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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is one of the main causes of morbidity and mortality worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> In Spain&#44; it affects approximately 10&#37; of the general population aged between 40 and 80 years&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The Global Initiative for Chronic Obstructive Pulmonary Disease &#40;GOLD&#41; Strategy for Diagnosis&#44; Management and Prevention of COPD recommends that drug treatment be guided by a combined evaluation of the patient&#39;s severity of airflow limitation &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; prior history of exacerbations&#44; and symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> To this end&#44; GOLD recommends the use of validated questionnaires&#44; such as the Medical Research Council Dyspnea scale &#40;MRC&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> the COPD Assessment Test &#40;CAT&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> or the Clinical COPD Questionnaire &#40;CCQ&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> The CAT questionnaire&#44; specifically&#44; has been adapted and validated in over 60 languages and dialects throughout the world&#44; including Spanish&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In general terms&#44; a person is considered bilingual if they are competent in 2 languages and can easily switch from one to the other&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7&#44;8</span></a> Spain is a country in which inhabitants in some autonomous communities are bilingual in 2 official languages&#44; primarily Catalonia&#44; Galicia&#44; and the Basque Country&#44; which have the highest percentage of speakers of languages other than Spanish&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9&#44;10</span></a> In Catalonia&#44; for example&#44; according to the 2013 linguistic census of the Statistical Institute of Catalonia &#40;IDESCAT&#41;&#44; Catalan was the habitual language of 36&#46;3&#37; of the overall population&#44; and this proportion rose to more than 60&#37; in most regions of the province<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a>&#59; in Galicia&#44; according to data from the Statistical Institute of Galicia&#44; 33&#46;9&#37; of the population said that they were most comfortable speaking Galician&#44; and 29&#37; read Galician and Spanish equally competently<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a>&#59; in the Basque Country&#44; the Basque Country Sociolinguistic Survey &#40;ESE&#41;&#44; conducted by the Department of Education&#44; Linguistic Policy and Culture of the Basque Government&#44; found that 22&#46;6&#37; of the population consider themselves Basque speakers or use Basque and Spanish indiscriminately&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> These data reflect the situation in each autonomous community&#44; but it must be remembered that Catalan and Basque&#44; in particular&#44; are also spoken in other regions&#44; such as the Balearic Islands&#44; in the case of Catalan&#44; or in Navarre&#44; in the case of Basque&#44; so the use of these languages is even more common and more geographically widespread&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate the linguistic equivalence between the CAT questionnaire in Spanish and its versions in 3 of the other official languages spoken in Spain&#58; Catalan&#44; Galician and Basque&#46; These versions were prepared using a specific methodology &#40;translation-backtranslation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> Our second objective was to evaluate the measurements and psychometric properties of each of the versions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Translation-Backtranslation</span><p id="par0025" class="elsevierStylePara elsevierViewall">Before starting the study&#44; the CAT questionnaire was translated and adapted culturally to Catalan&#44; Galician and Basque using a translation-backtranslation process<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> that involved 2 direct translations by professional bilingual translators&#44; which were reviewed and consolidated in a single&#44; consensus version&#46; This consensus version was backtranslated to Spanish by another professional bilingual translator&#44; and this backtranslation was compared with the original to detect any differences&#46; Finally&#44; the single version in each target language was completed by 10&#8211;15 COPD patients in each language&#46; The items from the Spanish version and the translated and adapted versions are included in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study Design</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was an observational&#44; multicenter study in which patients were enrolled consecutively&#46; Study data were collected in a single visit&#46; All questionnaires were self-administered&#46; The order of completion of the CAT questionnaire alternated&#58; patients with odd code numbers completed the Spanish version first&#44; followed by the Catalan &#40;CAT-C&#41;&#44; Galician &#40;CAT-G&#41; or Basque &#40;CAT-B&#41; version&#44; depending on the patient&#39;s autonomous community&#44; and patients with even code numbers completed the questionnaires in the inverse order&#46; Participants also completed the Saint George&#39;s Respiratory Questionnaire &#40;SGRQ&#41; on quality of life and the London Chest Activity of Daily Living scale &#40;LCADL&#41;&#44; both adapted for the Spanish