Utility of Induced Sputum in Routine Clinical Practice

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Practice" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "255" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Silvia Barril, Laura Sebastián, Gianluca Cotta, Astrid Crespo, Eder Mateus, Montserrat Torrejón, David Ramos-Barbón, Vicente Plaza" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Silvia" "apellidos" => "Barril" ] 1 => array:2 [ "nombre" => "Laura" "apellidos" => "Sebastián" ] 2 => array:2 [ "nombre" => "Gianluca" "apellidos" => "Cotta" ] 3 => array:2 [ "nombre" => "Astrid" "apellidos" => "Crespo" ] 4 => array:2 [ "nombre" => "Eder" "apellidos" => "Mateus" ] 5 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Torrejón" ] 6 => array:2 [ "nombre" => "David" "apellidos" => "Ramos-Barbón" ] 7 => array:4 [ "nombre" => "Vicente" "apellidos" => "Plaza" "email" => array:1 [ 0 => "vplaza@santpau.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Asma y Alergia, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del esputo inducido en la práctica clínica habitual" ] ] "textoCompleto" => "IntroductionBronchial inflammation plays a major role in the pathogenesis of important respiratory tract diseases, such as asthma or chronic obstructive lung disease (COPD). A tool for evaluating the type and intensity of bronchial inflammation would be of great benefit in the assessment and control of these diseases, particularly in the more severe forms.Endobronchial biopsy is the gold standard in the study of bronchial inflammation; being an invasive procedure, however, its use as a diagnostic tool is limited.<a class="elsevierStyleCrossRef" href="#bib0190">1</a> Accordingly, interest is growing in non-invasive procedures, and new techniques for measuring fractional exhaled nitric oxide (FENO) and inflammatory cell count (ICC) in induced sputum (IS) are attracting particular attention.While FENO identifies eosinophilic bronchial inflammation, it does not recognize other inflammatory types, so its utility is limited.<a class="elsevierStyleCrossRef" href="#bib0195">2</a> IS is a validated standardized technique, considered the gold standard non-invasive methods for evaluating bronchial inflammation and for distinguishing between inflammatory phenotypes.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Its clinical applications are becoming more refined, and it is of particular benefit in asthma, due to its high yield. It can be used as a complementary diagnostic tool in asthma,<a class="elsevierStyleCrossRef" href="#bib0205">4</a> and is of benefit in determining inflammatory phenotypes,<a class="elsevierStyleCrossRef" href="#bib0210">5</a> adjusting treatment, and predicting therapeutic response.<a class="elsevierStyleCrossRefs" href="#bib0215">6,7</a> It has also been indicated in the management of difficult-to-control asthma (DCA) in Spanish and international guidelines.<a class="elsevierStyleCrossRefs" href="#bib0225">8–10</a> Its use is not restricted purely to asthma: it is also useful for determining the etiology of chronic cough,<a class="elsevierStyleCrossRefs" href="#bib0240">11,12</a> gastroesophageal reflux (GER)<a class="elsevierStyleCrossRef" href="#bib0250">13</a> and other entities, such as COPD, infectious diseases, eosinophilic bronchitis, lung cancer, interstitial lung diseases, and heart failure.<a class="elsevierStyleCrossRefs" href="#bib0255">14–19</a>However, despite its validity and applicability, ICC in IS is not routinely performed in standard clinical practice, probably because it requires a certain degree of technical experience in obtaining, manipulating and interpreting the samples, in addition to being laborious and costly. Nevertheless, the data provided by IS testing is so obviously of interest<a class="elsevierStyleCrossRef" href="#bib0235">10</a> that we are surprised how rarely it is used in high-level pulmonology departments. The aim of this study was to evaluate the contribution of ICC in IS in healthcare practices.MethodsDesignThis was a retrospective, descriptive study performed in standard clinical practice to determine the clinical utility of ICC in IS.Study PopulationAll patients who underwent ICC in IS as part of their standard care in the pulmonology department of our hospital over the course of 1 year (May 2012–May 2013) were included, irrespective of their previous treatment, which often included inhaled corticosteroids (ICS), particularly in asthma patients. Patients who underwent the procedure for exclusively investigational purposes were excluded.Ethical and Legal AspectsSince this was a descriptive, retrospective study performed in standard clinical practice conditions, the Clinical Research Ethics Committee was informed only of our interest in collecting this information from the clinical records of the patients. All study data collection was anonymous.Primary EndpointsThe primary endpoint was the proportion of patients in whom IS was clinically useful. IS was considered useful when the ICC provided information that could be used for establishing a diagnosis and/or when it led directly to a decision on therapeutic management. Three observers, independent from the treating physicians (SB, LS, and GC), assessed these premises by reviewing the clinical records.The asthma group included patients with clinically suspected asthma and those with a previous diagnosis of asthma. In the DCA group, all patients had asthma meeting criteria for poor control. IS was considered of use in diagnosis when the determination of bronchial eosinophilia led to the diagnosis of patients with a clinical history consistent with asthma.<a class="elsevierStyleCrossRef" href="#bib0285">20</a> It was also classified as useful in patients with a previously established diagnosis of asthma or DCA, when the determination of the inflammatory phenotype helped clarify the nature of the patient's respiratory symptoms<a class="elsevierStyleCrossRefs" href="#bib0230">9,10,21</a> in the following circumstances: suspicion of poor treatment compliance, exposure to airborne allergens, or insufficient treatment in the case of an eosinophilic phenotype; suspicion of an erroneous diagnosis or another associated disease or resistance to corticosteroids in the case of bronchial neutrophilia; a paucigranulocytic phenotype suggested controlled eosinophilia, confounding diagnoses, or paucigranulocytic variables. IS was considered therapeutically useful in the following situations: in patients with bronchial eosinophilia when the decision was taken to increase ICS, initiate systemic corticosteroids (SCS), initiate interventions for improving compliance, or initiate leukotriene receptor antagonists;<a class="elsevierStyleCrossRefs" href="#bib0215">6,7</a> in patients with a neutrophilic phenotype<a class="elsevierStyleCrossRefs" href="#bib0215">6,7</a> when antibiotics or long-acting β2-agonists were initiated or ICS dosing was reduced; and in patients with a paucigranulocytic phenotype when the addition of long-acting β2-agonists was evaluated or the steroid dose was reduced.<a class="elsevierStyleCrossRefs" href="#bib0215">6,7</a>In patients with chronic cough, ICC was considered to be useful when findings helped identify the reason for the cough<a class="elsevierStyleCrossRefs" href="#bib0240">11,12</a> in the following circumstances: a case of bronchial eosinophilia arousing suspicion of asthma, eosinophilic bronchitis, or occupational disease; or a neutrophilic phenotype aroused suspicion of infectious bronchitis or bronchiectasis. IS was considered of therapeutic utility when findings led to the initiation of ICS or antibiotic therapy. Finally, the finding of lipophages in patients with chronic cough or clinically suspected GER helped identify a diagnosis of GER. Initiation of antacids or antireflux measures was considered a therapeutic contribution.Secondary EndpointsDemographic, clinical and functional data were collected from all patients, and the main reasons for requesting IS and the characteristics of the sample (cell count, sample quality and inflammatory phenotype) were recorded.ProceduresSpirometrySpirometry was performed using a Daptospir-600 device (Sibelmed SA, Barcelona, Spain), by an experienced operator, following SEPAR 2013 guidelines.<a class="elsevierStyleCrossRef" href="#bib0295">22</a> The reference values were those established for a Mediterranean population.<a class="elsevierStyleCrossRef" href="#bib0300">23</a>Fractional Exhaled Nitric OxideThis was carried out using an electrochemical device (NO Vario Analyzer. FILT Lungen and Thorax Diagnostic GmHb, Berlin, Germany) at a flow of 50ml/s, following the recommendations of the ATS/ERS.<a class="elsevierStyleCrossRef" href="#bib0305">24</a> A significant elevation was considered any value ≥50ppb.<a class="elsevierStyleCrossRef" href="#bib0310">25</a>Induced SputumThe process of inducing and processing sputum was performed by specially trained and qualified healthcare professionals, according to the standard procedure.<a class="elsevierStyleCrossRef" href="#bib0315">26</a> Briefly, the sample was obtained after nebulization with hypertonic saline solution 3% using an ultrasound nebulizer (Omron NEU07). Serial spirometries were performed throughout induction. Procedures were suspended if FEV1 fell by 20% or more from baseline. The sample was processed within 2h of collection. Mucoid cumulates were selected manually, separated from the saliva, and treated with dithiothreitol (Sputolysin®, Calbiochem Corp., San Diego, CA) diluted 1:10. Dithiothreitol was added to a volume equivalent to 4 times the weight in milligrams of the selected plugs, along with the same volume of phosphate-buffered saline solution. Cell viability (live cells), concentration (cells/gram of sputum) and the percentage of squamous cells were evaluated (the latter considered as upper airway contamination), using hemocytometry and trypan blue staining. The cells were centrifuged to obtain a sediment that was used to determine the differential leukocyte count, using Wright-Giemsa staining, according to the procedure described by Pizzichini et al.<a class="elsevierStyleCrossRef" href="#bib0320">27</a> Lipophages were also identified, using Oil Red O lipid staining.<a class="elsevierStyleCrossRef" href="#bib0325">28</a> The sample was classified as “high quality” when the cell concentration was >1×106cells/g, viability>40%, and a concentration of epithelial cells<20%. IS samples were classified according to the differential leukocyte count into 4 inflammatory phenotypes, according to the criteria of Simpson et al.<a class="elsevierStyleCrossRef" href="#bib0330">29</a>: eosinophilic (eosinophils>3%); neutrophilic (neutrophils>61%); mixed (eosinophils>3% and neutrophils>61%), and paucigranulocytic (eosinophils<3% and neutrophils<61%).<a class="elsevierStyleCrossRefs" href="#bib0195">2,30</a>Asthma Control TestA validated version in Spanish<a class="elsevierStyleCrossRef" href="#bib0340">31</a> of the Asthma Control Test was used to establish the degree of clinical control in asthma patients. This is a 5-item patient-reported outcome measure of the degree of control of asthma in the last 4 weeks. Answers to each question are scored individually from 1 to 5 points, for a total score ranging from 5 (worst control possible) to 25 (best control possible). A score of 20 points or more is considered “controlled asthma” and 19 points or fewer is “uncontrolled asthma”. Uncontrolled asthma is subdivided into “partially controlled asthma” (16–19 points) and “poorly controlled asthma” (5–15 points).Statistical AnalysisResults are expressed as means and standard deviation for continuous variables with normal distribution. For continuous variables which did not fit a normal distribution, values were expressed in median and interquartile range, and for categorical variables, frequency and percentages were presented. Analysis of variance (ANOVA) or the Kruskal–Wallis test were used to compare demographic and clinical data among the 4 groups, depending on whether distribution of variables was normal or not. Categorical variables were compared using the Chi-squared test. Results were considered significant in case of P<.05. All analyses were carried out using the SPSS statistical package (v.22).ResultsA total of 171 patients were included, 95 (55.6%) of whom were women, and mean age was 50 (±15) years. Sociodemographic and clinical data of the study group are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Patients included in the study were classified according to the reason for ordering an IS. The most common reasons were asthma in general (103 [59.20%]) and DCA (34 [19.54%]), to complete the diagnostic process or to determine the inflammatory phenotype. The next most common reasons were chronic cough (19 [10.9%]) and suspected GER (15 [8.6%]). Three cases (1.7%) were classified as “other causes” and were excluded because of their heterogenic nature.Patients were classified according to the severity of their asthma and DCA, as follows: intermittent asthma 10 (7.2%) cases; mild persistent asthma 41 (29.9%), moderate 33 (24.1%) and severe 45 (32.8%). Eight cases (5.8%) were being investigated for suspected asthma. The mean Asthma Control Test score in the asthma group was 21.36 (±5.10) and in the DCA group, it was 15.9 (±5.12).<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of the IS samples. In the ICC, the highest percentage of eosinophils was observed in the DCA group, and the highest lipophage percentage was in patients with chronic cough and GER. IS was classified as “high quality” in 98 (57.3%) cases. The paucigranulocytic phenotype was predominant among the overall study cohort (88 [51.5%]) and among the subgroups for which IS was requested, although the eosinophilic phenotype emerged as the second most common phenotype in the asthma and DCA groups with 32 (31.1%) and 10 (29.4%) cases, respectively.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>A weakly positive correlation was observed between age and neutrophilia in ICC (R=0.15, P=.05). However, no correlation was observed between the presence of eosinophils in IS and FENO values (R=0.12, P=.14).Finally, the IS result contributed to clinical decision-making in 115 (67.3%) of cases, assisting diagnosis in 98 (57.3%) patients, and therapeutic decisions in 85 (49.7%). The results are listed by reason for IC in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. IS was of greatest benefit in decision-making in the general asthma group, followed by DCA: 74 (71.8%) and 23 (67.6%), respectively, although there were no differences in its utility among the different reasons for request. In the asthma group, a similar contribution to the diagnostic process (59 [57.3%]) and to therapeutic decision-making (58 [56.3%] was also observed. However, in the DCA group, IS provided more useful information for diagnostic (23 [57.6%] patients) than therapeutic (15 [44.1%] patients) decision-making. Likewise, in the chronic cough group, IS was more useful for guiding diagnosis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). In patients with suspected GER, the identification of a significant number of lipophages supported the diagnosis in 8 (53.3%) patients.