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although it is estimated that these are low in industrialised countries and higher in developing countries&#46; Thus in the native Alaskan population&#44; the prevalence varies between 10 and 20&#47;1000 population&#44; while in the US it is calculated that it could be around 53 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Nevertheless&#44; various data are available that lead us to believe that its prevalence is continuing to rise as a result of transplants&#44; immunosuppressant treatment&#44; the human immunodeficiency virus &#40;HIV&#41; epidemic&#44; the return of tuberculosis&#44; a longer life expectancy and&#44; especially&#44; the chronic nature of respiratory diseases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Without question&#44; the reason for the higher number of BQ diagnoses is due to the introduction of high resolution computed tomography &#40;HRCT&#41;&#44; which has enabled the lung parenchyma to be viewed in more detail&#44; demonstrating that BQ is more common than expected and moreover&#44; the cylindrical forms are able to modify the prognosis of the diseases that generate them&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Quality of life studies in patients with BQ are important for determining their clinical status&#44; which sometimes differs from the lung function or radiological extension&#44; and for assessing the general response to treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> An improvement in the quality of life has been achieved in patients with BQ in recent years&#44; thanks to early diagnosis by HRCT&#44; a notable improvement in treatment&#44; respiratory physiotherapy and proper management of associated comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with chronic lung diseases often have symptoms of depression&#44; 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sex&#44; body mass index &#40;BMI&#41; and smoking habits were collected&#44; classifying the latter into non-smoker&#44; ex-smoker &#40;when the patient had not smoked for 1 year&#41; and active smoker&#46; The possible aetiologies of the BQ were established after performing the tests recommended in the diagnostic algorithm laid down in the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41; Bronchiectasis Guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The following were evaluated&#58; the Charlson comorbidity index&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> dyspnoea grade according to the Medical Research Council &#40;MRC&#41; scale&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> usual amount of expectoration in ml&#44; estimated by the patient in 24<span class="elsevierStyleHsp" style=""></span>h measured in&#58; teaspoon &#40;5<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; dessert spoon &#40;10<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; wine glass &#40;100<span class="elsevierStyleHsp" style=""></span>ml&#41; or water glass &#40;200<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; and the macroscopic appearance of the secretions&#44; classified into four grades&#58; mucous &#40;whitish&#41;&#44; mucopurulent &#40;light yellow&#41;&#44; purulent &#40;greenish&#41; and brownish&#46; The presence of haemoptysis &#8805;100<span class="elsevierStyleHsp" style=""></span>ml&#47;day and sinusitis &#40;defined by suggestive symptoms&#58; nasal blockage&#44; postnasal drip&#44; rhinorrhoea and local pain and&#47;or consistent findings on the paranasal sinus CT scan&#41; was assessed&#46; Lung function tests were carried out close to completion of the questionnaire&#44; using a spirometer &#40;Vmax Sensormedics&#41;&#46; BQ was classified by HRCT according to type &#40;cylindrical or cystic&#41; and extension of their location into&#58; localised&#44; if they affected a single lobe&#44; and diffuse&#44; if they affected more than four lobes &#40;assessing the lingula as an independent lobe&#41;&#44; unilateral&#44; if they were present in a single lung and bilateral&#44; if they were observed in both lungs&#46; Data were also collected on previous bacterial colonisation&#44; defined as the presence of the same microorganism in three consecutive samples with a minimum interval of one month&#44; and whether they received aerosol antibiotic treatment&#46; Respiratory exacerbations were evaluated&#44; defined as the need for antibiotic treatments due to an increase in respiratory symptoms&#44; and hospitalisation in the previous 2 years for this reason&#44; and whether they received any treatment for anxiety or depression&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients completed the following questionnaires voluntarily&#44; after having signed the informed consent form&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">-</span></span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Beck Depression Inventory &#40;BDI-II&#41;&#58;</span> this is a 21-item questionnaire used to evaluate the severity &#40;symptomatic intensity&#41; of depression&#46; For each item&#44; the patient has to select the answer that best reflects his or her state at the present time and during the past week&#46; The total score is obtained by adding the values of the selected phrases&#44; which range from 0 to 3&#46; The score obtained ranges from 0 to 63 points&#46; The commonly accepted cut-off points for grading the intensity&#47;severity are as follows&#58; 0&#8211;9&#58; no depression&#44; 10&#8211;18&#58; mild depression&#44; 19&#8211;29&#59; moderate depression and &#8805;30 points severe depression&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However&#44; higher cut-off points are recommended in patients with chronic disease&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Therefore&#44; we divided the patients into two groups&#58; &#8220;no symptoms of depression&#8221; &#40;&#60;14&#41; and &#8220;symptoms of depression&#8221; &#40;&#8805;14&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">State-Trait Anxiety Inventory &#40;STAI&#41;&#58;</span> this is a questionnaire composed of 20 items that assess &#8220;state anxiety&#8221; &#40;temporary emotional state influenced by environmental factors that protect from or generate anxiety&#41; and a further 20 items that evaluate &#8220;trait anxiety&#8221; &#40;personality factor that predisposes an individual to suffer from anxiety&#41;&#46; The