population&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">15&#44;16</span></a> Sociodemographic and clinical data&#44; including comorbidities &#40;cardiovascular&#44; metabolic&#44; neurological and musculoskeletal diseases&#44; and mood&#47;psychiatric disorders&#41;&#44; dyspnea grade &#40;MRC scale&#41;&#44; presence and number of exacerbations&#44; and COPD grade and level of severity according to GOLD criteria<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> were also recorded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patients</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was performed in patients aged 40 years or older&#44; diagnosed with COPD at least 6 months before study inclusion &#40;post-bronchodilator FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#60;0&#46;7&#41;&#44; with a current or past smoking history of more than 10 pack-years&#44; and clinically stable COPD in at least the previous 3 months&#46; Subjects were excluded if they presented other chronic respiratory diseases that might confound study results or if they had cognitive disorders that could affect their ability to complete the questionnaires&#46; Study patients were also required to be completely fluent&#44; both written and spoken&#44; in the 2 official languages &#40;Spanish and Catalan&#44; Galician or Basque&#41;&#46; The study was performed simultaneously in 2 primary care centers in Catalonia&#44; Galicia and the Basque Country&#44; with the participation of physicians who regularly treated COPD patients&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical Aspects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study protocol was reviewed and approved by accredited ethics committees&#44; and participants gave written informed consent&#46; The study was performed in compliance with the ethical and confidentiality requirements applicable to this type of study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data Analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">To evaluate the concordance of each of the linguistic versions with the CAT&#44; a total of 50 patients were required for each language&#46; This sample size would be sufficient to detect intraclass correlation coefficients &#40;ICC&#41; greater or equal to 0&#46;5 &#40;moderate concordance&#41;&#44; assuming a minimum ICC of 0&#46;2&#44; with a level of significance of 0&#46;05 and a statistical power of 0&#46;80&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Concordance between the CAT-C&#44; CAT-G and CAT-B with the CAT was analyzed using the ICC for the overall questionnaire score&#44; and the weighted kappa statistic was used for individual items&#46; Kappa statistic reference values were&#58; &#60;0&#46;20&#44; poor&#59; 0&#46;21&#8211;0&#46;40&#44; weak&#59; 0&#46;41&#8211;0&#46;60&#44; moderate&#59; 0&#46;61&#8211;0&#46;80&#44; good&#44; and 0&#46;81&#8211;1&#46;00&#44; very good&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Possible deviations in extreme values are presented in the Bland&#8211;Altman plots in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Reliability was analyzed in terms of internal consistency&#44; using Cronbach&#39;s alpha&#46; Construct validity was evaluated in terms of discriminant and convergent validity&#46; To determine discriminant validity&#44; the correlation between the scores of each of the CAT versions and clinical variables was analyzed using the Pearson correlation coefficient and analysis of variance &#40;ANOVA&#41;&#46; For convergent validity&#44; the correlation between the scores of the CAT questionnaires and the SGRQ questionnaire&#44; the LCADL scale and the question on patient-perceived state of health was evaluating using the Pearson correlation coefficient and the ANOVA&#46; Finally&#44; questionnaire feasibility was evaluated by calculating the rate of non-completion&#44; time to administer&#44; and the percentage of patients with ceiling effect &#40;maximum score on the questionnaire&#41; and floor effect &#40;minimum score on the questionnaire&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Patient Characteristics &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> includes the 48&#44; 48 and 55 evaluable patients in Catalonia&#44; Galicia and the Basque Country&#44; respectively&#46; Their mean age &#40;standard deviation&#44; SD&#41; was 69&#46;0 &#40;9&#46;7&#41; years&#44; 79&#46;5&#37; were men and 11&#46;3&#37; had studied to university level&#59; 31&#46;8&#37; of patients smoked 37&#46;3 &#40;13&#46;6&#41; pack-years and 68&#46;2&#37; were former smokers of 38&#46;3 &#40;23&#46;7&#41; pack-years&#46; Post-bronchodilator spirometry showed FEV<span class="elsevierStyleInf">1</span> values of 64&#46;2&#37; &#40;17&#46;6&#41;&#44; and FEV<span class="elsevierStyleInf">1</span>&#47;FVC of 60&#46;3&#37; &#40;9&#46;0&#41;&#46; In total&#44; 24&#46;8&#37; of patients had mild COPD &#40;GOLD grade I&#41;&#44; 59&#46;1&#37; moderate COPD &#40;GOLD grade II&#41; and 16&#46;1&#37; had severe&#47;very severe COPD &#40;GOLD grades III&#8211;IV&#41;&#46; With regard to GOLD groups&#44; 29&#46;1&#37; were in group A&#44; 50&#46;3&#37; in group B&#44; 2&#46;6&#37; in group C&#44; and 17&#46;9&#37; in group D&#46; On the MRC scale&#44; 18&#37; had grade 1 dyspnea&#44; 56&#46;7&#37; had grade 2&#44; 21&#46;3&#37; grade 3&#44; and 4&#37; grade 4&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In total&#44; 21&#46;5&#37; reported exacerbations in the previous 6 months&#44; requiring a change in medication in 37&#46;9&#37; &#40;89&#46;7&#37; received antibiotics