Editorial
Chronic Domiciliary Oxygen Therapy–Year SEPAR
Oxigenoterapia crónica domiciliaria: año SEPAR
Francisco Ortega Ruiz
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Read
5927
Timeswas read the article
2187
Total PDF
3740
Total HTML
Share statistics
array:23 [ "pii" => "S157921291400127X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.04.005" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "891" "copyright" => "SEPAR" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2014;50:209-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2654 "formatos" => array:3 [ "EPUB" => 127 "HTML" => 1890 "PDF" => 637 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289614000039" "issn" => "03002896" "doi" => "10.1016/j.arbres.2013.12.003" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "891" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2014;50:209-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11490 "formatos" => array:3 [ "EPUB" => 118 "HTML" => 10266 "PDF" => 1106 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Oxigenoterapia crónica domiciliaria: año SEPAR" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "210" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Chronic Domiciliary Oxygen Therapy—Year SEPAR" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Ortega Ruiz" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Ortega Ruiz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157921291400127X" "doi" => "10.1016/j.arbr.2014.04.005" "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/S157921291400127X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614000039?idApp=UINPBA00003Z" "url" => "/03002896/0000005000000006/v1_201405240608/S0300289614000039/v1_201405240608/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212914001207" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.02.009" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "936" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2014;50:211-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2783 "formatos" => array:3 [ "EPUB" => 117 "HTML" => 2064 "PDF" => 602 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Domiciliary Respiratory Therapies SEPAR Year 2014. A Real Health Challenge" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "211" "paginaFinal" => "212" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Año SEPAR de las terapias respiratorias domiciliarias. Un verdadero desafío sanitario" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Egea Santaolalla, Juan Fernando Masa Jiménez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Egea Santaolalla" ] 1 => array:2 [ "nombre" => "Juan Fernando" "apellidos" => "Masa Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614000866" "doi" => "10.1016/j.arbres.2014.02.013" "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/S0300289614000866?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001207?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000006/v1_201405291004/S1579212914001207/v1_201405291004/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Chronic Domiciliary Oxygen Therapy–Year SEPAR" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "210" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Francisco Ortega Ruiz" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Francisco" "apellidos" => "Ortega Ruiz" "email" => array:1 [ 0 => "francisco.ortega.sspa@juntadeandalucia.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oxigenoterapia crónica domiciliaria: año SEPAR" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Oxygen was the first treatment shown to increase survival in patients with chronic obstructive pulmonary disease (COPD). Current recommendations for the prescription of continuous domiciliary oxygen therapy (CDO) are based on the results of 2 clinical trials published over 30 years ago: the <span class="elsevierStyleItalic">Nocturnal Oxygen Therapy Trial</span> (NOTT) and the <span class="elsevierStyleItalic">Medical Research Council</span> (MRC) study.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> CDO is indicated in patients with COPD and resting PaO<span class="elsevierStyleInf">2</span> ≤55<span class="elsevierStyleHsp" style=""></span>mmHg or resting PaO<span class="elsevierStyleInf">2</span> between 56 and 59<span class="elsevierStyleHsp" style=""></span>mmHg with evidence of chronic pulmonary hypertension or polycythemia. Based on the hypothesis that the beneficial effect of oxygen is a result of the correction of hypoxemia, irrespective of the cause, this indication has been extended by analogy to chronic respiratory failure caused by other respiratory (idiopathic pulmonary fibrosis, cystic fibrosis, etc.) and non-respiratory diseases (heart failure). However, the effectiveness of continuous oxygen therapy on survival in these other disease entities has not been demonstrated, and studies justifying indication in these cases are required.