score of both parts classifies patients into a percentile with respect to the general population&#46; The general population are classified by sex and age<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">St&#46; George&#39;s Respiratory Questionnaire &#40;SGRQ&#41;&#58;</span> this is a 50-item questionnaire &#40;76 levels&#41; divided into three components&#58; symptoms&#44; activity and impact&#46; The score for each of the scales and a total score are calculated&#46; The range of possible scores is between 0 &#40;no impairment in quality of life&#41; and 100 &#40;maximum impairment in quality of life&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">The patients were not assessed by Mental Health specialists&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical Analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Descriptive analysis of the quantitative variables was performed by calculating the means and standard deviations&#44; using the percentage for the qualitative variables&#46; The normality of the variables was verified using the Kolmogorov&#8211;Smirnov test&#59; non-parametric tests were used in the absence of a normal distribution&#46; Patient subgroups established by the psychological questionnaires were analysed &#40;state-trait anxiety percentiles and according to the cut-off point in depression&#41;&#46; The Chi-squared test was used for qualitative clinical variables and the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for comparison of means when two subgroups were compared&#44; using analysis of variance when there were more than two&#46; All calculations were performed using SPSS v&#46;15&#46;0&#59; <span class="elsevierStyleItalic">P</span> values &#60;&#46;05 were considered statistically significant in all cases&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Characteristics of Patients With Bronchiectasis</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the patient characteristics and quality of life scores&#46; With respect to the bronchiectasis aetiologies&#44; 22 were secondary to tuberculosis&#44; 6 to childhood infections&#44; 1 to immotile cilia disease&#44; 2 to immunoglobulin deficiency&#44; 1 to post-lung transplant&#44; and in 32 patients the cause could not be determined&#46; Eight patients had asthma and 4 had COPD&#46; Seventy-three percent &#40;73&#37;&#41; of patients had cough and dyspnoea&#46; With respect to chronic colonisation&#44; 21 patients were colonised&#44; 15 &#40;71&#46;4&#37;&#41; by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; 4 &#40;19&#37;&#41; by <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; 1 by <span class="elsevierStyleItalic">Moraxella catharralis</span> and 1 by <span class="elsevierStyleItalic">Staphylococcus aureus&#46;</span> Of the 21 patients with chronic colonisation&#44; 16 &#40;21&#46;6&#37;&#41; received inhaled antibiotic treatment&#46; Eleven patients received treatment for anxiety and 6 for depression&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Beck Depression Inventory</span><p id="par0075" class="elsevierStylePara elsevierViewall">After analysing the results of the Beck depression Inventory using a cut-off point of 14&#44; 34&#37; of patients had symptoms of depression &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">State-Trait Anxiety Inventory</span><p id="par0080" class="elsevierStylePara elsevierViewall">The results obtained in the STAI questionnaire showed that&#44; with respect to the general population&#44; 43 patients &#40;58&#46;1&#37;&#41; were above the 50th percentile for state anxiety&#44; and 42 patients &#40;56&#46;8&#37;&#41; for trait anxiety &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Twenty-one patients had symptoms of both anxiety and depression&#46; The scores in the questionnaires were related with the most significant clinical variables&#44; such as age&#44; sex&#44; dyspnoea&#44; cough&#44; amount of expectoration&#44; lung function&#44; localised or diffuse extension of the BQ&#44; chronic colonisation&#44; exacerbations and hospitalisations in the previous 2 years&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">State-trait Depression and Anxiety and Clinical Variables</span><p id="par0090" class="elsevierStylePara elsevierViewall">The amount of expectoration was significantly related with trait anxiety &#40;<span class="elsevierStyleItalic">P</span>&#61;0&#46;024&#41;&#46; A relationship was also found between anxiety &#40;state and trait&#41; and bacterial colonisation &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;037&#41;&#44; and specifically with colonisation by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;16&#41; and trait anxiety &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2&#44; 3 and 4</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The depression scores were related with sex&#44; with women being more affected&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">State-trait Depression and Anxiety and Quality of Life</span><p id="par0095" class="elsevierStylePara elsevierViewall">No relationship was found between the groups established by the psychological screening questionnaires and the quality of life scores &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Several studies have been published in recent years assessing psychological disorders in chronic respiratory diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> finding a high prevalence of anxiety and depression&#46; Similarly&#44; in patients with BQ&#44; although there are very few studies&#44; a higher prevalence of anxiety and depression has been observed compared to the general population&#46; The presence of psychological morbidity may be associated with poor treatment adherence<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and consequently&#44; worse disease control and a deterioration in the quality of life&#46; There is only one recently published study in Spain that includes a mixed population of patients with BQ &#40;CF and non-CF&#41;&#44; but with a lower median age &#40;32 years&#41; than patients we normally see in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Therefore&#44; we considered it interesting to explore the psychological morbidity exclusively in patients with non-CF BQ&#44; using two validated questionnaires in Spanish&#44; specific for screening depression and anxiety respectively&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There