Original Article
Prevalence and Perception of 24-h Symptom Patterns in Patients With Stable Chronic Obstructive Pulmonary Disease in Spain
Prevalencia y percepción de la variabilidad diaria de los síntomas en pacientes con enfermedad pulmonar obstructiva crónica estable en España
Juan José Soler-Cataluñaa, Jaume Sauledab, Luis Valdésc, Pilar Marínd, Ramón Agüeroe, Maite Pérezf, Marc Miravitllesg,
Corresponding author
a Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Ciber de Enfermedades Respiratorias (CIBERES), Valencia, Spain
b Servicio de Neumología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
c Servicio de Neumología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
d Servicio de Neumología, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
e Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
f Departamento Médico, AstraZeneca Farmacéutica, Barcelona, Spain
g Servicio de Neumología, Hospital Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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=> array:1 [ 0 => "mmiravitlles@vhebron.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Ciber de Enfermedades Respiratorias (CIBERES), Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitari Son Espases, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Departamento Médico, AstraZeneca Farmacéutica, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia y percepción de la variabilidad diaria de los síntomas en pacientes con enfermedad pulmonar obstructiva crónica estable en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 654 "Ancho" => 2295 "Tamanyo" => 138140 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Relationship between COPD symptoms and levels of anxiety in the Spanish population (<span class="elsevierStyleItalic">n</span>=122).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The main symptoms of chronic obstructive pulmonary disease (COPD) are cough, expectoration, and dyspnea. Until recently, the general opinion was that COPD symptoms, unlike asthma symptoms,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> did not change much over the course of the day. However, in recent years, it has become clear that COPD patients find that their respiratory symptoms vary over the course of the day.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2–4</span></a> Curiously, Kessler et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> observed differences among different European regions in the perception of symptom variability, but this study only included patients with severe or very severe COPD (FEV<span class="elsevierStyleInf">1</span><50% predicted).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our group was involved in a recently published European observational study,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> designed to determine the prevalence and severity of symptoms over a 24-h period in stable COPD patients with any level of airflow limitation seen in routine clinical practice (the ASSESS study). Since a large proportion of patients in this study were recruited from Spanish hospitals, we thought that it would be interesting to perform a subanalysis of this population, in order to define the prevalence and profile of 24-h respiratory symptom patterns in patients with any stage of COPD severity, compared to patients in other European countries.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Our secondary objective was to evaluate the relationship between COPD symptoms and health-related quality of life (HRQoL), anxiety and depression levels, quality of sleep, and COPD exacerbations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was an epidemiological, observational, multicenter study performed in Spain and other European countries (Germany, Denmark, France, Netherlands, Italy, Sweden and United Kingdom) between April 2011 and November 2013. We present the results from patients included in Spain. Respiratory medicine specialists in 14 hospitals located throughout Spain (Cantabria, Castilla-La Mancha, Catalonia, Community of Valencia, Galicia, Balearic Islands, Madrid, Navarre, and the Basque Country) took part in this study.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients were ≥40 years of age with an accumulated history of smoking of ≥10 pack-years and a diagnosis of COPD of any severity (stages I to IV) according to GOLD criteria (2010).<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> To be included, they had to be stable, with no exacerbations in the previous month. Exclusion criteria were: modifications in COPD treatment regimen in the 3 months before the study visit, previous diagnosis of asthma, sleep apnea syndrome or chronic respiratory disease other than COPD, or any acute or chronic disease which, in the opinion of the investigator, would limit the patient's ability to participate in the study.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study was performed according to the principles of the Declaration of Helsinki and Good Clinical Practice guidelines of the International Conference on Harmonization. All patients gave their written informed consent before inclusion. The study was approved by the Clinical Research Ethics Committee of the Hospital Clínic de Barcelona.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data Collection</span><p id="par0030" class="elsevierStylePara elsevierViewall">The following data were collected during the study visit: demographic, anthropometric and socioeconomic characteristics, smoking habit, data from the latest available spirometry (up to 12 months previously), disease severity according to the GOLD 2010 criteria, current treatment for COPD, exacerbations in the year before the visit. Patients were also asked to complete the following questionnaires:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Night-time, morning and daytime COPD symptoms: a self-administered 33-item questionnaire, developed by the sponsor, on the frequency and severity of COPD symptoms (dyspnea, cough, expectoration, chest tightness, chest congestion, wheezing) during each time interval in the week before the visit, and in a normal week in the previous month (defined as the week considered by the patient as the most typical of the previous month). The questionnaires consist of 3 sections. The first (13 questions) addresses night-time symptoms (the time between the patient going to bed and getting up), the second (10 questions) asks about morning symptoms (between getting up and about 11 o’clock in the morning), and the third (10 questions) addresses daytime symptoms (from 11 o’clock in the morning until bedtime).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0040" class="elsevierStylePara elsevierViewall">COPD Assessment Test (CAT) questionnaire<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a>: an 8-item questionnaire evaluating HRQoL in COPD with scores from 0 to 40, higher scores representing poorer HRQoL.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0045" class="elsevierStylePara elsevierViewall">Hospital Anxiety and Depression Scale (HADS)<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a>: a self-administered 14-item scale measuring levels of anxiety and depression (with 7 questions in each respective subscale). Scores in each subscale range from 0 to 21, higher scores representing higher levels of anxiety and depression.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0050" class="elsevierStylePara elsevierViewall">COPD and Asthma Sleep Impact Scale (CASIS)<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9,10</span></a>: a self-administered 7-item scale evaluating sleeping problems associated with COPD and asthma. Total score is from 0 to 100, higher scores representing greater sleep deterioration in the previous week.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">All variables were included in a descriptive analysis: mean and standard deviation for quantitative variables and frequencies for qualitative variables. The population for analysis included patients who met all the screening criteria and completed the night-time, morning and daytime questionnaires (evaluable population). No substitution methods were used for missing data. The Chi-squared test was used to compare qualitative variables and the Mann–Whitney–Wilcoxon test was used for continuous variables. Statistical significance was set at <span class="elsevierStyleItalic">P</span><.05. All analyses were performed using the SAS<span class="elsevierStyleSup">®</span> System for Windows version 9.2 statistical package.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 124 Spanish patients were screened: 2 (1.6%) did not fulfill the inclusion/exclusion criteria, so the final number of evaluable patients was 122. The total number of evaluable patients in other European countries was 605. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main characteristics of both populations. The mean age of the Spanish cohort was 69 (SD=9) years (similar to the European mean), and most were men. In fact, the percentage of men in Spain was significantly higher than in other European countries (91.0% versus 60.7%, <span class="elsevierStyleItalic">P</span><.0001). The percentage of active smokers among the Spanish group was 22.1%, similar to that of the other Europeans, but the pack-year consumption of the Spaniards was higher (<span class="elsevierStyleItalic">P</span><.0001). The Spanish patients performed more physical activity (45.1% vs 28.6%, <span class="elsevierStyleItalic">P</span><.01), and a greater number of them were retired (84.4% vs 76.7%, <span class="elsevierStyleItalic">P</span><.05). Scores for the CAT, HADS anxiety subscale score, and the CASIS questionnaires were lower among the Spaniards (<span class="elsevierStyleItalic">P</span><.05 for all) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Mean post-bronchodilator FEV<span class="elsevierStyleInf">1</span> (% predicted) in the Spanish population was 50.5% (SD=19.4%), similar to the European group. A total of 44.3% had severe COPD (stage III) according to GOLD 2010 criteria. This proportion was numerically higher than the European population (34.3%), but the difference was not statistically significant (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In total, 99.2% of the Spanish patients were receiving treatment for COPD. The most common treatment was a combination of a long-acting beta-2 agonist (LABA), a long-acting anticholinergic (LAMA), and inhaled corticosteroids (ICS), and this combination was prescribed more frequently in Spain than in other European countries: 62.3% versus 46.1% (<span class="elsevierStyleItalic">P</span><.0001). Quadruple therapy (LABA, LAMA, ICS, and a phosphodiesterase-4 inhibitor) was prescribed to 7.4% of Spanish patients compared to 1.0% of the non-Spanish population (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">During the week before inclusion in the study, more than half of the Spanish patients (52.5%) experienced COPD symptoms during the 3 periods of the day, and 15.6% did so during 2 periods. These percentages were significantly lower (<span class="elsevierStyleItalic">P</span><.001) than for patients in the rest of Europe: 57.5% and 24.8%, respectively (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Symptoms most frequently occurred in both the Spanish and non-Spanish populations in the morning and during the day, but to a greater extent in the non-Spaniards (71.3% vs 83.5% and 71.3% vs 85.0% morning and daytime symptoms, respectively [<span class="elsevierStyleItalic">P</span><.01 for both]). Up to 59.0% of Spanish patients had at least 1 COPD symptom during the night (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Symptom severity was comparable in the different periods of the day. Most symptoms were described as mild or moderate by the Spanish cohort (93.9%, 95.5% and 83.3% reported mild or moderate symptoms during the morning, during the rest of the day or during the night, respectively). A significantly greater percentage of non-Spanish patients reported severe or very severe daytime symptoms (11.8% vs 4.6%; <span class="elsevierStyleItalic">P</span><.01) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Cough (reported by 59.8% of the Spanish group), expectoration (57.4%) and dyspnea (53.3% Spanish vs 75.0% non-Spanish; <span class="elsevierStyleItalic">P</span><.0001) were the most common COPD symptoms among the Spanish population, followed by wheezing, chest tightness or congestion (each reported by 15.6% of the population). The frequency of each individual symptom varied over the 24<span class="elsevierStyleHsp" style=""></span>h of the day. Cough and expectoration were more common in the morning and dyspnea-related symptoms increased during the day. Wheezing was more common at night than during the day (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Morning or daytime dyspnea, reported by 29.5% and 46.7% of the Spanish population, increased to 56% and 68.9%, respectively, in the non-Spanish population (<span class="elsevierStyleItalic">P</span><.0001 for both).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Patients with symptoms throughout the day had poorer HRQoL and higher levels of anxiety and depression than symptom-free patients (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3–5</a>). CAT questionnaire scores were lower for Spanish patients with daytime symptoms than for the non-Spanish population (16.9 vs 20.5, <span class="elsevierStyleItalic">P</span><.05). Patients with night-time COPD symptoms had a poorer quality of sleep than those without night-time symptoms (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). CASIS scale scores were lower for Spanish patients with symptoms during the 3 periods of the day than for the non-Spanish population (42.0 vs 52.8, <span class="elsevierStyleItalic">P</span><.05).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">When the scores were analyzed by time periods, the CAT score was significantly worse in patients with at least 1 COPD symptom during the morning, the day or at night, compared to patients who were symptom-free in the same time intervals (<span class="elsevierStyleItalic">P</span><.0001 for all) (data for the Spanish population shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). Moreover, anxiety levels were significantly higher in patients with at least 1 symptom during the night or the day, compared to patients who were symptom-free in the same period (<span class="elsevierStyleItalic">P</span><.05 for both). Depression levels were also higher in patients with at least 1 symptom at night, in the morning or during the day, compared to symptom-free patients in the same time intervals (<span class="elsevierStyleItalic">P</span><.05 for all). Patients with at least 1 COPD symptom during the night or in the morning had a significantly poorer quality of sleep than patients who were symptom-free during the same time intervals (<span class="elsevierStyleItalic">P</span><.01 for both).</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">With respect to COPD exacerbations in Spanish patients, night-time or daytime symptoms were significantly associated with the number of exacerbations in the previous year, although the association with morning symptoms was not significant. The mean number of exacerbations was greater in patients with at least 1 COPD symptom during the night or the day, compared to patients who were symptom-free during the same time intervals (1.6 [SD=1.7] exacerbations vs 0.9 [SD=1.1], and 1.5 [SD=1.6] exacerbations vs 0.8 [SD=1.2], respectively; <span class="elsevierStyleItalic">P</span><.05 for all).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Our study revealed that more than half (53%) of Spanish patients with COPD receiving stable treatment and in any stage of disease severity experience symptoms during all periods of the day (morning, day and night), two thirds (68%) during at least 2 periods of the day, and 81% during at least 1 time interval. Morning symptoms, particularly cough and expectoration, are the most common. However, up to 59% of patients are also symptomatic at night.</p><p id="par0100" class="elsevierStylePara elsevierViewall">It is interesting to note that the European population was generally more symptomatic than the Spanish.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> A total of 58% reported symptoms throughout the day and 82% in 2 or 3 periods during the day: these percentages were significantly higher than in the Spanish population. Moreover, Spanish patients reported fewer daytime symptoms, compared to the European population.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Among the European population, 84% reported at least 1 morning symptom and 85% had at least 1 daytime symptom, compared to 71% of the Spanish group who had at least 1 morning or daytime symptom.</p><p id="par0105" class="elsevierStylePara elsevierViewall">These differences between the 2 populations were maintained, despite similarities in airflow limitation. Moreover, the perception of symptom severity during the day differed slightly, with almost all Spanish patients (96%) reporting symptoms as mild or moderate, compared to 88% of the European population. The correlation between lung function compromise and the perception of symptoms is weak,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> so other factors may be contributing to the low rate of symptoms reported by the Spanish group. It is interesting to note that mean scores obtained in both the CAT and the CASIS scale for the Spanish population with night-time, morning or daytime symptoms were lower than the scores obtained for the European population,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> confirming a better HRQoL and a better quality of sleep in the Spanish population compared to the general, more symptomatic, European population.</p><p id="par0110" class="elsevierStylePara elsevierViewall">There could be many reasons to explain why Spanish patients are less symptomatic or have a better HRQoL, but a key factor may be their COPD maintenance treatment. Most Spanish patients (up to 70%) received a combination of LABA, LAMA, and ICS, and this regimen was prescribed to a significantly higher percentage of Spaniards than Europeans (47%).