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In contrast with the results of the MRC or NOTT clinical trials, supplementary oxygen has not been shown to improve survival in patients with COPD and moderate hypoxemia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, these studies have been criticized for reporting a small number of patients, an inappropriately short study period and inadequate average daily administration of oxygen–approximately 13.5<span class="elsevierStyleHsp" style=""></span>h, clearly insufficient for showing effects on mortality. It is known, for example, that patients with COPD and chronic respiratory failure receiving CDO have a rebound effect, with pulmonary vascular resistance increasing when oxygen is suspended for periods as short as 3<span class="elsevierStyleHsp" style=""></span>h a day. Moreover, it is clear that the mortality rate in COPD patients with comorbidities is higher. Nevertheless, none of the studies analyzing the effects of CDO evaluate the influence of comorbidities in general or of cardiovascular disease in particular. It is currently unclear if continuous oxygen therapy reduces metabolic and/or cardiovascular death in hypoxemic COPD patients. Current guidelines do not provide any indications for “pure” patients (with no associated comorbidities), and the therapeutic effects of CDO are analyzed in groups that are poorly representative of COPD patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although some data point to a lower survival rate in patients with nocturnal saturations, the role of continuous oxygen therapy in the management of these patients remains controversial. The available data, based on small cohorts, suggest that continuous oxygen supplements do not affect survival in COPD patients with isolated nocturnal desaturations. The findings of studies investigating the effects of oxygen therapy on quality of sleep are limited and conflicting, with one study showing an improvement in sleep quality<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and another showing no change.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Thus, although the quality of sleep in COPD patients is known to be poor, the effects of nocturnal administration of oxygen are unknown. Furthermore, oxygen supplements do not appear either to reduce the prevalence of cardiac arrhythmias in patients with nocturnal desaturations or to affect pulmonary hemodynamics, and do not prevent the long-term development of pulmonary hypertension.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Around 30%–40% of COPD patients without hypoxemia or with moderate resting hypoxemia have desaturations during exercise, and this may be a factor for poor prognosis. Oxygen therapy has been shown to increase exercise capacity, at least in the short term, in various chronic diseases. Despite this increase in exercise tolerance, it remains unclear whether oxygen therapy should be prescribed to patients who are hypoxemic only during exercise. Even less information is available on the long-term effects, and some studies have even found that the initial improvement in distance walked is lost over time.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In any event, it seems reasonable to propose the use of oxygen administered by portable systems in appropriately selected cases that do not present very intense changes in arterial blood gases, with a PaO<span class="elsevierStyleInf">2</span> of between 80 and 60<span class="elsevierStyleHsp" style=""></span>mmHg and a clear reduction in exercise capacity, in whom an acute benefit has been shown on exercise testing and oxygen response. After the selected system is implemented, it would be desirable to confirm that the advantages and benefits persist during daily activities and to show that there is an increase in exercise tolerance and ease in performing the same activities and a reduction in the need for rests, etc.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A recent report from the National Heart, Lung and Blood Institute on long-term oxygen therapy in COPD patients has pointed out the arbitrary nature of the current clinical guidelines for the use of oxygen therapy, the limited size of the trials on which the recommendations are based, the length of time since the available studies were published, the lack of knowledge on the duration of therapy or the appropriate moment for prescribing oxygen and the best device for administering oxygen therapy to each individual patient.