are few studies on this topic in the medical literature&#44; notwithstanding the previously cited study by Olveira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This study analysed the prevalence of anxiety and depression using the Hospital Anxiety and Depression Scale &#40;HADS&#41;&#44; and assessed the quality of life in patients with BQ &#40;with and without CF&#41;&#46; The authors reported that 20&#37; of patients had high scores for depression and 38&#37; for anxiety&#46; Age was related with symptoms of both anxiety and depression&#44; and anxiety was related with frequent exacerbations&#46; After controlling for confounding variables&#44; demographic &#40;age and sex&#41; and clinical &#40;exacerbations&#44; daily sputum production&#44; aetiology and spirometry values&#41;&#44; both depression and anxiety predicted worse quality of life&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Similarly&#44; the study by O&#8217;Leary et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> assessed anxiety and depression using the HADS and quality of life using the SGRQ in 111 patients with a mean age of 52 years&#46; The authors found moderate to severe anxiety in 17&#37; of cases and depression in 9&#37;&#44; relating both with the quality of life&#46; Neither anxiety nor depression was related with the extension of the BQ in the HRCT&#44; lung function&#44; PaO<span class="elsevierStyleInf">2</span> or sex&#46; Depression was related with dyspnoea&#44; physical and mental fatigue and exercise tolerance&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A Korean study conducted in outpatients&#44; 84 with COPD&#44; 33 with bronchiectasis and 7 with asthma&#44; evaluated using the same questionnaires as those used in our study &#40;BDI-II and STAI&#41;&#44; described 55&#37; depression in patients with BQ &#40;similar to COPD&#41; and 39&#37; anxiety &#40;higher than in COPD and asthmatic patients&#41;&#46; They concluded that BQ patients who were most affected by psychological symptoms were those with greater bronchial obstruction and a history of smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; it was observed that more than half the patients had scores above the 50th percentile for anxiety &#40;state and trait&#41;&#44; and one-third had depression&#46; Unlike other studies&#44; it was found only that the amount of expectoration and bacterial colonisation&#44; specifically for <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; was related with anxiety&#46; Women had higher scores for depression&#44; a finding that does not agree with the aforementioned studies&#44; although it is consistent with data found in the general population&#44; which describe a two or three times higher prevalence of depression in women&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> We did not find any relationship between quality of life and psychological morbidity&#46; Although patients with depression had higher scores&#44; they were not significant on any questionnaire&#46; This could be because patients did not have very high scores on the SGRQ and there could have been other factors such as age&#44; the obligation to have daily treatment&#44; as well as some aspects not considered&#44; like the civil status or social factors&#44; which may have caused the high prevalence of anxiety and depression&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">It is important to highlight the proportion of patients with symptoms of depression and anxiety in our study&#46; These differences could be partly due to the older age of the patients enrolled&#44; but mainly to the differences in sensitivity of the questionnaires&#44; as the HADS was used in previous studies while this one used the STAI and BDI-II&#46; Thus&#44; in the Korean study&#44; the percentages were closer to ours&#46; The BDI-II is more sensitive than the HADS&#44; as it evaluates a wide spectrum of depressive symptoms&#44; although as it includes not only symptoms in the cognitive sphere &#40;items 1&#8211;14&#41; but in the somatic sphere &#40;items 15&#8211;21&#41;&#44; these may overlap with those of the disease itself&#44; overestimating the prevalence of depression&#46; In order to avoid this&#44; we increased the cut-off point&#44; as recommended in the literature for chronically ill patients&#46; Similarly&#44; the STAI questionnaire provides more information than the HADS&#44; as its two sub-scales allow differentiation between temporary anxiety &#40;state&#41; and anxious personality &#40;trait&#41;&#46; In addition&#44; the patient characteristics or variables analysed were different&#44; which could likewise affect the difference in results&#46; Therefore&#44; studies are required with a larger number of patients using the same questionnaires to refine these differences&#46; It is clear that any psychological disorder can have consequences on therapeutic compliance&#44; and thus on the course of the disease&#44; so their diagnosis is very important&#46; Validated psychological screening questionnaires can help in routine clinical practice to select patients who should be referred to Mental Health specialists&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">There are somewhat more studies on psychological morbidity in BQ patients with CF&#44; which also show a high prevalence&#44; although on analysing the relationship with the clinical variables&#44; not all of the results agree&#44; as happened in our case&#46; While some find agreement between the exacerbations and anxiety&#44; not all show a relationship between lung function or extension of the lesions on HRCT with anxiety or depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">This study has some limitations&#58; the first is the number of patients enrolled and the second&#44; not having used&#44; in addition to the aforementioned questionnaires&#44; the HADS&#44; with which there is previous experience in patients with BQ&#46; The third limitation was not having referred all patients for formal psychological interviews and having been able to establish the sensitivity and specificity of the questionnaires&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We can conclude that there is a high prevalence of depression and anxiety in patients with non-cystic fibrosis bronchiectasis&#46; This disease should therefore be assessed for proper management and to prevent the consequences of psychological morbidity&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of Interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interests with respect to the present article&#46;</p></span></span>"