</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nine out of 10 Spanish patients were men, compared to 6 out of 10 in other European countries.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> This greater proportion of men in the Spanish cohort may also contribute to the fact that HRQoL was better and Spanish patients were less symptomatic than the European population. Some authors have shown that women with COPD have worse HRQoL and report more respiratory symptoms than men, even when their disease is similarly severe.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12–14</span></a> Nevertheless, the greater proportion of men among the Spanish COPD group may be explained by the lower prevalence of COPD among women in Spain,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a> and by the higher rates of underdiagnosis in women compared to men.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> We should also remember that the Spanish patients were more physically active than their Europeans counterparts (perhaps because there were more retired subjects in the Spanish group), a factor associated with better HRQoL in COPD patients.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Cough and expectoration were the symptoms most commonly reported by the Spanish, while in the European population, it was dyspnea.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">15–18</span></a> Dyspnea is one of the factors most closely associated with HRQoL.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> Cough and expectoration are typical symptoms of the chronic bronchitis COPD phenotype,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> and are associated with more frequent exacerbations and hospitalization.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> In our study, Spanish patients who reported at least 1 night-time or daytime COPD symptom had approximately twice the number of exacerbations in the previous year, compared to those who reported no symptoms in the same time periods. Roche et al.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> reported that patients with morning COPD symptoms typically had a higher rate of exacerbations compared to those without morning symptoms, although in this earlier study, patients with morning symptoms were significantly older, and were more often active smokers with poorer lung function than patients without morning symptoms. We did not have the necessary data to compare demographic or clinical characteristics according to symptoms, but we are not surprised to see a relationship between patient-reported symptoms and the number of exacerbations, since exacerbations involve worsening respiratory symptoms. Moreover, in more symptomatic patients, it is more likely that worsening symptoms will exceed the threshold of normal diurnal variation and develop into an exacerbation.</p><p id="par0125" class="elsevierStylePara elsevierViewall">When the distribution of symptoms throughout the 24-h period was analyzed, we found that our population more frequently reported morning symptoms. Other observational studies also found that patients report more intense symptoms in the morning, when they get up,<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2,4,23</span></a> and these symptoms impact greatly on their health status and activities of daily living.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2,22–26</span></a> In our study, HRQoL was significantly compromised in patients with at least 1 morning COPD symptom, compared to patients with no symptoms in the same time interval; the same patients also had higher scores in the HADS depression subscale.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Up to 60% of both the Spanish and the European population had night-time symptoms.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Night-time symptoms were significantly associated with poorer HRQoL and higher scores on both the anxiety and depression subscales of the HADS. Furthermore, patients with night-time symptoms had a poorer quality of sleep, so our results support a correlation between quality of sleep and HRQoL in COPD patients.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Price et al.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> also found that patients with night-time symptoms had a significantly worse health status than patients without. As might be expected, patients with a 24-h pattern of COPD symptoms are those who have poorer HRQoL and higher levels of anxiety and depression.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The observational design of this study has some inherent limitations, including a possible selection bias. The main limitation is the lack of a control group that would allow us to determine if the differences observed between the Spanish and European patients are due to inherent characteristics of their COPD or to pre-existing differences between the populations. The study design also prevents us from clarifying another important question: why does the Spanish population, with the same grade of disease severity, have a better HRQoL and fewer symptoms than the European population? Other variables not described here may possibly explain why the Spaniards reported fewer symptoms. Another point to bear in mind is that the study population is relatively small, so some care is needed when extrapolating the conclusions to all COPD patients. Larger studies would help confirm our results.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion, more than half of Spanish COPD patients show respiratory symptoms 24<span class="elsevierStyleHsp" style=""></span>h a day. Morning symptoms, particularly cough and expectoration, occur more frequently. Even when symptoms are reported as mainly mild or moderate, they affect health-related quality of life. Spanish patients are less symptomatic than patients in other European countries. Healthcare professionals must pay more attention to 24-h respiratory symptom patterns in COPD, even in stable patients.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">This study was funded by <span class="elsevierStyleGrantSponsor" id="gs1">AstraZeneca Farmacéutica</span>.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Author Contributions</span><p id="par0150" class="elsevierStylePara elsevierViewall">MM designed the study, coordinated the research group and directed data analysis. JJSC, JS, LV, PM, RA and MM participated in clinical data collection, reviewed the manuscript, and approved the final version. JJSC was the leading investigator in Spain. MP participated in manuscript review.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of Interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">JJSC has received fees for scientific consultancy and/or for speaking at conferences organized by Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Ferrer, GlaxoSmithKline, Laboratorios Esteve, Pfizer, Menarini, Mundipharma and Novartis. MP works in the Medical Department of AstraZeneca Farmacéutica, Spain. MM has received fees for scientific consultancy and/or for speaking at conferences organized by Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, Grupo Ferrer, GlaxoSmithKline, Grifols, Laboratorios Esteve, Pfizer, Teva, Cipla, Menarini, Novartis, Gebro Pharma and Takeda. The other authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres655746" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec665361" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres655745" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 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" => "xpalclavsec665362" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data Collection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Author Contributions" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-04" "fechaAceptado" => "2015-11-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec665361" "palabras" => array:4 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Health-related quality of life" 2 => "Symptoms" 3 => "Variation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec665362" "palabras" => array:4 [ 0 => "Enfermedad pulmonar obstructiva crónica" 1 => "Calidad de vida relacionada con la salud" 2 => "Síntomas" 3 => "Variabilidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Few studies have examined the 24-h symptom profile in patients with chronic obstructive pulmonary disease (COPD). The main objective of this study was to determine daily variations in the symptoms of patients with stable COPD in Spain, compared with other European countries.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational study conducted in 8 European countries. The results from the Spanish cohort (<span class="elsevierStyleItalic">n</span>=122) are compared with the other European subjects (<span class="elsevierStyleItalic">n</span>=605). We included patients with COPD whose treatment had been unchanged in the previous 3 months. Patients completed questionnaires on morning, day-time, and night-time symptoms of COPD, the COPD Assessment Test (CAT), the hospital anxiety and depression scale (HADS), and the COPD and Asthma Sleep Impact Scale (CASIS).