Classification of Chronic Obstructive Pulmonary Disease Severity According to the New Global Initiative for Chronic Obstructive Lung Disease 2011 Guidelines: COPD Assessment Test Versus Modified Medical Research Council Scale

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[ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1038 "Ancho" => 996 "Tamanyo" => 58584 ] ] "descripcion" => array:1 [ "en" => "Stent placement in superior vena cava (SVC) and left innominate vein. (A) Initial venogram obtained from the femoral access route with the catheter tip placed in the right internal jugular vein, showing occlusion of the SVC and bilateral innominate veins, widening and retrograde filling of the azygous vein (arrow) and collateral circulation (curved arrow). (B) Venogram obtained with left internal jugular vein access, showing occlusion of the right innominate vein (arrow), retrograde filling of the subclavian vein (arrowhead) and collateral circulation (curved arrow). (C) Final venogram after placement of two overlapping 18×60 and 20×60mm stents in the SVC and the innominate vein (arrow). Energetic filling of the pulmonary artery can be seen (arrowhead). Obstruction was overcome via a left jugular vein access route, guidewire with loop and stents inserted via the right femoral vein (through-and-through technique or flossing)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gonçalo Sobrinho, Pedro Aguiar" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gonçalo" "apellidos" => "Sobrinho" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Aguiar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613003396" "doi" => "10.1016/j.arbres.2013.10.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613003396?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914000718?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000004/v1_201404030045/S1579212914000718/v1_201404030045/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Classification of Chronic Obstructive Pulmonary Disease Severity According to the New Global Initiative for Chronic Obstructive Lung Disease 2011 Guidelines: COPD Assessment Test Versus Modified Medical Research Council Scale" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "129" "paginaFinal" => "134" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cristina Rieger-Reyes, Francisco Javier García-Tirado, Francisco Javier Rubio-Galán, José María Marín-Trigo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Cristina" "apellidos" => "Rieger-Reyes" "email" => array:1 [ 0 => "cris.rieger.reyes@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "García-Tirado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Rubio-Galán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "José María" "apellidos" => "Marín-Trigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Centro de Salud Torre Ramona, Unidad Docente de Medicina Familiar y Comunitaria, Sector II, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Clasificación de la gravedad de la enfermedad pulmonar obstructiva crónica según la nueva guía Iniciativa Global para la Enfermedad Obstructiva Crónica 2011: COPD Assessment Test versus modified Medical Research Council" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1306 "Ancho" => 1575 "Tamanyo" => 70482 ] ] "descripcion" => array:1 [ "en" => "Distribution of mMRC vs CAT. Spearman correlation index: ρ=0.613; P<.01." ] ] ] "textoCompleto" => "IntroductionChronic obstructive pulmonary disease (COPD) affects 9.1% of the Spanish adult population aged between 40 and 69 years and is one of the leading causes of death from non-communicable diseases worldwide.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> COPD management guidelines specify that diagnosis must include spirometry. This test classifies disease severity according to the percentage of FEV1 compared to the predicted value (FEV1%), and the treatment strategy is defined accordingly.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> However, this procedure correlates relatively poorly with patient mortality and symptomatology.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> A multidimensional evaluation that incorporates not only pulmonary function but also quantification of symptoms (e.g. dyspnea scales), the patient's nutritional status and exercise capacity, such as the BODE index,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> has contributed to a change in how this disease is perceived.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>The Global Initiative for Chronic Obstructive Lung Disease (GOLD 2011) revision proposes that patients are stratified according to disease severity, with the incorporation of symptoms determined with the modified Medical Research Council (mMRC) scale or the state of health using the COPD Assessment Test (CAT), as well as the patient's history of exacerbations and post-bronchodilator (pb) FEV1%.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Patients are classified according to risk: low risk (pbFEV1%≥50% or <2 exacerbations in the previous year) and high risk (pbFEV1%<50% or ≥2 exacerbations in the previous year). The risk index must be determined according to air flow limitation and history of exacerbations. Depending on the symptomatic impact, patients are classified as having less symptoms (CAT<10 or mMRC 0–1) or more symptoms (CAT≥10 or mMRC≥2). Thus, four categories are identified: A (low risk, less symptoms), B (low risk, more symptoms), C (high risk, less symptoms), D (high risk, more symptoms). The proposed therapeutic approach is different for each group<a class="elsevierStyleCrossRef" href="#bib0040">8</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The aim of this study was to determine from an observational study cohort (BODE Center, Zaragoza, Spain) if the choice of a symptoms scale (mMRC) or a questionnaire measuring quality of life (CAT) originates differences in the assignation to the various severity categories and the corresponding therapeutic implications.Patients and MethodsStudy DesignThe BODE Project is a multicenter observational study to evaluate the natural history of COPD. Patients were initially selected between 1996 and 2000 and have been followed up on an annual basis. The protocol and major health outcomes have been described previously.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Diagnosis of COPD was established according to the GOLD criteria<a class="elsevierStyleCrossRef" href="#bib0040">8</a>: pbFEV1%/FVC%<0.7, along with an accumulated tobacco use of >20 pack-years. Between January 2010 and September 2012, 283 new patients were evaluated in our center, and this latter study group was used for this analysis.ProceduresStandardized measurements in the BODE cohort included demographic data, clinical records and health and quality of life questionnaires, including the CAT and mMRC. Both assessments were administered on the same day and by the same interviewer for each patient.The CAT questionnaire is a self-administered tool for evaluating the quality of life of the COPD patient. It consists of 8 items, producing a score of 0–40; a higher score indicates a poorer state of health.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> The mMRC dyspnea scale is an instrument that establishes dyspnea severity in relation to various physical tasks. It consists of 5 items and is scored on a range of 0 (no dyspnea or only with strenuous exertion) to 4 (dyspnea at rest).<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Spirometry was performed before and 20–30min after inhalation of 200μg salbutamol according to a standardized procedure.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> All patients performed a 6-min walking test.Assignation of patients to the GOLD 2011 categories was established independently, using the mMRC scale (dyspnea) and the CAT scale (quality of life). The stratification rules specify that first the patient has to be stratified to groups A or C when mMRC is 0–1 or CAT score is <10, or to groups B or D when mMRC is ≥2 or CAT score is ≥10 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Then the patient's risk has to be established using one of the two procedures. With one procedure, patients with pbFEV1%≥50% are assigned to categories A or B (low risk) and patients with pbFEV1<50% are assigned to categories C or D (high risk). The other procedure consists of establishing the risk on the basis of exacerbations suffered by the patient during the year prior to the evaluation: patients with 0 or 1 exacerbation are stratified to groups A or B (low risk) and patients with ≥2 exacerbations are stratified to groups C or D (high risk). Exacerbations are defined as acute events characterized as a worsening of respiratory symptoms beyond normal day-to-day variations leading to a change in habitual medication.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> An exacerbation was defined as severe when the patient was seen in the emergency room or admitted to hospital. Data from previous exacerbations were obtained from questionnaires administered to the patients and from the databases of the intranet system of the Aragon Healthcare Service. To establish risk, the higher index between airflow limitation measured by pbFEV1% and exacerbation history was selected.Statistical AnalysisA descriptive analysis was made of the characteristics of the patients included in the series. Data on demographic and clinical variables, respiratory function tests and stress tests were analyzed. The patient cohort was classified into four categories, according to the GOLD 2011 criteria (A, B, C and D), using the CTA questionnaire, and, alternatively, the mMRC scale. The degree of concordance between the results obtained from the application of both methods to the same patient cohort was determined by calculating the weighted kappa (κ) index (agreement or concordance between ordinal qualitative diagnostic tests). The Spearman correlation (non-parametric estimator rho [ρ]) was calculated to evaluate the consistency between the two evaluation methods recorded in the ordinal qualitative scale. The ANOVA test was used to compare the means of the clinical and functional variables in the four GOLD 2011 categories, according to whether one or the other evaluation method was used for classifying the patients. Analyses were performed using SPSS 19.0® software.ResultsOf the 283 patients enrolled in the study, 260 (92%) were men and 23 (8%) were women. The mean age was 71±12 years. Main demographic, clinical and functional variables are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows these variables grouped by sex with an evaluation of any significant differences between the various parameters analyzed. In this visit, 70 (24.7%) patients were still active smokers. The mean pbFEV1% was 62.4±19.9%. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the distribution of patients according to their CAT and mMRC values; correlation was calculated with the Spearman coefficient ρ=0.613.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>When the CAT questionnaire was used for classifying patients according to the GOLD 2011 criteria, the percentage distribution of patients to the groups was the following: category A, 34.3%; category B, 19.4%; category C, 19.8%, and category D, 26.5%. When the mMRC was applied, the result was: category A, 36.4%; category B, 17.3%; category C, 18.0%, and category D, 28.3% (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>When the results from the application of both evaluation methods were examined, it was found that in category A, the classification of 81 patients coincided (83.5% of those classified using CAT and 78.6% of those classified with mMRC). In category B, the classification of 33 patients coincided (60% of those classified with CAT and 67.34% of those classified with mMRC). In category C, the classification of 34 patients coincided (60.7% of those classified with CAT and 66.7% of those classified with mMRC). In category D, the classification of 58 patients coincided (77.3% of those classified with CAT and 72.5% of those classified with mMRC) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).The κ coefficient for the classification of the patients using the 2 methods was 0.63, indicating a moderate degree of concordance. The calculated κ index was 0.44 for the 152 patients assigned to categories A and B (moderate-weak degree of concordance). The index for the 131 patients classified in categories C and D was 0.38, indicating an even poorer degree of concordance (weak). This implies that for low-risk categories (A and B), the concordance obtained was 75%, while for the high-risk categories (C and D), the concordance was 70%.The clinical and functional characteristics of the patients in each of the GOLD 2011 categories, depending on the method applied (CAT or mMRC), are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. There were no differences in the categories for age and body mass index (BMI) between patients classified by mMRC or CTA. Only the pack-year index (PYI) was significantly different between category D and the other categories, regardless of whether the classification was made by mMRC or CAT (P<.001). However, the walking test was different between the patients from groups A (fewer symptoms) and B (more symptoms) when classification was performed with mMRC (P<.01), while it was similar between these groups when they were classified using CAT. There were also much greater differences between groups C and D (both with high risk of exacerbations but fewer or more symptoms, respectively) in the walking test when the patients were classified with mMRC (P<.001) vs CAT (P=.003).