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionThe main finding of our study is that ICC in IS is useful in routine clinical practice, since it provides important information for clinical decision-making in two thirds (67.3%) of patients in whom this complementary procedure was requested.Most experience and data on the use of IS are from asthma patients. Accordingly, IS was usually ordered in the context of asthma and DCA. Diagnostic applications are based mainly on the well-established relationships between asthma and eosinophilia in sputum.<a class="elsevierStyleCrossRef" href="#bib0210">5</a> If a cutoff point is set at 1% eosinophils in sputum, IS has a sensitivity of 80% and a specificity of 95% for confirming a diagnosis of asthma.<a class="elsevierStyleCrossRef" href="#bib0285">20</a> Although the most typical finding is eosinophilia in sputum, a systematic review of over 25 studies in asthma patients from different populations with varying degrees of severity,<a class="elsevierStyleCrossRef" href="#bib0345">32</a> and more recently, a study which analyzed 508 patients with asthma,<a class="elsevierStyleCrossRef" href="#bib0350">33</a> found that approximately 50% of these patients had non-eosinophilic asthma. In our series, more patients had non-eosinophilic asthma than generally described in the literature. However, the contribution of IS to confirming the diagnosis or determining the inflammatory phenotype was 67.6% in DCA and 57.3% in asthma.Characterization of the inflammatory phenotype has important therapeutic implications, since each has a different response to anti-inflammatory treatment. Little et al.<a class="elsevierStyleCrossRef" href="#bib0355">34</a> observed that patients with asthma who showed eosinophilia in IS had a significant increase in FEV1 after 2 weeks of treatment with SCS. Moreover, IS tests can reduce the number of exacerbations in asthmatic patients. Two randomized trials<a class="elsevierStyleCrossRefs" href="#bib0215">6,7</a> conducted in asthmatics whose treatment was adjusted according to clinical practice guideline recommendations or according to their IS eosinophil count showed a reduction in the number of exacerbations in patients whose treatment was established on the basis of their ICC. These results were confirmed in a recent systematic review,<a class="elsevierStyleCrossRef" href="#bib0360">35</a> and are reflected in the latest ATS/ERS guidelines on the management of severe asthma.<a class="elsevierStyleCrossRef" href="#bib0305">24</a> These recommendations state that in hospitals with the appropriate experience, treatment of patients with severe asthma should be based on both clinical criteria and monitoring of IS eosinophil levels. We also studied the contribution of IS to therapeutic decision-making in asthma patients. Results centered on the eosinophilic and neutrophilic phenotypes, but in some cases the decision to reduce steroid treatment was made in clinically stable patients who revealed a paucigranulocytic phenotype, according to clinical practice guidelines. Nevertheless, these premises only apply to selected patients, since the monitoring of eosinophilia in IS has not been adopted as a routine method in standard clinical practice.In patients with chronic cough, defined as a >3-week history of cough not immediately preceded by an acute process, IS is recommended to complete the diagnostic process.<a class="elsevierStyleCrossRefs" href="#bib0240">11,12</a> Bronchial eosinophilia revealed in patients with chronic cough can help guide the diagnosis of asthma, eosinophilic bronchitis, or occupational asthma, and can also predict a favorable response to steroid treatment. In our study, none of our chronic cough patients had eosinophilia in IS. However, in 3 (15.8%) patients, neutrophilia predominated, suggesting infectious disease. The finding of lipophages in IS (>7%) is 90% sensitive and 89% specific for a diagnosis of GER.<a class="elsevierStyleCrossRef" href="#bib0250">13</a> Lipophages (>7%) were found in 8 study patients investigated for chronic cough and for suspected GER, which explained 42.1% of causes of chronic cough, and supported 53.3% of suspected GER cases.In line with the previous literature,<a class="elsevierStyleCrossRefs" href="#bib0290">21,36</a> we found evidence among our series of a trend toward increased bronchial neutrophilia as age advances. However, more studies are need to determine if these findings affect the diagnostic yield of IS in elderly patients.In spite of all the reports in the literature describing the benefits of IS, only Moritz et al.,<a class="elsevierStyleCrossRef" href="#bib0370">37</a> in a series of 151 IS samples, found the results to be clinically useful in standard clinical practice, because they modified medical treatment in 82 (55%) of cases. The contribution was even greater in asthmatic patients: steroid dosing was modified in 48 patients (64.7%). The results of our study are similar to those described by Moritz et al. However, in our opinion, the contribution of the procedure to the diagnostic process must be included if the real benefit is to be studied.In spite of the limitations of the retrospective nature of this study (which, for example, in the case of asthma made it impossible to determine any improvements in future risk), the utility of the procedure was evaluated by observers who were independent from the treating physicians, in order to reduce subjectivity bias. Moreover, IS samples were induced, processed and evaluated according to a systematized protocol, by highly experienced technical staff, in compliance with the strict quality control standards of our laboratory. These precautions contributed to reducing potential variability among observers assessing ICC and standardizing sample collection and processing.To conclude, our study demonstrates that ICC in IS is beneficial in clinical decision-making, particularly in 2 common entities, asthma and chronic cough. We provide arguments for recommending the use of this technique in clinical practice, at least in referral pulmonology departments, particularly those equipped with dedicated asthma units.Conflict of InterestsThe authors declare that they have no conflict of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres631373" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec644201" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres631372" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec644202" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study Population" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical and Legal Aspects" ] 3 => array:3 [ "identificador" => "sec0030" "titulo" => "Primary Endpoints" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Secondary Endpoints" ] ] ] 4 => array:3 [ "identificador" => "sec0040" "titulo" => "Procedures" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Spirometry" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Fractional Exhaled Nitric Oxide" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Induced Sputum" ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Asthma Control Test" ] ] ] 5 => array:2 [ "identificador" => "sec0065" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0070" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of Interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-13" "fechaAceptado" => "2015-10-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec644201" "palabras" => array:3 [ 0 => "Asthma" 1 => "Induced sputum" 2 => "Clinical utility" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec644202" "palabras" => array:3 [ 0 => "Asma" 1 => "Esputo inducido" 2 => "Utilidad clínica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine the general and specific utility in diagnosis and/or treatment of induced sputum (IS) inflammatory cell counts in routine clinical practice. MethodsRetrospective study of 171 patients referred for clinical sputum induction over a 1-year period in the pulmonology department of a referral hospital. Independent observers established whether the information provided by IS inflammatory cell count was useful for making diagnostic and therapeutic decisions. ResultsThe most frequent reasons for determination of IS inflammatory cell count were: asthma 103 (59.20%); uncontrolled asthma 34 (19.54%); chronic cough 19 (10.9%), and gastroesophageal reflux 15 (8.6%). In 115 patients (67.3%) it was generally useful for diagnosis and/or treatment; in 98 patients (57.3%) it provided diagnostic information and in 85 patients (49.7%) it assisted in therapeutic decision-making. In asthma, uncontrolled asthma, chronic cough and gastroesophageal reflux, the results were useful in 71.8%, 67.6%, 47.4% and 60%, respectively. ConclusionThe information provided by IS inflammatory cell count is extremely useful in clinical practice, especially in asthma and chronic cough. These results may justify the inclusion of the IS technique in pulmonology departments and asthma units of referral centers." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosDeterminar la utilidad general y específica (diagnóstica y/o terapéutica) del recuento de las células inflamatorias (RCI) del esputo inducido (EI) en situación de asistencia clínica real. MétodosEstudio retrospectivo que incluyó a los 171 pacientes que durante un año se les recogió un EI para determinar su RCI en un servicio de Neumología de un hospital de referencia. Observadores independientes al equipo médico habitual establecieron si la información proporcionada por el RCI del EI fue útil en la toma de decisiones diagnósticas y terapéuticas. ResultadosLas causas más frecuentes que motivaron la solicitud del RCI del EI fueron: asma 103 (59,20%); asma de control difícil 34 (19,54%); tos crónica 19 (10,9%), y reflujo gastroesofágico 15 (8,6%). En 115 (67,3%) pacientes el RCI del EI resultó clínicamente útil (valoración general); en 98 (57,3%) proporcionó información diagnóstica, y en 85 (49,7%), información terapéutica relevante. En el asma, asma de control difícil, tos crónica y reflujo gastroesofágico fue útil en el 71,8, el 67,6, el 47,4 y el 60%, respectivamente. ConclusionesLa información proporcionada por el RCI del EI resulta de gran utilidad en la práctica clínica, particularmente en el asma y la tos crónica. Estos resultados podrían proporcionar argumentos para recomendar la incorporación de la técnica en los servicios de Neumología de referencia y en las unidades de excelencia de asma." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Barril S, Sebastián L, Cotta G, Crespo A, Mateus E, Torrejón M, et al. Utilidad del esputo inducido en la práctica clínica habitual. Arch Bronconeumol. 2016;52:250–255." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "FENO, fractional expired nitric oxide; FEV1, forced expiratory volume in 1s; GER, gastroesophageal reflux; ICS, inhaled corticosteroid; pred., predicted value; SCS, systemic corticosteroid.Values expressed as mean±standard deviation, median (interquartile range) or as percentage, as indicated." "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"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All (n=171) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asthma (n=103) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difficult-to-control asthma (n=34) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic Cough (n=19) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GER (n=15) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95 (55.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (46.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (64.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (73.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV1 (% pred.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89±22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70±25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91±25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FENO (ppb) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32±25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32±22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive skin prick test (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients receiving ICS (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">142 (83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89 (86.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (57.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (53.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICS dose<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (μg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">800 (320–1.600) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">720 (320–1.200) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1600 (800–1.600) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">800 (0–800) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0–800) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients receiving SCS (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients receiving antileukotrienes (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66 (38.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 (40.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (70.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035927.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "ICS dose converted to budesonide equivalents." ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and Clinical Characteristics of the Overall Study Series and by Subgroups According to the Reason for Requesting Inflammatory Cell Count in Induced Sputum." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "GER, gastroesophageal reflux; IS, induced sputum; TCC, total cell count.Values expressed as mean±standard deviation, median (interquartile range) or as percentage, as indicated." "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"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All (n=171) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asthma (n=103) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difficult-to-control Asthma (n=34) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic Cough (n=19) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GER (n=15) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Cellularity of induced sputum</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TCC (103 cells/g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.56 (1–2.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.8 (1–2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.58 (0.9–3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.38 (1.1–2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.46 (1.1–1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cell viability (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51 (38–71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.5 (38–69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.1 (37.8–73.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (39.3–71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (28.9–63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polymorphonuclear (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42±24.