Original Articles
Attitudes Toward the Diagnosis of Chronic Obstructive Pulmonary Disease in Primary Care
M. Miravitllesa,
, C. de la Rozaa, K. Naberanb, M. Lambanc, E. Gobarttd, A. Martíne, K.R. Chapmanf
Corresponding author
marcm@clinic.ub.es
Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España
Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España
a Servicio de Neumología, Institut Clínic del Tórax, IDIBAPS, Hospital Clínic, Barcelona, Spain
b Grupo de Neumología de la Sociedad Catalana de Medicina de Familia, Spain
c Centro de Salud Rebolería, Zaragoza, Spain
d Departamento Médico, Boehringer Ingelheim, Spain
e Departamento Médico, Pfizer, Spain
f Division of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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"apellidos" => "Miravitlles" "email" => array:1 [ 0 => "marcm@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "de la Roza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "K." "apellidos" => "Naberan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Lamban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 4 => array:3 [ "nombre" => "E." 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"apellidos" => "Chapman" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff6" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Institut Clínic del Tórax, IDIBAPS, Hospital Clínic, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Grupo de Neumología de la Sociedad Catalana de Medicina de Familia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Centro de Salud Rebolería, Zaragoza, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento Médico, Boehringer Ingelheim, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Departamento Médico, Pfizer, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] 5 => array:3 [ "entidad" => "Division of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff6" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-02-07" "fechaAceptado" => "2005-05-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154166" "palabras" => array:5 [ 0 => "COPD" 1 => "Diagnosis" 2 => "Sex" 3 => "Primary care" 4 => "Spirometry" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154165" "palabras" => array:5 [ 0 => "EPOC" 1 => "Diagnóstico" 2 => "Sexo" 3 => "Atención primaria" 4 => "Espirometría" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Although the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results.</p> <span class="elsevierStyleSectionTitle">Method</span><p class="elsevierStyleSimplePara elsevierViewall">A representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">COPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">There is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) ha aumentado en el sexo feme-nino, pero aún se considera una enfermedad que afecta so-bre todo a los varones. Este estudio pretendió identificar las actitudes diagnósticas de los médicos de atención primaria frente a pacientes con EPOC según su sexo y los resultados de la espirometría.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Participó en el estudio una muestra representa-tiva de 839 médicos de atención primaria. Cada uno de ellos resolvió uno entre 8 casos posibles de pacientes con EPOC. La mitad de éstos correspondía a un paciente varón y la otra mitad a una mujer con historia clínica y exploración fí-sica idénticas. Tras la historia y la exploración física se soli-citó a los participantes un diagnóstico provisional, así como las pruebas diagnósticas necesarias. Se facilitaron después los resultados de la espirometría que mostraban una obstrucción de carácter moderado o grave. Los resultados ne-gativos de una prueba broncodilatadora y de una prueba con corticoides orales se dieron a continuación.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La EPOC fue un diagnóstico provisional más probable para los pacientes varones que para las muje-res (<span class="elsevierStyleItalic">odds ratio</span> [OR]: 1,55; intervalo de confianza [IC] del 95%, 1,15-2,1). Este sesgo desaparecía después de mostrar los resultados anormales de la espirometría. Los pacientes con una obstrucción de carácter grave eran diagnosticados con mayor probabilidad de EPOC que aquellos con una obstrucción moderada OR: 1,5; IC del 95%, 1,08-2,09).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Existe un sesgo diagnóstico en función del sexo del paciente. En muchas ocasiones no se diagnostica a los pacientes con EPOC que presentan una obstrucción moderada. Estos sesgos podrían comprometer el diagnóstico precoz de la EPOC en un grupo cada vez más frecuente de individuos en riesgo.</p>" ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">This study was funded by Boehringer Ingelheim España and Pfizer España.