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThe recent revision of the GOLD 2011 guidelines proposes that when classifying COPD patients, the medical community should take into consideration not only functional deterioration, but also symptoms and risk of exacerbations.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> To establish the degree of functional deterioration, it has been proposed that the same severity grades as those currently used be maintained, i.e., mild (pbFEV1%>80%), moderate (pbFEV1%≥80% and <50%), severe (pbFEV1%≥30% and <50%) and very severe (pbFEV1% <30%). The risk of exacerbation is determined by history of exacerbations in the year prior to the evaluation (<2 or ≥2, respectively). The guidelines leave the choice of method for determining symptoms up to the physician: either the mMRC modified dyspnea scale (few symptoms when mMRC is <2 and more symptoms when mMRC is ≥2) or the CAT quality of life questionnaire (low impact for CAT<10 and high impact for CAT≥10). Our results suggest that the use of one or the other evaluation method changes the assignation of a significant number of patients to one or another category of COPD severity according to the new GOLD guidelines. Thus, these evaluation methods cannot be taken as equivalent, as different treatment strategies are recommended for an individual patient, depending on the use of one or the other method.The CAT questionnaire reflects the effects of the disease on the patient's health. It is a specific quality of life questionnaire for COPD<a class="elsevierStyleCrossRefs" href="#bib0025">5,9,12,13</a> that evaluates not only dyspnea but also other respiratory symptoms, such as the presence and intensity of cough or sputum; it also has a total of 8 items, including exercise capacity, sleep and activities of daily life, producing a score of between 0 and 40. The CAT is a simple questionnaire and may be of use in standard clinical practice. It has proven to be valid for discriminating patient severity.<a class="elsevierStyleCrossRefs" href="#bib0045">9,12,14,15</a> However, it is not a diagnostic tool; its purpose is to complement information obtained from pulmonary function measurements and very little is known about its potential prognostic role.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> This questionnaire is particularly sensitive to the effect of changes in health status after exacerbations<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and the effect of respiratory rehabilitation.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> A recent review confirmed the validity of the CAT (among other specific questionnaires) as an instrument for measuring quality of life in COPD, when particularly compared to other generic tools. Unfortunately, this review did not analyze the validity of the role of the mMRC.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> The mMRC is a dyspnea scale that is easier to use, particularly in primary care,<a class="elsevierStyleCrossRef" href="#bib0090">18</a> and can be incorporated into multidimensional tools for the evaluation of COPD, such as BODE<a class="elsevierStyleCrossRef" href="#bib0030">6</a> and ADO (age, dyspnea, obstruction).<a class="elsevierStyleCrossRef" href="#bib0095">19</a> In addition, dyspnea correlates better with the quality of life of COPD patients than objective functional parameters.<a class="elsevierStyleCrossRefs" href="#bib0050">10,15</a> Clinical determination of dyspnea reveals the functional capacity of the patient and provides a measurement of the efficacy of the treatment,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> while correlating closely with 5-year survival in patients with COPD.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> It has also shown greater predictive capacity regarding the outcome of respiratory rehabilitation, irrespective of the degree of obstruction.<a class="elsevierStyleCrossRefs" href="#bib0030">6,18,21</a>There were no significant differences in age, BMI and FEV1 among patients in the A and B and C and D groups, whether they were classified with mMRC or CAT. However, the exercise capacity of patients in the B vs A and D vs C groups is lower when they are categorized using mMRC rather than CAT. This suggests that dyspnea is much more important than quality of life as a variable affecting the daily life of COPD patients.COPD patients included in our cohort have similar demographic, clinical and functional characteristics to those from other studies published in the literature, and the distribution of patients over the different categories is also similar.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> In our series, the correlation obtained between the use of the CAT or the mMRC was moderate (ρ=0.613) and similar to that of another cross-sectional cohort study.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> According to our results, the application of either CAT or mMRC for classifying patients to the new GOLD 2011 categories would mean a reclassification of patients in the low (A and B) and high-risk categories (C and D). The calculation of the concordance index depending on whether CAT or mMRC is applied is moderate-weak for the A-B categories (κ=0.44), and even weaker for the C-D categories (κ=0.38). In relative terms, this translates to a concordance of 75% in categories A and B and 70% in categories C and D. Thus, the use of these two evaluation methods is not equivalent, and more than 25% of patients are reclassified after use of one or the other method. This result impacts considerably on the treatment strategies for reclassified patients. The greatest differences in treatment are found among the categories A (the first-line drug treatment recommended is based on short-acting bronchodilators) and B (the first-line drug treatment recommended is based on long-acting bronchodilators and pulmonary rehabilitation). There were small differences between categories C and D, affecting only the alternative drug treatment options, while the recommendations for non-drug treatment are the same.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>A recent study that also compared the outcome of applying both evaluation methods similarly concluded that the new GOLD 2011 classification may need some adjustment. These authors propose a new cut-off point for the application of the mMRC scale (few symptoms=0; more symptoms≥1).<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Two more studies, also recent, carried out in South Korea and in the United States, in very different geographical and sociocultural environments that are unlike Spain, obtained results identical to our own, and drew similar conclusions. One of these studies analyzed 257 South Korean patients in a single center, and obtained results equivalent to our own.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> The other study was a multicenter study that included 4484 North American subjects with COPD, as part of the COPDGene study. They analyzed the results of applying mMRC or the SGRQ questionnaire (as a surrogate for CAT) and concluded similarly that the choice of one or the other tool for measuring symptoms influences the assignation of categories.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>In the latest GOLD 2013 revision, the evaluation of COPD patients has been augmented with the inclusion of the Clinical COPD Questionnaire (CCQ).<a class="elsevierStyleCrossRef" href="#bib0130">26</a> In the initial section of the revision, Methodology and Summary of New Recommendations, and further on in the section Symptom Evaluation, it is made clear that this is a self-administered questionnaire especially designed for measuring the clinical monitoring of COPD patients. The revision underlines that the data support the validity, reliability and sensitivity of this short and easily administered questionnaire. It specifies that on the basis of current knowledge, the cut-off point of CCQ=0–1 may be considered for classifying patients to groups A and C, and a result of CCQ>1 may be used to classify patients to groups B or D. However, the authors declare that more studies are required to validate the discriminative capacity and the practical implications of the CCQ in the detection of exacerbations in daily care. And then, subsequently, in the section on Combined COPD Evaluation, the same proposal for combined evaluation put forward in the GOLD 2011 guidelines, based only on CAT or mMRC for the symptomatic evaluation of the degree of COPD involvement, is maintained, with no explicit mention of the CCQ<a class="elsevierStyleCrossRef" href="#bib0130">26</a>The study presented here has certain limitations: the sample size is relatively small, although the majority of the studies on COPD measurement instruments have a similar or smaller number of patients.<a class="elsevierStyleCrossRefs" href="#bib0025">5,24</a> Furthermore, as this is not a cross-sectional study, the prognostic value of the results was not recorded. Nor was any correlation with comorbidities established between the different categories. Comorbidities presented by the patients may have a significant effect on disease prognosis, and should also be taken into account for the combined evaluation of COPD in any future revision of the GOLD guidelines.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>ConclusionsClassification of COPD patients into categories according to the combined evaluation proposed by the GOLD 2011 revision varies according to the evaluation method used in the symptomatic evaluation of patients (CAT or mMRC). More than 25% of patients in the different categories are reclassified if one or the other method is used, implying differences in the recommended treatment strategy. Longitudinal studies are needed to evaluate which assessment method best classifies the patient, with attention being paid to the prognostic capacity of such instruments.Conflict of InterestsThe authors declare that they have no conflict of interest in the preparation of this manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres327146" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Patients and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec308816" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres327145" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Pacientes y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec308815" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedures" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-07-07" "fechaAceptado" => "2013-09-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec308816" "palabras" => array:5 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Questionnaires" 2 => "Classification" 3 => "Concordance" 4 => "Correlation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec308815" "palabras" => array:5 [ 0 => "Enfermedad pulmonar obstructiva crónica" 1 => "Cuestionarios" 2 => "Categorización" 3 => "Concordancia" 4 => "Correlación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionThe GOLD 2011 revision proposes to stratify patients with chronic obstructive pulmonary disease (COPD) by measuring the impact of the disease using the modified Medical Research Council (mMRC) scale or COPD assessment test (CAT). Our aim was to determine whether both methods are equivalent. Patients and methodsObservational study on a cohort of 283 patients diagnosed with COPD. We analyzed the demographic and lung function results. Patients were assessed by CAT and mMRC on the same day by the same interviewer, and divided into GOLD 2011 categories according to the result of the evaluation. The degree of concordance and Spearman correlation were determined. We used ANOVA on the clinical and functional variables of the four GOLD 2011 categories. ResultsOn assessing the classification of patients according to the method used, an overall correlation of ρ=0.613 and a degree of concordance of κ=0.63 (moderate) were obtained. κ=0.44 was obtained for the 152 patients in categories A and B (moderate-low), and at 0.38 for the 131 patients in categories C and D (low). Differences were observed between the categories in terms of functional parameters. ConclusionsThe classification of patients with COPD using the assessment proposed by GOLD 2011 varies according to the method used (CAT or mMRC); more than 25% of patients were reclassified into different categories, implying differences in the recommended therapeutic strategy. Longitudinal studies are needed to appraise which method does better classification of the patients, according to its prognostic ability." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa revisión GOLD 2011 propone estratificar a los pacientes con EPOC midiendo la repercusión de la enfermedad mediante la escala mMRC o mediante el cuestionario CAT. Nuestro objetivo es conocer si la elección de un método u otro resulta equivalente. Pacientes y métodosEstudio observacional sobre una cohorte de 283 pacientes diagnosticados de EPOC. Se analizaron resultados demográficos, funcionales respiratorios y de evaluación mediante CAT y mMRC, aplicados el mismo día y por el mismo entrevistador a cada paciente. Se distribuyeron en categorías GOLD 2011 según el resultado de la evaluación y se determinó el grado de concordancia y la correlación de Spearman. Se utilizó el test de ANOVA sobre las variables clínicas y funcionales de las 4 categorías GOLD 2011. ResultadosAl evaluar la clasificación de pacientes según el método empleado, se obtuvo una correlación global ρ=0,613 y un grado de concordancia κ=0,63 (moderado). Se obtuvo κ=0,44 para los 152 pacientes de las categorías A y B (moderado-débil), y de 0,38 para los 131 pacientes de las categorías C y D (débil). Se apreciaron diferencias entre categorías en cuanto a parámetros funcionales. ConclusionesLa clasificación de los pacientes con EPOC según la evaluación propuesta por GOLD 2011 varía según se emplee CAT o mMRC; se reclasifica a más del 25% de pacientes en diferentes categorías, implicando diferencias en la estrategia terapéutica recomendada. Son necesarios estudios longitudinales que permitan valorar qué método clasifica mejor a los pacientes, atendiendo a su capacidad pronóstica." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Rieger-Reyes C, García-Tirado FJ, Rubio-Galán FJ, Marín-Trigo JM. Clasificación de la gravedad de la enfermedad pulmonar obstructiva crónica según la nueva guía Iniciativa Global para la Enfermedad Obstructiva Crónica 2011: COPD Assessment Test versus modified Medical Research Council. Arch Bronconeumol. 2014;50:129–134." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1552 "Ancho" => 2224 "Tamanyo" => 197047 ] ] "descripcion" => array:1 [ "en" => "GOLD 2011 categories and drug treatment (first recommendation) for each category." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1306 "Ancho" => 1575 "Tamanyo" => 70482 ] ] "descripcion" => array:1 [ "en" => "Distribution of mMRC vs CAT. Spearman correlation index: ρ=0.613; P<.01." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1164 "Ancho" => 2983 "Tamanyo" => 164427 ] ] "descripcion" => array:1 [ "en" => "Schematic of migration between GOLD categories depending on results of the application of CAT or mMRC (see distribution of data and explanatory note in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>)." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "FEV1%: forced expiratory volume in one second, percentage of predicted value; FVC: forced vital capacity; HT: hypertension; BMI: body mass index; PYI: pack-year index; pb: post-bronchodilator; PBD(+): positive bronchodilator test; SatO2: oxygen saturation." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \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">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">283 patients \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \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">Sex \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">260 (92%) males; 23 (8%) females \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Age \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71±12 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">BMI \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.5±4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Active smoker \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 patients (24.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">PYI \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.8±36.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Comorbidities \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HT: 152 patients (53.7%); dyslipidemia: 106 (37.5%); diabetes: 53 (18.7%); cardiovascular episodes: 124 (43.8%); no comorbidity: 48 (17%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFEV1% \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.4%±20.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">PBD(+) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 patients (11.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Baseline SatO2 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.9%±6.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Walking test \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">389.2m±96.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab478842.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \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">Spirometry results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \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">FVC \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">2.8l±0.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">FVC% \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">76.8%±19.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">FEV1 \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">1.6l±0.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">FEV1% \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">57.5%±19.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">FEV1/FVC \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">0.54±0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">FEV1/FVC% \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">0.74±0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFVC \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">3.07l±0.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFVC% \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">82.8%±19.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFEV1 \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">1.7l±0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFEV1% \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">62.4%±20.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFEV1/FVC \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">0.55±0.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFEV1/FVC % \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">0.75±17.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab478843.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic, Clinical and Functional Variables (Mean±Standard Deviation)." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "FEV1%: forced expiratory volume in one second, percentage of predicted value; BMI: body mass index; PYI: pack-year index; NS: not significant; pb: post-bronchodilator; PBD(+): positive bronchodilator test; SatO2: oxygen saturation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">Females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">P \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \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">n \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">260 (92%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (8%) \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Age \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.3 years±7.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.5 years±8.6 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS (P=.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">BMI \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6±4.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.3±7.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P<.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Active smoker \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (23.1%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (43.5%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P<.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">PYI \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.6±33.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.3±21 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P<.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pbFEV1% \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.9%±20.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.5%±21.8 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS (P<.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">PBD(+) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (11.1%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (17.4%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS (P=.36) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Baseline SatO2 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.3%±6.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.4%±2.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS (P<.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Walking test \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">390.1m±95.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">380.3m±111 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS (P<.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab478844.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic, Clinical and Functional Variables by Sex (Mean±Standard Deviation)." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Explanatory note: When the mMRC scale was applied, 103 patients were classified as A; of these, 22 were classified as B when the CAT questionnaire was applied. Similarly, when the CAT was applied, 97 patients were classified as A, but 16 of these were then classified as B using the mMRC. With the mMRC, 49 patients were classified as B, but 16 of these had been classified as A using the CAT; with the CAT, 55 patients were classified as B, but 22 of these had been classified as A with the mMRC. The same situation arose for categories C and D, depending on whether one questionnaire or the other was applied. There was no migration between AB and CD, as this depends on the risk criteria (AB: low risk; CD: high risk), as can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \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">GOLD CAT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="5" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GOLD mMRC</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">Total \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \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">A \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">81 \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">16 \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">0 \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">0 \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">97 (35%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">B \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">22 \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">33 \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">0 \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">0 \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">55 (19%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">C \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">0 \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">0 \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">34 \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">22 \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">56 (20%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">D \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">0 \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">0 \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">17 \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">58 \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">75 (26%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Total \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">103 (36%) \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">49 (17%) \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">51 (18%) \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">80 (29%) \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">283 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab478845.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Cohort GOLD 2011 Classification With CAT and mMRC (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>)." ] ] 6 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Values expressed as means for each category." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \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">mMRC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">CAT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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">D \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \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">Age \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">70.3 \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">70.5 \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">69.1 \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">72.3 \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">Age \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">71.3 \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">68.8 \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">70.1 \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">71.