and&#47;or corticosteroids&#44; and 31&#46;0&#37; required hospitalization&#41;&#46; Mean &#40;SD&#41; number of exacerbations in the previous 6 months was 0&#46;3 &#40;0&#46;6&#41; exacerbations&#46; Comorbidities were observed in 81&#46;5&#37; of patients&#44; in particular cardiovascular diseases &#40;57&#46;0&#37;&#41; and metabolic diseases &#40;39&#46;1&#37;&#41;&#59; no statistically significant relationship was found between comorbidities and scores obtained on the different versions of the CAT questionnaire&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">CAT Questionnaire Validation in Catalan&#44; Galician and Basque</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Equivalence &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">The mean difference &#40;SD&#41; between the CAT questionnaire score and the versions in Catalan&#44; Galician and Basque was 0&#46;3 &#40;1&#46;8&#41;&#59; 0&#46;4 &#40;2&#46;4&#41;&#44; and &#8211;0&#46;5 &#40;3&#46;0&#41; points&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; None of these differences was statistically significant&#46; ICCs were 0&#46;963&#44; 0&#46;942 and 0&#46;929&#44; respectively&#46; The Bland&#8211;Altman plot did not reveal any systematic bias between the version in Spanish and the different linguistic versions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Concordance between the CAT and CAT-C questionnaires was very good for all items &#40;kappa&#62;0&#46;800 in all questions&#41;&#46; The version in Galician showed a moderate concordance in question 6 &#40;kappa&#61;0&#46;577&#41;&#44; while good levels of concordance were achieved for the individual items according to the weighted kappa statistic &#40;kappa&#8805;0&#46;644&#41;&#44; with the exception of question 8&#44; that only reached a 50&#37; level of concordance with the CAT questionnaire&#46; The level of concordance between the CAT and CAT-B questionnaires was good or very good for all items &#40;kappa between 0&#46;678 and 0&#46;852&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Reliability</span><p id="par0085" class="elsevierStylePara elsevierViewall">The CAT questionnaire and the other versions showed good internal consistency &#40;Cronbach&#39;s alpha&#41;&#46; The CAT-C obtained a coefficient of 0&#46;796&#44; the CAT-B obtained the highest value &#40;coefficient&#61;0&#46;861&#41;&#44; and the CAT-G the lowest &#40;coefficient&#61;0&#46;721&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discriminant Validity</span><p id="par0090" class="elsevierStylePara elsevierViewall">The ability of the CAT questionnaires in the Catalan&#44; Galician and Basque linguistic versions to correlate with different clinical aspects of patients varied&#44; depending on the version and the clinical parameter&#44; although it was generally acceptable&#46; The CAT-C questionnaire was the only one that correlated with the presence of exacerbations&#44; and only exacerbations in the 6 previous months&#44; with mean scores &#40;SD&#41; in patients with and without exacerbations of 11&#46;5 &#40;5&#46;9&#41; and 22&#46;0 &#40;8&#46;5&#41;&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;019&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; while CAT-C and CAT-B discriminated well between patients in terms of severity of airflow limitation &#40;GOLD grades&#41;&#46; All linguistic versions also correlated with the GOLD severity groups&#59; the greatest correlation was found for group C&#47;D&#44; except for the CAT-G&#44; which correlated best with group B &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001 in all comparisons&#41;&#46; The CAT-G and CAT-B questionnaires discriminated well between grades of dyspnea &#40;MRC scale&#41; &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;010 and <span class="elsevierStyleItalic">P</span>&#61;&#46;012&#44; respectively&#41;&#44; while in the CAT-C&#44; the score was higher for dyspnea grade 1 than for grade 2&#44; so discrimination was rather poor &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; Finally&#44; post-bronchodilator FEV<span class="elsevierStyleInf">1</span> &#40;&#37;&#41; and FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#37;&#41; showed a statistically significant correlation with the scores in the different versions of the CAT questionnaire&#44; while no correlation was found for FVC &#40;&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Convergent Validity</span><p id="par0095" class="elsevierStylePara elsevierViewall">Convergent validity was also positive in general&#44; and scores of all CAT questionnaire versions correlated significantly &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; with all dimensions of the SGRQ and with its total score&#44; thus confirming the validity of all of the versions of the CAT questionnaire&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The physical activities dimension score of the LCADL obtained statistically significant coefficients with all versions of the CAT questionnaire&#44; the highest being 0&#46;534 achieved by the CAT-G questionnaire &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Feasibility</span><p id="par0105" class="elsevierStylePara elsevierViewall">All patients fully completed the questionnaires&#44; except for 1 who did not complete the CAT-G questionnaire&#46; A single case of floor effect was observed in the CAT-B and CAT questionnaires&#44; but no ceiling effect was found&#46; Time to administer was short in all cases&#44; with mean values ranging between 128 and 175 seconds&#46; Comparison of the time needed to complete