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            2 => "Depression"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with chronic bronchiectasis &#40;BQ&#41; may suffer from psychological disorders&#46; The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit&#44; using validated questionnaires&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We included patients consecutively diagnosed with BQ &#40;unrelated to cystic fibrosis&#41; by high resolution computed tomography in the study&#46; Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory&#44; State-Trait Anxiety Inventory and St&#46; George&#39;s Respiratory Questionnaire&#44; after signing the informed consent&#46; They were classified according to their scores on the psychological screening questionnaires&#44; and their results were compared with the clinical&#44; radiological and functional parameters and Quality of Life&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">70 patients were included&#44; 48 women and 22 men&#44; with a mean age of 64&#46;19 years&#46; Thirty-four percent &#40;34&#37;&#41; of patients showed symptoms of depression&#44; and around 55&#37; had scores above the 50th percentile in trait and state anxiety&#46; The amount of sputum was associated with trait anxiety&#46; Bacterial colonisation was related to anxiety &#40;trait and state&#41;&#44; especially <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> colonisation&#46; Female patients showed a higher risk of depression&#46; There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A high percentage of patients with BQ presented anxiety &#40;trait and state&#41; and depression&#46; The daily sputum production and bacterial colonisation &#40;especially with <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#41; were the variables most related to anxiety&#59; depression was more common in women&#46; We believe that the presence of psychological disorders should be evaluated&#44; especially in patients with this profile&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">los pacientes con bronquiectasias &#40;BQ&#41;&#44; como enfermos cr&#243;nicos&#44; pueden verse afectados por trastornos psicol&#243;gicos&#46; El objetivo del trabajo fue valorar la presencia de s&#237;ntomas de ansiedad y depresi&#243;n&#44; mediante cuestionarios validados&#44; en pacientes con BQ controlados en una Unidad Monogr&#225;fica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">de forma consecutiva se incluyeron en el estudio pacientes diagnosticados de BQ&#44; no relacionadas con fibrosis qu&#237;stica&#44; mediante una tomograf&#237;a axial computerizada de alta resoluci&#243;n&#46; Los enfermos estaban en fase estable en las &#250;ltimas 3 semanas y cumplimentaron los cuestionarios&#58; Inventario de depresi&#243;n de Beck&#44; Escala de ansiedad estado-rasgo y St George&#44; despu&#233;s de firmar el consentimiento informado&#46; Los pacientes fueron clasificados seg&#250;n las puntuaciones obtenidas en los cuestionarios de cribado psicol&#243;gico y sus resultados se compararon con las variables cl&#237;nicas&#44; radiol&#243;gicas y funcionales y las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">70 enfermos&#44; 48 de ellos mujeres y 22 hombres&#44; con una edad media de 64&#44;19 a&#241;os respondieron de forma voluntaria a los cuestionarios&#46; El 34&#37; de los pacientes mostraron s&#237;ntomas de depresi&#243;n y alrededor del 55&#37; puntuaciones por encima del percentil 50 en ansiedad &#40;rasgo y estado&#41;&#46; La cantidad de expectoraci&#243;n se relacion&#243; con la ansiedad rasgo&#46; La colonizaci&#243;n bacteriana se relacion&#243; con la ansiedad &#40;rasgo y estado&#41;&#44; especialmente la colonizaci&#243;n por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#46; El sexo femenino&#44; mostr&#243; mayor riego de depresi&#243;n&#46; No existi&#243; relaci&#243;n entre las clasificaciones establecidas de ansiedad y depresi&#243;n y las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">los pacientes con BQ muestran en un alto porcentaje presencia de s&#237;ntomas de ansiedad&#44; rasgo y estado&#44; as&#237; como de depresi&#243;n&#46; Los m&#225;s afectados por ansiedad son los m&#225;s expectoradores y los colonizados por bacterias&#44; y por depresi&#243;n las mujeres&#46; Creemos que es necesario valorar la presencia de psicomorbilidad asociada&#44; especialmente en este perfil de enfermos&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gir&#243;n Moreno RM&#44; et al&#46; Trastornos psicol&#243;gicos y calidad de vida en pacientes con bronquiectasias no relacionadas con fibrosis qu&#237;stica&#46; Arch Bronconeumol&#46; 2013&#59;49&#58;415&#8211;20&#46;</p>"
      ]
    ]
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        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient classification according to BDI&#46;</p>"
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        "etiqueta" => "Fig&#46; 2"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relationship state anxiety in colonisation by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#46;</p>"
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Adult females</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">State anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Trait anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">State anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Trait anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">P 75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P 85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">P 99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#46;2&#177;14&#46;22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&#47;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;85&#177;1&#46;25&nbsp;\t\t\t\t\t\t\n
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Original Article
Presence of Anxiety and Depression in Patients With Bronchiectasis Unrelated to Cystic Fibrosis
Trastornos psicológicos y calidad de vida en pacientes con bronquiectasias no relacionadas con fibrosis quística
Rosa María Girón Moreno
Corresponding author
rngiron@gmail.com

Corresponding author.