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive lung disease deaths in the United States from 1979 through 1993. An analysis using multiple-cause mortality data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "DM Mannino" 1 => "C Brown" 2 => "GA Giovino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.156.3.9702026" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1997" "volumen" => "156" "paginaInicial" => "814" "paginaFinal" => "818" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9309998" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Costs of chronic bronchitis and COPD. A one year follow-up study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M Miravitlles" 1 => "C Murio" 2 => "T Guerrero" 3 => "R Gisbert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2003" "volumen" => "123" "paginaInicial" => "784" "paginaFinal" => "791" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12628879" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Costes de la EPOC en España. Estimación a partir de un estudio epidemiológico poblacional" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "JF Masa" 1 => "V Sobradillo" 2 => "C Villasante" 3 => "CA Jiménez-Ruiz" 4 => "L Fernández-Fau" 5 => "JL Viejo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "72" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14746730" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Economic impact of pulmonary drugs on direct costs of stable chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "JL Izquierdo Alonso" 1 => "J de Miguel Díez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Journal of COPD" "fecha" => "2004" "volumen" => "1" "paginaInicial" => "215" "paginaFinal" => "233" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacoeconomic evaluation of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "DE Hilleman" 1 => "N Dewan" 2 => "M Malesker" 3 => "M Friedman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2000" "volumen" => "118" "paginaInicial" => "1278" "paginaFinal" => "1285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11083675" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El coste de la enfermedad pulmonar obstructiva crónica en España. Opciones para una optimización de recursos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M Miravitlles" 1 => "M Figueras" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "388" "paginaFinal" => "393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11674939" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Geographical variations in prevalence and underdiagnosis of COPD. Results of the IBERPOC multicentre epidemiological study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V Sobradillo Peña" 1 => "M Miravitlles" 2 => "R Gabriel" 3 => "CA Jiménez-Ruiz" 4 => "C Villasante" 5 => "JF Masa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2000" "volumen" => "118" "paginaInicial" => "981" "paginaFinal" => "989" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11035667" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The health impact of undiagnosed airflow obstruction in a national sample of United States adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "DB Coultas" 1 => "D Mapel" 2 => "R Gagnon" 3 => "E Lydick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.164.3.2004029" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2001" "volumen" => "164" "paginaInicial" => "372" "paginaFinal" => "377" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11500335" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and treatment of chronic airways obstruction in adults over the age of 45" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "DS Renwick" 1 => "MJ Connolly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1996" "volumen" => "51" "paginaInicial" => "164" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8711649" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gender bias in the diagnosis of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "KR Chapman" 1 => "DP Tashkin" 2 => "DJ Pye" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2001" "volumen" => "119" "paginaInicial" => "1691" "paginaFinal" => "1695" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11399692" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio demográfico del tabaquismo en el Área de Salud 5 de Valencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R Peris Cardells" 1 => "I Rico Salvador" 2 => "P Herrera de Pablo" 3 => "A Pérez Jiménez" 4 => "F Sánchez-Toril López" 5 => "JA Pérez Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "160" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15030730" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease: are women more susceptible than men?