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">BMI \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">28.6 \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">29.1 \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">28.1 \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">28.2 \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">BMI \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">28.5 \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">29.3 \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">28.1 \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">28.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">PYI \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">58.4 \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">62.3 \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">55.7 \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">69.7<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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">PYI \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">58.35 \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">61.96 \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">55.40 \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">70.86<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">pb FEV1% \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">75.3 \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">69.1 \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">56.3 \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">44.5 \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">pb FEV1% \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">73.4 \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">73.1 \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">54.6 \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">45.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \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">Walking test \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">414 \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">364<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \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">417 \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">344<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \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">Walking test \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">400 \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">396 \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">400 \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">354<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab478841.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "P<.001 vs rest of categories." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "P<.01 vs category A." ] 2 => array:3 [ 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Miravitlles" 1 => "C. Llor" 2 => "R. Castellar" 3 => "I. Izquierdo" 4 => "E. Baró" 5 => "E. Donado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00087208" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2009" "volumen" => "33" "paginaInicial" => "519" "paginaFinal" => "527" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19164354" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current controversies. Future perspectives in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Agustí" 1 => "J. Vestbo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201103-0405PP" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "184" "paginaInicial" => "507" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21680951" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.F. Rabe" 1 => "S. Hurd" 2 => "A. Anzueto" 3 => "P.J. Barnes" 4 => "S.A. Buist" 5 => "P. Calverley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200703-456SO" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2007" "volumen" => "176" "paginaInicial" => "532" "paginaFinal" => "555" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17507545" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de Práctica Clínica para el Diagnóstico y Tratamiento de Pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) – Guía Española de la EPOC (GesEPOC)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Grupo de Trabajo de GesEPOC" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(12)70044-3" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2012" "volumen" => "48" "numero" => "Suppl. 1" "paginaInicial" => "2" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23116901" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of quality of life instruments for use in COPD care and research: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.W.M. Weldam" 1 => "M.J. Schuurmans" 2 => "R. Liu" 3 => "J.W.J. Lammers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijnurstu.2012.07.017" "Revista" => array:6 [ "tituloSerie" => "Int J Nurs Stud" "fecha" => "2013" "volumen" => "50" "paginaInicial" => "688" "paginaFinal" => "707" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22921317" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.R. Celli" 1 => "C.G. Cote" 2 => "J.M. Marín" 3 => "C. Casanova" 4 => "M. Montes de Oca" 5 => "R.A. Mendez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa021322" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "1005" "paginaFinal" => "1012" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14999112" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iniciativa GOLD 2011. ¿Cambio de paradigma?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Rodriguez-Roisin" 1 => "A. Agusti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.02.018" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2012" "volumen" => "48" "paginaInicial" => "286" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22537593" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0091674907020003" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: revised 2011. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Jan21.pdf">http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Jan21.pdf</a> [accessed 27.09.13]." ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and first validation of the COPD assessment test" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.W. Jones" 1 => "G. Harding" 2 => "P. Berry" 3 => "I. Wiklund" 4 => "W.-H. Chen" 5 => "N. Kline Leidy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00102509" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "648" "paginaFinal" => "654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19720809" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.C. Bestall" 1 => "E.A. Paul" 2 => "R. Garrod" 3 => "R. Garnham" 4 => "P.W. Jones" 5 => "J. Wedzicha" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "1999" "volumen" => "54" "paginaInicial" => "581" "paginaFinal" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10377201" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0091674909015346" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standardization of spirometry, 1994 update" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "American Thoracic Society" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.152.3.7663792" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1995" "volumen" => "152" "paginaInicial" => "1107" "paginaFinal" => "1136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7663792" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Creating scenarios of the impact of COPD and their relationship to COPD assessment test (CATTM) scores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.W. Jones" 1 => "M. Tabberer" 2 => "W.-H. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2466-11-42" "Revista" => array:5 [ "tituloSerie" => "BMC Pulm Med" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21835018" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessing Elath status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.G. Tsiligianni" 1 => "T. van der Molen" 2 => "D. Moraitaki" 3 => "I. López" 4 => "J.W.H. Kocks" 5 => "K. Karagiannis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2466-12-20" "Revista" => array:5 [ "tituloSerie" => "BMC Pulm Med" "fecha" => "2012" "volumen" => "12" "paginaInicial" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22607459" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COPD: functional status, health status and primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.W. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4104/pcrj.2011.00073" "Revista" => array:6 [ "tituloSerie" => "Prim Care Respir J" "fecha" => "2011" "volumen" => "20" "paginaInicial" => "227" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21808943" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Évaluation du COPD Assessment Test (CAT) chez des patients BPCO en état stable" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Marchand" 1 => "G. Maury" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmr.2011.09.043" "Revista" => array:6 [ "tituloSerie" => "Rev Mal Respir" "fecha" => "2012" "volumen" => "29" "paginaInicial" => "391" "paginaFinal" => "397" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22440303" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Properties of the COPD assessment test in a cross-sectional European study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.W. Jones" 1 => "G. Brusselle" 2 => "R.W. dal Negro" 3 => "M. Ferrer" 4 => "P. Kardos" 5 => "M.L. Levy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00177210" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2011" "volumen" => "38" "paginaInicial" => "29" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21565915" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Test of the responsiveness of the COPD assessment test following acute exacerbation and pulmonary rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.W. Jones" 1 => "G. Harding" 2 => "I. Wiklund" 3 => "P. Berry" 4 => "M. Tabberer" 5 => "R. Yu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-0309" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "142" "paginaInicial" => "134" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22281796" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional status measurement in COPD: a review of available methods and their feasibility in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.W.H. Kocks" 1 => "G.M. Asijee" 2 => "I.G. Tsiligianni" 3 => "H.A.M. Kerstjens" 4 => "T. van der Molen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4104/pcrj.2011.00031" "Revista" => array:6 [ "tituloSerie" => "Prim Care Respir J" "fecha" => "2011" "volumen" => "20" "paginaInicial" => "269" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21523316" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Puhan" 1 => "J. Garcia-Aymerich" 2 => "M. Frey" 3 => "G. Riet" 4 => "J.M. Antó" 5 => "A.G. Agustí" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61301-5" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "704" "paginaFinal" => "711" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19716962" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of clinical methods for rating dyspnea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Mahler" 1 => "C.K. Wells" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "1988" "volumen" => "93" "paginaInicial" => "80" "paginaFinal" => "86" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Nishimura" 1 => "T. Izumi" 2 => "M. Tsukino" 3 => "T. Oga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "121" "paginaInicial" => "1434" "paginaFinal" => "1440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12006425" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0091674900225347" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distribution and prognostic validity of the new GOLD grading classification" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.B. Soriano" 1 => "I. Alfageme" 2 => "P. Almagro" 3 => "C. Casanova" 4 => "C. Esteban" 5 => "J.J. Soler Cataluña" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.12-1053" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2013" "volumen" => "143" "paginaInicial" => "694" "paginaFinal" => "702" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23187891" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparisons of health status scores with mMRC grades in a primary care COPD population: Implications for the new GOLD 2011 classification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.W. Jones" 1 => "L. Adamek" 2 => "G. Nadeau" 3 => "N. 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Original Article

Classification of Chronic Obstructive Pulmonary Disease Severity According to the New Global Initiative for Chronic Obstructive Lung Disease 2011 Guidelines: COPD Assessment Test Versus Modified Medical Research Council Scale

Clasificación de la gravedad de la enfermedad pulmonar obstructiva crónica según la nueva guía Iniciativa Global para la Enfermedad Obstructiva Crónica 2011: COPD Assessment Test versus modified Medical Research Council

Cristina Rieger-Reyesa,

Corresponding author

cris.rieger.reyes@gmail.com

Corresponding author.