the questionnaire revealed a small but statistically significant difference only between the CAT and the CAT-B&#44; with a mean difference &#40;SD&#41; of 15&#46;6 &#40;48&#46;8&#41; seconds &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;043&#41;&#46;</p></span></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The results of this study demonstrate the linguistic equivalence and validity of the versions in Catalan&#44; Galician and Basque with the previously validated version in Spanish&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The term &#8220;bilingualism&#8221; refers to the ability to use 2 languages indiscriminately&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> Bilingual individuals can adopt and understand concepts&#44; values&#44; attitudes and expectations in the 2 languages that they master&#44; so bilingual patients represent a population whose responses should not be automatically extrapolated to the monolingual population&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> For this reason&#44; it is important that a patient&#39;s experience with respect to their disease and the description of their resulting state of health can be expressed in the language in which they feel most comfortable&#44; even if they are bilingual&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The results of this study show that there is a good correlation between the scores in each of the translated versions of the CAT &#40;Catalan&#44; Galician and Basque&#41; and the Spanish version<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> &#40;previously validated and equivalent to the English version&#41;&#46; When the validity of each of the new versions of the CAT questionnaire was evaluated&#44; similar results to those obtained from the Spanish version were obtained&#46; The high internal consistency observed with all the CAT versions &#40;between 0&#46;72 and 0&#46;86&#41; is clearly higher than the accepted threshold for these types of instrument&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a> confirming the reliability of the versions&#46; Internal consistency is also in line with the values obtained for the original CAT in English<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> and the Spanish version&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> Like the Spanish version of the CAT&#44; the 3 versions studied showed good correlation with lung function measurements and LDADL scores&#44; and a statistically significant association with the severity groups defined in the study and the perception of dyspnea evaluated using the MRC scale&#44; primarily in the Galician and Basque versions&#59; this relationship between the CAT and dyspnea was previously confirmed in studies such as that of Okutan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> although those authors only found statistically significant differences for dyspnea grades 1 and 2&#44; while in this study&#44; the CAT-G and the CAT-B discriminated well among all MRC grades&#46; Correlation with the SGRQ was not only good&#44; but also the correlation coefficients with the total score on this questionnaire were very similar to those described in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">We should point out that the 3 versions of the CAT did not detect the same clinical differences among patients&#44; and that only the CAT-C discriminated between the presence of exacerbations&#44; and only exacerbations in the 6 previous months&#46; This aspect must be further investigated by administering the questionnaire to a larger study sample&#44; since in previous studies the CAT was found to be sensitive to differences in COPD stability&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6&#44;20</span></a> Nor did the versions show the same discriminatory power for airflow limitation&#44; as the CAT-G was the only one that did not show differences according to GOLD grades&#46; Despite the fact that all the versions of the CAT questionnaire distinguished between dyspnea grades &#40;MRC scale&#41; to a statistically significant degree&#44; the CAT-C only showed differences between grades 1&#8211;2 and grades 3&#8211;4&#46; These differences may be because the questionnaires were administered to 3 heterogeneous populations&#46; Although we attempted to obtain a uniform sample by using the same selection criteria in the 3 populations&#44; some differences emerged&#58; for example&#44; a considerably greater number of men than women were included&#44; particularly in Catalonia and Galicia&#46; This is probably because no methods were employed to ensure the homogeneity of the sample&#44; either at the time of patient selection &#40;e&#46;g&#46;&#44; gender quotas&#41;&#44; nor were statistical techniques subsequently used to minimize those biases&#44; since a comparison of the 3 populations was not included in the study objectives&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">When feasibility was examined&#44; the 3 versions showed satisfactory results with slight differences in time to administer between the version in Basque and the version in Spanish&#44; but this difference of only 15 seconds was not substantial&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Other limitations of this study include the fact that&#44; although the number of patients in each group is sufficient to meet the primary objective&#44; i&#46;e&#46;&#44; evaluation of the equivalence of each version with the Spanish version of the CAT&#44; the sample size may be limited for drawing conclusions regarding the validity of the