for data analysis. A significance level of <span class="elsevierStyleItalic">P</span><.05 was accepted for all analysis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nearly two-thirds (27/41; 65.9%) of patients with COPD had upper airway symptoms (Group 1). These patients presented with higher peripheral blood eosinophilia, more severe lower airway obstruction, and an increased incidence of sinusitis on CT-PNS. They also reported a significantly poorer QoL on the SGRQ and SNOT-22 questionnaires (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In Group 1, patients with radiological sinusitis, moderate positive correlation was observed between CT-PNS (Lund-Mackay) and SNOT-22 QoL scores (<span class="elsevierStyleItalic">r</span>=0.58; <span class="elsevierStyleItalic">P</span>=.009). Furthermore, a positive correlation was observed between nasal symptoms based on SNOT-22 and more general SGRQ scores in these patients (<span class="elsevierStyleItalic">r</span>=0.41; <span class="elsevierStyleItalic">P</span>=.03).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The incidence of upper airway symptoms in different studies ranges from 40% to 88%.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–6</span></a> Three-quarters of the 61 patients with moderate-to-severe COPD from the East London COPD (ELCOPD) study cohort presented at least 1 nasal symptom.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> An inverse relationship was established between nasal patency in COPD and severity of airflow obstruction.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> In our series, patients with upper airway symptoms also presented with more severe lower airway obstruction.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Radiological sinusitis was documented in 19/27 (70.4%) Group 1 patients. QoL scores were consistent with findings from other studies.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,6–8</span></a> The ELCOPD study<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> reported a mean SNOT-20 score of 1.24, showing that nasal symptoms impaired QoL. The higher symptom, total SGRQ and SNOT-22 scores showed significantly poorer QoL in Group 1 patients, highlighting the adverse impact of upper airway symptoms in patients with COPD. A positive correlation was observed between SNOT-22 and total SGRQ scores in Group 1 patients, indicating a negative impact on overall QoL. In the 19 patients with sinusitis on CT-PNS in Group 1, CT-PNS scores showed a moderately strong positive correlation with SNOT-22 scores, which is consistent with a previous study.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> The small sample size in our study was a limitation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This study highlights the incidence and significant impact of upper airway symptoms on QoL in patients with COPD. It is therefore imperative to determine upper airway involvement in patients with COPD, as this may lead to suboptimal control of the disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study was funded by the <span class="elsevierStyleGrantSponsor" id="gs1">Vallabhbhai Patel Chest Institute, University of Delhi, Delhi</span>.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in one second; FVC: forced vital capacity; L: liters; L-M: Lund-Mackay; SD: standard deviation; SGRQ: St. George's Respiratory Questionnaire; SNOT-22: Sino Nasal Outcome Test-22.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Descriptor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">COPD patients with upper airway symptoms (Group 1)<br>(n=27) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">COPD patients without upper airway symptoms (Group 2)<br>(n=14) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years): mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.7±10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.9±11.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender male: n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (96.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (92.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of symptoms: mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.8±7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.3±6.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current smokers: n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of smoking (years): mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.2±11.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.4±11.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pack years of smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.48±25.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.07±32.77 (<span class="elsevierStyleItalic">P</span>=.257) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Absolute eosinophil count (cells/mm<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">335.03±301.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">149.92±66.17 (<span class="elsevierStyleItalic">P</span>=.02)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-bronchodilator FEV<span class="elsevierStyleInf">1</span> (L): mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.44±0.