, Francisco Javier García-Tiradob, Francisco Javier Rubio-Galána, José María Marín-Trigoc

a Centro de Salud Torre Ramona, Unidad Docente de Medicina Familiar y Comunitaria, Sector II, Zaragoza, Spain

b Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, Spain

c Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; affects 9&#46;1&#37; of the Spanish adult population aged between 40 and 69 years and is one of the leading causes of death from non-communicable diseases worldwide&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> COPD management guidelines specify that diagnosis must include spirometry&#46; This test classifies disease severity according to the percentage of FEV<span class="elsevierStyleInf">1</span> compared to the predicted value &#40;FEV<span class="elsevierStyleInf">1</span>&#37;&#41;&#44; and the treatment strategy is defined accordingly&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; this procedure correlates relatively poorly with patient mortality and symptomatology&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A multidimensional evaluation that incorporates not only pulmonary function but also quantification of symptoms &#40;e&#46;g&#46; dyspnea scales&#41;&#44; the patient&#39;s nutritional status and exercise capacity&#44; such as the BODE index&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> has contributed to a change in how this disease is perceived&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD 2011&#41; revision proposes that patients are stratified according to disease severity&#44; with the incorporation of symptoms determined with the modified Medical Research Council &#40;mMRC&#41; scale or the state of health using the COPD Assessment Test &#40;CAT&#41;&#44; as well as the patient&#39;s history of exacerbations and post-bronchodilator &#40;pb&#41; FEV<span class="elsevierStyleInf">1</span>&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Patients are classified according to risk&#58; low risk &#40;pbFEV<span class="elsevierStyleInf">1</span>&#37;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50&#37; or &#60;2 exacerbations in the previous year&#41; and high risk &#40;pbFEV<span class="elsevierStyleInf">1</span>&#37;<span class="elsevierStyleHsp" style=""></span>&#60;50&#37; or &#8805;2 exacerbations in the previous year&#41;&#46; The risk index must be determined according to air flow limitation and history of exacerbations&#46; Depending on the symptomatic impact&#44; patients are classified as having <span class="elsevierStyleItalic">less symptoms</span> &#40;CAT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 or mMRC 0&#8211;1&#41; or <span class="elsevierStyleItalic">more symptoms</span> &#40;CAT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10 or mMRC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Thus&#44; four categories are identified&#58; A &#40;low risk&#44; less symptoms&#41;&#44; B &#40;low risk&#44; more symptoms&#41;&#44; C &#40;high risk&#44; less symptoms&#41;&#44; D &#40;high risk&#44; more symptoms&#41;&#46; The proposed therapeutic approach is different for each group<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to determine from an observational study cohort &#40;BODE Center&#44; Zaragoza&#44; Spain&#41; if the choice of a symptoms scale &#40;mMRC&#41; or a questionnaire measuring quality of life &#40;CAT&#41; originates differences in the assignation to the various severity categories and the corresponding therapeutic implications&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">The BODE Project is a multicenter observational study to evaluate the natural history of COPD&#46; Patients were initially selected between 1996 and 2000 and have been followed up on an annual basis&#46; The protocol and major health outcomes have been described previously&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Diagnosis of COPD was established according to the GOLD criteria<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#58; pbFEV<span class="elsevierStyleInf">1</span>&#37;&#47;FVC&#37;<span class="elsevierStyleHsp" style=""></span>&#60;0&#46;7&#44; along with an accumulated tobacco use of &#62;20 pack-years&#46; Between January 2010 and September 2012&#44; 283 new patients were evaluated in our center&#44; and this latter study group was used for this analysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedures</span><p id="par0025" class="elsevierStylePara elsevierViewall">Standardized measurements in the BODE cohort included demographic data&#44; clinical records and health and quality of life questionnaires&#44; including the CAT and mMRC&#46; Both assessments were administered on the same day and by the same interviewer for each patient&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The CAT questionnaire is a self-administered tool for evaluating the quality of life of the COPD patient&#46; It consists of 8 items&#44; producing a score of 0&#8211;40&#59; a higher score indicates a poorer state of health&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The mMRC dyspnea scale is an instrument that establishes dyspnea severity in relation to various physical tasks&#46; It consists of 5 items and is scored on a range of 0 &#40;no dyspnea or only with strenuous exertion&#41; to 4 &#40;dyspnea at rest&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Spirometry was performed before and 20&#8211;30<span class="elsevierStyleHsp" style=""></span>min after inhalation of 200<span class="elsevierStyleHsp" style=""></span>&#956;g salbutamol according to a standardized procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> All patients performed a 6-min walking test&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Assignation of patients to the GOLD 2011 categories was established independently&#44; using the mMRC scale &#40;dyspnea&#41; and the CAT scale &#40;quality of life&#41;&#46; The stratification rules specify that first the patient has to be stratified to groups A or C when mMRC is 0&#8211;1 or CAT score is &#60;10&#44; or to groups B or D when mMRC is &#8805;2 or CAT score is &#8805;10 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Then the patient&#39;s risk has to be established using one of the two procedures&#46; With one procedure&#44; patients with pbFEV<span class="elsevierStyleInf">1</span>&#37;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50&#37; are assigned to categories A or B &#40;low risk&#41; and patients with pbFEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;50&#37; are assigned to categories C or D &#40;high risk&#41;&#46; The other procedure consists of establishing the risk on the basis of exacerbations suffered by the patient during the year prior to the evaluation&#58; patients with 0 or 1 exacerbation are stratified to groups A or B &#40;low risk&#41; and patients with &#8805;2 exacerbations are stratified to groups C or D &#40;high risk&#41;&#46; Exacerbations are defined as acute events characterized as a worsening of respiratory symptoms beyond normal day-to-day variations leading to a change in habitual medication&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> An exacerbation was defined as severe when the patient was seen in the emergency room or admitted to hospital&#46; Data from previous exacerbations were obtained from questionnaires administered to the patients and from the databases of the intranet system of the Aragon Healthcare Service&#46; To establish risk&#44; the higher index between airflow limitation measured by pbFEV<span class="elsevierStyleInf">1</span>&#37; and exacerbation history was selected&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical Analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">A descriptive analysis was made of the characteristics of the patients included in the series&#46; Data on demographic and clinical variables&#44; respiratory function tests and stress tests were analyzed&#46; The patient cohort was classified into four categories&#44; according to the GOLD 2011 criteria &#40;A&#44; B&#44; C and D&#41;&#44; using the CTA questionnaire&#44; and&#44; alternatively&#44; the mMRC scale&#46; The degree of concordance between the results obtained from the application of both methods to the same patient cohort was determined by calculating the weighted kappa &#40;<span class="elsevierStyleItalic">&#954;</span>&#41; index &#40;agreement or concordance between ordinal qualitative diagnostic tests&#41;&#46; The Spearman correlation &#40;non-parametric estimator rho &#91;<span class="elsevierStyleItalic">&#961;</span>&#93;&#41; was calculated to evaluate the consistency between the two evaluation methods recorded in the ordinal qualitative scale&#46; The ANOVA test was used to compare the means of the clinical and functional variables in the four GOLD 2011 categories&#44; according to whether one or the other evaluation method was used for classifying the patients&#46; Analyses were performed using SPSS 19&#46;0<span class="elsevierStyleSup">&#174;</span> software&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 283 patients enrolled in the study&#44; 260 &#40;92&#37;&#41; were men and 23 &#40;8&#37;&#41; were women&#46; The mean age was 71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 years&#46; Main demographic&#44; clinical and functional variables are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows these variables grouped by sex with an evaluation of any significant differences between the various parameters analyzed&#46; In this visit&#44; 70 &#40;24&#46;7&#37;&#41; patients were still active smokers&#46; The mean pbFEV<span class="elsevierStyleInf">1</span>&#37; was 62&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;9&#37;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the distribution of patients according to their CAT and mMRC values&#59; correlation was calculated with the Spearman coefficient <span class="elsevierStyleItalic">&#961;</span>&#61;0&#46;613&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">When the CAT questionnaire was used for classifying patients according to the GOLD 2011 criteria&#44; the percentage distribution of patients to the groups was the following&#58; category A&#44; 34&#46;3&#37;&#59; category B&#44; 19&#46;4&#37;&#59; category C&#44; 19&#46;8&#37;&#44; and category D&#44; 26&#46;5&#37;&#46; When the mMRC was applied&#44; the result was&#58; category A&#44; 36&#46;4&#37;&#59; category B&#44; 17&#46;3&#37;&#59; category C&#44; 18&#46;0&#37;&#44; and category D&#44; 28&#46;3&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">When the results from the application of both evaluation methods were examined&#44; it was found that in category A&#44; the classification of 81 patients coincided &#40;83&#46;5&#37; of those classified using CAT and 78&#46;6&#37; of those classified with mMRC&#41;&#46; In category B&#44; the classification of 33 patients coincided &#40;60&#37; of those classified with CAT and 67&#46;34&#37; of those classified with mMRC&#41;&#46; In category C&#44; the classification of 34 patients coincided &#40;60&#46;7&#37; of those classified with CAT and 66&#46;7&#37; of those classified with mMRC&#41;&#46; In category D&#44; the classification of 58 patients coincided &#40;77&#46;3&#37; of those classified with CAT and 72&#46;5&#37; of those classified with mMRC&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">&#954;</span> coefficient for the classification of the patients using the 2 methods was 0&#46;63&#44; indicating a moderate degree of concordance&#46; The calculated <span class="elsevierStyleItalic">&#954;</span> index was 0&#46;44 for the 152 patients assigned to categories A and B &#40;moderate-weak degree of concordance&#41;&#46; The index for the 131 patients classified in categories C and D was 0&#46;38&#44; indicating an even poorer degree of concordance &#40;weak&#41;&#46; This implies that for low-risk categories &#40;A and B&#41;&#44; the concordance obtained was 75&#37;&#44; while for the high-risk categories &#40;C and D&#41;&#44; the concordance was 70&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The clinical and functional characteristics of the patients in each of the GOLD 2011 categories&#44; depending on the method applied &#40;CAT or mMRC&#41;&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; There were no differences in the categories for age and body mass index &#40;BMI&#41; between patients classified by mMRC or CTA&#46; Only the pack-year index &#40;PYI&#41; was significantly different between category D and the other categories&#44; regardless of whether the classification was made by mMRC or CAT &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; However&#44; the walking test was different between the patients from groups A &#40;fewer symptoms&#41; and B &#40;more symptoms&#41; when classification was performed with mMRC &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#44; while it was similar between these groups when they were classified using CAT&#46; There were also much greater differences between groups C and D &#40;both with high risk of exacerbations but fewer or more symptoms&#44; respectively&#41; in the walking test when the patients were classified with mMRC &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; vs CAT &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The recent revision of the GOLD 2011 guidelines proposes that when classifying COPD patients&#44; the medical community should take into consideration not only functional deterioration&#44; but also symptoms and risk of exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> To establish the degree of functional deterioration&#44; it has been proposed that the same severity grades as those currently used be maintained&#44; i&#46;e&#46;&#44; mild &#40;pbFEV<span class="elsevierStyleInf">1</span>&#37;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>80&#37;&#41;&#44; moderate &#40;pbFEV<span