versions studied and subgroup analysis&#44; so the validation data must be taken as exploratory&#44; and the values that show statistical significance must be interpreted with caution&#46; Moreover&#44; although feasibility of all of the versions of the CAT was good&#44; patients completed the questionnaires knowing that they were participating in a research project&#44; so the response rates in standard clinical practice conditions may be lower&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; these results show that the versions of the CAT questionnaire in Catalan&#44; Galician and Basque are equivalent to the version in Spanish&#44; so they can be considered as valid for use in the evaluation of the impact of COPD symptoms on patients&#8217; lives&#46; These are tools that do not only help to improve the doctor&#8211;patient interaction by allowing a patient to express their health situation in the language in which they feel most comfortable&#44; but they also help patients evaluate their symptoms by letting them chose to complete the questionnaire in the language that is easiest for them to read and understand&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">This study was funded by GlaxoSmithKline and IMS Health received funding from GlaxoSmithKline for their contribution &#40;etrack no&#46; 113047&#41;&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Authorship</span><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">1&#46;</span> Study conception and design&#58; &#193;lvar Agust&#237;&#44; Alberto Fern&#225;ndez-Villar&#44; Alberto Capelastegui&#44; Manuel Garc&#237;a-Losa&#44; Guadalupe S&#225;nchez&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">2&#46;</span> Data collection&#58; Concepci&#243;n Nogueiras&#44; Crist&#243;bal Esteban&#44; Jaime Gonz&#225;lez&#44; Juan Luis Mend&#237;a&#44; Lourdes Arregui&#44; Mar&#237;a Inmaculada Gorordo&#44; Teresa Genover&#44; Francisco Tomas Sesma&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">3&#46;</span> Data analysis and interpretation&#58; &#193;lvar Agust&#237;&#44; Alberto Fern&#225;ndez-Villar&#44; Alberto Capelastegui&#44; Beatriz Velasco and Guadalupe S&#225;nchez&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">4&#46;</span> Writing&#44; review and approval of the submitted manuscript&#58; &#193;lvar Agust&#237;&#44; Alberto Fern&#225;ndez-Villar&#44; Alberto Capelastegui&#44; Manuel Garc&#237;a-Losa&#44; Beatriz Velasco&#44; Guadalupe S&#225;nchez&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of Interests</span><p id="par0170" class="elsevierStylePara elsevierViewall">AC and JF have no conflict of interests&#46; AA has participated in advisory boards for GSK&#44; Novartis&#44; Chiesi&#44; Almirall&#44; Takeda and Roche&#46; AA has received speaker&#39;s honoraria&#44; including participation in boards for GSK&#44; Novartis&#44; Chiesi&#44; Almirall&#44; Takeda and Astra-Zeneca&#46; BV and GS are employees of GSK and have shares in GSK&#46; MGL was an employee of GSK and has shares in GSK&#46;</p></span></span>"
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          "titulo" => "Abstract"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Method"
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            0 => array:2 [
              "identificador" => "sec0015"
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              "titulo" => "Study Design"
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              "titulo" => "Patients"
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              "titulo" => "Ethical Aspects"
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              "titulo" => "Data Analysis"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Patient Characteristics &#40;Table 2&#41;"
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              "titulo" => "CAT Questionnaire Validation in Catalan&#44; Galician and Basque"
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                0 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Equivalence &#40;Table 3&#41;"
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                  "identificador" => "sec0060"
                  "titulo" => "Reliability"
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                2 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "Discriminant Validity"
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                3 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "Convergent Validity"
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                  "identificador" => "sec0075"
                  "titulo" => "Feasibility"
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          "identificador" => "sec0095"
          "titulo" => "Conflict of Interests"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-05-04"
    "fechaAceptado" => "2016-10-23"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:5 [
            0 => "Chronic obstructive pulmonary disease"
            1 => "COPD Assessment Test validation"
            2 => "Catalan"
            3 => "Galician"
            4 => "Basque"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec856899"
          "palabras" => array:5 [
            0 => "Enfermedad pulmonar obstructiva cr&#243;nica"
            1 => "Validaci&#243;n del COPD Assessment Test"
            2 => "Catal&#225;n"
            3 => "Gallego"
            4 => "Vasco"
          ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the linguistic equivalence of the COPD Assessment Test versions in Catalan &#40;CAT-C&#41;&#44; Galician &#40;CAT-G&#41; and Basque &#40;CAT-V&#41; with the validated Spanish version &#40;CAT&#41; in COPD patients able to use both official languages&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Study performed in primary care centers in Catalonia&#44; Galicia and the Basque Country&#46; Half of the patients completed the questionnaire in their local language followed by the CAT in Spanish&#44; while the other half did so in reverse order&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">151 COPD patients were included in the study&#44; with a mean age of 69&#46;0 &#40;SD&#58; 9&#46;7&#41; years&#46; Most &#40;79&#46;5&#37;&#41; were men&#44; 11&#46;3&#37; were educated up touniversity level&#44; and 31&#46;8&#37; were current smokers&#46; Mean FEV1 was 61&#46;4&#37; &#40;SD&#58; 16&#46;8&#41; predicted and 83&#46;9&#37; of patients were GOLD grade I or II&#46; Concordance between CAT-C&#44; CAT-G and CAT-V and CAT was high&#44; with differences between scores from 0&#46;4 to &#8722;0&#46;5&#46; Reliability &#40;Cronbach&#39;s alpha&#41; ranged from 0&#46;72 to 0&#46;86&#46; Convergent validity&#44; when correlated with the Medical Research Council Dyspnea scale &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41; and Saint George&#39;s Respiratory Questionnaire &#40;ICC&#44; <span class="elsevierStyleItalic">r</span>&#61;0&#46;74&#41; scores&#44; was significant&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CAT-C&#44; CAT-G and CAT-V scores were similar to CAT scores&#44; with high correlation and concordance&#46; These results show the equivalence between the validated Spanish CAT and the version in other languages&#44; so CAT-C&#44; CAT-G and CAT-V can be used in individuals whose main language is Catalan&#44; Galician or Basque&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
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            "titulo" => "Methods"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la equivalencia ling&#252;&#237;stica de las versiones del cuestionario COPD Assessment Test en catal&#225;n &#40;CAT-C&#41;&#44; gallego &#40;CAT-G&#41; y vasco &#40;CAT-V&#41; con la versi&#243;n en castellano &#40;CAT&#41; en pacientes con enfermedad pulmonar obstructiva cr&#243;nica que hablan indistintamente las 2 lenguas cooficiales&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio realizado en centros de atenci&#243;n primaria de Catalu&#241;a&#44; Galicia y Pa&#237;s Vasco&#46; La mitad de los pacientes complet&#243; primero el CAT en castellano seguido del CAT en la lengua correspondiente de este estudio&#59; la otra mitad lo hizo en orden inverso&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 151 pacientes con edad media &#40;DE&#41; de 69&#44;0 &#40;9&#44;7&#41; a&#241;os&#46; Un 79&#44;5&#37; eran hombres&#44; el 11&#44;3&#37; ten&#237;a estudios universitarios y el 31&#44;8&#37; eran fumadores&#46; El valor medio &#40;DE&#41; de la FEV<span class="elsevierStyleInf">1</span> fue del 61&#44;4&#37; &#40;16&#44;8&#41; del valor de referencia&#46; La mayor&#237;a de pacientes &#40;83&#44;9&#37;&#41; ten&#237;a un grado GOLD I&#47;II de limitaci&#243;n al flujo a&#233;reo&#46; La concordancia entre las puntuaciones de las diferentes versiones del CAT fue alta&#44; con diferencias entre 0&#44;4 y &#8211;0&#44;5 puntos&#46; Su fiabilidad &#40;Cronbach&#41; fue de 0&#44;72-0&#44;86&#46; La validez convergente al correlacionar con el nivel de disnea de la escala Medical Research Council Dyspnea scale &#40;p&#61;0&#44;003&#41; y con el Saint George&#39;s Respiratory Questionnaire &#40;ICC&#44; r&#61;0&#44;74&#41; fue significativa&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las puntuaciones obtenidas con CAT-C&#44; CAT-G y CAT-V fueron similares a las de CAT&#44; con una alta correlaci&#243;n y concordancia entre ellas&#46; Estos resultados muestran la equivalencia entre las versiones de CAT en diferentes lenguas e indican que este cuestionario puede ser utilizado indistintamente en pacientes cuya lengua principal sea catal&#225;n&#44; gallego o vasco&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0025"
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            "titulo" => "M&#233;todos"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Agust&#237; A&#44; Fern&#225;ndez-Villar A&#44; Capelastegui A&#44; Garc&#237;a-Losa M&#44; Velasco B&#44; S&#225;nchez G&#46; Estudio de la validez de las versiones en catal&#225;n&#44; gallego y vasco del cuestionario COPD assessment test y equivalencia con la versi&#243;n en castellano&#46; Arch Bronconeumol&#46; 2017&#59;53&#58;311&#8211;317&#46;</p>"
      ]
    ]
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">List of participating investigators and experts</p> <p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pulmonologists</span></p> <p id="par0190" class="elsevierStylePara elsevierViewall">Alvar Agust&#237;&#44; Institut del T&#243;rax&#44; Hospital Cl&#237;nic&#46; IDIBAPS&#44; Universitat de Barcelona&#44; Centro de Investigaci&#243;n Biom&#233;dica&#44; Servicio de Neumolog&#237;a&#46;</p> <p id="par0195" class="elsevierStylePara elsevierViewall">Alberto Capelastegui&#44; Hospital de Galdakao-Usansolo&#44; Galdakao &#40;Bizkaia&#41;&#46;</p> <p id="par0200" class="elsevierStylePara elsevierViewall">Alberto Fern&#225;ndez-Villar&#44; Servicio de Neumolog&#237;a&#44; Estructura Organizativa de Gesti&#243;n Integrada de Vigo&#44; IBIV&#44; Vigo &#40;Pontevedra&#41;&#46;</p> <p id="par0205" class="elsevierStylePara elsevierViewall">Cristobal Esteban&#44; Servicio de Neumolog&#237;a&#44; H&#46; Galdakao&#46;</p> <p