Letter to the Editor
Mortality in Obesity-hypoventilation Syndrome and Prognostic Risk Factors
Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico
Javier Navarro Esteva
, Carlos Hinojosa Astudillo, Gabriel Juliá Serdá
Corresponding author
Servicio de Neumología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
Read
5300
Timeswas read the article
2011
Total PDF
3289
Total HTML
Share statistics
array:24 [ "pii" => "S1579212915001706" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.05.018" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1034" "copyright" => "SEPAR" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:420-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2046 "formatos" => array:3 [ "EPUB" => 137 "HTML" => 1309 "PDF" => 600 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289614003329" "issn" => "03002896" "doi" => "10.1016/j.arbres.2014.06.022" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1034" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:420-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3422 "formatos" => array:3 [ "EPUB" => 103 "HTML" => 2608 "PDF" => 711 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "420" "paginaFinal" => "421" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Mortality in Obesity-hypoventilation Syndrome and Prognostic Risk Factors" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Navarro Esteva, Carlos Hinojosa Astudillo, Gabriel Juliá Serdá" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Navarro Esteva" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Hinojosa Astudillo" ] 2 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Juliá Serdá" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212915001706" "doi" => "10.1016/j.arbr.2015.05.018" "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/S1579212915001706?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614003329?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000008/v2_201511200118/S0300289614003329/v2_201511200118/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212915001718" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.05.019" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1063" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:421-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2110 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 1477 "PDF" => 514 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Abdominal Findings in Lymphangioleiomyomatosis: A Report of Two Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "421" "paginaFinal" => "422" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patología abdominal asociada a la linfangioleiomiomatosis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1040 "Ancho" => 1300 "Tamanyo" => 176396 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Radiological findings in the case, characterized by (A) multiple pulmonary cysts, (B) a right renal mass (yellow arrow), and (C) multiple round cystic lesions in the retroperitoneum (yellow arrows) and pelvis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Helena Gómez Herrero, Carmen Sánchez Rodríguez, Álvaro Gargallo Vaamonde" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Helena" "apellidos" => "Gómez Herrero" ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Sánchez Rodríguez" ] 2 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Gargallo Vaamonde" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614003883" "doi" => "10.1016/j.arbres.2014.09.014" "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/S0300289614003883?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001718?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000008/v2_201511200100/S1579212915001718/v2_201511200100/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S157921291500169X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.05.017" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1016" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:419-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2035 "formatos" => array:3 [ "EPUB" => 148 "HTML" => 1397 "PDF" => 490 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pleural Effusion Secondary to <span class="elsevierStyleItalic">Actinomyces</span> Infection as a Late Complication of Laparoscopic Cholecystectomy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "419" "paginaFinal" => "420" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrame pleural secundario a infección por <span class="elsevierStyleItalic">Actinomyces</span> como complicación tardía de una colecistectomía laparoscópica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 695 "Ancho" => 1401 "Tamanyo" => 126476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Image of the lesion in the lateral region of the right hemithorax. (B) Chest CT slice showing thickening of the pleura of the right posterolateral costophrenic angle with a hypodense area inside, with extrapleural fat involvement, muscle thickening and pleural effusion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rocío Magdalena Díaz Campos, Francisco López-Medrano, Antonio Lalueza, Fernando Granados Caballero, Victoria Villena Garrido" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Rocío Magdalena" "apellidos" => "Díaz Campos" ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "López-Medrano" ] 2 => array:2 [ "nombre" => "Antonio" "apellidos" => "Lalueza" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Granados Caballero" ] 4 => array:2 [ "nombre" => "Victoria" "apellidos" => "Villena Garrido" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614002750" "doi" => "10.1016/j.arbres.2014.07.002" "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/S0300289614002750?