class="elsevierStyleInf">1</span>&#37;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>80&#37; and &#60;50&#37;&#41;&#44; severe &#40;pbFEV<span class="elsevierStyleInf">1</span>&#37;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30&#37; and &#60;50&#37;&#41; and very severe &#40;pbFEV<span class="elsevierStyleInf">1</span>&#37; &#60;<span class="elsevierStyleHsp" style=""></span>30&#37;&#41;&#46; The risk of exacerbation is determined by history of exacerbations in the year prior to the evaluation &#40;&#60;2 or &#8805;2&#44; respectively&#41;&#46; The guidelines leave the choice of method for determining symptoms up to the physician&#58; either the mMRC modified dyspnea scale &#40;few symptoms when mMRC is &#60;2 and more symptoms when mMRC is &#8805;2&#41; or the CAT quality of life questionnaire &#40;low impact for CAT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 and high impact for CAT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10&#41;&#46; Our results suggest that the use of one or the other evaluation method changes the assignation of a significant number of patients to one or another category of COPD severity according to the new GOLD guidelines&#46; Thus&#44; these evaluation methods cannot be taken as equivalent&#44; as different treatment strategies are recommended for an individual patient&#44; depending on the use of one or the other method&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The CAT questionnaire reflects the effects of the disease on the patient&#39;s health&#46; It is a specific quality of life questionnaire for COPD<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9&#44;12&#44;13</span></a> that evaluates not only dyspnea but also other respiratory symptoms&#44; such as the presence and intensity of cough or sputum&#59; it also has a total of 8 items&#44; including exercise capacity&#44; sleep and activities of daily life&#44; producing a score of between 0 and 40&#46; The CAT is a simple questionnaire and may be of use in standard clinical practice&#46; It has proven to be valid for discriminating patient severity&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12&#44;14&#44;15</span></a> However&#44; it is not a diagnostic tool&#59; its purpose is to complement information obtained from pulmonary function measurements and very little is known about its potential prognostic role&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This questionnaire is particularly sensitive to the effect of changes in health status after exacerbations<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and the effect of respiratory rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> A recent review confirmed the validity of the CAT &#40;among other specific questionnaires&#41; as an instrument for measuring quality of life in COPD&#44; when particularly compared to other generic tools&#46; Unfortunately&#44; this review did not analyze the validity of the role of the mMRC&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The mMRC is a dyspnea scale that is easier to use&#44; particularly in primary care&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and can be incorporated into multidimensional tools for the evaluation of COPD&#44; such as BODE<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and ADO &#40;age&#44; dyspnea&#44; obstruction&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In addition&#44; dyspnea correlates better with the quality of life of COPD patients than objective functional parameters&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;15</span></a> Clinical determination of dyspnea reveals the functional capacity of the patient and provides a measurement of the efficacy of the treatment&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> while correlating closely with 5-year survival in patients with COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It has also shown greater predictive capacity regarding the outcome of respiratory rehabilitation&#44; irrespective of the degree of obstruction&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;18&#44;21</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">There were no significant differences in age&#44; BMI and FEV<span class="elsevierStyleInf">1</span> among patients in the A and B and C and D groups&#44; whether they were classified with mMRC or CAT&#46; However&#44; the exercise capacity of patients in the B vs A and D vs C groups is lower when they are categorized using mMRC rather than CAT&#46; This suggests that dyspnea is much more important than quality of life as a variable affecting the daily life of COPD patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">COPD patients included in our cohort have similar demographic&#44; clinical and functional characteristics to those from other studies published in the literature&#44; and the distribution of patients over the different categories is also similar&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In our series&#44; the correlation obtained between the use of the CAT or the mMRC was moderate &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;613&#41; and similar to that of another cross-sectional cohort study&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> According to our results&#44; the application of either CAT or mMRC for classifying patients to the new GOLD 2011 categories would mean a reclassification of patients in the low &#40;A and B&#41; and high-risk categories &#40;C and D&#41;&#46; The calculation of the concordance index depending on whether CAT or mMRC is applied is moderate-weak for the A-B categories &#40;<span class="elsevierStyleItalic">&#954;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;44&#41;&#44; and even weaker for the C-D categories &#40;<span class="elsevierStyleItalic">&#954;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;38&#41;&#46; In relative terms&#44; this translates to a concordance of 75&#37; in categories A and B and 70&#37; in categories C and D&#46; Thus&#44; the use of these two evaluation methods is not equivalent&#44; and more than 25&#37; of patients are reclassified after use of one or the other method&#46; This result impacts considerably on the treatment strategies for reclassified patients&#46; The greatest differences in treatment are found among the categories A &#40;the first-line drug treatment recommended is based on short-acting bronchodilators&#41; and B &#40;the first-line drug treatment recommended is based on long-acting bronchodilators and pulmonary rehabilitation&#41;&#46; There were small differences between categories C and D&#44; affecting only the alternative drug treatment options&#44; while the recommendations for non-drug treatment are the same&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A recent study that also compared the outcome of applying both evaluation methods similarly concluded that the new GOLD 2011 classification may need some adjustment&#46; These authors propose a new cut-off point for the application of the mMRC scale &#40;few symptoms<span class="elsevierStyleHsp" style=""></span>&#61;0&#59; more symptoms<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Two more studies&#44; also recent&#44; carried out in South Korea and in the United States&#44; in very different geographical and sociocultural environments that are unlike Spain&#44; obtained results identical to our own&#44; and drew similar conclusions&#46; One of these studies analyzed 257 South Korean patients in a single center&#44; and obtained results equivalent to our own&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The other study was a multicenter study that included 4484 North American subjects with COPD&#44; as part of the COPDGene study&#46; They analyzed the results of applying mMRC or the SGRQ questionnaire &#40;as a surrogate for CAT&#41; and concluded similarly that the choice of one or the other tool for measuring symptoms influences the assignation of categories&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In the latest GOLD 2013 revision&#44; the evaluation of COPD patients has been augmented with the inclusion of the <span class="elsevierStyleItalic">Clinical COPD Questionnaire</span> &#40;CCQ&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In the initial section of the revision&#44; <span class="elsevierStyleItalic">Methodology and Summary of New Recommendations</span>&#44; and further on in the section <span class="elsevierStyleItalic">Symptom Evaluation</span>&#44; it is made clear that this is a self-administered questionnaire especially designed for measuring the clinical monitoring of COPD patients&#46; The revision underlines that the data support the validity&#44; reliability and sensitivity of this short and easily administered questionnaire&#46; It specifies that on the basis of current knowledge&#44; the cut-off point of CCQ<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#8211;1 may be considered for classifying patients to groups A and C&#44; and a result of CCQ<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1 may be used to classify patients to groups B or D&#46; However&#44; the authors declare that more studies are required to validate the discriminative capacity and the practical implications of the CCQ in the detection of exacerbations in daily care&#46; And then&#44; subsequently&#44; in the section on <span class="elsevierStyleItalic">Combined COPD Evaluation</span>&#44; the same proposal for combined evaluation put forward in the GOLD 2011 guidelines&#44; based only on CAT or mMRC for the symptomatic evaluation of the degree of COPD involvement&#44; is maintained&#44; with no explicit mention of the CCQ<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The study presented here has certain limitations&#58; the sample size is relatively small&#44; although the majority of the studies on COPD measurement instruments have a similar or smaller number of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;24</span></a> Furthermore&#44; as this is not a cross-sectional study&#44; the prognostic value of the results was not recorded&#46; Nor was any correlation with comorbidities established between the different categories&#46; Comorbidities presented by the patients may have a significant effect on disease prognosis&#44; and should also be taken into account for the combined evaluation of COPD in any future revision of the GOLD guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">Classification of COPD patients into categories according to the combined evaluation proposed by the GOLD 2011 revision varies according to the evaluation method used in the symptomatic evaluation of patients &#40;CAT or mMRC&#41;&#46; More than 25&#37; of patients in the different categories are reclassified if one or the other method is used&#44; implying differences in the recommended treatment strategy&#46; Longitudinal studies are needed to evaluate which assessment method best classifies the patient&#44; with attention being paid to the prognostic capacity of such instruments&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of Interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest in the preparation of this manuscript&#46;</p></span></span>"
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        0 => array:2 [
          "identificador" => "xres327146"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Patients and methods"
            3 => "Results"
            4 => "Conclusions"
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        1 => array:2 [
          "identificador" => "xpalclavsec308816"
          "titulo" => "Keywords"
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          "identificador" => "xres327145"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "Pacientes y m&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
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          "identificador" => "xpalclavsec308815"
          "titulo" => "Palabras clave"
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              "titulo" => "Study Design"
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          "identificador" => "sec0045"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-07-07"
    "fechaAceptado" => "2013-09-27"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec308816"
          "palabras" => array:5 [
            0 => "Chronic obstructive pulmonary disease"
            1 => "Questionnaires"
            2 => "Classification"
            3 => "Concordance"
            4 => "Correlation"
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      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec308815"
          "palabras" => array:5 [
            0 => "Enfermedad pulmonar obstructiva cr&#243;nica"
            1 => "Cuestionarios"
            2 => "Categorizaci&#243;n"
            3 => "Concordancia"