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean age: 69 (standard deviation [SD]=9) years; mean post-bronchodilator FEV<span class="elsevierStyleInf">1</span>: 50.5 (SD=19.4)% (similar in Spanish and European cohorts). The proportion of men among the Spanish cohort was greater (91.0% versus 60.7%, <span class="elsevierStyleItalic">P</span><.0001). A total of 52.5% patients experienced some type of symptoms throughout the day, compared to 57.5% of the other Europeans (<span class="elsevierStyleItalic">P</span><.001). Patients with symptoms throughout the day had poorer health-related quality of life (HRQoL) and higher levels of anxiety/depression than patients without symptoms. Patients with night-time symptoms had a poorer quality of sleep. Spanish patients with symptoms throughout the day had better CAT scores (16.9 versus 20.5 in the other Europeans, <span class="elsevierStyleItalic">P</span><.05).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Despite receiving treatment, more than half of patients report symptoms throughout the day. These patients have poorer HRQoL and higher levels of anxiety/depression. Among patients with similar lung function, the Spanish cohort was less symptomatic and reported better HRQoL than other Europeans.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hay pocos estudios sobre la distribución circadiana de los síntomas de la enfermedad pulmonar obstructiva crónica (EPOC) durante las 24<span class="elsevierStyleHsp" style=""></span>h del día. El objetivo principal fue conocer la variabilidad diaria de los síntomas en pacientes con EPOC estable en España en comparación con otros países europeos.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional realizado en 8 países europeos. Se presentan resultados de pacientes españoles (<span class="elsevierStyleItalic">n</span>=122) versus resto de europeos (<span class="elsevierStyleItalic">n</span>=605). Se incluyeron pacientes con EPOC, sin modificaciones en el tratamiento en los 3<span class="elsevierStyleHsp" style=""></span>meses anteriores. Los pacientes rellenaron: cuestionario de síntomas matutinos, diurnos y nocturnos de la EPOC, cuestionario <span class="elsevierStyleItalic">COPD Assessment Test</span> (CAT), escala de ansiedad y depresión hospitalaria (HADS) y escala del impacto del sueño por asma y EPOC (CASIS).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Edad media: 69 (DE=9) años; FEV<span class="elsevierStyleInf">1</span> posbroncodilatador medio: 50,5 (DE=19,4) % (similar en españoles y europeos). La proporción de hombres entre los españoles fue superior (91,0% versus 60,7%, p<0,0001). El 52,5% experimentaron algún tipo de síntomas durante todo el día (57,5% resto europeos, p<0,001). Los pacientes con síntomas durante todo el día tuvieron peor calidad de vida relacionada con la salud (CVRS) y niveles mayores de ansiedad/depresión que los pacientes sin síntomas. Los pacientes con síntomas nocturnos tenían peor calidad del sueño. Los pacientes españoles con síntomas durante todo el día mostraron una mejor puntuación en el CAT (16,9 versus 20,5 resto europeos, p<0,05).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A pesar de recibir tratamiento, más de la mitad de los pacientes refieren síntomas durante todo el día. Estos pacientes presentan peor CVRS, peor calidad del sueño y niveles aumentados de ansiedad/depresión. A igual función pulmonar, los españoles son menos sintomáticos y refieren mejor CVRS en comparación con otros europeos.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 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" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as: Soler-Cataluña JJ, Sauleda J, Valdés L, Marín P, Agüero R, Pérez M, et al. Prevalencia y percepción de la variabilidad diaria de los síntomas en pacientes con enfermedad pulmonar obstructiva crónica estable en España. Arch Bronconeumol. 2016;52:308–315.</p>" ] ] "multimedia" => array:11 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1097 "Ancho" => 1650 "Tamanyo" => 97516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients with possible combinations of symptoms over a 24-h period in the Spanish population (<span class="elsevierStyleItalic">n</span>=122), compared to other European countries (Germany, Denmark, France, Netherlands, Italy, Sweden, and United Kingdom; <span class="elsevierStyleItalic">n</span>=605).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1529 "Ancho" => 2250 "Tamanyo" => 129636 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prevalence of COPD symptoms over a 24-h period in the Spanish population (<span class="elsevierStyleItalic">n</span>=122).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 662 "Ancho" => 2309 "Tamanyo" => 132257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relationship between COPD symptoms and quality of life in the Spanish population (<span class="elsevierStyleItalic">n</span>=122).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 654 "Ancho" => 2295 "Tamanyo" => 138140 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Relationship between COPD symptoms and levels of anxiety in the Spanish population (<span class="elsevierStyleItalic">n</span>=122).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 634 "Ancho" => 2291 "Tamanyo" => 131979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Relationship between COPD symptoms and levels of depression in the Spanish population (<span class="elsevierStyleItalic">n</span>=122).</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 721 "Ancho" => 2551 "Tamanyo" => 158661 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Relationship between COPD symptoms and quality of sleep in the Spanish population (<span class="elsevierStyleItalic">n</span>=122).</p>" ] ] 6 => 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="spar0080" class="elsevierStyleSimplePara elsevierViewall">BMI, body-mass index; CAT, COPD Assessment Test; CASIS, COPD and Asthma Sleep Impact Scale; SD, standard deviation; HADS, Hospital Anxiety and Depression Scale; NS, not significant.</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Missing data (<span class="elsevierStyleItalic">n</span>): sex (other countries: 1), age (other countries: 2), BMI (other countries: 7), pack-years (Spain: 1; other countries: 3), physical activity (other countries: 4), employment status (other countries: 6), educational level (other countries: 12).</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"> \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">Spain (<span class="elsevierStyleItalic">n</span>=122) \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">Other Countries<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> (<span class="elsevierStyleItalic">n</span>=605) \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> \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="4" align="left" valign="top"><span class="elsevierStyleItalic">Demographic characteristics</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>Sex, men, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">111 (91.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">367 (60.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \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>Age (years), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.9 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.9 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Anthropometric characteristics, mean (SD)</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>BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.7 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.3 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Smoking habit</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>Active smokers, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (22.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">175 (28.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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>Pack-years, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.1 (29.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.0 (23.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Physical activity, n (%)</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>Sedentary (no type of exercise) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (20.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">193 (31.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0011 \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>Moderate (15<span class="elsevierStyleHsp" style=""></span>min walking, 2 or 3 times/week) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (34.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">235 (38.8) \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"><span class="elsevierStyleHsp" style=""></span>Active (some sport or 15<span class="elsevierStyleHsp" style=""></span>min walking, >3 times/week) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (45.