id="par0210" class="elsevierStylePara elsevierViewall">Mar&#237;a Inmaculada Gorordo Unzueta&#44; Servicio de Neumolog&#237;a&#44; H&#46; Galdakao&#46;</p> <p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Primary care physicians</span></p> <p id="par0220" class="elsevierStylePara elsevierViewall">Concepci&#243;n Nogueiras&#44; C&#46;S&#46; Val Minor&#46;</p> <p id="par0225" class="elsevierStylePara elsevierViewall">Jaime Gonzalez Rey&#44; C&#46;S&#46; Matam&#225; de Vigo&#44;</p> <p id="par0230" class="elsevierStylePara elsevierViewall">Juan Luis Mend&#237;a Gorostidi&#44; C&#46;S&#46; Amara Centro&#46;</p> <p id="par0235" class="elsevierStylePara elsevierViewall">Lourdes Arregui&#44; C&#46;S&#46; Amara Centro&#46;</p> <p id="par0240" class="elsevierStylePara elsevierViewall">Teresa Genover Llimona&#44; C&#46;S&#46; San Rafael&#46;</p> <p id="par0245" class="elsevierStylePara elsevierViewall">Francisco Tomas Sesma Aisa&#44; C&#46;S&#46; San Rafael&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Annex 1"
            "identificador" => "sec0100"
          ]
        ]
      ]
    ]
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        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Analysis of concordance between the CAT and CAT-C&#44; CAT-G and CAT-B&#58; Bland&#8211;Altman plots&#46;</p>"
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      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAT-C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAT-G&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAT-B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nunca toso-<br>Siempre estoy tosiendo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mai no tusso-<br>Sempre estic tossint&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Non tuso nunca-<br>Sempre estou tusindo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ez dut inoiz eztulik egiten-Beti eztulka ari naiz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No tengo flema &#40;mucosidad&#41; en el pecho-<br>Tengo el pecho completamente lleno de flema &#40;mucosidad&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No tinc flegma &#40;mucositat&#41; al pit-Tinc el pit completament ple de flegma &#40;mucositat&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Non te&#241;o flegma<br>&#40;mucosidade&#41; no peito-<br>Te&#241;o o peito completamente cheo de flegma &#40;mucosidade&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ez daukat flemarik &#40;mukirik&#41; bularrean-<br>Bularra erabat flemaz &#40;mukiz&#41; beteta daukat&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No siento ninguna opresi&#243;n en el pecho-Siento mucha opresi&#243;n en el pecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No sento cap opressi&#243; al pit-<br>Sento molta opressi&#243; al pit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Non sinto opresi&#243;n ningunha no peito-<br>Sinto moita opresi&#243;n no peito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bular aldean ez dut inolako estutasunik-<br>Bular aldean estutasun handia dut&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuando subo una pendiente o un tramo de escaleras&#44; no me falta el aire-<br>Cuando subo una pendiente o un tramo de escaleras&#44; me falta mucho el aire&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Quan pujo un pendent o un tram d&#8217;escales&#44; no em falta l&#8217;aire-<br>Quan pujo un pendent o un tram d&#8217;escales&#44; em falta molt l&#8217;aire&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cando subo unha pendente ou un tramo de escaleiras non me falta o aire-<br>Cando subo unha pendente ou un tramo de escaleiras f&#225;ltame moito o aire&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Maldan gora edo eskaileretan gora noanean&#44; ez zait arnasa estutzen-<br>Maldan gora edo eskaileretan gora noanean&#44; arnas-estuka jartzen naiz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No me siento limitado para realizar actividades dom&#233;sticas-<br>Me siento muy limitado para realizar actividades dom&#233;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No em sento limitat&#47;da per realitzar activitats dom&#232;stiques-Em sento molt limitat&#47;da per realitzar activitats dom&#232;stiques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Non me sinto limitado&#47;a para realizar actividades dom&#233;sticas-<br>S&#237;ntome moi limitado&#47;a para realizar actividades dom&#233;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ez daukat arazorik etxeko lanak egiteko-<br>Ezinean ibiltzen naiz etxeko lanak egiteko&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Me siento seguro al salir de casa a pesar de la afecci&#243;n pulmonar que padezco-<br>No me siento nada seguro al salir de casa debido a la afecci&#243;n pulmonar que padezco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Em sento segur&#47;a en sortir de casa malgrat l&#8217;afecci&#243; pulmonar que pateixo-<br>No em sento gens segur&#47;a en sortir de casa a causa de l&#8217;afecci&#243; pulmonar que pateixo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;ntome seguro&#47;a ao sa&#237;r da casa a pesar da afecci&#243;n pulmonar que padezo-<br>Non me sinto nada seguro&#47;a ao sa&#237;r da casa pola afecci&#243;n pulmonar que padezo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Seguru sentitzen naiz etxetik irtetean&#44; biriketako gaixotasuna izan arren-<br>Ez naiz inondik ere seguru sentitzen etxetik irtetean&#44; biriketako gaixotasuna dela-eta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duermo