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.1±25.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.0±25.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.5±25.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.2±23.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphocytes (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.7 (0.3–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.7 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.6 (0.3–0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.7 (0.4–0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.6 (0.3–0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Macrophages (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (21.9–62.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.3 (25.5–45.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.8 (20.9–59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.3 (28.2–68.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.3 (0.3–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Eosinophils (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.9 (0.3–4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.9 (0.3–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7 (0.3–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3 (0–1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.3–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lipophages (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0–0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0–0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0–0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0–15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (0–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Quality of induced sputum</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (30.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (32.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (21.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (40.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medium (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (12.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (11.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (15.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98 (57.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 (58.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (55.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (63.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (46.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Inflammatory phenotype</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutrophilic (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (20.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (15.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (20.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Eosinophilic (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (26.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (31.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (29.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (26.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paucigranulocytic (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 (51.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (46.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (44.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (84.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (53.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mixed (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035926.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of Induced Sputum." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "GER, gastroesophageal reflux.Values expressed as absolute frequencies and percentages." "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"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All (n=171) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asthma (n=103) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difficult-to-control Asthma (n=34) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic Cough (n=19) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GER (n=15) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Overall clinical utility (diagnostic/therapeutic contribution)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (67.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (71.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (67.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (47.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (32.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (28.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (32.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (52.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Diagnostic contribution</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 (57.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (57.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (67.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (42.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (53.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.337 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 (42.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (42.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (32.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (57.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (46.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Therapeutic contribution</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 (49.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (56.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (44.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (26.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (46.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.092 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 (50.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (43.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (55.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (73.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (53.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035925.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Contribution of Results Provided by Inflammatory Cell Count in Induced Sputum in Overall Clinical, Diagnostic and Therapeutic Decision-making." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Broncoscopia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.M. Muñoz" 1 => "A. Torrego" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Inflamometría en asma, EPOC y rinitis" "paginaInicial" => "191" "paginaFinal" => "204" "serieFecha" => "2012" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0195" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noneosinophilic asthma: a distinc clinical and pathologic phenotype" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Haldar" 1 => "I.D. Ravord" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Allergy Clinc Immunol" "fecha" => "2007" "volumen" => "119" "paginaInicial" => "1043" "paginaFinal" => "1052" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0200" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standardized methodology of sputum induction and processing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Djukanović" 1 => "P.J. Sterk" 2 => "J.V. Fahy" 3 => "F.E. Hargreave" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Eur Respir J" "fecha" => "2002" "volumen" => "20" "numero" => "Suppl" "paginaInicial" => "1" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12166553" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0205" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical applications of induced sputum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.E. Brightling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.129.5.1344" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2006" "volumen" => "129" "paginaInicial" => "1344" "paginaFinal" => "1348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16685028" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0210" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of induced sputum in adults with asthma: Identification of subgroup with isolated sputum neutrophilia and poor response to inhaled corticosteroids" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.H. Green" 1 => "C.E. Brightling" 2 => "G. Woltmann" 3 => "D. Parker" 4 => "A.J. Wardlaw" 5 => "I.D. Pavord" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "875" "paginaFinal" => "879" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12324674" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0215" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in sputum eosinophils predict loss of asthma control" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Jatakanon" 1 => "S. Lim" 2 => "P.J. Barnes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Crit Care Med" "fecha" => "2000" "volumen" => "161" "paginaInicial" => "64" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0220" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.H. Green" 1 => "C.E. Brightling" 2 => "S. McKenna" 3 => "B. Hargadon" 4 => "D. Parker" 5 => "P. Bradding" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(02)11679-5" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2002" "volumen" => "360" "paginaInicial" => "1715" "paginaFinal" => "1721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12480423" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0225" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normativa SEPAR para el asma de control difícil" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. López-Viña" 1 => "R. Agüero-Balbín" 2 => "J.L. Aller-Alvarez" 3 => "T. Bazús-González" 4 => "B.G. Cosio" 5 => "A. de Diego-Damiá" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "513" "paginaFinal" => "523" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16194515" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0230" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Guía Española para el Manejo del Asma (GEMA 4.0)" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "1" "paginaFinal" => "68" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0235" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.F. Chung" 1 => "S.E. Wenzel" 2 => "J.L. Brozek" 3 => "A. Bush" 4 => "M. Castro" 5 => "P.J. Sterk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00202013" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "343" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24337046" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0240" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normativa SEPAR sobre la tos crónica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. De Diego Damiá" 1 => "V. Plaza Moral" 2 => "V. Garrigues Gil" 3 => "J.L. Izquierdo Alonso" 4 => "A. López Viña" 5 => "J. Mullol Miret" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2002" "volumen" => "38" "paginaInicial" => "236" "paginaFinal" => "245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12028932" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0245" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for the management of cough in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.H. Morice" 1 => "L. McGarvey" 2 => "I. Pavord" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2005.044941" "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "2006" "volumen" => "61" "numero" => "Suppl 1" "paginaInicial" => "1" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16396949" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0250" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Parameswaran" 1 => "M. Anvari" 2 => "A. Efthimiadis" 3 => "D. Kamada" 4 => "F.E. Hargreaves" 5 => "C.J. Allen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2000" "volumen" => "16" "paginaInicial" => "1119" "paginaFinal" => "1122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11292116" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0255" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Siva" 1 => "R.H. Green" 2 => "C.E. Brightling" 3 => "M. Shelley" 4 => "B. Hargadon" 5 => "S. McKenna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00146306" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2007" "volumen" => "29" "paginaInicial" => "906" "paginaFinal" => "913" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17301099" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0260" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. McWilliams" 1 => "A.U. Wells" 2 => "A.C. Harrison" 3 => "S. Lindstrom" 4 => "R.J. Cameron" 5 => "E. Foskin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "1010" "paginaFinal" => "1014" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12454293" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0265" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic bronchitis is an important cause of chronic cough" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.E. Brightling" 1 => "R. Ward" 2 => "K.L. Goh" 3 => "A.J. Wardlaw" 4 => "I.D. Pavord" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.160.2.9810100" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1999" "volumen" => "160" "paginaInicial" => "406" "paginaFinal" => "410" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10430705" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0270" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Induced sputum in the diagnosis of peripheral lung cancer not visible endoscopically" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Agustí" 1 => "A. Xaubet" 2 => "C. Montón" 3 => "M. Solé" 4 => "N. Soler" 5 => "M. Carrión" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/rmed.2001.1173" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2001" "volumen" => "95" "paginaInicial" => "822" "paginaFinal" => "828" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11601749" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0275" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflamación bronquial, clínica respiratoria y función pulmonar en el síndrome de Sjögren primario" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Bellido-Casado" 1 => "V. Plaza" 2 => "C. Díaz" 3 => "C. Geli" 4 => "J. Domínguez" 5 => "G. Margarit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2011.01.003" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "330" "paginaFinal" => "334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21429651" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0280" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of left-ventricular dysfunction from induced sputum examination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Leigh" 1 => "R.F. Sharon" 2 => "A. Efthimiadis" 3 => "F.E. Hargreave" 4 => "A.D. Kitching" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(99)80018-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1999" "volumen" => "354" "paginaInicial" => "833" "paginaFinal" => "834" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10485730" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0285" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of