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500169X?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000008/v2_201511200100/S157921291500169X/v2_201511200100/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Mortality in Obesity-hypoventilation Syndrome and Prognostic Risk Factors" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "420" "paginaFinal" => "421" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Navarro Esteva, Carlos Hinojosa Astudillo, Gabriel Juliá Serdá" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Javier" "apellidos" => "Navarro Esteva" "email" => array:2 [ 0 => "jnavest@gobiernodecanarias.org" 1 => "jnesteva7@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Hinojosa Astudillo" ] 2 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Juliá Serdá" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The clinical presentation of patients with obesity-hypoventilation syndrome (OHS) is heterogeneous in terms of severity, ranging from those with few symptoms referred for suspected sleep apnea–hypopnea syndrome (SAHS), to those diagnosed after admission to an intensive care unit for hypercapnic encephalopathy. Published clinical series indicate that OHS is associated with major morbidity and mortality, with respiratory or cardiovascular failure causing fatal outcome. It is likely that failure to suspect the respiratory disorder together with cardiovascular comorbidity at the time of diagnosis contribute to an unfavorable prognosis in specific patients.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several observational series estimating mortality in this group and identifying associated risk factors have been published.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a> Ojeda Castillejo et al. recently published an interesting prospective study in <span class="elsevierStyleItalic">Archivos de Bronconeumología</span> on the evolution of patients with OHS, and we would like to comment on several aspects of this series.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This study has probably the longest follow-up time (mean >7 years) of those hitherto published; patients were closely monitored, and seemingly appropriate ventilation criteria were established. As regards results, the authors found that the OHS group without SAHS had higher mortality, and that, in contrast to earlier studies, persistence of reduced forced vital capacity (FVC) had prognostic value. Moreover, and contrary to what might be expected,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> they found that baseline paO<span class="elsevierStyleInf">2</span> had no prognostic value. Although the results of studies such as this are relevant and necessary to understand the natural history of patients with OHS, the absence of some data limits interpretation of the results:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0015" class="elsevierStylePara elsevierViewall">Patients were recruited either after they had been stabilized following hospital admission for respiratory acidosis, or during a visit to the clinic. Hospitalized patients may have more comorbidities than those recruited in the clinic.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> However, the authors do not provide data on comorbidities.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0020" class="elsevierStylePara elsevierViewall">In the mortality analysis, the authors do not indicate if they included patients who did not comply with non-invasive mechanical ventilation (NIV) or continued positive airway pressure (CPAP) therapy–a total of 9 subjects. This is another relevant detail, as lack of compliance has been associated with higher mortality.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> The distribution of non-compliers by patient group is also unknown.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0025" class="elsevierStylePara elsevierViewall">The many causes of hypoxemia under NIV include central hypoventilation and ventilation/perfusion disorders. In this respect, there are clinical practice guidelines that recommend a support pressure setting of at least 10<span class="elsevierStyleHsp" style=""></span>mmHg (inspiratory positive airway pressure [IPAP]–expiratory positive airway pressure [EPAP]) before assessing whether oxygen should be added. In the paper by Ojeda Castillejo et al., it is not clear if this consideration has been taken into account.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0030" class="elsevierStylePara elsevierViewall">ANOVA or the Student's <span class="elsevierStyleItalic">t</span>-test with Bonferroni correction is more appropriate for a comparative analysis of FVC values over time.</p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">To summarize, to estimate prognostic factors of mortality in patients with OHS, NIV or CPAP settings must be correct, and a detailed study of potentially relevant risk factors should be made. Additionally, and while awaiting the results of ongoing studies, it will be interesting to see if nocturnal monitoring of NIV in poor responders (by analyzing the ventilator software with or without simultaneous polygraphy) will have a positive effect on their quality of life and prognosis for survival.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors did not receive any funding for writing this manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro Esteva J, Hinojosa Astudillo C, Juliá Serdá G. Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico. Arch Bronconeumol. 2015;51:420-421.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.A. Pérez de Llano" 1 => "R. Golpe" 2 => "M. Ortiz Piquer" 3 => "A. Veres Racamonde" 4 => "M. Vázquez Caruncho" 5 => "O. Caballero Muinelos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.128.2.587" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "128" "paginaInicial" => "587" "paginaFinal" => "594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16100142" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcome of noninvasive positive pressure ventilation for obesity hypoventilation syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Priou" 1 => "J.F. Hamel" 2 => "C. Person" 3 => "N. Meslier" 4 => "J.L. Racineux" 5 => "T. Urban" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-2472" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "138" "paginaInicial" => "84" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20348200" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Carrillo" 1 => "M. Ferrer" 2 => "G. González-Díaz" 3 => "A. López-Martínez" 4 => "N. Llamas" 5 => "M. Alcazar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201206-1101OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2012" "volumen" => "186" "paginaInicial" => "1279" "paginaFinal" => "1285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23103736" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Borel" 1 => "B. Burel" 2 => "R. Tamisier" 3 => "S. Dias-Domingos" 4 => "J.P. Baguet" 5 => "P. Levy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0052006" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "e52006" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23341888" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive mechanical ventilation in patients with obesity hypoventilation syndrome. Long-term outcome and prognostic factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Ojeda Castillejo" 1 => "P. de Lucas Ramos" 2 => "S. López Martín" 3 => "P. Resano Barrios" 4 => "P. Rodríguez Rodríguez" 5 => "L. Morán Caicedo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2014.02.015" "Revista" => array:6 [ "tituloSerie" => "Arch. Bronconeumol." "fecha" => "2015" "volumen" => "51" "paginaInicial" => "61" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24703500" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000008/v2_201511200100/S1579212915001706/v2_201511200100/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000008/v2_201511200100/S1579212915001706/v2_201511200100/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001706?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 1 | 2 |
| 2024 October | 39 | 21 | 60 |
| 2024 September | 40 | 13 | 53 |
| 2024 August | 66 | 47 | 113 |
| 2024 July | 41 | 17 | 58 |
| 2024 June | 44 | 25 | 69 |
| 2024 May | 69 | 30 | 99 |
| 2024 April | 35 | 27 | 62 |
| 2024 March | 41 | 19 | 60 |
| 2024 February | 45 | 16 | 61 |
| 2023 March | 6 | 7 | 13 |
| 2023 February | 40 | 21 | 61 |
| 2023 January | 29 | 36 | 65 |
| 2022 December | 44 | 35 | 79 |
| 2022 November | 50 | 32 | 82 |
| 2022 October | 50 | 35 | 85 |
| 2022 September | 29 | 27 | 56 |
| 2022 August | 41 | 42 | 83 |
| 2022 July | 28 | 51 | 79 |
| 2022 June | 26 | 30 | 56 |
| 2022 May | 34 | 44 | 78 |
| 2022 April | 33 | 39 | 72 |
| 2022 March | 39 | 46 | 85 |
| 2022 February | 38 | 44 | 82 |
| 2022 January | 34 | 33 | 67 |
| 2021 December | 28 | 40 | 68 |
| 2021 November | 37 | 43 | 80 |
| 2021 October | 33 | 43 | 76 |
| 2021 September | 42 | 54 | 96 |
| 2021 August | 36 | 31 | 67 |
| 2021 July | 23 | 34 | 57 |
| 2021 June | 43 | 35 | 78 |
| 2021 May | 42 | 24 | 66 |
| 2021 April | 117 | 83 | 200 |
| 2021 March | 110 | 22 | 132 |
| 2021 February | 53 | 25 | 78 |
| 2021 January | 47 | 36 | 83 |
| 2020 December | 48 | 24 | 72 |
| 2020 November | 38 | 19 | 57 |
| 2020 October | 36 | 23 | 59 |
| 2020 September | 28 | 14 | 42 |
| 2020 August | 74 | 12 | 86 |
| 2020 July | 40 | 33 | 73 |
| 2020 June | 38 | 15 | 53 |
| 2020 May | 35 | 17 | 52 |
| 2020 April | 35 | 26 | 61 |
| 2020 March | 30 | 13 | 43 |
| 2020 February | 53 | 19 | 72 |
| 2020 January | 37 | 10 | 47 |
| 2019 December | 33 | 24 | 57 |
| 2019 November | 25 | 23 | 48 |
| 2019 October | 17 | 10 | 27 |
| 2019 September | 27 | 8 | 35 |
| 2019 August | 28 | 13 | 41 |
| 2019 July | 22 | 28 | 50 |
| 2019 June | 21 | 13 | 34 |
| 2019 May | 15 | 20 | 35 |
| 2019 April | 47 | 49 | 96 |
| 2019 March | 36 | 22 | 58 |
| 2019 February | 27 | 24 | 51 |
| 2019 January | 28 | 8 | 36 |
| 2018 December | 37 | 15 | 52 |
| 2018 November | 57 | 26 | 83 |
| 2018 October | 60 | 23 | 83 |
| 2018 September | 25 | 7 | 32 |
| 2018 May | 12 | 0 | 12 |
| 2018 April | 27 | 8 | 35 |
| 2018 March | 23 | 6 | 29 |
| 2018 February | 39 | 7 | 46 |
| 2018 January | 95 | 11 | 106 |
| 2017 December | 84 | 13 | 97 |
| 2017 November | 16 | 10 | 26 |
| 2017 October | 28 | 12 | 40 |
| 2017 September | 23 | 7 | 30 |
| 2017 August | 24 | 14 | 38 |
| 2017 July | 20 | 5 | 25 |
| 2017 June | 32 | 22 | 54 |
| 2017 May | 22 | 5 | 27 |
| 2017 April | 21 | 10 | 31 |
| 2017 March | 10 | 8 | 18 |
| 2017 February | 14 | 8 | 22 |
| 2017 January | 18 | 4 | 22 |
| 2016 December | 26 | 17 | 43 |
| 2016 November | 29 | 10 | 39 |
| 2016 October | 27 | 18 | 45 |
| 2016 September | 34 | 17 | 51 |
| 2016 August | 28 | 14 | 42 |
| 2016 July | 37 | 23 | 60 |
| 2016 March | 6 | 0 | 6 |
| 2015 December | 6 | 0 | 6 |
| 2015 October | 25 | 2 | 27 |
| 2015 September | 13 | 10 | 23 |
| 2015 August | 0 | 2 | 2 |
| 2015 July | 0 | 1 | 1 |
| 2015 June | 0 | 1 | 1 |
Show all