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "KR Chapman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2004.01.003" "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "331" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15099893" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent trends in physician diagnosed COPD in women and men in the UK" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "JB Soriano" 1 => "WC Maier" 2 => "P Egger" 3 => "G Visick" 4 => "B Thakrar" 5 => "J Sykes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2000" "volumen" => "55" "paginaInicial" => "789" "paginaFinal" => "794" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10950900" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia y factores de riesgo de EPOC en fumadores y ex fumadores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "JI Jaen Díaz" 1 => "C de Castro Mesa" 2 => "MJ Gontan García-Salamanca" 3 => "F López de Castro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2003" "volumen" => "39" "paginaInicial" => "554" "paginaFinal" => "558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14636492" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Encuesta de la actitud terapéutica y de control de los médicos generales de las ABS de Barcelona, respecto a enfermedades obstructivas respiratorias" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C Naberan Toña" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "1994" "volumen" => "13" "paginaInicial" => "112" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8167246" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis. A prospective multicenter study in the community" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the DAFNE Study Group" "etal" => false "autores" => array:3 [ 0 => "M Miravitlles" 1 => "C Murio" 2 => "T Guerrero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2001" "volumen" => "17" "paginaInicial" => "928" "paginaFinal" => "933" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11488328" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fiabilidad del diagnóstico de la EPOC en atención primaria y neumología en España. Factores predictivos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J de Miguel Díez" 1 => "JL Izquierdo Alonso" 2 => "J Molina París" 3 => "JM Rodríguez González-Moro" 4 => "P de Lucas Ramos" 5 => "G Gaspar Alonso-Vega" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2003" "volumen" => "39" "paginaInicial" => "203" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12749802" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early detection of COPD in a high-risk population using spirometric screening" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J Zielinski" 1 => "M Bednarek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2001" "volumen" => "119" "paginaInicial" => "731" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11243950" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Office spirometry significantly improves early detection of COPD in General Practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J Buffels" 1 => "J Degryse" 2 => "J Heyrman" 3 => "M Decramer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "125" "paginaInicial" => "1394" "paginaFinal" => "1399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15078751" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Active detection of chronic obstructive pulmonary disease and asthma in the general population. Results and economic consequences of the DIMCA program" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G van den Boom" 1 => "CP van Schayck" 2 => "MP van Mollen" 3 => "PR Tirimanna" 4 => "JJ den Otter" 5 => "PM van Grunsven" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.158.6.9709003" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1998" "volumen" => "158" "paginaInicial" => "1730" "paginaFinal" => "1738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9847260" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desarrollo y resultados de un programa de cribado de la EPOC en atención primaria. El proyecto PADOC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "M Miravitlles" 1 => "I Fernández" 2 => "T Guerrero" 3 => "C Murio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2000" "volumen" => "36" "paginaInicial" => "500" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11116545" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La espirometría es un buen método para la detección y el seguimiento de la EPOC en fumadores de alto riesgo en atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J Clotet" 1 => "X Gómez-Arbones" 2 => "C Ciria" 3 => "JM Albalad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "155" "paginaFinal" => "159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15030729" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La espirometría en el domicilio del paciente: una tecnología al alcance de la mano" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J Giner" 1 => "P Casan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "39" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14718120" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of a population of COPD patients identified from a population-based study. Focus on previous diagnosis and never smokers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M Miravitlles" 1 => "M Ferrer" 2 => "A Pont" 3 => "JL Viejo" 4 => "JF Masa" 5 => "R Gabriel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2005.01.012" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2005" "volumen" => "99" "paginaInicial" => "985" "paginaFinal" => "995" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15950139" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease stage and health-related quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M