            4 => "Correlaci&#243;n"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The GOLD 2011 revision proposes to stratify patients with chronic obstructive pulmonary disease &#40;COPD&#41; by measuring the impact of the disease using the modified Medical Research Council &#40;mMRC&#41; scale or COPD assessment test &#40;CAT&#41;&#46; Our aim was to determine whether both methods are equivalent&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational study on a cohort of 283 patients diagnosed with COPD&#46; We analyzed the demographic and lung function results&#46; Patients were assessed by CAT and mMRC on the same day by the same interviewer&#44; and divided into GOLD 2011 categories according to the result of the evaluation&#46; The degree of concordance and Spearman correlation were determined&#46; We used ANOVA on the clinical and functional variables of the four GOLD 2011 categories&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">On assessing the classification of patients according to the method used&#44; an overall correlation of <span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;613 and a degree of concordance of <span class="elsevierStyleItalic">&#954;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63 &#40;moderate&#41; were obtained&#46; <span class="elsevierStyleItalic">&#954;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;44 was obtained for the 152 patients in categories A and B &#40;moderate-low&#41;&#44; and at 0&#46;38 for the 131 patients in categories C and D &#40;low&#41;&#46; Differences were observed between the categories in terms of functional parameters&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The classification of patients with COPD using the assessment proposed by GOLD 2011 varies according to the method used &#40;CAT or mMRC&#41;&#59; more than 25&#37; of patients were reclassified into different categories&#44; implying differences in the recommended therapeutic strategy&#46; Longitudinal studies are needed to appraise which method does better classification of the patients&#44; according to its prognostic ability&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La revisi&#243;n GOLD 2011 propone estratificar a los pacientes con EPOC midiendo la repercusi&#243;n de la enfermedad mediante la escala mMRC o mediante el cuestionario CAT&#46; Nuestro objetivo es conocer si la elecci&#243;n de un m&#233;todo u otro resulta equivalente&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional sobre una cohorte de 283 pacientes diagnosticados de EPOC&#46; Se analizaron resultados demogr&#225;ficos&#44; funcionales respiratorios y de evaluaci&#243;n mediante CAT y mMRC&#44; aplicados el mismo d&#237;a y por el mismo entrevistador a cada paciente&#46; Se distribuyeron en categor&#237;as GOLD 2011 seg&#250;n el resultado de la evaluaci&#243;n y se determin&#243; el grado de concordancia y la correlaci&#243;n de Spearman&#46; Se utiliz&#243; el test de ANOVA sobre las variables cl&#237;nicas y funcionales de las 4 categor&#237;as GOLD 2011&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Al evaluar la clasificaci&#243;n de pacientes seg&#250;n el m&#233;todo empleado&#44; se obtuvo una correlaci&#243;n global &#961;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;613 y un grado de concordancia &#954;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;63 &#40;moderado&#41;&#46; Se obtuvo &#954;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;44 para los 152 pacientes de las categor&#237;as A y B &#40;moderado-d&#233;bil&#41;&#44; y de 0&#44;38 para los 131 pacientes de las categor&#237;as C y D &#40;d&#233;bil&#41;&#46; Se apreciaron diferencias entre categor&#237;as en cuanto a par&#225;metros funcionales&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La clasificaci&#243;n de los pacientes con EPOC seg&#250;n la evaluaci&#243;n propuesta por GOLD 2011 var&#237;a seg&#250;n se emplee CAT o mMRC&#59; se reclasifica a m&#225;s del 25&#37; de pacientes en diferentes categor&#237;as&#44; implicando diferencias en la estrategia terap&#233;utica recomendada&#46; Son necesarios estudios longitudinales que permitan valorar qu&#233; m&#233;todo clasifica mejor a los pacientes&#44; atendiendo a su capacidad pron&#243;stica&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Rieger-Reyes C&#44; Garc&#237;a-Tirado FJ&#44; Rubio-Gal&#225;n FJ&#44; Mar&#237;n-Trigo JM&#46; Clasificaci&#243;n de la gravedad de la enfermedad pulmonar obstructiva cr&#243;nica seg&#250;n la nueva gu&#237;a Iniciativa Global para la Enfermedad Obstructiva Cr&#243;nica 2011&#58; <span class="elsevierStyleItalic">COPD Assessment Test</span> versus <span class="elsevierStyleItalic">modified Medical Research Council</span>&#46; Arch Bronconeumol&#46; 2014&#59;50&#58;129&#8211;134&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">GOLD 2011 categories and drug treatment &#40;first recommendation&#41; for each category&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of mMRC vs CAT&#46; Spearman correlation index&#58; <span class="elsevierStyleItalic">&#961;</span>&#61;0&#46;613&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Schematic of migration between GOLD categories depending on results of the application of CAT or mMRC &#40;see distribution of data and explanatory note in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>&#37;&#58; forced expiratory volume in one second&#44; percentage of predicted value&#59; FVC&#58; forced vital capacity&#59; HT&#58; hypertension&#59; BMI&#58; body mass index&#59; PYI&#58; pack-year index&#59; pb&#58; post-bronchodilator&#59; PBD&#40;&#43;&#41;&#58; positive bronchodilator test&#59; SatO<span class="elsevierStyleInf">2</span>&#58; oxygen saturation&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">283 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \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">Sex&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">260 &#40;92&#37;&#41; males&#59; 23 &#40;8&#37;&#41; females&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">Age&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">BMI&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">Active smoker&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 patients &#40;24&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">PYI&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">Comorbidities&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="left" valign="\n
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                  \t\t\t\t">HT&#58; 152 patients &#40;53&#46;7&#37;&#41;&#59; dyslipidemia&#58; 106 &#40;37&#46;5&#37;&#41;&#59; diabetes&#58; 53 &#40;18&#46;7&#37;&#41;&#59; cardiovascular episodes&#58; 124 &#40;43&#46;8&#37;&#41;&#59; no comorbidity&#58; 48 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">pbFEV<span class="elsevierStyleInf">1</span>&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;4&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">PBD&#40;&#43;&#41;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 patients &#40;11&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">Baseline SatO<span class="elsevierStyleInf">2</span>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;9&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">Walking test&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">389&#46;2<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>96&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" style="border-bottom: 2px solid black">Spirometry results&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" 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  " align="left" valign="\n
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                  \t\t\t\t">FVC&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">2&#46;8<span class="elsevierStyleHsp" style=""></span>l&#177;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">FVC&#37;&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">76&#46;8&#37;&#177;19&#46;8&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  " align="left" valign="\n
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                  \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">82&#46;8&#37;&#177;19&#46;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</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">pbFEV<span class="elsevierStyleInf">1</span>&#47;FVC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">pbFEV<span class="elsevierStyleInf">1</span>&#47;FVC &#37;&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">0&#46;75&#177;17&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; Clinical and Functional Variables &#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>Standard Deviation&#41;&#46;</p>"
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                  \t\t\t\t">28&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&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">pbFEV<span class="elsevierStyleInf">1</span>&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&#46;9&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;1&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;8&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;6&#41;&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PBD&#40;&#43;&#41;&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">29 &#40;11&#46;1&#37;&#41;&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
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                  \t\t\t\t">4 &#40;17&#46;4&#37;&#41;&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
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                  \t\t\t\t">NS &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">93&#46;3&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;5&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">93&#46;4&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7&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">NS &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Walking test&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="left" valign="\n
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                  \t\t\t\t">390&#46;1<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>95&#46;1&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
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                  \t\t\t\t">380&#46;3<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>111&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab478844.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; Clinical and Functional Variables by Sex &#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>Standard Deviation&#41;&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Explanatory note&#58;</span> When the mMRC scale was applied&#44; 103 patients were classified as A&#59; of these&#44; 22 were classified as B when the CAT questionnaire was applied&#46; Similarly&#44; when the CAT was applied&#44; 97 patients were classified as A&#44; but 16 of these were then classified as B using the mMRC&#46; With the mMRC&#44; 49 patients were classified as B&#44; but 16 of these had been classified as A using the CAT&#59; with the CAT&#44; 55 patients were classified as B&#44; but 22 of these had been classified as A with the mMRC&#46; The same situation arose for categories C and D&#44; depending on whether one questionnaire or the other was applied&#46; There was no migration between AB and CD&#44; as this depends on the risk criteria &#40;AB&#58; low risk&#59; CD&#58; high risk&#41;&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">GOLD CAT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">GOLD mMRC</td></tr><tr title="table-row"><td class="td" title="\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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">A&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
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                  \t\t\t\t" style="border-bottom: 2px solid black">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&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">81&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">16&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">0&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">0&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">97 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&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">0&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">0&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">55 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">C&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">0&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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">34&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">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">D&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">0&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">0&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">17&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">58&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">75 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">Total&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">103 &#40;36&#37;&#41;&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">49 &#40;17&#37;&#41;&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">51 &#40;18&#37;&#41;&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">80 &#40;29&#37;&#41;&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">283 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab478845.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Cohort GOLD 2011 Classification With CAT and mMRC &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Values expressed as means for each category&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \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">mMRC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">CAT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \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">Age&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">70&#46;3&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;5&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">69&#46;1&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">72&#46;3&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">Age&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">71&#46;3&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">68&#46;8&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">70&#46;1&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">71&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \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">BMI&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&#46;6&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">29&#46;1&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&#46;1&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&#46;2&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">BMI&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">28&#46;5&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">29&#46;3&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Usefulness of the Medical Research Council &#40;MRC&#41; dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease"