, Gilda Fernandes Vasconcelos, Carolina Cisneros, Rosa Mar Gómez-Punter, Gonzalo Segrelles Calvo, Julio Ancochea
Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
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although it is estimated that these are low in industrialised countries and higher in developing countries&#46; Thus in the native Alaskan population&#44; the prevalence varies between 10 and 20&#47;1000 population&#44; while in the US it is calculated that it could be around 53 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Nevertheless&#44; various data are available that lead us to believe that its prevalence is continuing to rise as a result of transplants&#44; immunosuppressant treatment&#44; the human immunodeficiency virus &#40;HIV&#41; epidemic&#44; the return of tuberculosis&#44; a longer life expectancy and&#44; especially&#44; the chronic nature of respiratory diseases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Without question&#44; the reason for the higher number of BQ diagnoses is due to the introduction of high resolution computed tomography &#40;HRCT&#41;&#44; which has enabled the lung parenchyma to be viewed in more detail&#44; demonstrating that BQ is more common than expected and moreover&#44; the cylindrical forms are able to modify the prognosis of the diseases that generate them&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Quality of life studies in patients with BQ are important for determining their clinical status&#44; which sometimes differs from the lung function or radiological extension&#44; and for assessing the general response to treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> An improvement in the quality of life has been achieved in patients with BQ in recent years&#44; thanks to early diagnosis by HRCT&#44; a notable improvement in treatment&#44; respiratory physiotherapy and proper management of associated comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with chronic lung diseases often have symptoms of depression&#44; anxiety or both&#44; causing deterioration in the quality of life&#44; social and recreational functioning and&#44; in some cases&#44; affecting therapeutic compliance&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Thus&#44; it is important to evaluate the patient&#39;s condition from a psychological point of view&#44; and to assess how these disorders could interfere in daily life&#46; Patients with BQ&#44; as chronically ill patients&#44; can also suffer from psychological disorders&#44; although there are few studies in this respect&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> As a working hypothesis&#44; we proposed that patients with non-cystic fibrosis bronchiectasis &#40;non-CF BQ&#41; could have a high prevalence of depression and anxiety&#44; and that these could be related with different clinical parameters&#46; The aim of this study was to assess the presence of anxiety and depression symptoms using psychological screening questionnaires&#44; 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teaspoon &#40;5<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; dessert spoon &#40;10<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; wine glass &#40;100<span class="elsevierStyleHsp" style=""></span>ml&#41; or water glass &#40;200<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; and the macroscopic appearance of the secretions&#44; classified into four grades&#58; mucous &#40;whitish&#41;&#44; mucopurulent &#40;light yellow&#41;&#44; purulent &#40;greenish&#41; and brownish&#46; The presence of haemoptysis &#8805;100<span class="elsevierStyleHsp" style=""></span>ml&#47;day and sinusitis &#40;defined by suggestive symptoms&#58; nasal blockage&#44; postnasal drip&#44; rhinorrhoea and local pain and&#47;or consistent findings on the paranasal sinus CT scan&#41; was assessed&#46; Lung function tests were carried out close to completion of the questionnaire&#44; using a spirometer &#40;Vmax Sensormedics&#41;&#46; BQ was classified by HRCT according to type &#40;cylindrical or cystic&#41; and extension of their location into&#58; localised&#44; if they affected a single lobe&#44; and diffuse&#44; if they affected more than four lobes &#40;assessing the lingula as an independent lobe&#41;&#44; unilateral&#44; if they were present in a single lung and bilateral&#44; if they were observed in both lungs&#46; Data were also collected on previous bacterial colonisation&#44; defined as the presence of the same microorganism in three consecutive samples with a minimum interval of one month&#44; and whether they received aerosol antibiotic treatment&#46; Respiratory exacerbations were evaluated&#44; defined as the need for antibiotic treatments due to an increase in respiratory symptoms&#44; and hospitalisation in the previous 2 years for this reason&#44; and whether they received any treatment for anxiety or depression&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients completed the following questionnaires voluntarily&#44; after having signed the informed consent form&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">-</span></span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Beck Depression Inventory &#40;BDI-II&#41;&#58;</span> this is a 21-item questionnaire used to evaluate the severity &#40;symptomatic intensity&#41; of depression&#46; For each item&#44; the patient has to select the answer that best reflects his or her state at the present time and during the past week&#46; The total score is obtained by adding the values of the selected phrases&#44; which range from 0 to 3&#46; The score obtained ranges from 0 to 63 points&#46; The commonly accepted cut-off points for grading the intensity&#47;severity are as follows&#58; 0&#8211;9&#58; no depression&#44; 10&#8211;18&#58; mild depression&#44; 19&#8211;29&#59; moderate depression and &#8805;30 points severe depression&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However&#44; higher cut-off points are recommended in patients with chronic disease&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Therefore&#44; we divided the patients into two groups&#58; &#8220;no symptoms of depression&#8221; &#40;&#60;14&#41; and &#8220;symptoms of depression&#8221; &#40;&#8805;14&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">State-Trait Anxiety Inventory &#40;STAI&#41;&#58;</span> this is a questionnaire composed of 20 items that assess &#8220;state anxiety&#8221; &#40;temporary emotional state influenced by environmental factors that protect from or generate anxiety&#41; and a further 20 items that evaluate &#8220;trait anxiety&#8221; &#40;personality