Letter to the Editor
Etiological Pattern of Community-Acquired Pneumonia: Importance of the Geographical Factor
Patrón etiológico de la neumonía adquirida en la comunidad: importancia del factor geográfico
Agustín Julián-Jiménez
, Manuel Flores Chacartegui, Ana Nieves Piqueras-Martínez
Corresponding author
Servicio de Urgencias-Medicina Interna, Complejo Hospitalario de Toledo, Toledo, Spain
Read
5102
Timeswas read the article
1724
Total PDF
3378
Total HTML
Share statistics
array:24 [ "pii" => "S1579212914000755" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.03.004" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "817" "copyright" => "SEPAR" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2014;50:156-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2598 "formatos" => array:3 [ "EPUB" => 115 "HTML" => 1925 "PDF" => 558 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289613002366" "issn" => "03002896" "doi" => "10.1016/j.arbres.2013.08.001" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "817" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2014;50:156-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4617 "formatos" => array:3 [ "EPUB" => 104 "HTML" => 3936 "PDF" => 577 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Patrón etiológico de la neumonía adquirida en la comunidad: importancia del factor geográfico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "156" "paginaFinal" => "157" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Etiological Pattern of Community-Acquired Pneumonia: Importance of the Geographical Factor" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1515 "Ancho" => 1667 "Tamanyo" => 98344 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribución estacional de los patógenos causales de la neumonía adquirida en la comunidad.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Invierno: diciembre a febrero; Primavera: marzo a mayo; Verano: junio a agosto; Otoño: septiembre a noviembre.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Agustín Julián-Jiménez, Manuel Flores Chacartegui, Ana Nieves Piqueras-Martínez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Agustín" "apellidos" => "Julián-Jiménez" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Flores Chacartegui" ] 2 => array:2 [ "nombre" => "Ana Nieves" "apellidos" => "Piqueras-Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212914000755" "doi" => "10.1016/j.arbr.2014.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914000755?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613002366?idApp=UINPBA00003Z" "url" => "/03002896/0000005000000004/v1_201403310024/S0300289613002366/v1_201403310024/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212914000706" "issn" => "15792129" "doi" => "10.1016/j.arbr.2013.07.012" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "804" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2014;50:157-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3234 "formatos" => array:3 [ "EPUB" => 133 "HTML" => 2544 "PDF" => 557 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Bronchioloalveolar Carcinoma: Time for a New Term" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "158" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma broncoalveolar: un término a actualizar" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Sanz-Santos, Felipe Andreo, Juan Ruiz-Manzano" "autores" => array:3 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Sanz-Santos" ] 1 => array:2 [ "nombre" => "Felipe" "apellidos" => "Andreo" ] 2 => array:2 [ "nombre" => "Juan" "apellidos" => "Ruiz-Manzano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613002226" "doi" => "10.1016/j.arbres.2013.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613002226?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914000706?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000004/v1_201404030045/S1579212914000706/v1_201404030045/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212914000767" "issn" => "15792129" "doi" => "10.1016/j.arbr.2013.07.013" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "819" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2014;50:156" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2600 "formatos" => array:3 [ "EPUB" => 114 "HTML" => 1951 "PDF" => 535 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Endobronchial Ultrasound Guided Needle Sampling Without Aspiration: And the Cell Block?