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                          "etal" => false
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                            4 => "P&#46;W&#46; Jones"
                            5 => "J&#46; Wedzicha"
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                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Thorax"
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                        "volumen" => "54"
                        "paginaInicial" => "581"
                        "paginaFinal" => "585"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10377201"
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                      "titulo" => "Standardization of spirometry&#44; 1994 update"
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                          "colaboracion" => "American Thoracic Society"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "152"
                        "paginaInicial" => "1107"
                        "paginaFinal" => "1136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7663792"
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                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Creating scenarios of the impact of COPD and their relationship to COPD assessment test &#40;CATTM&#41; scores"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            2 => "W&#46;-H&#46; Chen"
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                      ]
                    ]
                  ]
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                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21835018"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Assessing Elath status in COPD&#46; A head-to-head comparison between the COPD assessment test &#40;CAT&#41; and the clinical COPD questionnaire &#40;CCQ&#41;"
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                            3 => "I&#46; L&#243;pez"
                            4 => "J&#46;W&#46;H&#46; Kocks"
                            5 => "K&#46; Karagiannis"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2466-12-20"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Pulm Med"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22607459"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "COPD&#58; functional status&#44; health status and primary care"
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                            0 => "P&#46;W&#46; Jones"
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                    0 => array:2 [
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                        "tituloSerie" => "Prim Care Respir J"
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                        "volumen" => "20"
                        "paginaInicial" => "227"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21808943"
                            "web" => "Medline"
                          ]
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                      "titulo" => "&#201;valuation du COPD Assessment Test &#40;CAT&#41; chez des patients BPCO en &#233;tat stable"
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                          "etal" => false
                          "autores" => array:2 [
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                    0 => array:2 [
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                        "tituloSerie" => "Rev Mal Respir"
                        "fecha" => "2012"
                        "volumen" => "29"
                        "paginaInicial" => "391"
                        "paginaFinal" => "397"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22440303"
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                    0 => array:2 [
                      "titulo" => "Properties of the COPD assessment test in a cross-sectional European study"
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                        "tituloSerie" => "Eur Respir J"
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                        "paginaInicial" => "29"
                        "paginaFinal" => "35"
                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "Test of the responsiveness of the COPD assessment test following acute exacerbation and pulmonary rehabilitation"
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                            5 => "R&#46; Yu"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22281796"
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Functional status measurement in COPD&#58; a review of available methods and their feasibility in primary care"
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                            3 => "H&#46;A&#46;M&#46; Kerstjens"
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                    0 => array:2 [
                      "doi" => "10.4104/pcrj.2011.00031"
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                        "tituloSerie" => "Prim Care Respir J"
                        "fecha" => "2011"
                        "volumen" => "20"
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                        "paginaFinal" => "275"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21523316"
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                ]
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              "identificador" => "bib0095"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease&#58; the updated BODE index and the ADO index"
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                          "etal" => true
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                            4 => "J&#46;M&#46; Ant&#243;"
                            5 => "A&#46;G&#46; Agust&#237;"
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                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2009"
                        "volumen" => "374"
                        "paginaInicial" => "704"
                        "paginaFinal" => "711"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19716962"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0100"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of clinical methods for rating dyspnea"
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                          "autores" => array:2 [
                            0 => "D&#46;A&#46; Mahler"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1988"
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                        "paginaInicial" => "80"
                        "paginaFinal" => "86"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            3 => "T&#46; Oga"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
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                        "paginaFinal" => "1440"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12006425"
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              "identificador" => "bib0110"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Distribution and prognostic validity of the new GOLD grading classification"
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                            4 => "C&#46; Esteban"
                            5 => "J&#46;J&#46; Soler Catalu&#241;a"
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                        ]
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                        "paginaInicial" => "694"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23187891"
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                0 => array:2 [
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                      "titulo" => "Comparisons of health status scores with mMRC grades in a primary care COPD population&#58; Implications for the new GOLD 2011 classification"
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                            3 => "N&#46; Banik"
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Eur Respir J"
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                        "volumen" => "42"
                        "paginaInicial" => "647"
                        "paginaFinal" => "654"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23258783"
                            "web" => "Medline"
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              "identificador" => "bib0120"
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                      "titulo" => "Differences in classification of COPD group using COPD assessment test &#40;CAT&#41; or modified Medical Research Council &#40;mMRC&#41; dyspnea scores&#58; a cross-sectional analyses"
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                            5 => "I&#46;J&#46; Oh"
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                    0 => array:2 [
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                        "volumen" => "13"
                        "paginaInicial" => "35"
                        "paginaFinal" => "39"
                        "link" => array:1 [
                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "GOLD 2011 disease severity classification in COPDGene&#58; a prospective cohort study"
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                        "volumen" => "1"
                        "paginaInicial" => "43"
                        "paginaFinal" => "50"
                        "link" => array:1 [
                          0 => array:2 [
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                ]
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              "identificador" => "bib0130"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Global strategy for the diagnosis&#44; management&#44; and prevention of chronic obstructive pulmonary disease&#58; GOLD executive summary"
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                        0 => array:2 [
                          "etal" => true
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                    0 => array:2 [
                      "doi" => "10.1164/rccm.201204-0596PP"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "paginaInicial" => "347"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
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                          ]
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                    ]
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                ]
              ]
            ]
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              "identificador" => "bib0135"
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Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2014.03.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	2	9
2024 October	116	33	149
2024 September	103	51	154
2024 August	115	70	185
2024 July	79	39	118
2024 June	85	40	125
2024 May	129	40	169
2024 April	55	25	80
2024 March	51	26	77
2024 February	38	28	66
2024 January	1	0	1
2023 June	1	0	1
2023 March	30	14	44
2023 February	150	51	201
2023 January	116	68	184
2022 December	116	81	197
2022 November	159	72	231
2022 October	186	73	259
2022 September	146	63	209
2022 August	177	89	266
2022 July	145	98	243
2022 June	163	64	227
2022 May	185	113	298
2022 April	231	125	356
2022 March	215	143	358
2022 February	185	103	288
2022 January	209	103	312
2021 December	163	94	257
2021 November	240	86	326
2021 October	214	51	265
2021 September	128	42	170
2021 August	136	54	190
2021 July	184	48	232
2021 June	223	51	274
2021 May	291	39	330
2021 April	709	102	811
2021 March	465	25	490
2021 February	293	26	319
2021 January	314	26	340
2020 December	343	30	373
2020 November	378	28	406
2020 October	277	34	311
2020 September	207	19	226
2020 August	128	26	154
2020 July	117	24	141
2020 June	156	8	164
2020 May	224	19	243
2020 April	288	41	329
2020 March	202	18	220
2020 February	233	20	253
2020 January	139	29	168
2019 December	176	16	192
2019 November	152	23	175
2019 October	133	20	153
2019 September	164	20	184
2019 August	115	25	140
2019 July	137	30	167
2019 June	198	27	225
2019 May	285	34	319
2019 April	331	31	362
2019 March	340	27	367
2019 February	287	25	312
2019 January	320	28	348
2018 December	301	33	334
2018 November	309	35	344
2018 October	408	27	435
2018 September	195	12	207
2018 June	1	0	1
2018 May	202	0	202
2018 April	295	6	301
2018 March	210	3	213
2018 February	153	8	161
2018 January	149	6	155
2017 December	147	7	154
2017 November	188	8	196
2017 October	118	13	131
2017 September	122	21	143
2017 August	114	22	136
2017 July	84	19	103
2017 June	108	25	133
2017 May	108	29	137
2017 April	153	33	186
2017 March	139	12	151
2017 February	124	25	149
2017 January	117	14	131
2016 December	117	10	127
2016 November	218	15	233
2016 October	249	19	268
2016 September	275	19	294
2016 August	269	21	290
2016 July	114	16	130
2016 June	1	0	1
2016 May	1	0	1
2016 March	1	0	1
2016 February	2	0	2
2015 December	3	0	3
2015 October	259	4	263
2015 September	203	19	222
2015 August	172	26	198
2015 July	256	17	273
2015 June	171	18	189
2015 May	211	26	237
2015 April	161	13	174
2015 March	192	26	218
2015 February	143	11	154
2015 January	94	25	119
2014 December	80	27	107
2014 November	91	25	116
2014 October	85	13	98
2014 September	76	17	93
2014 August	83	23	106
2014 July	64	20	84
2014 May	0	3	3
2014 April	1	1	2

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