factor that predisposes an individual to suffer from anxiety&#41;&#46; The score of both parts classifies patients into a percentile with respect to the general population&#46; The general population are classified by sex and age<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">St&#46; George&#39;s Respiratory Questionnaire &#40;SGRQ&#41;&#58;</span> this is a 50-item questionnaire &#40;76 levels&#41; divided into three components&#58; symptoms&#44; activity and impact&#46; The score for each of the scales and a total score are calculated&#46; The range of possible scores is between 0 &#40;no impairment in quality of life&#41; and 100 &#40;maximum impairment in quality of life&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">The patients were not assessed by Mental Health specialists&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical Analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Descriptive analysis of the quantitative variables was performed by calculating the means and standard deviations&#44; using the percentage for the qualitative variables&#46; The normality of the variables was verified using the Kolmogorov&#8211;Smirnov test&#59; non-parametric tests were used in the absence of a normal distribution&#46; Patient subgroups established by the psychological questionnaires were analysed &#40;state-trait anxiety percentiles and according to the cut-off point in depression&#41;&#46; The Chi-squared test was used for qualitative clinical variables and the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for comparison of means when two subgroups were compared&#44; using analysis of variance when there were more than two&#46; All calculations were performed using SPSS v&#46;15&#46;0&#59; <span class="elsevierStyleItalic">P</span> values &#60;&#46;05 were considered statistically significant in all cases&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Characteristics of Patients With Bronchiectasis</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the patient characteristics and quality of life scores&#46; With respect to the bronchiectasis aetiologies&#44; 22 were secondary to tuberculosis&#44; 6 to childhood infections&#44; 1 to immotile cilia disease&#44; 2 to immunoglobulin deficiency&#44; 1 to post-lung transplant&#44; and in 32 patients the cause could not be determined&#46; Eight patients had asthma and 4 had COPD&#46; Seventy-three percent &#40;73&#37;&#41; of patients had cough and dyspnoea&#46; With respect to chronic colonisation&#44; 21 patients were colonised&#44; 15 &#40;71&#46;4&#37;&#41; by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; 4 &#40;19&#37;&#41; by <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; 1 by <span class="elsevierStyleItalic">Moraxella catharralis</span> and 1 by <span class="elsevierStyleItalic">Staphylococcus aureus&#46;</span> Of the 21 patients with chronic colonisation&#44; 16 &#40;21&#46;6&#37;&#41; received inhaled antibiotic treatment&#46; Eleven patients received treatment for anxiety and 6 for depression&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Beck Depression Inventory</span><p id="par0075" class="elsevierStylePara elsevierViewall">After analysing the results of the Beck depression Inventory using a cut-off point of 14&#44; 34&#37; of patients had symptoms of depression &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">State-Trait Anxiety Inventory</span><p id="par0080" class="elsevierStylePara elsevierViewall">The results obtained in the STAI questionnaire showed that&#44; with respect to the general population&#44; 43 patients &#40;58&#46;1&#37;&#41; were above the 50th percentile for state anxiety&#44; and 42 patients &#40;56&#46;8&#37;&#41; for trait anxiety &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Twenty-one patients had symptoms of both anxiety and depression&#46; The scores in the questionnaires were related with the most significant clinical variables&#44; such as age&#44; sex&#44; dyspnoea&#44; cough&#44; amount of expectoration&#44; lung function&#44; localised or diffuse extension of the BQ&#44; chronic colonisation&#44; exacerbations and hospitalisations in the previous 2 years&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">State-trait Depression and Anxiety and Clinical Variables</span><p id="par0090" class="elsevierStylePara elsevierViewall">The amount of expectoration was significantly related with trait anxiety &#40;<span class="elsevierStyleItalic">P</span>&#61;0&#46;024&#41;&#46; A relationship was also found between anxiety &#40;state and trait&#41; and bacterial colonisation &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;037&#41;&#44; and specifically with colonisation by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;16&#41; and trait anxiety &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2&#44; 3 and 4</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The depression scores were related with sex&#44; with women being more affected&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">State-trait Depression and Anxiety and Quality of Life</span><p id="par0095" class="elsevierStylePara elsevierViewall">No relationship was found between the groups established by the psychological screening questionnaires and the quality of life scores &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Several studies have been published in recent years assessing psychological disorders in chronic respiratory diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> finding a high prevalence of anxiety and depression&#46; Similarly&#44; in patients with BQ&#44; although there are very few studies&#44; a higher prevalence of anxiety and depression has been observed compared to the general population&#46; The presence of psychological morbidity may be associated with poor treatment adherence<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and consequently&#44; worse disease control and a deterioration in the quality of life&#46; There is only one recently published study in Spain that includes a mixed population of patients with BQ &#40;CF and non-CF&#41;&#44; but with a lower median age &#40;32 years&#41; than patients we normally see in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Therefore&#44; we considered it interesting to explore the psychological morbidity exclusively in patients with non-CF BQ&#44; using two validated questionnaires in Spanish&#44; specific for screening depression and anxiety respectively&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There are few studies on this topic in the medical literature&#44; notwithstanding the previously cited study by