the validity of different diagnostic tests in adults with asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.J. Hunter" 1 => "C.E. Brightling" 2 => "G. Woltmann" 3 => "A.J. Wardlaw" 4 => "I.D. Pavord" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "12" "paginaInicial" => "1051" "paginaFinal" => "1057" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0290" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between airway inflammation, hyperresponsiveness, and obstruction in asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.G. Woodruff" 1 => "R. Khashayar" 2 => "S.C. Lazarus" 3 => "S. Janson" 4 => "P. Avila" 5 => "H.A. Boushey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mai.2001.119411" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2001" "volumen" => "108" "paginaInicial" => "753" "paginaFinal" => "758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11692100" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0295" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normativa SEPAR. Espirometría" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. García-Río" 1 => "M. Calle" 2 => "F. Burgos" 3 => "P. Casan" 4 => "F. del Campo" 5 => "J.B. Gáldiz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Broncomeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "338" "paginaFinal" => "401" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0300" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spirometric reference values from a Mediterranean population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Roca" 1 => "J. Sanchis" 2 => "A. Agusti-Vidal" 3 => "F. Segarra" 4 => "D. Navajas" 5 => "R. Rodriguez-Roisin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Bull Eur Physiopathol Respir" "fecha" => "1986" "volumen" => "22" "paginaInicial" => "217" "paginaFinal" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3730638" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0305" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200406-710ST" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2005" "volumen" => "171" "paginaInicial" => "912" "paginaFinal" => "930" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15817806" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0310" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.A. Dweik" 1 => "P.B. Boggs" 2 => "S.C. Erzurum" 3 => "C.G. Irvin" 4 => "M.W. Leigh" 5 => "J.O. Lundberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.9120-11ST" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "184" "paginaInicial" => "602" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21885636" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0315" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standardised methodology of sputum induction and processing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Djukanovic" 1 => "P.J. Sterck" 2 => "J.V. Fahy" 3 => "F.E. Hargreave" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Respir J Suppl" "fecha" => "2002" "volumen" => "37" "paginaInicial" => "1" "paginaFinal" => "2" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0320" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Pizzichini" 1 => "M.M. Pizzichini" 2 => "A. Efthimiadis" 3 => "S. Evans" 4 => "M.M. Morris" 5 => "D. Squiallace" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.154.2.8756799" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1996" "volumen" => "154" "paginaInicial" => "308" "paginaFinal" => "317" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8756799" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0325" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grant/Riverside Methodist Hospitals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.M. Green" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "1994" "editorial" => "Grant Histology Procedure Manual" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0330" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory subtypes in asthma: assessment and identification using induced sputum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Simpson" 1 => "R. Scott" 2 => "M.J. Boyle" 3 => "P.G. Gibson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2006.00784.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2006" "volumen" => "11" "paginaInicial" => "54" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16423202" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0335" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive methods to measure airway inflammation: future considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Magnussen" 1 => "O. Holz" 2 => "P.J. Sterk" 3 => "F.E. Hargreave" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2000" "volumen" => "16" "paginaInicial" => "1175" "paginaFinal" => "1179" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11292124" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0340" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of the Spanish version of the Asthma Control Test (ACT)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Vega" 1 => "X. Badia" 2 => "C. Badiola" 3 => "A. López-Viña" 4 => "J.M. Olaguíbel" 5 => "C. Picado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/02770900701752615" "Revista" => array:6 [ "tituloSerie" => "J Asthma" "fecha" => "2007" "volumen" => "44" "paginaInicial" => "867" "paginaFinal" => "872" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18097865" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0345" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-eosinophilic asthma: importance and possible mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Douwes" 1 => "P. Gibson" 2 => "J. Pekkanen" 3 => "N. Pearce" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "643" "paginaFinal" => "648" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12096210" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0350" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distribution of sputum cellular phenotype in a large asthma cohort: predicting factors for eosinophilic vs neutrophilic inflammation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.N. Schleich" 1 => "M. Manise" 2 => "J. Sele" 3 => "M. Henket" 4 => "L. Seidel" 5 => "R. Louis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2466-13-11" "Revista" => array:5 [ "tituloSerie" => "BMC Pulm Med" "fecha" => "2013" "volumen" => "13" "paginaInicial" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23442497" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0355" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-invasive markers of airway inflammation as predictors of oral steroids responsiveness in asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.A1 Little" 1 => "G.W. Chalmers" 2 => "K.J. MacLeod" 3 => "C. McSharry" 4 => "N.C. Thomson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2000" "volumen" => "55" "paginaInicial" => "232" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10679543" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0360" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review and meta-analysis: tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.L. Petsky" 1 => "C.J. Cates" 2 => "T.J. Lasserson" 3 => "A.M. Li" 4 => "C. Turner" 5 => "J.A. Kynaston" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2010.135574" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "199" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20937641" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0365" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The influence of age on induced sputum differential cell counts in normal subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.A. Thomas" 1 => "R.H. Green" 2 => "C.E. Brightling" 3 => "S.S. Birring" 4 => "D. Parker" 5 => "A.J. Wardlaw" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.126.6.1811" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "126" "paginaInicial" => "1811" "paginaFinal" => "1814" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15596678" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0370" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determination of the inflammatory component of airway diseases by induced sputum cell counts: used in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P1 Moritz" 1 => "L.J. Steidle" 2 => "M.B. Felisbino" 3 => "T. Kleveston" 4 => "M.M. Pizzichini" 5 => "E. Pizzichini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bras Pneumol" "fecha" => "2008" "volumen" => "34" "paginaInicial" => "913" "paginaFinal" => "921" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19099097" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000005/v1_201604270052/S1579212916300088/v1_201604270052/en/main.assets" "Apartado" => array:4 [ "identificador" => "9374" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000005/v1_201604270052/S1579212916300088/v1_201604270052/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916300088?idApp=UINPBA00003Z"]

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Utility of Induced Sputum in Routine Clinical Practice

Utilidad del esputo inducido en la práctica clínica habitual

Silvia Barril, Laura Sebastián, Gianluca Cotta, Astrid Crespo, Eder Mateus, Montserrat Torrejón, David Ramos-Barbón, Vicente Plaza

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vplaza@santpau.cat

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Unidad de Asma y Alergia, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

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and new techniques for measuring fractional exhaled nitric oxide &#40;FE<span class="elsevierStyleInf">NO</span>&#41; and inflammatory cell count &#40;ICC&#41; in induced sputum &#40;IS&#41; are attracting particular attention&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">While FE<span class="elsevierStyleInf">NO</span> identifies eosinophilic bronchial inflammation&#44; it does not recognize other inflammatory types&#44; so its utility is limited&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> IS is a validated standardized technique&#44; considered the gold standard non-invasive methods for evaluating bronchial inflammation and for distinguishing between inflammatory phenotypes&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Its clinical applications are becoming more refined&#44; and it is of particular benefit in asthma&#44; due to its high yield&#46; It can be used as a complementary diagnostic tool in asthma&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> and is of benefit in determining inflammatory phenotypes&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> adjusting treatment&#44; and predicting therapeutic response&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a> It has also been indicated in the management of difficult-to-control asthma &#40;DCA&#41; in Spanish and international guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">8&#8211;10</span></a> Its use is not restricted purely to asthma&#58; it is also useful for determining the etiology of chronic cough&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11&#44;12</span></a> gastroesophageal reflux &#40;GER&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> and other entities&#44; such as COPD&#44; infectious diseases&#44; eosinophilic bronchitis&#44; lung cancer&#44; interstitial lung diseases&#44; and heart failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">14&#8211;19</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">However&#44; despite its validity and applicability&#44; ICC in IS is not routinely performed in standard clinical practice&#44; probably because it requires a certain degree of technical experience in obtaining&#44; manipulating and interpreting the samples&#44; in addition to being laborious and costly&#46; Nevertheless&#44; the data provided by IS testing is so obviously of interest<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> that we are surprised how rarely it is used in high-level pulmonology departments&#46; The aim of this study was to evaluate the contribution of ICC in IS in healthcare practices&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective&#44; descriptive study performed in standard clinical practice to determine the clinical utility of ICC in IS&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study Population</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients who underwent ICC in IS as part of their standard care in the pulmonology department of our hospital over the course of 1 year &#40;May 2012&#8211;May 2013&#41; were included&#44; irrespective of their previous treatment&#44; which often included inhaled corticosteroids &#40;ICS&#41;&#44; particularly in asthma patients&#46; Patients who underwent the procedure for exclusively investigational purposes were excluded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical and Legal Aspects</span><p id="par0035" class="elsevierStylePara elsevierViewall">Since this was a descriptive&#44; retrospective study performed in standard clinical practice conditions&#44; the Clinical Research Ethics Committee was informed only of our interest in collecting this information from the clinical records of the patients&#46; All study data collection was anonymous&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Primary Endpoints</span><p id="par0040" class="elsevierStylePara elsevierViewall">The primary endpoint was the proportion of patients in whom IS was clinically useful&#46; IS was considered useful when the ICC provided information that could be used for establishing a diagnosis and&#47;or when it led directly to a decision on therapeutic management&#46; Three observers&#44; independent from the treating physicians &#40;SB&#44; LS&#44; and GC&#41;&#44; assessed these premises by reviewing the clinical records&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The asthma group included patients with clinically suspected asthma and those with a previous diagnosis of asthma&#46; In the DCA group&#44; all patients had asthma meeting criteria for poor control&#46; IS was considered of use in diagnosis when the determination of bronchial eosinophilia led to the diagnosis of patients with a clinical history consistent with asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> It was also classified as useful in patients with a previously established diagnosis of asthma or DCA&#44; when the determination of the inflammatory phenotype helped clarify the nature of the patient&#39;s respiratory symptoms<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#44;10&#44;21</span></a> in the following circumstances&#58; suspicion of poor treatment compliance&#44; exposure to airborne allergens&#44; or insufficient treatment in the case of an eosinophilic phenotype&#59; suspicion of an erroneous diagnosis or another associated disease or resistance to corticosteroids in the case of bronchial neutrophilia&#59; a paucigranulocytic phenotype suggested controlled eosinophilia&#44; confounding diagnoses&#44; or paucigranulocytic variables&#46; IS was considered therapeutically useful in the