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 (28.6) \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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Employment status, n (%)</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>Retired/pensioner \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 (84.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">464 (76.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0357 \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>Unemployed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (6.9) \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"><span class="elsevierStyleHsp" style=""></span>Employee (part-time or full-time) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (15.4) \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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Educational level, n (%)</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>No education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (27.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \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>Primary education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (44.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">176 (29.1) \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"><span class="elsevierStyleHsp" style=""></span>Secondary education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (16.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289 (47.8) \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"><span class="elsevierStyleHsp" style=""></span>Higher education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (12.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (12.2) \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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Questionnaires completed by patients, mean (SD)</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>CAT score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.2 (7.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \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>HADS score (anxiety subscale) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0252 \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>HADS score (depression subscale) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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>CASIS score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.1 (17.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.8 (19.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1077261.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Germany, Denmark, France, Netherlands, Italy, Sweden, and United Kingdom.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">General Characteristics of the Spanish Population (<span class="elsevierStyleItalic">n</span>=122) and Other European Countries (<span class="elsevierStyleItalic">n</span>=605).</p>" ] ] 7 => 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:3 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>, forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; NS, not significant; SD, standard deviation.</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Missing data (<span class="elsevierStyleItalic">n</span>): Post-bronchodilator FEV<span class="elsevierStyleInf">1</span> (other countries: 29), post-bronchodilator FEV<span class="elsevierStyleInf">1</span> (% predicted) (other countries: 7), post-bronchodilator FVC (other countries: 31), post-bronchodilator FVC (% predicted) (other countries: 14), post-bronchodilator FEV<span class="elsevierStyleInf">1</span>/FVC (other countries: 31), disease severity (Spain: 2; other countries: 61).</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"> \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">Spain (<span class="elsevierStyleItalic">n</span>=122) \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">Other Countries<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> (<span class="elsevierStyleItalic">n</span>=605) \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> \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="4" align="left" valign="top"><span class="elsevierStyleItalic">Spirometry characteristics, mean (SD)</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>Post-bronchodilator FEV<span class="elsevierStyleInf">1</span> (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1364.8 (518.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1403.7 (603.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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>Post-bronchodilator FEV<span class="elsevierStyleInf">1</span> (% predicted) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.5 (19.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.3 (20.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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>Post-bronchodilator FVC (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2900.9 (767.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2756.5 (985.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0191 \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>Post-bronchodilator FVC (% predicted) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.3 (19.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.8 (22.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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>Post-bronchodilator FEV<span class="elsevierStyleInf">1</span>/FVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.51 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Disease severity (GOLD 2010), n (%)</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>Stage I (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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>Stage II (moderate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (36.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">220 (36.5) \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"><span class="elsevierStyleHsp" style=""></span>Stage III (severe) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (44.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">207 (34.3) \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"><span class="elsevierStyleHsp" style=""></span>Stage IV (very severe) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (10.1) \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 => "xTab1077262.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Germany, Denmark, France, Netherlands, Italy, Sweden, and United Kingdom.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Lung Function Among the Spanish Population (<span class="elsevierStyleItalic">n</span>=122) and Other European Countries (<span class="elsevierStyleItalic">n</span>=605).</p>" ] ] 8 => 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:3 [ "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">ICS, inhaled corticosteroids; LABA, long-acting beta-2 agonist; LAMA, long-acting anticholinergic; PDE4I, phosphodiesterase-4 inhibitor; SABA, short-acting beta-2 agonist; SAMA, short-acting anticholinergic.</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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment, <span class="elsevierStyleItalic">n</span> (%) \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">Spain (<span class="elsevierStyleItalic">n</span>=122) \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">Other Countries<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> (<span class="elsevierStyleItalic">n</span>=605) \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">SABA only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (2.5) \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">SAMA only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.2) \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">LABA only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (10.1) \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">LAMA only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (7.1) \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">SABA+SAMA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.5) \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">LABA+ICS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (15.0) \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">LABA+LAMA+ICS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (62.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">279 (46.1) \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">LABA+LABA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (10.4) \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">LABA+ICS+PDE4I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.8) \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">LAMA+ICS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1.3) \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 only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.8) \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">LABA+LAMA+ICS+PDE4I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1.0) \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">LABA+ICS+PDE4I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.7) \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+PDE4I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \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 treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1077264.