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "156" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Punción guiada por ultrasonografía endobronquial sin aspiración: ¿y el bloque celular?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Felipe Andreo García, José Sanz Santos, Maria Llatjós Sanuy, Juan Ruiz Manzano" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Felipe" "apellidos" => "Andreo García" ] 1 => array:2 [ "nombre" => "José" "apellidos" => "Sanz Santos" ] 2 => array:2 [ "nombre" => "Maria" "apellidos" => "Llatjós Sanuy" ] 3 => array:2 [ "nombre" => "Juan" "apellidos" => "Ruiz Manzano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S030028961300238X" "doi" => "10.1016/j.arbres.2013.07.017" "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/S030028961300238X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914000767?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000004/v1_201404030045/S1579212914000767/v1_201404030045/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Etiological Pattern of Community-Acquired Pneumonia: Importance of the Geographical Factor" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "156" "paginaFinal" => "157" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Agustín Julián-Jiménez, Manuel Flores Chacartegui, Ana Nieves Piqueras-Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Agustín" "apellidos" => "Julián-Jiménez" "email" => array:2 [ 0 => "agustinj@sescam.jccm.es" 1 => "agustin.jj@wanadoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Flores Chacartegui" ] 2 => array:2 [ "nombre" => "Ana Nieves" "apellidos" => "Piqueras-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urgencias-Medicina Interna, Complejo Hospitalario de Toledo, Toledo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patrón etiológico de la neumonía adquirida en la comunidad: importancia del factor geográfico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1515 "Ancho" => 1667 "Tamanyo" => 94872 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Seasonal distribution of causative pathogens of community-acquired pneumonia.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Winter: December to February, Spring: March to May, Summer: June to August, Fall: September to November.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the manuscript of Herrera-Lara et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> recently published in <span class="elsevierStyleItalic">Archivos de Bronconeumología</span>. We welcome this study, which shows the influence of season and climate on the etiology of community-acquired pneumonia (CAP), although only in patients admitted to the pneumology ward. This is one limitation recognized by the authors. Another is the lack of follow-up of patients discharged from the emergency department (ED), that account for more than 50% of the CAP cases seen in those units.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These data are in line with the data of our group,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and show the quantitative importance of this subgroup when calculating the overall etiology of the disease. Several factors must be taken into consideration when determining CAP etiology, including climate, season, age, place of employment, treatment, comorbidity, patient characteristics, concurrent viral epidemic, etc.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The most recent consensus guidelines for CAP point out that <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> is the most common pathogen in outpatients (including those discharged), hospitalized patients, and intensive care patients (35, 43 and 42% of isolates, respectively). They also mention the increasing importance of <span class="elsevierStyleItalic">Legionella pneumophila</span>, which accounts for 6, 8 and 8% of the cases classified as above, respectively. These figures are consistent with those published by Herrera-Lara et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who reported that 8.6% of cases are caused by <span class="elsevierStyleItalic">L. pneumophila</span>. Here, in Toledo, the climate tends toward colder, wetter winters and warmer, wetter summers: the average winter temperature in Toledo in 2009–2011 was 7.20<span class="elsevierStyleHsp" style=""></span>°C compared to the mean 9.72<span class="elsevierStyleHsp" style=""></span>°C reported in the study of Herrera-Lara