following situations&#58; in patients with bronchial eosinophilia when the decision was taken to increase ICS&#44; initiate systemic corticosteroids &#40;SCS&#41;&#44; initiate interventions for improving compliance&#44; or initiate leukotriene receptor antagonists&#59;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a> in patients with a neutrophilic phenotype<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a> when antibiotics or long-acting &#946;2-agonists were initiated or ICS dosing was reduced&#59; and in patients with a paucigranulocytic phenotype when the addition of long-acting &#946;2-agonists was evaluated or the steroid dose was reduced&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In patients with chronic cough&#44; ICC was considered to be useful when findings helped identify the reason for the cough<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11&#44;12</span></a> in the following circumstances&#58; a case of bronchial eosinophilia arousing suspicion of asthma&#44; eosinophilic bronchitis&#44; or occupational disease&#59; or a neutrophilic phenotype aroused suspicion of infectious bronchitis or bronchiectasis&#46; IS was considered of therapeutic utility when findings led to the initiation of ICS or antibiotic therapy&#46; Finally&#44; the finding of lipophages in patients with chronic cough or clinically suspected GER helped identify a diagnosis of GER&#46; Initiation of antacids or antireflux measures was considered a therapeutic contribution&#46;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Secondary Endpoints</span><p id="par0055" class="elsevierStylePara elsevierViewall">Demographic&#44; clinical and functional data were collected from all patients&#44; and the main reasons for requesting IS and the characteristics of the sample &#40;cell count&#44; sample quality and inflammatory phenotype&#41; were recorded&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Procedures</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Spirometry</span><p id="par0060" class="elsevierStylePara elsevierViewall">Spirometry was performed using a Daptospir-600 device &#40;Sibelmed SA&#44; Barcelona&#44; Spain&#41;&#44; by an experienced operator&#44; following SEPAR 2013 guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> The reference values were those established for a Mediterranean population&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Fractional Exhaled Nitric Oxide</span><p id="par0065" class="elsevierStylePara elsevierViewall">This was carried out using an electrochemical device &#40;NO Vario Analyzer&#46; FILT Lungen and Thorax Diagnostic GmHb&#44; Berlin&#44; Germany&#41; at a flow of 50<span class="elsevierStyleHsp" style=""></span>ml&#47;s&#44; following the recommendations of the ATS&#47;ERS&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a> A significant elevation was considered any value &#8805;50<span class="elsevierStyleHsp" style=""></span>ppb&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Induced Sputum</span><p id="par0070" class="elsevierStylePara elsevierViewall">The process of inducing and processing sputum was performed by specially trained and qualified healthcare professionals&#44; according to the standard procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> Briefly&#44; the sample was obtained after nebulization with hypertonic saline solution 3&#37; using an ultrasound nebulizer &#40;Omron NEU07&#41;&#46; Serial spirometries were performed throughout induction&#46; Procedures were suspended if FEV<span class="elsevierStyleInf">1</span> fell by 20&#37; or more from baseline&#46; The sample was processed within 2<span class="elsevierStyleHsp" style=""></span>h of collection&#46; Mucoid cumulates were selected manually&#44; separated from the saliva&#44; and treated with dithiothreitol &#40;Sputolysin<span class="elsevierStyleSup">&#174;</span>&#44; Calbiochem Corp&#46;&#44; San Diego&#44; CA&#41; diluted 1&#58;10&#46; Dithiothreitol was added to a volume equivalent to 4 times the weight in milligrams of the selected plugs&#44; along with the same volume of phosphate-buffered saline solution&#46; Cell viability &#40;live cells&#41;&#44; concentration &#40;cells&#47;gram of sputum&#41; and the percentage of squamous cells were evaluated &#40;the latter considered as upper airway contamination&#41;&#44; using hemocytometry and trypan blue staining&#46; The cells were centrifuged to obtain a sediment that was used to determine the differential leukocyte count&#44; using Wright-Giemsa staining&#44; according to the procedure described by Pizzichini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> Lipophages were also identified&#44; using Oil Red O lipid staining&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a> The sample was classified as &#8220;high quality&#8221; when the cell concentration was &#62;1&#215;10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>cells&#47;g&#44; viability&#62;40&#37;&#44; and a concentration of epithelial cells&#60;20&#37;&#46; IS samples were classified according to the differential leukocyte count into 4 inflammatory phenotypes&#44; according to the criteria of Simpson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a>&#58; eosinophilic &#40;eosinophils&#62;3&#37;&#41;&#59; neutrophilic &#40;neutrophils&#62;61&#37;&#41;&#59; mixed &#40;eosinophils&#62;3&#37; and neutrophils&#62;61&#37;&#41;&#44; and paucigranulocytic &#40;eosinophils&#60;3&#37; and neutrophils&#60;61&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">2&#44;30</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Asthma Control Test</span><p id="par0075" class="elsevierStylePara elsevierViewall">A validated version in Spanish<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> of the Asthma Control Test was used to establish the degree of clinical control in asthma patients&#46; This is a 5-item patient-reported outcome measure of the degree of control of asthma in the last 4 weeks&#46; Answers to each question are scored individually from 1 to 5 points&#44; for a total score ranging from 5 &#40;worst control possible&#41; to 25 &#40;best control possible&#41;&#46; A score of 20 points or more is considered &#8220;controlled asthma&#8221; and 19 points or fewer is &#8220;uncontrolled asthma&#8221;&#46; Uncontrolled asthma is subdivided into &#8220;partially controlled asthma&#8221; &#40;16&#8211;19 points&#41; and &#8220;poorly controlled asthma&#8221; &#40;5&#8211;15 points&#41;&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Statistical Analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Results are expressed as means and standard deviation for continuous variables with normal distribution&#46; For continuous variables which did not fit a normal distribution&#44; values were expressed in median and interquartile range&#44; and for categorical variables&#44; frequency and percentages were presented&#46; Analysis of variance &#40;ANOVA&#41; or the Kruskal&#8211;Wallis test were used to compare demographic and clinical data among the 4 groups&#44; depending on whether distribution of variables was normal or not&#46; Categorical variables were compared using the Chi-squared test&#46; Results were considered significant in case of <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#46; All analyses were carried out using the SPSS statistical package &#40;v&#46;22&#41;&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 171 patients were included&#44; 95 &#40;55&#46;6&#37;&#41; of whom were women&#44; and mean age was 50 &#40;&#177;15&#41; years&#46; Sociodemographic and clinical data of the study group are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Patients included in the study were classified according to the reason for ordering an IS&#46; The most common reasons were asthma in general &#40;103 &#91;59&#46;20&#37;&#93;&#41; and DCA &#40;34 &#91;19&#46;54&#37;&#93;&#41;&#44; to complete the diagnostic process or to determine the inflammatory phenotype&#46; The next most common reasons were chronic cough &#40;19 &#91;10&#46;9&#37;&#93;&#41; and suspected GER &#40;15 &#91;8&#46;6&#37;&#93;&#41;&#46; Three cases &#40;1&#46;7&#37;&#41; were classified as &#8220;other causes&#8221; and were excluded because of their heterogenic nature&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Patients were classified according to the severity of their asthma and DCA&#44; as follows&#58; intermittent asthma 10 &#40;7&#46;2&#37;&#41; cases&#59; mild persistent asthma 41 &#40;29&#46;9&#37;&#41;&#44; moderate 33 &#40;24&#46;1&#37;&#41; and severe 45 &#40;32&#46;8&#37;&#41;&#46; Eight cases &#40;5&#46;8&#37;&#41; were being investigated for suspected asthma&#46; The mean Asthma Control Test score in the asthma group was 21&#46;36 &#40;&#177;5&#46;10&#41; and in the DCA group&#44; it was 15&#46;9 &#40;&#177;5&#46;12&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of the IS samples&#46; In the ICC&#44; the highest percentage of eosinophils was observed in the DCA group&#44; and the highest lipophage percentage was in patients with chronic cough and GER&#46; IS was classified as &#8220;high quality&#8221; in 98 &#40;57&#46;3&#37;&#41; cases&#46; The paucigranulocytic phenotype was predominant among the overall study cohort &#40;88 &#91;51&#46;5&#37;&#93;&#41; and among the subgroups for which IS was requested&#44; although the eosinophilic phenotype emerged as the second most common phenotype in the asthma and DCA groups with 32 &#40;31&#46;1&#37;&#41; and 10 &#40;29&#46;4&#37;&#41; cases&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">A weakly positive correlation was observed between age and neutrophilia in ICC &#40;<span class="elsevierStyleItalic">R</span>&#61;0&#46;15&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;05&#41;&#46; However&#44; no correlation was observed between the presence of eosinophils in IS and FE<span class="elsevierStyleInf">NO</span> values &#40;<span class="elsevierStyleItalic">R</span>&#61;0&#46;12&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;14&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Finally&#44; the IS result contributed to clinical decision-making in 115 &#40;67&#46;3&#37;&#41; of cases&#44; assisting diagnosis in 98 &#40;57&#46;3&#37;&#41; patients&#44; and therapeutic decisions in 85 &#40;49&#46;7&#37;&#41;&#46; The results are listed by reason for IC in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; IS was of greatest benefit in decision-making in the general asthma group&#44; followed by DCA&#58; 74 &#40;71&#46;8&#37;&#41; and 23 &#40;67&#46;6&#37;&#41;&#44; respectively&#44; although there were no differences in its utility among the different reasons for request&#46; In the asthma group&#44; a similar contribution to the diagnostic process &#40;59 &#91;57&#46;3&#37;&#93;&#41; and to therapeutic decision-making &#40;58 &#91;56&#46;3&#37;&#93; was also observed&#46; However&#44; in the DCA group&#44; IS provided more useful information for diagnostic &#40;23 &#91;57&#46;6&#37;&#93; patients&#41; than therapeutic &#40;15 &#91;44&#46;1&#37;&#93; patients&#41; decision-making&#46; Likewise&#44; in the chronic cough group&#44; IS was more useful for guiding diagnosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In patients with suspected GER&#44; the identification of a significant number of lipophages supported the diagnosis in 8 &#40;53&#46;3&#37;&#41; patients&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">The main finding of our study is that ICC in IS is useful in routine clinical practice&#44; since it provides important information for clinical decision-making in two thirds &#40;67&#46;3&#37;&#41; of patients in whom this complementary procedure was requested&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Most experience and data on the use of IS are from asthma patients&#46; Accordingly&#44; IS was usually ordered in the context of asthma and DCA&#46; Diagnostic applications are based mainly on the well-established relationships between asthma and eosinophilia in sputum&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> If a cutoff point is set at 1&#37; eosinophils in sputum&#44; IS has a sensitivity of 80&#37; and a specificity of 95&#37; for confirming a diagnosis of asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> Although the most typical finding is eosinophilia in sputum&#44; a systematic review of over 25 studies in asthma patients from different populations with varying degrees of severity&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> and more recently&#44; a study which analyzed 508 patients with asthma&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> found that approximately 50&#37; of these patients had non-eosinophilic asthma&#46; In our series&#44; more patients had non-eosinophilic asthma than generally described in the literature&#46; However&#44; the contribution of IS to confirming the diagnosis or determining the inflammatory phenotype was 67&#46;6&#37; in DCA and 57&#46;3&#37; in asthma&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Characterization of the inflammatory phenotype has important therapeutic implications&#44; since each has a different response to anti-inflammatory treatment&#46; Little et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a> observed that patients with asthma who showed eosinophilia in IS had a significant increase in FEV<span class="elsevierStyleInf">1</span> after 2 weeks of treatment with SCS&#46; Moreover&#44; IS tests can reduce the number of exacerbations in asthmatic patients&#46; Two randomized trials<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a> conducted in asthmatics whose treatment was adjusted according to clinical practice guideline recommendations or according to their IS eosinophil count showed a reduction in the number of exacerbations in patients whose treatment was established on the basis of their ICC&#46; These results were confirmed in a recent systematic review&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a> and are reflected in the latest ATS&#47;ERS guidelines on the management of severe asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a> These recommendations state that in hospitals with the appropriate experience&#44; treatment of patients with severe asthma should be based on both clinical criteria and monitoring of IS eosinophil levels&#46; We also studied the contribution of IS to therapeutic decision-making in asthma patients&#46; Results centered on the eosinophilic and neutrophilic phenotypes&#44; but in some cases the decision to reduce steroid treatment was made in clinically stable patients who revealed a paucigranulocytic phenotype&#44; according to clinical practice guidelines&#46; Nevertheless&#44; these premises only apply to selected patients&#44; since the monitoring of eosinophilia in IS has not been adopted as a routine method in standard clinical practice&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In patients with chronic cough&#44; defined as a &#62;3-week history of cough not immediately preceded by an acute process&#44; IS is recommended to complete the diagnostic process&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11&#44;12</span></a> Bronchial