Olveira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This study analysed the prevalence of anxiety and depression using the Hospital Anxiety and Depression Scale &#40;HADS&#41;&#44; and assessed the quality of life in patients with BQ &#40;with and without CF&#41;&#46; The authors reported that 20&#37; of patients had high scores for depression and 38&#37; for anxiety&#46; Age was related with symptoms of both anxiety and depression&#44; and anxiety was related with frequent exacerbations&#46; After controlling for confounding variables&#44; demographic &#40;age and sex&#41; and clinical &#40;exacerbations&#44; daily sputum production&#44; aetiology and spirometry values&#41;&#44; both depression and anxiety predicted worse quality of life&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Similarly&#44; the study by O&#8217;Leary et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> assessed anxiety and depression using the HADS and quality of life using the SGRQ in 111 patients with a mean age of 52 years&#46; The authors found moderate to severe anxiety in 17&#37; of cases and depression in 9&#37;&#44; relating both with the quality of life&#46; Neither anxiety nor depression was related with the extension of the BQ in the HRCT&#44; lung function&#44; PaO<span class="elsevierStyleInf">2</span> or sex&#46; Depression was related with dyspnoea&#44; physical and mental fatigue and exercise tolerance&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A Korean study conducted in outpatients&#44; 84 with COPD&#44; 33 with bronchiectasis and 7 with asthma&#44; evaluated using the same questionnaires as those used in our study &#40;BDI-II and STAI&#41;&#44; described 55&#37; depression in patients with BQ &#40;similar to COPD&#41; and 39&#37; anxiety &#40;higher than in COPD and asthmatic patients&#41;&#46; They concluded that BQ patients who were most affected by psychological symptoms were those with greater bronchial obstruction and a history of smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; it was observed that more than half the patients had scores above the 50th percentile for anxiety &#40;state and trait&#41;&#44; and one-third had depression&#46; Unlike other studies&#44; it was found only that the amount of expectoration and bacterial colonisation&#44; specifically for <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; was related with anxiety&#46; Women had higher scores for depression&#44; a finding that does not agree with the aforementioned studies&#44; although it is consistent with data found in the general population&#44; which describe a two or three times higher prevalence of depression in women&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> We did not find any relationship between quality of life and psychological morbidity&#46; Although patients with depression had higher scores&#44; they were not significant on any questionnaire&#46; This could be because patients did not have very high scores on the SGRQ and there could have been other factors such as age&#44; the obligation to have daily treatment&#44; as well as some aspects not considered&#44; like the civil status or social factors&#44; which may have caused the high prevalence of anxiety and depression&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">It is important to highlight the proportion of patients with symptoms of depression and anxiety in our study&#46; These differences could be partly due to the older age of the patients enrolled&#44; but mainly to the differences in sensitivity of the questionnaires&#44; as the HADS was used in previous studies while this one used the STAI and BDI-II&#46; Thus&#44; in the Korean study&#44; the percentages were closer to ours&#46; The BDI-II is more sensitive than the HADS&#44; as it evaluates a wide spectrum of depressive symptoms&#44; although as it includes not only symptoms in the cognitive sphere &#40;items 1&#8211;14&#41; but in the somatic sphere &#40;items 15&#8211;21&#41;&#44; these may overlap with those of the disease itself&#44; overestimating the prevalence of depression&#46; In order to avoid this&#44; we increased the cut-off point&#44; as recommended in the literature for chronically ill patients&#46; Similarly&#44; the STAI questionnaire provides more information than the HADS&#44; as its two sub-scales allow differentiation between temporary anxiety &#40;state&#41; and anxious personality &#40;trait&#41;&#46; In addition&#44; the patient characteristics or variables analysed were different&#44; which could likewise affect the difference in results&#46; Therefore&#44; studies are required with a larger number of patients using the same questionnaires to refine these differences&#46; It is clear that any psychological disorder can have consequences on therapeutic compliance&#44; and thus on the course of the disease&#44; so their diagnosis is very important&#46; Validated psychological screening questionnaires can help in routine clinical practice to select patients who should be referred to Mental Health specialists&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">There are somewhat more studies on psychological morbidity in BQ patients with CF&#44; which also show a high prevalence&#44; although on analysing the relationship with the clinical variables&#44; not all of the results agree&#44; as happened in our case&#46; While some find agreement between the exacerbations and anxiety&#44; not all show a relationship between lung function or extension of the lesions on HRCT with anxiety or depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">This study has some limitations&#58; the first is the number of patients enrolled and the second&#44; not having used&#44; in addition to the aforementioned questionnaires&#44; the HADS&#44; with which there is previous experience in patients with BQ&#46; The third limitation was not having referred all patients for formal psychological interviews and having been able to establish the sensitivity and specificity of the questionnaires&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We can conclude that there is a high prevalence of depression and anxiety in patients with non-cystic fibrosis bronchiectasis&#46; This disease should therefore be assessed for proper management and to prevent the consequences of psychological morbidity&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of Interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interests with respect to the present article&#46;</p></span></span>"
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              "titulo" => "Characteristics of Patients With Bronchiectasis"