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Germany, Denmark, France, Netherlands, Italy, Sweden, and United Kingdom.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Current COPD Maintenance Treatment in the Spanish Population (<span class="elsevierStyleItalic">n</span>=122) and Other European Countries (<span class="elsevierStyleItalic">n</span>=605) (<span class="elsevierStyleItalic">P</span><.0001).</p>" ] ] 9 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">NS, not significant.</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"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Night-time</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Morning</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Daytime</th></tr><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">Spain (<span class="elsevierStyleItalic">n</span>=122) \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">Other Countries<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> (<span class="elsevierStyleItalic">n</span>=605) \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> \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">Spain (<span class="elsevierStyleItalic">n</span>=122) \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">Other Countries<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> (<span class="elsevierStyleItalic">n</span>=605) \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> \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">Spain (<span class="elsevierStyleItalic">n</span>=122) \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">Other Countries<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> (<span class="elsevierStyleItalic">n</span>=605) \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> \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="10" align="left" valign="top"><span class="elsevierStyleItalic">Prevalence of symptoms, n (%)</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>Patients with ≥1 symptom in the last week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (59.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">386 (63.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (71.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">505 (83.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (71.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">514 (85.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0004 \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>≥3 times in the last week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (39.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">264 (43.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (52.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">391 (64.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0148 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (50.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">365 (60.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0468 \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>≥3 times in a typical week during the previous month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (46.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">321 (53.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (57.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">418 (69.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (54.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">401 (66.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0168 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" 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="10" align="left" valign="top"><span class="elsevierStyleItalic">Severity of symptom in the last week, n (%)</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a></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>Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (58.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156 (44.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (53.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">208 (42.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (59.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">202 (40.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0071 \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>Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (30.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">157 (45.0) \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><td class="td" title="table-entry " align="char" valign="top">33 (40.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">217 (44.4) \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><td class="td" title="table-entry " align="char" valign="top">32 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">240 (47.9) \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"><span class="elsevierStyleHsp" style=""></span>Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (9.5) \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><td class="td" title="table-entry " align="char" valign="top">5 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (11.5) \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><td class="td" title="table-entry " align="char" valign="top">4 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (11.0) \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><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>Very severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.9) \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><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1.6) \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><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.8) \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 => "xTab1077260.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Germany, Denmark, France, Netherlands, Italy, Sweden, and United Kingdom.</p>" ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Percentages based on patients who experienced symptoms in the last week and provided severity data.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Prevalence and Severity of COPD Symptoms Throughout a 24-h Period in the Spanish Population (<span class="elsevierStyleItalic">n</span>=122) and Other European Countries (<span class="elsevierStyleItalic">n</span>=605).</p>" ] ] 10 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">CASIS, Sleep and Asthma Sleep Impact Scale; CAT, COPD Assessment Test; HADS, Hospital Anxiety and Depression Scale; NS, not significant; SD, standard deviation.</p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Missing data (<span class="elsevierStyleItalic">n</span>): CAT score, no night-time symptoms (1), no morning symptoms (1), at least 1 daytime symptom (1); HADS anxiety subscale, at least 1 night-time symptom (1), at least 1 daytime symptom (1); HADS depression subscale score, no night-time symptoms (1), no morning symptoms (1), CASIS score, no night-time symptoms (1), no morning symptoms (1), no daytime symptoms (1).</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"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Night-time</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Morning</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Daytime</th></tr><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">No Night-time Symptoms \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">At Least 1 Night-time Symptom \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> \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">No Morning Symptoms \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">At Least 1 Morning Symptom \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> \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">No Daytime Symptoms \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">At Least 1 Daytime Symptom \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> \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">CAT score, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.2 (8.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.4 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.2 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \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">HADS score (anxiety subscale), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.2 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0040 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.9 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0460 \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">HADS score (depression subscale), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.0 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0029 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.2 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0257 \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">CASIS score, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.8 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.5 (18.