et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and accumulated rainfall was 54.3<span class="elsevierStyleHsp" style=""></span>L compared to their 35.2<span class="elsevierStyleHsp" style=""></span>L; average summer temperatures were 26.23<span class="elsevierStyleHsp" style=""></span>°C vs 24.6<span class="elsevierStyleHsp" style=""></span>°C, and rainfall was 15.9<span class="elsevierStyleHsp" style=""></span>L vs 8.27<span class="elsevierStyleHsp" style=""></span>L, respectively. We have studied the incidence of CAP according to the seasonal pattern and differences in frequency between <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">L. pneumophila</span>, using the databases of several studies on the management of CAP in the years 2009–2011.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a><span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">L. pneumophila</span> were systematically investigated in all patients with sepsis, admitted with pneumococcus and <span class="elsevierStyleItalic">L. pneumophila</span> serogroup 1 antigens in urine (membrane immunochromatograpy-Binax NOW<span class="elsevierStyleSup">®</span>). Blood and sputum cultures with direct seeding were requested for inpatients when possible (<span class="elsevierStyleItalic">Legionella</span>: direct immunofluorescence of <span class="elsevierStyleItalic">Legionella pneumophila</span> antigen), and 1698 CAP cases from ED were included (51% were admitted to hospital and etiologic diagnosis was obtained in 39.5%). The seasonal distribution compared with the study of Herrera-Lara et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> was as follows: winter (38 vs 36.6%), spring (25 vs 20.2%), summer (8 vs 18.5%) and fall (31 vs 24.7%). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows a similar distribution pattern for both in all seasons (<span class="elsevierStyleItalic">P</span>=NS). Other diagnoses, such as atypical bacteria (2.5% for <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> and <span class="elsevierStyleItalic">Chlamydophila pneumoniae</span>) and viral infection (0.5%–1%), showed no seasonal differences, although their proportions are likely to be underestimated, as they were not studied systematically. In conclusion, CAP etiology is influenced not only by the climate and season, but also by geographical location and other factors.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Julián-Jiménez A, Flores Chacartegui M, Piqueras-Martínez AN. Patrón etiológico de la neumonía adquirida en la comunidad: importancia del factor geográfico. Arch Bronconeumol. 2014;50:156–157.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1515 "Ancho" => 1667 "Tamanyo" => 94872 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Seasonal distribution of causative pathogens of community-acquired pneumonia.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Winter: December to February, Spring: March to May, Summer: June to August, Fall: September to November.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do seasonal changes and climate influence the etiology of community acquired pneumonia?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Herrera-Lara" 1 => "E. Fernández-Fabrellas" 2 => "A. Cervera-Juan" 3 => "R. Blanquer-Olias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.11.001" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "140" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23305778" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio INFURG-SEMES: epidemiología de las infecciones en los servicios de urgencias hospitalarios y evolución durante la última década" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Martínez Ortiz de Zárate" 1 => "J. González del Castillo" 2 => "A. Julián Jiménez" 3 => "P. Piñera Salmerón" 4 => "F. Llopis Roca" 5 => "J.M. Guardiola Tey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2013" "volumen" => "25" "paginaInicial" => "368" "paginaFinal" => "378" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved management of community-acquired pneumonia in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Julián-Jiménez" 1 => "M.J. Palomo de los Reyes" 2 => "R. Parejo Miguez" 3 => "N. Laín-Terés" 4 => "R. Cuena-Boy" 5 => "A. Lozano-Ancín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.12.008" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "230" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23477946" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía multidisciplinar para la valoración pronóstica, diagnóstico y tratamiento de la neumonía adquirida en la comunidad" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Torres" 1 => "J. Barberán" 2 => "M. Falguera" 3 => "R. Menéndez" 4 => "J. Molina" 5 => "P. Olaechea" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2013" "volumen" => "140" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intervenciones para mejorar el manejo de la neumonía adquirida en la comunidad desde el servicio de urgencias" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Julián-Jiménez" 1 => "R. Parejo Miguez" 2 => "R. Cuena Boy" 3 => "M.J. Palomo de los Reyes" 4 => "N. Laín Terés" 5 => "A. Lozano Ancín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2013" "volumen" => "25" "paginaInicial" => "379" "paginaFinal" => "392" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000004/v1_201404030045/S1579212914000755/v1_201404030045/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000004/v1_201404030045/S1579212914000755/v1_201404030045/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914000755?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 42 | 16 | 58 |
| 2024 September | 28 | 12 | 40 |
| 2024 August | 64 | 34 | 98 |
| 2024 July | 37 | 23 | 60 |
| 2024 June | 49 | 32 | 81 |
| 2024 May | 82 | 32 | 114 |
| 2024 April | 39 | 22 | 61 |
| 2024 March | 32 | 17 | 49 |
| 2024 February | 31 | 18 | 49 |
| 2023 March | 5 | 3 | 8 |
| 2023 February | 21 | 20 | 41 |
| 2023 January | 19 | 24 | 43 |
| 2022 December | 33 | 29 | 62 |
| 2022 November | 34 | 20 | 54 |
| 2022 October | 36 | 39 | 75 |
| 2022 September | 26 | 22 | 48 |
| 2022 August | 40 | 36 | 76 |
| 2022 July | 27 | 41 | 68 |
| 2022 June | 21 | 26 | 47 |
| 2022 May | 26 | 37 | 63 |
| 2022 April | 34 | 21 | 55 |
| 2022 March | 32 | 34 | 66 |
| 2022 February | 35 | 30 | 65 |
| 2022 January | 30 | 36 | 66 |
| 2021 December | 35 | 34 | 69 |
| 2021 November | 29 | 50 | 79 |
| 2021 October | 36 | 49 | 85 |
| 2021 September | 24 | 41 | 65 |
| 2021 August | 33 | 44 | 77 |
| 2021 July | 29 | 24 | 53 |
| 2021 June | 25 | 49 | 74 |
| 2021 May | 36 | 31 | 67 |
| 2021 April | 84 | 36 | 120 |
| 2021 March | 42 | 18 | 60 |
| 2021 February | 14 | 14 | 28 |
| 2021 January | 20 | 14 | 34 |
| 2020 December | 19 | 23 | 42 |
| 2020 November | 20 | 10 | 30 |
| 2020 October | 14 | 11 | 25 |
| 2020 September | 10 | 10 | 20 |
| 2020 August | 17 | 12 | 29 |
| 2020 July | 28 | 14 | 42 |
| 2020 June | 17 | 8 | 25 |
| 2020 May | 25 | 12 | 37 |
| 2020 April | 34 | 16 | 50 |
| 2020 March | 23 | 15 | 38 |
| 2020 February | 35 | 19 | 54 |
| 2020 January | 24 | 10 | 34 |
| 2019 December | 31 | 14 | 45 |
| 2019 November | 26 | 15 | 41 |
| 2019 October | 22 | 7 | 29 |
| 2019 September | 20 | 8 | 28 |
| 2019 August | 20 | 13 | 33 |
| 2019 July | 9 | 14 | 23 |
| 2019 June | 12 | 7 | 19 |
| 2019 May | 22 | 14 | 36 |
| 2019 April | 40 | 9 | 49 |
| 2019 March | 47 | 15 | 62 |
| 2019 February | 34 | 13 | 47 |
| 2019 January | 33 | 12 | 45 |
| 2018 December | 36 | 18 | 54 |
| 2018 November | 71 | 24 | 95 |
| 2018 October | 62 | 14 | 76 |
| 2018 September | 29 | 11 | 40 |
| 2018 May | 13 | 0 | 13 |
| 2018 April | 17 | 6 | 23 |
| 2018 March | 21 | 2 | 23 |
| 2018 February | 34 | 7 | 41 |
| 2018 January | 99 | 8 | 107 |
| 2017 December | 124 | 2 | 126 |
| 2017 November | 41 | 8 | 49 |
| 2017 October | 24 | 8 | 32 |
| 2017 September | 27 | 8 | 35 |
| 2017 August | 47 | 15 | 62 |
| 2017 July | 34 | 5 | 39 |
| 2017 June | 34 | 10 | 44 |
| 2017 May | 19 | 4 | 23 |
| 2017 April | 19 | 14 | 33 |
| 2017 March | 19 | 24 | 43 |
| 2017 February | 23 | 2 | 25 |
| 2017 January | 20 | 1 | 21 |
| 2016 December | 30 | 4 | 34 |
| 2016 November | 38 | 8 | 46 |
| 2016 October | 37 | 15 | 52 |
| 2016 September | 34 | 11 | 45 |
| 2016 August | 42 | 7 | 49 |
| 2016 July | 25 | 9 | 34 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 38 | 3 | 41 |
| 2015 September | 42 | 10 | 52 |
| 2015 August | 34 | 14 | 48 |
| 2015 July | 36 | 7 | 43 |
| 2015 June | 26 | 2 | 28 |
| 2015 May | 44 | 9 | 53 |
| 2015 April | 24 | 8 | 32 |
| 2015 March | 40 | 5 | 45 |
| 2015 February | 24 | 6 | 30 |
| 2015 January | 26 | 13 | 39 |
| 2014 December | 26 | 8 | 34 |
| 2014 November | 37 | 10 | 47 |
| 2014 October | 37 | 14 | 51 |
| 2014 September | 28 | 15 | 43 |
| 2014 August | 44 | 13 | 57 |
| 2014 July | 30 | 12 | 42 |
| 2014 May | 0 | 1 | 1 |
| 2014 April | 4 | 0 | 4 |
Show all