sin problemas-<br>Tengo problemas para dormir debido a la afecci&#243;n pulmonar que padezco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dormo sense problemes-<br>Tinc problemes per dormir a causa de l&#8217;afecci&#243; pulmonar que pateixo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Durmo sen problemas-<br>Te&#241;o problemas para durmir debido &#225; afecci&#243;n pulmonar que padezo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ez dut arazorik lo egiteko-<br>Lo egiteko arazoak ditut&#44; biriketako gaitza dela-eta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Item 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tengo mucha energ&#237;a-<br>No tengo ninguna energ&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinc molta energia-<br>No tinc gens d&#8217;energia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Te&#241;o moita enerx&#237;a-<br>Non te&#241;o enerx&#237;a ningunha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indartsu sentitzen naiz-<br>Ez dut batere indarrik&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Catalonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Galicia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Basque Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;6 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;9 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;5 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;0 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Sex</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Educational level</td><td class="td" title="table-entry  " align="left" valign="top">Lower than primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not known&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FVC &#40;&#37;&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;7 &#40;12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;4 &#40;20&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;3 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#46;2 &#40;17&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span> &#40;&#37;&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;1 &#40;16&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;7 &#40;17&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;4 &#40;19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;4 &#40;16&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#37;&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;9 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;3 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;4 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;8 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">GOLD criteria</td><td class="td" title="table-entry  " align="left" valign="top">GOLD I &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GOLD II &#40;moderate&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GOLD III&#8211;IV &#40;severe-very severe&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Severity groups</td><td class="td" title="table-entry  " align="left" valign="top">Group A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Group B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Group C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Group D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">MRC dyspnea scale</td><td class="td" title="table-entry  " align="left" valign="top">Grade 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">C&#47;D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;0 &#40;7&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;2 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;059&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;5 &#40;6&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;2 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;9 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;6 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;3 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;6 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;4 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;351&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;9 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;8 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;8 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;2 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;5 &#40;6&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;5 &#40;9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CAT-B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;6 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;4 &#40;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;9 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;3 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;0 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;8 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;0 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;9 &#40;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;5 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;3 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;1 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;6 &#40;7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;163&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;046&nbsp;\t\t\t\t\t\t\n
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                      "doi" => "10.1183/09031936.00025214"
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                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2014"
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