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.5 (13.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.7 (18.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0056 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.0 (15.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.8 (18.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1077263.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">CAT, HADS and CASIS Questionnaire Scores, According to Presence of Respiratory Symptoms in the Spanish Population (<span class="elsevierStyleItalic">n</span>=122).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diurnal rhythm of asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.J. Clark" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "1987" "volumen" => "91" "numero" => "6 Suppl." "paginaInicial" => "137S" "paginaFinal" => "141S" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3107921" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0150" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptom variability in patients with severe COPD: a pan-European cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Kessler" 1 => "M.R. Partridge" 2 => "M. Miravitlles" 3 => "M. Cazzola" 4 => "C. Vogelmeier" 5 => "D. Leynaud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00051110" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "264" "paginaFinal" => "272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21115606" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0155" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variability of respiratory symptoms in severe COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Espinosa de los Monteros" 1 => "C. Peña" 2 => "E.J. Soto Hurtado" 3 => "J. Jareño" 4 => "M. Miravitlles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2011.07.004" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2012" "volumen" => "48" "paginaInicial" => "3" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21944843" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0160" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient's perception of symptoms related to morning activity in chronic obstructive pulmonary disease: the SYMBOL study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.J. Kim" 1 => "B.K. Lee" 2 => "C.Y. Jung" 3 => "Y.J. Jeon" 4 => "D.S. Hyun" 5 => "K.C. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3904/kjim.2012.27.4.426" "Revista" => array:6 [ "tituloSerie" => "Korean J Intern Med" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "426" "paginaFinal" => "435" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23269884" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0165" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "H. Worth" 2 => "J. Soler Cataluña" 3 => "D. Price" 4 => "F. de Benedetto" 5 => "N. Roche" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12931-014-0122-1" "Revista" => array:5 [ "tituloSerie" => "Respir Res" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25331383" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0170" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global Initiative for Chronic Obstructive Lung Disease (GOLD)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Global Strategy for the Diagnosis, Management and Prevention of COPD" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2010" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0175" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and first validation of the COPD assessment test" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.W. Jones" 1 => "G. Harding" 2 => "P. Berry" 3 => "I. Wiklund" 4 => "W-H. Chen" 5 => "N.K. Leidy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00102509" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "648" "paginaFinal" => "654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19720809" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0180" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The hospital anxiety and depression scale" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.S. Zigmond" 1 => "R.P. Snaith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Psychiatr Scand" "fecha" => "1983" "volumen" => "67" "paginaInicial" => "361" "paginaFinal" => "370" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6880820" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0185" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and psychometric assessment of the COPD and Asthma Sleep Impact Scale (CASIS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.F. Pokrzywinski" 1 => "D.M. Meads" 2 => "S.P. McKenna" 3 => "G.A. Glendenning" 4 => "D.A. Revicki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1477-7525-7-98" "Revista" => array:5 [ "tituloSerie" => "Health Qual Life Outcomes" "fecha" => "2009" "volumen" => "7" "paginaInicial" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19968881" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0190" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of the LCOPD, CAFS and CASIS scales in understanding the impact of COPD on patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "M. Iriberri" 2 => "M. Barrueco" 3 => "M. Lleonart" 4 => "E. Villarrubia" 5 => "J. Galera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000341175" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2013" "volumen" => "86" "paginaInicial" => "190" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23037958" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0195" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importance and variability of symptoms in chronic obstructive pulmonary disease. Their significance for treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.L. López-Campos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(10)70063-6" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2010" "volumen" => "46" "numero" => "Suppl. 8" "paginaInicial" => "20" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21334552" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0200" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gender and COPD in patients attending a pulmonary clinic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.P. De Torres" 1 => "C. Casanova" 2 => "C. Hernández" 3 => "J. Abreu" 4 => "A. Aguirre-Jaime" 5 => "B.R. Celli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.128.4.2012" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "128" "paginaInicial" => "2012" "paginaFinal" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236849" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0205" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gender associated differences in determinants of quality of life in patients with COPD: a case series study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. De Torres" 1 => "C. Casanova" 2 => "C. Hernández" 3 => "J. Abreu" 4 => "A. Montejo de Garcini" 5 => "A. Aguirre-Jaime" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1477-7525-4-72" "Revista" => array:5 [ "tituloSerie" => "Health Qual Life Outcomes" "fecha" => "2006" "volumen" => "4" "paginaInicial" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17007639" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0210" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impairment of quality of life in women with chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Naberan" 1 => "A. Azpeitia" 2 => "J. Cantoni" 3 => "M. Miravitlles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2011.09.014" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2012" "volumen" => "106" "paginaInicial" => "367" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22018505" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0215" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.B. Soriano" 2 => "F. García-Río" 3 => "L. Muñoz" 4 => "E. Duran-Tauleria" 5 => "G. Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2009.115725" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "863" "paginaFinal" => "868" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19553233" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0220" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Underdiagnosis of chronic obstructive pulmonary disease in women: quantification of the problem, determinants and proposed actions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Ancochea" 1 => "M. Miravitlles" 2 => "F. García-Río" 3 => "L. Muñoz" 4 => "G. Sánchez" 5 => "V. Sobradillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.11.010" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "223" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23317767" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0225" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Daily physical activity, functional capacity and quality of life in patients with COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Dürr" 1 => "S. Zogg" 2 => "D. Miedinger" 3 => "E.H. Steveling" 4 => "S. Maier" 5 => "J.D. Leuppi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/15412555.2014.898050" "Revista" => array:6 [ "tituloSerie" => "COPD" "fecha" => "2014" "volumen" => "11" "paginaInicial" => "689" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24945972" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0230" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient's perception of exacerbations of COPD—the PERCEIVE study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Miravitlles" 1 => "A. Anzueto" 2 => "D. Legnani" 3 => "L. Forstmeier" 4 => "M. Fargel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2006.07.010" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2007" "volumen" => "101" "paginaInicial" => "453" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16938447" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0235" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors determining the quality of life of patients with COPD in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J. Molina" 2 => "K. Naberan" 3 => "J.M. Cots" 4 => "F. Ros" 5 => "C. Llor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1753465807086097" "Revista" => array:6 [ "tituloSerie" => "Ther Adv Respir Dis" "fecha" => "2007" "volumen" => "1" "paginaInicial" => "85" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19124350" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0240" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish guideline for COPD (GesEPOC). Update 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.J. Soler-Cataluña" 2 => "M. Calle" 3 => "J. Molina" 4 => "P. Almagro" 5 => "J.A. Quintano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(14)70070-5" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2014" "volumen" => "50" "numero" => "Suppl. 1" "paginaInicial" => "1" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24507959" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0245" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P-R. Burgel" 1 => "P. Nesme-Meyer" 2 => "P. Chanez" 3 => "D. Caillaud" 4 => "P. Carré" 5 => "T. Perez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-2062" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2009" "volumen" => "135" "paginaInicial" => "975" "paginaFinal" => "982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19017866" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0250" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real world COPD: association of morning symptoms with clinical and patient reported outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Roche" 1 => "M. Small" 2 => "S. Broomfield" 3 => "V. Higgins" 4 => "R. Pollard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/15412555.2013.844784" "Revista" => array:6 [ "tituloSerie" => "COPD" "fecha" => "2013" "volumen" => "10" "paginaInicial" => "679" "paginaFinal" => "686" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24127914" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0255" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A cross-sectional observational study to investigate daily symptom variability, effects of symptom on morning activities and therapeutic expectations of patients and physicians in COPD-SUNRISE study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kuyucu" 1 => "S.Z. Güçlü" 2 => "B. Saylan" 3 => "C. Demir" 4 => "T. Senol" 5 => "S. Güner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Tüberküloz Ve Toraks" "fecha" => "2011" "volumen" => "59" "paginaInicial" => "328" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22233302" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0260" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Partridge" 1 => "N. Karlsson" 2 => "I.R. Small" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1185/03007990903103006" "Revista" => array:6 [ "tituloSerie" => "Curr Med Res Opin" "fecha" => "2009" "volumen" => "25" "paginaInicial" => "2043" "paginaFinal" => "2048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19569976" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0265" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COPD symptoms in the morning: impact, evaluation and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Roche" 1 => "N.H. Chavannes" 2 => "M. Miravitlles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1465-9921-14-112" "Revista" => array:5 [ "tituloSerie" => "Respir Res" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24143997" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0270" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of morning symptoms on daily activities in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. O’Hagan" 1 => "N.H. Chavannes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1185/03007995.2013.857648" "Revista" => array:6 [ "tituloSerie" => "Curr Med Res Opin" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "301" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24195740" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0275" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep quality predicts quality of life in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.M. Scharf" 1 => "N. Maimon" 2 => "T. Simon-Tuval" 3 => "B.J. Bernhard-Scharf" 4 => "H. Reuveni" 5 => "A. Tarasiuk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S15666" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21311688" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0280" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of night-time symptoms in COPD: a real-world study in five European countries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Price" 1 => "M. Small" 2 => "G. Milligan" 3 => "V. Higgins" 4 => "E.G. Gil" 5 => "J. Estruch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S48570" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "595" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24348032" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgement" "texto" => "<p id="par0160" class="elsevierStylePara elsevierViewall">Eva Mateu of the Medical Department of TFS assisted in the scientific writing of this article.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000006/v1_201605260126/S1579212916300258/v1_201605260126/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/15792129/0000005200000006/v1_201605260126/S1579212916300258/v1_201605260126/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916300258?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 58 | 19 | 77 |
| 2024 September | 50 | 18 | 68 |
| 2024 August | 77 | 39 | 116 |
| 2024 July | 98 | 28 | 126 |
| 2024 June | 87 | 31 | 118 |
| 2024 May | 65 | 35 | 100 |
| 2024 April | 36 | 33 | 69 |
| 2024 March | 42 | 16 | 58 |
| 2024 February | 33 | 23 | 56 |
| 2023 October | 0 | 1 | 1 |
| 2023 March | 14 | 4 | 18 |
| 2023 February | 33 | 19 | 52 |
| 2023 January | 26 | 27 | 53 |
| 2022 December | 45 | 34 | 79 |
| 2022 November | 64 | 28 | 92 |
| 2022 October | 37 | 34 | 71 |
| 2022 September | 23 | 38 | 61 |
| 2022 August | 28 | 42 | 70 |
| 2022 July | 30 | 47 | 77 |
| 2022 June | 21 | 41 | 62 |
| 2022 May | 34 | 39 | 73 |
| 2022 April | 34 | 26 | 60 |
| 2022 March | 39 | 41 | 80 |
| 2022 February | 37 | 29 | 66 |
| 2022 January | 43 | 40 | 83 |
| 2021 December | 47 | 32 | 79 |
| 2021 November | 44 | 42 | 86 |
| 2021 October | 42 | 42 | 84 |
| 2021 September | 38 | 47 | 85 |
| 2021 August | 29 | 34 | 63 |
| 2021 July | 33 | 26 | 59 |
| 2021 June | 54 | 34 | 88 |
| 2021 May | 56 | 53 | 109 |
| 2021 April | 126 | 127 | 253 |
| 2021 March | 42 | 42 | 84 |
| 2021 February | 30 | 28 | 58 |
| 2021 January | 31 | 31 | 62 |
| 2020 December | 30 | 29 | 59 |
| 2020 November | 32 | 23 | 55 |
| 2020 October | 37 | 27 | 64 |
| 2020 September | 29 | 19 | 48 |
| 2020 August | 27 | 15 | 42 |
| 2020 July | 45 | 32 | 77 |
| 2020 June | 46 | 16 | 62 |
| 2020 May | 54 | 18 | 72 |
| 2020 April | 55 | 22 | 77 |
| 2020 March | 45 | 14 | 59 |
| 2020 February | 40 | 21 | 61 |
| 2020 January | 87 | 33 | 120 |
| 2019 December | 58 | 16 | 74 |
| 2019 November | 28 | 24 | 52 |
| 2019 October | 29 | 6 | 35 |
| 2019 September | 22 | 10 | 32 |
| 2019 August | 41 | 16 | 57 |
| 2019 July | 36 | 18 | 54 |
| 2019 June | 29 | 11 | 40 |
| 2019 May | 36 | 31 | 67 |
| 2019 April | 36 | 31 | 67 |
| 2019 March | 43 | 25 | 68 |
| 2019 February | 39 | 21 | 60 |
| 2019 January | 36 | 16 | 52 |
| 2018 December | 37 | 16 | 53 |
| 2018 November | 80 | 15 | 95 |
| 2018 October | 130 | 19 | 149 |
| 2018 September | 25 | 12 | 37 |
| 2018 May | 18 | 1 | 19 |
| 2018 April | 33 | 6 | 39 |
| 2018 March | 11 | 2 | 13 |
| 2018 February | 22 | 8 | 30 |
| 2018 January | 23 | 10 | 33 |
| 2017 December | 23 | 10 | 33 |
| 2017 November | 33 | 10 | 43 |
| 2017 October | 25 | 22 | 47 |
| 2017 September | 26 | 5 | 31 |
| 2017 August | 27 | 24 | 51 |
| 2017 July | 19 | 5 | 24 |
| 2017 June | 36 | 22 | 58 |
| 2017 May | 43 | 13 | 56 |
| 2017 April | 46 | 14 | 60 |
| 2017 March | 18 | 21 | 39 |
| 2017 February | 15 | 13 | 28 |
| 2017 January | 12 | 9 | 21 |
| 2016 December | 35 | 20 | 55 |
| 2016 November | 49 | 37 | 86 |
| 2016 October | 59 | 44 | 103 |
| 2016 September | 43 | 6 | 49 |
| 2016 August | 5 | 2 | 7 |
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