eosinophilia revealed in patients with chronic cough can help guide the diagnosis of asthma&#44; eosinophilic bronchitis&#44; or occupational asthma&#44; and can also predict a favorable response to steroid treatment&#46; In our study&#44; none of our chronic cough patients had eosinophilia in IS&#46; However&#44; in 3 &#40;15&#46;8&#37;&#41; patients&#44; neutrophilia predominated&#44; suggesting infectious disease&#46; The finding of lipophages in IS &#40;&#62;7&#37;&#41; is 90&#37; sensitive and 89&#37; specific for a diagnosis of GER&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> Lipophages &#40;&#62;7&#37;&#41; were found in 8 study patients investigated for chronic cough and for suspected GER&#44; which explained 42&#46;1&#37; of causes of chronic cough&#44; and supported 53&#46;3&#37; of suspected GER cases&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In line with the previous literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">21&#44;36</span></a> we found evidence among our series of a trend toward increased bronchial neutrophilia as age advances&#46; However&#44; more studies are need to determine if these findings affect the diagnostic yield of IS in elderly patients&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In spite of all the reports in the literature describing the benefits of IS&#44; only Moritz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> in a series of 151 IS samples&#44; found the results to be clinically useful in standard clinical practice&#44; because they modified medical treatment in 82 &#40;55&#37;&#41; of cases&#46; The contribution was even greater in asthmatic patients&#58; steroid dosing was modified in 48 patients &#40;64&#46;7&#37;&#41;&#46; The results of our study are similar to those described by Moritz et al&#46; However&#44; in our opinion&#44; the contribution of the procedure to the diagnostic process must be included if the real benefit is to be studied&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In spite of the limitations of the retrospective nature of this study &#40;which&#44; for example&#44; in the case of asthma made it impossible to determine any improvements in future risk&#41;&#44; the utility of the procedure was evaluated by observers who were independent from the treating physicians&#44; in order to reduce subjectivity bias&#46; Moreover&#44; IS samples were induced&#44; processed and evaluated according to a systematized protocol&#44; by highly experienced technical staff&#44; in compliance with the strict quality control standards of our laboratory&#46; These precautions contributed to reducing potential variability among observers assessing ICC and standardizing sample collection and processing&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">To conclude&#44; our study demonstrates that ICC in IS is beneficial in clinical decision-making&#44; particularly in 2 common entities&#44; asthma and chronic cough&#46; We provide arguments for recommending the use of this technique in clinical practice&#44; at least in referral pulmonology departments&#44; particularly those equipped with dedicated asthma units&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of Interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the general and specific utility in diagnosis and&#47;or treatment of induced sputum &#40;IS&#41; inflammatory cell counts in routine clinical practice&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of 171 patients referred for clinical sputum induction over a 1-year period in the pulmonology department of a referral hospital&#46; Independent observers established whether the information provided by IS inflammatory cell count was useful for making diagnostic and therapeutic decisions&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The most frequent reasons for determination of IS inflammatory cell count were&#58; asthma 103 &#40;59&#46;20&#37;&#41;&#59; uncontrolled asthma 34 &#40;19&#46;54&#37;&#41;&#59; chronic cough 19 &#40;10&#46;9&#37;&#41;&#44; and gastroesophageal reflux 15 &#40;8&#46;6&#37;&#41;&#46; In 115 patients &#40;67&#46;3&#37;&#41; it was generally useful for diagnosis and&#47;or treatment&#59; in 98 patients &#40;57&#46;3&#37;&#41; it provided diagnostic information and in 85 patients &#40;49&#46;7&#37;&#41; it assisted in therapeutic decision-making&#46; In asthma&#44; uncontrolled asthma&#44; chronic cough and gastroesophageal reflux&#44; the results were useful in 71&#46;8&#37;&#44; 67&#46;6&#37;&#44; 47&#46;4&#37; and 60&#37;&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The information provided by IS inflammatory cell count is extremely useful in clinical practice&#44; especially in asthma and chronic cough&#46; These results may justify the inclusion of the IS technique in pulmonology departments and asthma units of referral centers&#46;</p></span>"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar la utilidad general y espec&#237;fica &#40;diagn&#243;stica y&#47;o terap&#233;utica&#41; del recuento de las c&#233;lulas inflamatorias &#40;RCI&#41; del esputo inducido &#40;EI&#41; en situaci&#243;n de asistencia cl&#237;nica real&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo que incluy&#243; a los 171 pacientes que durante un a&#241;o se les recogi&#243; un EI para determinar su RCI en un servicio de Neumolog&#237;a de un hospital de referencia&#46; Observadores independientes al equipo m&#233;dico habitual establecieron si la informaci&#243;n proporcionada por el RCI del EI fue &#250;til en la toma de decisiones diagn&#243;sticas y terap&#233;uticas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las causas m&#225;s frecuentes que motivaron la solicitud del RCI del EI fueron&#58; asma 103 &#40;59&#44;20&#37;&#41;&#59; asma de control dif&#237;cil 34 &#40;19&#44;54&#37;&#41;&#59; tos cr&#243;nica 19 &#40;10&#44;9&#37;&#41;&#44; y reflujo gastroesof&#225;gico 15 &#40;8&#44;6&#37;&#41;&#46; En 115 &#40;67&#44;3&#37;&#41; pacientes el RCI del EI result&#243; cl&#237;nicamente &#250;til &#40;valoraci&#243;n general&#41;&#59; en 98 &#40;57&#44;3&#37;&#41; proporcion&#243; informaci&#243;n diagn&#243;stica&#44; y en 85 &#40;49&#44;7&#37;&#41;&#44; informaci&#243;n terap&#233;utica relevante&#46; En el asma&#44; asma de control dif&#237;cil&#44; tos cr&#243;nica y reflujo gastroesof&#225;gico fue &#250;til en el 71&#44;8&#44; el 67&#44;6&#44; el 47&#44;4 y el 60&#37;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La informaci&#243;n proporcionada por el RCI del EI resulta de gran utilidad en la pr&#225;ctica cl&#237;nica&#44; particularmente en el asma y la tos cr&#243;nica&#46; Estos resultados podr&#237;an proporcionar argumentos para recomendar la incorporaci&#243;n de la t&#233;cnica en los servicios de Neumolog&#237;a de referencia y en las unidades de excelencia de asma&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Barril S&#44; Sebasti&#225;n L&#44; Cotta G&#44; Crespo A&#44; Mateus E&#44; Torrej&#243;n M&#44; et al&#46; Utilidad del esputo inducido en la pr&#225;ctica cl&#237;nica habitual&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;250&#8211;255&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">FE<span class="elsevierStyleInf">NO</span>&#44; fractional expired nitric oxide&#59; FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s&#59; GER&#44; gastroesophageal reflux&#59; ICS&#44; inhaled corticosteroid&#59; pred&#46;&#44; predicted value&#59; SCS&#44; systemic corticosteroid&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean&#177;standard deviation&#44; median &#40;interquartile range&#41; or as percentage&#44; as indicated&#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"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All &#40;<span class="elsevierStyleItalic">n</span>&#61;171&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asthma &#40;<span class="elsevierStyleItalic">n</span>&#61;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difficult-to-control asthma &#40;<span class="elsevierStyleItalic">n</span>&#61;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic Cough &#40;<span class="elsevierStyleItalic">n</span>&#61;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GER &#40;<span class="elsevierStyleItalic">n</span>&#61;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 &#40;55&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;46&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;64&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;73&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#177;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#177;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#177;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#177;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#177;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span> &#40;&#37; pred&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#177;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#177;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#177;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#177;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#177;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FE<span class="elsevierStyleInf">NO</span> &#40;ppb&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#177;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#177;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#177;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#177;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive skin prick test &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients receiving ICS &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">142 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89 &#40;86&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;57&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;53&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICS dose<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;&#956;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">800 &#40;320&#8211;1&#46;600&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">720 &#40;320&#8211;1&#46;200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1600 &#40;800&#8211;1&#46;600&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">800 &#40;0&#8211;800&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#8211;800&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients receiving SCS &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients receiving antileukotrienes &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;38&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;40&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;70&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">ICS dose converted to budesonide equivalents&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and Clinical Characteristics of the Overall Study Series and by Subgroups According to the Reason for Requesting Inflammatory Cell Count in Induced Sputum&#46;</p>"
        ]
      ]
      1 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "identificador" => "at2"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">GER&#44; gastroesophageal reflux&#59; IS&#44; induced sputum&#59; TCC&#44; total cell count&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean&#177;standard deviation&#44; median &#40;interquartile range&#41; or as percentage&#44; as indicated&#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"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All &#40;<span class="elsevierStyleItalic">n</span>&#61;171&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asthma &#40;<span class="elsevierStyleItalic">n</span>&#61;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difficult-to-control Asthma &#40;<span class="elsevierStyleItalic">n</span>&#61;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic Cough &#40;<span class="elsevierStyleItalic">n</span>&#61;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GER &#40;<span class="elsevierStyleItalic">n</span>&#61;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Cellularity of induced sputum</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TCC &#40;10<span class="elsevierStyleSup">3</span> cells&#47;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;56 &#40;1&#8211;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;8 &#40;1&#8211;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;58 &#40;0&#46;9&#8211;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;38 &#40;1&#46;1&#8211;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;46 &#40;1&#46;1&#8211;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cell viability &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;38&#8211;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;5 &#40;38&#8211;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;1 &#40;37&#46;8&#8211;73&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;39&#46;3&#8211;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;28&#46;9&#8211;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polymorphonuclear &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#177;24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#46;1&#177;25&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;0&#177;25&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#46;5&#177;25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;2&#177;23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lymphocytes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;7 &#40;0&#46;3&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;7 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6 &#40;0&#46;3&#8211;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;7 &#40;0&#46;4&#8211;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6 &#40;0&#46;3&#8211;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Macrophages &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;21&#46;9&#8211;62&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;3 &#40;25&#46;5&#8211;45&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#46;8 &#40;20&#46;9&#8211;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;3 &#40;28&#46;2&#8211;68&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;3 &#40;0&#46;3&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Eosinophils &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9 &#40;0&#46;3&#8211;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9 &#40;0&#46;3&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;7 &#40;0&#46;3&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3 &#40;0&#8211;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;3&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lipophages &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#8211;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;0&#8211;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Quality of induced sputum</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;30&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;30&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;32&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medium &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;12&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98 &#40;57&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;55&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;63&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;46&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Inflammatory phenotype</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neutrophilic &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;20&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;20&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Eosinophilic &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;26&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Paucigranulocytic &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;51&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;46&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;44&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;84&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;53&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mixed &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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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"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All &#40;<span class="elsevierStyleItalic">n</span>&#61;171&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asthma &#40;<span class="elsevierStyleItalic">n</span>&#61;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difficult-to-control Asthma &#40;<span class="elsevierStyleItalic">n</span>&#61;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic Cough &#40;<span class="elsevierStyleItalic">n</span>&#61;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GER &#40;<span class="elsevierStyleItalic">n</span>&#61;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Overall clinical utility &#40;diagnostic&#47;therapeutic contribution&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;67&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;71&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;67&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;47&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;32&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;57&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;42&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;42&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;32&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;57&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;46&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;56&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;26&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;46&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;50&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;43&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;73&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;53&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Contribution of Results Provided by Inflammatory Cell Count in Induced Sputum in Overall Clinical&#44; Diagnostic and Therapeutic Decision-making&#46;</p>"
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            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Broncoscopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;M&#46; Mu&#241;oz"
                            1 => "A&#46; Torrego"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Inflamometr&#237;a en asma&#44; EPOC y rinitis"
                        "paginaInicial" => "191"
                        "paginaFinal" => "204"
                        "serieFecha" => "2012"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noneosinophilic asthma&#58; a distinc clinical and pathologic phenotype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Haldar"
                            1 => "I&#46;D&#46; Ravord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Allergy Clinc Immunol"
                        "fecha" => "2007"
                        "volumen" => "119"
                        "paginaInicial" => "1043"
                        "paginaFinal" => "1052"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Standardized methodology of sputum induction and processing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Djukanovi&#263;"
                            1 => "P&#46;J&#46; Sterk"
                            2 => "J&#46;V&#46; Fahy"
                            3 => "F&#46;E&#46; Hargreave"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2002"
                        "volumen" => "20"
                        "numero" => "Suppl"
                        "paginaInicial" => "1"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12166553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical applications of induced sputum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;E&#46; Brightling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.129.5.1344"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "129"
                        "paginaInicial" => "1344"
                        "paginaFinal" => "1348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16685028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of induced sputum in adults with asthma&#58; Identification of subgroup with isolated sputum neutrophilia and poor response to inhaled corticosteroids"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;H&#46; Green"
                            1 => "C&#46;E&#46; Brightling"
                            2 => "G&#46; Woltmann"
                            3 => "D&#46; Parker"
                            4 => "A&#46;J&#46; Wardlaw"
                            5 => "I&#46;D&#46; Pavord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2002"
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                        "paginaInicial" => "875"
                        "paginaFinal" => "879"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12324674"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in sputum eosinophils predict loss of asthma control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Jatakanon"
                            1 => "S&#46; Lim"
                            2 => "P&#46;J&#46; Barnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "161"
                        "paginaInicial" => "64"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asthma exacerbations and sputum eosinophil counts&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;H&#46; Green"
                            1 => "C&#46;E&#46; Brightling"
                            2 => "S&#46; McKenna"
                            3 => "B&#46; Hargadon"
                            4 => "D&#46; Parker"
                            5 => "P&#46; Bradding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(02)11679-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2002"
                        "volumen" => "360"
                        "paginaInicial" => "1715"
                        "paginaFinal" => "1721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12480423"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa SEPAR para el asma de control dif&#237;cil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; L&#243;pez-Vi&#241;a"
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                            2 => "J&#46;L&#46; Aller-Alvarez"
                            3 => "T&#46; Baz&#250;s-Gonz&#225;lez"
                            4 => "B&#46;G&#46; Cosio"
                            5 => "A&#46; de Diego-Dami&#225;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "513"
                        "paginaFinal" => "523"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16194515"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Gu&#237;a Espa&#241;ola para el Manejo del Asma &#40;GEMA 4&#46;0&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2015"
                        "volumen" => "5"
                        "paginaInicial" => "1"
                        "paginaFinal" => "68"
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "10"
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                    0 => array:2 [
                      "titulo" => "International ERS&#47;ATS guidelines on definition&#44; evaluation and treatment of severe asthma"
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                          "autores" => array:6 [
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                            1 => "S&#46;E&#46; Wenzel"
                            2 => "J&#46;L&#46; Brozek"
                            3 => "A&#46; Bush"
                            4 => "M&#46; Castro"
                            5 => "P&#46;J&#46; Sterk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00202013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2014"
                        "volumen" => "43"
                        "paginaInicial" => "343"
                        "paginaFinal" => "373"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24337046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0240"
              "etiqueta" => "11"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Normativa SEPAR sobre la tos cr&#243;nica"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; De Diego Dami&#225;"
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                            2 => "V&#46; Garrigues Gil"
                            3 => "J&#46;L&#46; Izquierdo Alonso"
                            4 => "A&#46; L&#243;pez Vi&#241;a"
                            5 => "J&#46; Mullol Miret"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
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                        "paginaInicial" => "236"
                        "paginaFinal" => "245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12028932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for the management of cough in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;H&#46; Morice"
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                            2 => "I&#46; Pavord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.044941"
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                        "tituloSerie" => "Thorax"
                        "fecha" => "2006"
                        "volumen" => "61"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16396949"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "A&#46; Efthimiadis"
                            3 => "D&#46; Kamada"
                            4 => "F&#46;E&#46; Hargreaves"
                            5 => "C&#46;J&#46; Allen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "paginaFinal" => "1122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11292116"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0255"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Eosinophilic airway inflammation and exacerbations of COPD&#58; a randomised controlled trial"
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                          "etal" => true
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                            2 => "C&#46;E&#46; Brightling"
                            3 => "M&#46; Shelley"
                            4 => "B&#46; Hargadon"
                            5 => "S&#46; McKenna"
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                    0 => array:2 [
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                        "tituloSerie" => "Eur Respir J"
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                        "volumen" => "29"
                        "paginaInicial" => "906"
                        "paginaFinal" => "913"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17301099"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis"
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                          "autores" => array:6 [
                            0 => "T&#46; McWilliams"
                            1 => "A&#46;U&#46; Wells"
                            2 => "A&#46;C&#46; Harrison"
                            3 => "S&#46; Lindstrom"
                            4 => "R&#46;J&#46; Cameron"
                            5 => "E&#46; Foskin"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2002"
                        "volumen" => "57"
                        "paginaInicial" => "1010"
                        "paginaFinal" => "1014"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12454293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0265"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic bronchitis is an important cause of chronic cough"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;E&#46; Brightling"
                            1 => "R&#46; Ward"
                            2 => "K&#46;L&#46; Goh"
                            3 => "A&#46;J&#46; Wardlaw"
                            4 => "I&#46;D&#46; Pavord"
                          ]
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "160"
                        "paginaInicial" => "406"
                        "paginaFinal" => "410"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10430705"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Induced sputum in the diagnosis of peripheral lung cancer not visible endoscopically"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Agust&#237;"
                            1 => "A&#46; Xaubet"
                            2 => "C&#46; Mont&#243;n"
                            3 => "M&#46; Sol&#233;"
                            4 => "N&#46; Soler"
                            5 => "M&#46; Carri&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/rmed.2001.1173"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2001"
                        "volumen" => "95"
                        "paginaInicial" => "822"
                        "paginaFinal" => "828"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11601749"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0275"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflamaci&#243;n bronquial&#44; cl&#237;nica respiratoria y funci&#243;n pulmonar en el s&#237;ndrome de Sj&#246;gren primario"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Bellido-Casado"
                            1 => "V&#46; Plaza"
                            2 => "C&#46; D&#237;az"
                            3 => "C&#46; Geli"
                            4 => "J&#46; Dom&#237;nguez"
                            5 => "G&#46; Margarit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2011.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2011"
                        "volumen" => "47"
                        "paginaInicial" => "330"
                        "paginaFinal" => "334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21429651"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of left-ventricular dysfunction from induced sputum examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Leigh"
                            1 => "R&#46;F&#46; Sharon"
                            2 => "A&#46; Efthimiadis"
                            3 => "F&#46;E&#46; Hargreave"