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              "titulo" => "State-trait Depression and Anxiety and Quality of Life"
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            0 => "Cystic fibrosis"
            1 => "Anxiety"
            2 => "Depression"
            3 => "Health-related quality of life"
            4 => "<span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>"
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            0 => "Fibrosis qu&#237;stica"
            1 => "Ansiedad"
            2 => "Depresi&#243;n"
            3 => "Calidad de vida"
            4 => "<span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with chronic bronchiectasis &#40;BQ&#41; may suffer from psychological disorders&#46; The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit&#44; using validated questionnaires&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We included patients consecutively diagnosed with BQ &#40;unrelated to cystic fibrosis&#41; by high resolution computed tomography in the study&#46; Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory&#44; State-Trait Anxiety Inventory and St&#46; George&#39;s Respiratory Questionnaire&#44; after signing the informed consent&#46; They were classified according to their scores on the psychological screening questionnaires&#44; and their results were compared with the clinical&#44; radiological and functional parameters and Quality of Life&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">70 patients were included&#44; 48 women and 22 men&#44; with a mean age of 64&#46;19 years&#46; Thirty-four percent &#40;34&#37;&#41; of patients showed symptoms of depression&#44; and around 55&#37; had scores above the 50th percentile in trait and state anxiety&#46; The amount of sputum was associated with trait anxiety&#46; Bacterial colonisation was related to anxiety &#40;trait and state&#41;&#44; especially <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> colonisation&#46; Female patients showed a higher risk of depression&#46; There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A high percentage of patients with BQ presented anxiety &#40;trait and state&#41; and depression&#46; The daily sputum production and bacterial colonisation &#40;especially with <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#41; were the variables most related to anxiety&#59; depression was more common in women&#46; We believe that the presence of psychological disorders should be evaluated&#44; especially in patients with this profile&#46;</p>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">los pacientes con bronquiectasias &#40;BQ&#41;&#44; como enfermos cr&#243;nicos&#44; pueden verse afectados por trastornos psicol&#243;gicos&#46; El objetivo del trabajo fue valorar la presencia de s&#237;ntomas de ansiedad y depresi&#243;n&#44; mediante cuestionarios validados&#44; en pacientes con BQ controlados en una Unidad Monogr&#225;fica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">de forma consecutiva se incluyeron en el estudio pacientes diagnosticados de BQ&#44; no relacionadas con fibrosis qu&#237;stica&#44; mediante una tomograf&#237;a axial computerizada de alta resoluci&#243;n&#46; Los enfermos estaban en fase estable en las &#250;ltimas 3 semanas y cumplimentaron los cuestionarios&#58; Inventario de depresi&#243;n de Beck&#44; Escala de ansiedad estado-rasgo y St George&#44; despu&#233;s de firmar el consentimiento informado&#46; Los pacientes fueron clasificados seg&#250;n las puntuaciones obtenidas en los cuestionarios de cribado psicol&#243;gico y sus resultados se compararon con las variables cl&#237;nicas&#44; radiol&#243;gicas y funcionales y las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">70 enfermos&#44; 48 de ellos mujeres y 22 hombres&#44; con una edad media de 64&#44;19 a&#241;os respondieron de forma voluntaria a los cuestionarios&#46; El 34&#37; de los pacientes mostraron s&#237;ntomas de depresi&#243;n y alrededor del 55&#37; puntuaciones por encima del percentil 50 en ansiedad &#40;rasgo y estado&#41;&#46; La cantidad de expectoraci&#243;n se relacion&#243; con la ansiedad rasgo&#46; La colonizaci&#243;n bacteriana se relacion&#243; con la ansiedad &#40;rasgo y estado&#41;&#44; especialmente la colonizaci&#243;n por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#46; El sexo femenino&#44; mostr&#243; mayor riego de depresi&#243;n&#46; No existi&#243; relaci&#243;n entre las clasificaciones establecidas de ansiedad y depresi&#243;n y las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">los pacientes con BQ muestran en un alto porcentaje presencia de s&#237;ntomas de ansiedad&#44; rasgo y estado&#44; as&#237; como de depresi&#243;n&#46; Los m&#225;s afectados por ansiedad son los m&#225;s expectoradores y los colonizados por bacterias&#44; y por depresi&#243;n las mujeres&#46; Creemos que es necesario valorar la presencia de psicomorbilidad asociada&#44; especialmente en este perfil de enfermos&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gir&#243;n Moreno RM&#44; et al&#46; Trastornos psicol&#243;gicos y calidad de vida en pacientes con bronquiectasias no relacionadas con fibrosis qu&#237;stica&#46; Arch Bronconeumol&#46; 2013&#59;49&#58;415&#8211;20&#46;</p>"
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">State anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">State anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Trait anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P 75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P 85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P 99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#46;2&#177;14&#46;22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51&#47;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg</span>&#47;<span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup">2</span>&#41;<span class="elsevierStyleItalic">&#44; X</span>&#177;<span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#46;56&#177;3&#46;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">64&#46;9&#47;25&#46;7&#47;9&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Charlson Index&#44; X</span>&#177;<span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;85&#177;1&#46;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">MRC dyspnoea Grade 1&#47;Grade 2&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;30<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucous&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucopurulent&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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