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> On the other hand, it is common knowledge that COPD patients often do not use the portable oxygen therapy systems prescribed by their doctors. In another study, patients reported that they very rarely received instructions from their doctors on the use of supplementary oxygen, they did not have a clear idea of the benefits they might gain from oxygen supplements, they were afraid that that device would run out of oxygen during use, and the devices used for ambulatory oxygen were too heavy to carry.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This would suggest that patients use their oxygen devices less than prescribed, even if light portable units are supplied.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It is clear that despite the long history and widespread use of oxygen therapy, there are still many issues pending clarification. The 2014 SEPAR Year of the Chronic Patient and Domiciliary Respiratory Care could be a good time to address these matters.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ortega Ruiz F. Oxigenoterapia crónica domiciliaria: año SEPAR. Arch Bronconeumol. 2014;50:209–210.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Nocturnal Oxygen Therapy Trial group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1980" "volumen" => "93" "paginaInicial" => "391" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6776858" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Report of the Medical Research Council Working Party" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2213-2600(13)70179-6" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1981" "volumen" => "1" "paginaInicial" => "681" "paginaFinal" => "685" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24429269" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ambulatory home oxygen: What is the evidence for benefit, and who does it help?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.J. Criner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.01918" "Revista" => array:6 [ "tituloSerie" => "Respir Care" "fecha" => "2013" "volumen" => "58" "paginaInicial" => "48" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23271819" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term oxygen therapy stops the natural decline of endurance in COPD patients with reversible hypercapnia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Haidl" 1 => "C. Clement" 2 => "C. Wiese" 3 => "D. Dellweg" 4 => "D. Kohler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000079637" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2004" "volumen" => "71" "paginaInicial" => "342" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15316206" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term oxygen therapy in COPD: Evidences and open questions of current indications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Corrado" 1 => "T. Renda" 2 => "S. Bertini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4081/monaldi.2010.311" "Revista" => array:6 [ "tituloSerie" => "Monaldi Arch Chest Dis" "fecha" => "2010" "volumen" => "73" "paginaInicial" => "34" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20499792" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of oxygenation on sleep quality in chronic bronchitis and emphysema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.M. Calverley" 1 => "V. Brezinova" 2 => "N.J. Douglas" 3 => "J.R. Catterall" 4 => "D.C. Flenley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/arrd.1982.126.2.206" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1982" "volumen" => "126" "paginaInicial" => "206" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7103244" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. The effect of oxygen therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Fleetham" 1 => "P. West" 2 => "B. Mezon" 3 => "W. Conway" 4 => "T. Roth" 5 => "M. Kryger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/arrd.1982.126.3.429" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1982" "volumen" => "126" "paginaInicial" => "429" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7125332" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep-disordered breathing and COPD: The overlap syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.L. Owens" 1 => "A. Malhotra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respir Care" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "1333" "paginaFinal" => "1344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20875160" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomised trial of domiciliary, ambulatory oxygen in patients with COPD and dyspnoea but without resting hypoxaemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.P. Moore" 1 => "D.J. Berlowitz" 2 => "L. Denehy" 3 => "J.J. Pretto" 4 => "D.J. Brazzale" 5 => "K. Sharpe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2009.132522" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2011" "volumen" => "66" "paginaInicial" => "32" "paginaFinal" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20880870" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term oxygen treatment in chronic obstructive pulmonary disease: Recommendations for future research: an NHLBI workshop report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.L. Croxton" 1 => "W.C. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200507-1161WS" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2006" "volumen" => "174" "paginaInicial" => "373" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16614349" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000006/v1_201405291004/S157921291400127X/v1_201405291004/en/main.assets" "Apartado" => array:4 [ "identificador" => "14568" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000006/v1_201405291004/S157921291400127X/v1_201405291004/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291400127X?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 1 | 7 |
| 2024 October | 63 | 26 | 89 |
| 2024 September | 68 | 19 | 87 |
| 2024 August | 77 | 37 | 114 |
| 2024 July | 54 | 19 | 73 |
| 2024 June | 59 | 24 | 83 |
| 2024 May | 77 | 33 | 110 |
| 2024 April | 44 | 36 | 80 |
| 2024 March | 46 | 23 | 69 |
| 2024 February | 29 | 25 | 54 |
| 2023 March | 5 | 6 | 11 |
| 2023 February | 34 | 24 | 58 |
| 2023 January | 31 | 48 | 79 |
| 2022 December | 53 | 46 | 99 |
| 2022 November | 46 | 50 | 96 |
| 2022 October | 52 | 52 | 104 |
| 2022 September | 30 | 24 | 54 |
| 2022 August | 30 | 49 | 79 |
| 2022 July | 34 | 55 | 89 |
| 2022 June | 35 | 40 | 75 |
| 2022 May | 40 | 39 | 79 |
| 2022 April | 39 | 46 | 85 |
| 2022 March | 46 | 43 | 89 |
| 2022 February | 50 | 39 | 89 |
| 2022 January | 26 | 35 | 61 |
| 2021 December | 31 | 49 | 80 |
| 2021 November | 32 | 45 | 77 |
| 2021 October | 48 | 48 | 96 |
| 2021 September | 32 | 43 | 75 |
| 2021 August | 35 | 43 | 78 |
| 2021 July | 34 | 26 | 60 |
| 2021 June | 45 | 62 | 107 |
| 2021 May | 39 | 35 | 74 |
| 2021 April | 56 | 102 | 158 |
| 2021 March | 55 | 31 | 86 |
| 2021 February | 27 | 26 | 53 |
| 2021 January | 24 | 17 | 41 |
| 2020 December | 29 | 27 | 56 |
| 2020 November | 19 | 14 | 33 |
| 2020 October | 31 | 23 | 54 |
| 2020 September | 25 | 11 | 36 |
| 2020 August | 27 | 16 | 43 |
| 2020 July | 34 | 29 | 63 |
| 2020 June | 33 | 9 | 42 |
| 2020 May | 30 | 11 | 41 |
| 2020 April | 37 | 26 | 63 |
| 2020 March | 38 | 12 | 50 |
| 2020 February | 34 | 22 | 56 |
| 2020 January | 52 | 26 | 78 |
| 2019 December | 30 | 15 | 45 |
| 2019 November | 33 | 13 | 46 |
| 2019 October | 35 | 10 | 45 |
| 2019 September | 36 | 6 | 42 |
| 2019 August | 28 | 8 | 36 |
| 2019 July | 18 | 12 | 30 |
| 2019 June | 29 | 10 | 39 |
| 2019 May | 38 | 35 | 73 |
| 2019 April | 27 | 22 | 49 |
| 2019 March | 60 | 32 | 92 |
| 2019 February | 47 | 17 | 64 |
| 2019 January | 41 | 16 | 57 |
| 2018 December | 49 | 22 | 71 |
| 2018 November | 39 | 19 | 58 |
| 2018 October | 48 | 21 | 69 |
| 2018 September | 15 | 8 | 23 |
| 2018 May | 6 | 2 | 8 |
| 2018 April | 21 | 4 | 25 |
| 2018 March | 19 | 4 | 23 |
| 2018 February | 23 | 7 | 30 |
| 2018 January | 32 | 6 | 38 |
| 2017 December | 31 | 4 | 35 |
| 2017 November | 29 | 7 | 36 |
| 2017 October | 25 | 7 | 32 |
| 2017 September | 32 | 9 | 41 |
| 2017 August | 44 | 11 | 55 |
| 2017 July | 30 | 5 | 35 |
| 2017 June | 43 | 16 | 59 |
| 2017 May | 39 | 9 | 48 |
| 2017 April | 29 | 7 | 36 |
| 2017 March | 31 | 7 | 38 |
| 2017 February | 22 | 7 | 29 |
| 2017 January | 13 | 5 | 18 |
| 2016 December | 35 | 6 | 41 |
| 2016 November | 40 | 5 | 45 |
| 2016 October | 38 | 15 | 53 |
| 2016 September | 50 | 15 | 65 |
| 2016 August | 48 | 9 | 57 |
| 2016 July | 25 | 13 | 38 |
| 2016 March | 3 | 0 | 3 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 39 | 2 | 41 |
| 2015 September | 35 | 11 | 46 |
| 2015 August | 39 | 8 | 47 |
| 2015 July | 42 | 17 | 59 |
| 2015 June | 35 | 8 | 43 |
| 2015 May | 45 | 10 | 55 |
| 2015 April | 32 | 10 | 42 |
| 2015 March | 51 | 9 | 60 |
| 2015 February | 47 | 11 | 58 |
| 2015 January | 39 | 11 | 50 |
| 2014 December | 24 | 14 | 38 |
| 2014 November | 32 | 8 | 40 |
| 2014 October | 41 | 13 | 54 |
| 2014 September | 32 | 15 | 47 |
| 2014 August | 1 | 0 | 1 |
| 2014 July | 0 | 1 | 1 |
| 2014 June | 1 | 1 | 2 |
Show all