                            4 => "A&#46;D&#46; Kitching"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(99)80018-X"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "1999"
                        "volumen" => "354"
                        "paginaInicial" => "833"
                        "paginaFinal" => "834"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10485730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of the validity of different diagnostic tests in adults with asthma"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;J&#46; Hunter"
                            1 => "C&#46;E&#46; Brightling"
                            2 => "G&#46; Woltmann"
                            3 => "A&#46;J&#46; Wardlaw"
                            4 => "I&#46;D&#46; Pavord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2002"
                        "volumen" => "12"
                        "paginaInicial" => "1051"
                        "paginaFinal" => "1057"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0290"
              "etiqueta" => "21"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between airway inflammation&#44; hyperresponsiveness&#44; and obstruction in asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;G&#46; Woodruff"
                            1 => "R&#46; Khashayar"
                            2 => "S&#46;C&#46; Lazarus"
                            3 => "S&#46; Janson"
                            4 => "P&#46; Avila"
                            5 => "H&#46;A&#46; Boushey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mai.2001.119411"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol"
                        "fecha" => "2001"
                        "volumen" => "108"
                        "paginaInicial" => "753"
                        "paginaFinal" => "758"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11692100"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa SEPAR&#46; Espirometr&#237;a"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Garc&#237;a-R&#237;o"
                            1 => "M&#46; Calle"
                            2 => "F&#46; Burgos"
                            3 => "P&#46; Casan"
                            4 => "F&#46; del Campo"
                            5 => "J&#46;B&#46; G&#225;ldiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Broncomeumol"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "338"
                        "paginaFinal" => "401"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spirometric reference values from a Mediterranean population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Roca"
                            1 => "J&#46; Sanchis"
                            2 => "A&#46; Agusti-Vidal"
                            3 => "F&#46; Segarra"
                            4 => "D&#46; Navajas"
                            5 => "R&#46; Rodriguez-Roisin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Bull Eur Physiopathol Respir"
                        "fecha" => "1986"
                        "volumen" => "22"
                        "paginaInicial" => "217"
                        "paginaFinal" => "224"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3730638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "ATS&#47;ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide&#44; 2005"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200406-710ST"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "912"
                        "paginaFinal" => "930"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15817806"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official ATS clinical practice guideline&#58; interpretation of exhaled nitric oxide levels &#40;FENO&#41; for clinical applications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "P&#46;B&#46; Boggs"
                            2 => "S&#46;C&#46; Erzurum"
                            3 => "C&#46;G&#46; Irvin"
                            4 => "M&#46;W&#46; Leigh"
                            5 => "J&#46;O&#46; Lundberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.9120-11ST"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "184"
                        "paginaInicial" => "602"
                        "paginaFinal" => "615"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21885636"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Standardised methodology of sputum induction and processing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Djukanovic"
                            1 => "P&#46;J&#46; Sterck"
                            2 => "J&#46;V&#46; Fahy"
                            3 => "F&#46;E&#46; Hargreave"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Respir J Suppl"
                        "fecha" => "2002"
                        "volumen" => "37"
                        "paginaInicial" => "1"
                        "paginaFinal" => "2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Indices of airway inflammation in induced sputum&#58; reproducibility and validity of cell and fluid-phase measurements"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Pizzichini"
                            1 => "M&#46;M&#46; Pizzichini"
                            2 => "A&#46; Efthimiadis"
                            3 => "S&#46; Evans"
                            4 => "M&#46;M&#46; Morris"
                            5 => "D&#46; Squiallace"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.154.2.8756799"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1996"
                        "volumen" => "154"
                        "paginaInicial" => "308"
                        "paginaFinal" => "317"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8756799"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Grant&#47;Riverside Methodist Hospitals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;M&#46; Green"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "1994"
                        "editorial" => "Grant Histology Procedure Manual"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory subtypes in asthma&#58; assessment and identification using induced sputum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; Simpson"
                            1 => "R&#46; Scott"
                            2 => "M&#46;J&#46; Boyle"
                            3 => "P&#46;G&#46; Gibson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1843.2006.00784.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2006"
                        "volumen" => "11"
                        "paginaInicial" => "54"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16423202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive methods to measure airway inflammation&#58; future considerations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "O&#46; Holz"
                            2 => "P&#46;J&#46; Sterk"
                            3 => "F&#46;E&#46; Hargreave"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2000"
                        "volumen" => "16"
                        "paginaInicial" => "1175"
                        "paginaFinal" => "1179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11292124"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the Spanish version of the Asthma Control Test &#40;ACT&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Vega"
                            1 => "X&#46; Badia"
                            2 => "C&#46; Badiola"
                            3 => "A&#46; L&#243;pez-Vi&#241;a"
                            4 => "J&#46;M&#46; Olagu&#237;bel"
                            5 => "C&#46; Picado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/02770900701752615"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Asthma"
                        "fecha" => "2007"
                        "volumen" => "44"
                        "paginaInicial" => "867"
                        "paginaFinal" => "872"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18097865"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-eosinophilic asthma&#58; importance and possible mechanisms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Douwes"
                            1 => "P&#46; Gibson"
                            2 => "J&#46; Pekkanen"
                            3 => "N&#46; Pearce"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2002"
                        "volumen" => "57"
                        "paginaInicial" => "643"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
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                      ]
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                ]
              ]
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                      "titulo" => "Distribution of sputum cellular phenotype in a large asthma cohort&#58; predicting factors for eosinophilic vs neutrophilic inflammation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;N&#46; Schleich"
                            1 => "M&#46; Manise"
                            2 => "J&#46; Sele"
                            3 => "M&#46; Henket"
                            4 => "L&#46; Seidel"
                            5 => "R&#46; Louis"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "doi" => "10.1186/1471-2466-13-11"
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                        "tituloSerie" => "BMC Pulm Med"
                        "fecha" => "2013"
                        "volumen" => "13"
                        "paginaInicial" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23442497"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Non-invasive markers of airway inflammation as predictors of oral steroids responsiveness in asthma"
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                          "etal" => false
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                            0 => "S&#46;A1 Little"
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                            3 => "C&#46; McSharry"
                            4 => "N&#46;C&#46; Thomson"
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                      ]
                    ]
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                        "volumen" => "55"
                        "paginaInicial" => "232"
                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10679543"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "35"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A systematic review and meta-analysis&#58; tailoring asthma treatment on eosinophilic markers &#40;exhaled nitric oxide or sputum eosinophils&#41;"
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                        0 => array:2 [
                          "etal" => true
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                            3 => "A&#46;M&#46; Li"
                            4 => "C&#46; Turner"
                            5 => "J&#46;A&#46; Kynaston"
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                        "tituloSerie" => "Thorax"
                        "fecha" => "2012"
                        "volumen" => "67"
                        "paginaInicial" => "199"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20937641"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The influence of age on induced sputum differential cell counts in normal subjects"
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                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "R&#46;A&#46; Thomas"
                            1 => "R&#46;H&#46; Green"
                            2 => "C&#46;E&#46; Brightling"
                            3 => "S&#46;S&#46; Birring"
                            4 => "D&#46; Parker"
                            5 => "A&#46;J&#46; Wardlaw"
                          ]
                        ]
                      ]
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                        "tituloSerie" => "Chest"
                        "fecha" => "2004"
                        "volumen" => "126"
                        "paginaInicial" => "1811"
                        "paginaFinal" => "1814"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15596678"
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                          ]
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                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
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                      "titulo" => "Determination of the inflammatory component of airway diseases by induced sputum cell counts&#58; used in clinical practice"
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                          "etal" => false
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                            4 => "M&#46;M&#46; Pizzichini"
                            5 => "E&#46; Pizzichini"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "paginaInicial" => "913"
                        "paginaFinal" => "921"
                        "link" => array:1 [
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Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2016.03.008

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	4	8
2024 October	47	24	71
2024 September	47	23	70
2024 August	64	31	95
2024 July	53	14	67
2024 June	61	26	87
2024 May	106	21	127
2024 April	40	31	71
2024 March	42	15	57
2024 February	50	21	71
2024 January	1	0	1
2023 March	6	4	10
2023 February	61	21	82
2023 January	31	26	57
2022 December	69	34	103
2022 November	45	22	67
2022 October	60	38	98
2022 September	32	42	74
2022 August	35	39	74
2022 July	30	41	71
2022 June	30	41	71
2022 May	40	38	78
2022 April	25	33	58
2022 March	42	47	89
2022 February	30	48	78
2022 January	27	42	69
2021 December	61	35	96
2021 November	47	41	88
2021 October	52	48	100
2021 September	35	46	81
2021 August	34	27	61
2021 July	28	23	51
2021 June	41	41	82
2021 May	41	25	66
2021 April	82	137	219
2021 March	54	23	77
2021 February	49	31	80
2021 January	26	23	49
2020 December	23	24	47
2020 November	29	20	49
2020 October	38	20	58
2020 September	33	16	49
2020 August	28	19	47
2020 July	40	32	72
2020 June	34	20	54
2020 May	42	27	69
2020 April	56	39	95
2020 March	31	27	58
2020 February	32	36	68
2020 January	51	18	69
2019 December	51	21	72
2019 November	44	28	72
2019 October	22	10	32
2019 September	37	9	46
2019 August	29	18	47
2019 July	37	26	63
2019 June	33	16	49
2019 May	39	16	55
2019 April	52	18	70
2019 March	44	13	57
2019 February	38	18	56
2019 January	34	17	51
2018 December	50	18	68
2018 November	81	23	104
2018 October	100	24	124
2018 September	36	13	49
2018 May	11	0	11
2018 April	22	12	34
2018 March	10	9	19
2018 February	21	8	29
2018 January	23	12	35
2017 December	29	12	41
2017 November	18	9	27
2017 October	22	10	32
2017 September	25	9	34
2017 August	19	10	29
2017 July	20	10	30
2017 June	30	17	47
2017 May	22	9	31
2017 April	25	7	32
2017 March	16	17	33
2017 February	8	6	14
2017 January	12	6	18
2016 December	37	14	51
2016 November	49	19	68
2016 October	33	36	69
2016 September	39	15	54
2016 August	55	10	65

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