Ferrer" 1 => "J Alonso" 2 => "J Morera" 3 => "RM Marrades" 4 => "A Khalaf" 5 => "C Aguar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1997" "volumen" => "127" "paginaInicial" => "1072" "paginaFinal" => "1079" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9412309" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway obstruction is common but unsuspected in patients admitted to a General Medicine Service" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D Zaas" 1 => "R Wise" 2 => "C Wiener" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "125" "paginaInicial" => "106" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14718428" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de las publicaciones sobre la EPOC en ARCHIVOS DE BRONCONEUMOLOGÍA 2 años des-pués de la designación del año EPOC" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S Díaz Lobato" 1 => "S Mayoralas Alises" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "575" "paginaFinal" => "579" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15574272" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004200000001/v1_201305150227/S1579212906601067/v1_201305150227/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004200000001/v1_201305150227/S1579212906601067/v1_201305150227/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906601067?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 29 | 17 | 46 |
| 2024 September | 32 | 22 | 54 |
| 2024 August | 51 | 35 | 86 |
| 2024 July | 24 | 21 | 45 |
| 2024 June | 38 | 35 | 73 |
| 2024 May | 44 | 34 | 78 |
| 2024 April | 32 | 27 | 59 |
| 2024 March | 29 | 15 | 44 |
| 2024 February | 18 | 24 | 42 |
| 2023 April | 1 | 0 | 1 |
| 2023 March | 4 | 2 | 6 |
| 2023 February | 14 | 18 | 32 |
| 2023 January | 19 | 45 | 64 |
| 2022 December | 27 | 25 | 52 |
| 2022 November | 26 | 23 | 49 |
| 2022 October | 37 | 43 | 80 |
| 2022 September | 13 | 27 | 40 |
| 2022 August | 27 | 43 | 70 |
| 2022 July | 24 | 48 | 72 |
| 2022 June | 22 | 29 | 51 |
| 2022 May | 24 | 38 | 62 |
| 2022 April | 26 | 25 | 51 |
| 2022 March | 18 | 38 | 56 |
| 2022 February | 22 | 30 | 52 |
| 2022 January | 13 | 30 | 43 |
| 2021 December | 15 | 50 | 65 |
| 2021 November | 20 | 41 | 61 |
| 2021 October | 18 | 40 | 58 |
| 2021 September | 12 | 42 | 54 |
| 2021 August | 9 | 22 | 31 |
| 2021 July | 12 | 24 | 36 |
| 2021 June | 8 | 23 | 31 |
| 2021 May | 15 | 31 | 46 |
| 2021 April | 13 | 35 | 48 |
| 2021 March | 6 | 23 | 29 |
| 2021 February | 8 | 14 | 22 |
| 2021 January | 9 | 19 | 28 |
| 2020 December | 11 | 9 | 20 |
| 2020 November | 6 | 12 | 18 |
| 2020 October | 14 | 12 | 26 |
| 2020 September | 4 | 10 | 14 |
| 2020 August | 7 | 7 | 14 |
| 2020 July | 6 | 14 | 20 |
| 2020 June | 8 | 3 | 11 |
| 2020 May | 17 | 13 | 30 |
| 2020 April | 13 | 9 | 22 |
| 2020 March | 14 | 15 | 29 |
| 2020 February | 12 | 7 | 19 |
| 2020 January | 12 | 11 | 23 |
| 2019 December | 13 | 16 | 29 |
| 2019 November | 3 | 5 | 8 |
| 2019 October | 4 | 12 | 16 |
| 2019 September | 11 | 15 | 26 |
| 2019 August | 10 | 3 | 13 |
| 2019 July | 46 | 14 | 60 |
| 2019 June | 44 | 7 | 51 |
| 2019 May | 47 | 10 | 57 |
| 2019 April | 15 | 28 | 43 |
| 2019 March | 7 | 22 | 29 |
| 2019 February | 13 | 11 | 24 |
| 2019 January | 3 | 11 | 14 |
| 2018 December | 6 | 20 | 26 |
| 2018 November | 11 | 15 | 26 |
| 2018 October | 24 | 14 | 38 |
| 2018 September | 12 | 15 | 27 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 4 | 8 | 12 |
| 2018 March | 2 | 3 | 5 |
| 2018 February | 7 | 6 | 13 |
| 2018 January | 6 | 6 | 12 |
| 2017 December | 6 | 6 | 12 |
| 2017 November | 4 | 2 | 6 |
| 2017 October | 5 | 13 | 18 |
| 2017 September | 4 | 1 | 5 |
| 2017 August | 8 | 10 | 18 |
| 2017 July | 2 | 2 | 4 |
| 2017 June | 5 | 13 | 18 |
| 2017 May | 6 | 11 | 17 |
| 2017 April | 3 | 4 | 7 |
| 2017 March | 3 | 5 | 8 |
| 2017 February | 1 | 6 | 7 |
| 2017 January | 1 | 5 | 6 |
| 2016 December | 4 | 8 | 12 |
| 2016 November | 5 | 6 | 11 |
| 2016 October | 9 | 9 | 18 |
| 2016 September | 9 | 11 | 20 |
| 2016 August | 6 | 5 | 11 |
| 2016 July | 7 | 0 | 7 |
| 2016 May | 1 | 0 | 1 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 49 | 1 | 50 |
| 2015 September | 51 | 40 | 91 |
| 2015 August | 47 | 9 | 56 |
| 2015 July | 47 | 7 | 54 |
| 2015 June | 30 | 7 | 37 |
| 2015 May | 49 | 9 | 58 |
| 2015 April | 57 | 8 | 65 |
| 2015 March | 49 | 14 | 63 |
| 2015 February | 47 | 8 | 55 |
| 2015 January | 54 | 6 | 60 |
| 2014 December | 57 | 7 | 64 |
| 2014 November | 49 | 7 | 56 |
| 2014 October | 75 | 11 | 86 |
| 2014 September | 55 | 12 | 67 |
| 2014 August | 50 | 11 | 61 |
| 2014 July | 48 | 9 | 57 |
| 2014 June | 54 | 10 | 64 |
| 2014 May | 48 | 7 | 55 |
| 2014 April | 59 | 10 | 69 |
| 2014 March | 74 | 8 | 82 |
| 2014 February | 72 | 12 | 84 |
| 2014 January | 47 | 5 | 52 |
| 2013 December | 68 | 7 | 75 |
| 2013 November | 51 | 6 | 57 |
| 2013 October | 36 | 12 | 48 |
| 2013 September | 39 | 7 | 46 |
| 2013 August | 56 | 14 | 70 |
| 2013 July | 50 | 14 | 64 |
| 2013 June | 41 | 6 | 47 |
| 2013 May | 31 | 4 | 35 |
| 2013 April | 29 | 5 | 34 |
| 2013 March | 12 | 2 | 14 |
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