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.96±0.76 (<span class="elsevierStyleItalic">P</span>=.04)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-bronchodilator FEV<span class="elsevierStyleInf">1</span> (L): mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.53±0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.07±0.77 (<span class="elsevierStyleItalic">P</span>=.03)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-bronchodilator FVC (L): mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.81±0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.88 ±0.68 (<span class="elsevierStyleItalic">P</span>=.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-bronchodilator FVC (L): mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.91±0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.01±0.67 (<span class="elsevierStyleItalic">P</span>=.72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-bronchodilator FEV<span class="elsevierStyleInf">1</span>/FVC ratio: mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.8±13.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.7±8.7 (<span class="elsevierStyleItalic">P</span>=.64) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiological sinusitis/mucosal thickening on CT-PNS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/14 (<span class="elsevierStyleItalic">P</span>=.003)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CT-PNS (L-M) scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.19±2.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.29±0.61 (<span class="elsevierStyleItalic">P</span>=.02)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SNOT 22 score: mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.87±0.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.38±0.38 (<span class="elsevierStyleItalic">P</span>=.0001)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SGRQ symptoms: mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68.7±16.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.46±15.37 (<span class="elsevierStyleItalic">P</span>=.0005)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SGRQ activity: mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.9±18.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65.54±20.54 (<span class="elsevierStyleItalic">P</span>=.07) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SGRQ impact: mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.8±22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.8±13.23 (<span class="elsevierStyleItalic">P</span>=.22) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SGRQ total: mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.5±16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51.28±14.5 (<span class="elsevierStyleItalic">P</span>=.01)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1578151.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Significant difference.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient Demographics, Baseline Characteristics and Quality of Life Scores.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD); 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| Year/Month | Html | Total | |
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| 2024 November | 5 | 2 | 7 |
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| 2024 July | 55 | 20 | 75 |
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| 2024 May | 65 | 25 | 90 |
| 2024 April | 40 | 31 | 71 |
| 2024 March | 37 | 20 | 57 |
| 2024 February | 27 | 14 | 41 |
| 2023 March | 15 | 5 | 20 |
| 2023 February | 95 | 22 | 117 |
| 2023 January | 45 | 31 | 76 |
| 2022 December | 77 | 30 | 107 |
| 2022 November | 92 | 26 | 118 |
| 2022 October | 80 | 41 | 121 |
| 2022 September | 34 | 28 | 62 |
| 2022 August | 42 | 42 | 84 |
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| 2021 March | 55 | 24 | 79 |
| 2021 February | 55 | 26 | 81 |
| 2021 January | 36 | 15 | 51 |
| 2020 December | 41 | 22 | 63 |
| 2020 November | 33 | 21 | 54 |
| 2020 October | 37 | 34 | 71 |
| 2020 September | 29 | 7 | 36 |
| 2020 August | 34 | 15 | 49 |
| 2020 July | 45 | 23 | 68 |
| 2020 June | 35 | 18 | 53 |
| 2020 May | 35 | 12 | 47 |
| 2020 April | 37 | 12 | 49 |
| 2020 March | 35 | 18 | 53 |
| 2020 February | 50 | 13 | 63 |
| 2020 January | 28 | 21 | 49 |
| 2019 December | 29 | 10 | 39 |
| 2019 November | 30 | 17 | 47 |
| 2019 October | 13 | 13 | 26 |
| 2019 September | 19 | 9 | 28 |
| 2019 August | 25 | 12 | 37 |
| 2019 July | 22 | 15 | 37 |
| 2019 June | 22 | 17 | 39 |
| 2019 May | 50 | 9 | 59 |
| 2019 April | 18 | 26 | 44 |
| 2019 March | 36 | 20 | 56 |
| 2019 February | 34 | 20 | 54 |
| 2019 January | 20 | 14 | 34 |
| 2018 December | 30 | 19 | 49 |
| 2018 November | 39 | 25 | 64 |
| 2018 October | 70 | 19 | 89 |
| 2018 September | 42 | 9 | 51 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 14 | 1 | 15 |
| 2018 April | 27 | 12 | 39 |
| 2018 March | 35 | 13 | 48 |
| 2018 February | 34 | 19 | 53 |
| 2018 January | 0 | 1 | 1 |
| 2017 December | 3 | 0 | 3 |
| 2017 November | 19 | 7 | 26 |
| 2017 July | 0 | 1 | 1 |
Show all
