Statistics

 array:25 [
  "pii" => "S0873215912000918"
  "issn" => "08732159"
  "doi" => "10.1016/j.rppneu.2012.05.002"
  "estado" => "S300"
  "fechaPublicacion" => "2013-01-01"
  "aid" => "108"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2013;19:19-27"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 18746
    "formatos" => array:3 [
      "EPUB" => 250
      "HTML" => 15563
      "PDF" => 2933
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2173511512000541"
      "issn" => "21735115"
      "doi" => "10.1016/j.rppnen.2012.06.003"
      "estado" => "S300"
      "fechaPublicacion" => "2013-01-01"
      "aid" => "108"
      "copyright" => "Sociedade Portuguesa de Pneumologia"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Pneumol. 2013;19:19-27"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5676
        "formatos" => array:3 [
          "EPUB" => 238
          "HTML" => 3879
          "PDF" => 1559
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
        "titulo" => "Idiopathic Pulmonary Fibrosis&#8212;Clinical presentation&#44; outcome and baseline prognostic factors in a Portuguese cohort"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "19"
            "paginaFinal" => "27"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Fibrose Pulmonar Idiop&#225;tica &#8211; Apresenta&#231;&#227;o cl&#237;nica&#44; evolu&#231;&#227;o e factores progn&#243;sticos basais numa coorte portuguesa"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1035
                "Ancho" => 2375
                "Tamanyo" => 111181
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier survival curves for all IPF patients &#40;left&#41; and for slow and rapid progressors &#40;right&#41; &#8211; months&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "F&#46; Soares Pires, P&#46; Caetano Mota, N&#46; Melo, D&#46; Costa, J&#46;M&#46; Jesus, R&#46; Cunha, S&#46; Guimar&#227;es, C&#46; Souto-Moura, A&#46; Morais"
            "autores" => array:9 [
              0 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Soares Pires"
              ]
              1 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Caetano Mota"
              ]
              2 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Melo"
              ]
              3 => array:2 [
                "nombre" => "D&#46;"
                "apellidos" => "Costa"
              ]
              4 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Jesus"
              ]
              5 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Cunha"
              ]
              6 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Guimar&#227;es"
              ]
              7 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Souto-Moura"
              ]
              8 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Morais"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S0873215912000918"
          "doi" => "10.1016/j.rppneu.2012.05.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000918?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511512000541?idApp=UINPBA00004E"
      "url" => "/21735115/0000001900000001/v1_201305151601/S2173511512000541/v1_201305151601/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0873215912001316"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2012.09.003"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "aid" => "120"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2013;19:28-37"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 10655
      "formatos" => array:3 [
        "EPUB" => 252
        "HTML" => 8604
        "PDF" => 1799
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
      "titulo" => "Nanoparticles&#44; nanotechnology and pulmonary nanotoxicology"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "28"
          "paginaFinal" => "37"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Nanopart&#237;culas&#44; nanotecnologia e nanotoxicologia pulmonar"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;J&#46; Ferreira, J&#46; Cemlyn-Jones, C&#46; Robalo Cordeiro"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;J&#46;"
              "apellidos" => "Ferreira"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Cemlyn-Jones"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Robalo Cordeiro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912001316?idApp=UINPBA00004E"
    "url" => "/08732159/0000001900000001/v2_201509041433/S0873215912001316/v2_201509041433/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0873215912000979"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2012.05.003"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "aid" => "114"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2013;19:13-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 11642
      "formatos" => array:3 [
        "EPUB" => 242
        "HTML" => 10048
        "PDF" => 1352
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Severe obstructive disease&#58; Similarities and differences between smoker and non-smoker patients with COPD and&#47;or bronchiectasis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "13"
          "paginaFinal" => "18"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Doen&#231;a obstrutiva grave&#58; semelhan&#231;as e diferen&#231;as entre os pacientes fumadores e n&#227;o-fumadores com DPOC e&#47;ou bronquiectasias"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Rezende Gon&#231;alves, M&#46; Corso Pereira, E&#46;M&#46; Figueiras Pedreira De Cerqueira, D&#46; Oliveira Magro, M&#46; Mello Moreira, I&#46;A&#46; Paschoal"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Rezende Gon&#231;alves"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Corso Pereira"
            ]
            2 => array:2 [
              "nombre" => "E&#46;M&#46;"
              "apellidos" => "Figueiras Pedreira De Cerqueira"
            ]
            3 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Oliveira Magro"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Mello Moreira"
            ]
            5 => array:2 [
              "nombre" => "I&#46;A&#46;"
              "apellidos" => "Paschoal"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000979?idApp=UINPBA00004E"
    "url" => "/08732159/0000001900000001/v2_201509041433/S0873215912000979/v2_201509041433/en/main.assets"
  ]
  "pt" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
    "titulo" => "Fibrose pulmonar idiop&#225;tica&#58; apresenta&#231;&#227;o cl&#237;nica&#44; evolu&#231;&#227;o e fatores de progn&#243;stico basais numa coorte portuguesa"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "19"
        "paginaFinal" => "27"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "F&#46; Soares Pires, P&#46; Caetano Mota, N&#46; Melo, D&#46; Costa, J&#46;M&#46; Jesus, R&#46; Cunha, S&#46; Guimar&#227;es, C&#46; Souto-Moura, A&#46; Morais"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "F&#46;"
            "apellidos" => "Soares Pires"
            "email" => array:1 [
              0 => "filipasp&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Caetano Mota"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "N&#46;"
            "apellidos" => "Melo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "D&#46;"
            "apellidos" => "Costa"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Jesus"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Cunha"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Guimar&#227;es"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Souto-Moura"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Morais"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Servi&#231;o de Pneumologia&#44; Centro Hospitalar de S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento de Epidemiologia Cl&#237;nica&#44; Medicina Preditiva e Sa&#250;de P&#250;blica da Faculdade de Medicina da Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Instituto de Sa&#250;de P&#250;blica da Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servi&#231;o de Radiologia&#44; Centro Hospitalar de S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servi&#231;o de Anatomia Patol&#243;gica&#44; Centro Hospitalar de S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Faculdade de Medicina da Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspond&#234;ncia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Idiopathic pulmonary fibrosis - clinical presentation&#44; outcome and baseline prognostic factors in a Portuguese cohort"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1030
            "Ancho" => 2371
            "Tamanyo" => 107237
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curvas de sobreviv&#234;ncia de Kaplan-Meier para todos os doentes com FPI inclu&#237;dos &#40;esquerda&#41; e para os doentes com progress&#227;o lenta e r&#225;pida &#40;direita&#41; &#8211; meses&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A Fibrose Pulmonar Idiop&#225;tica &#40;FPI&#41; &#233; a patologia mais comum no subgrupo das pneumonias intersticiais idiop&#225;ticas &#40;PII&#41;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; &#201; uma doen&#231;a associada ao envelhecimento&#44; com apresenta&#231;&#227;o geralmente nas sexta e s&#233;tima d&#233;cadas de vida&#44; e &#233; mais frequente no sexo masculino<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Quer a sua etiologia&#44; quer os mecanismos da doen&#231;a&#44; s&#227;o ainda largamente desconhecidos<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">O padr&#227;o histol&#243;gico t&#237;pico da FPI &#233; a pneumonia intersticial usual &#40;UIP&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Na aus&#234;ncia de biopsia&#44; a FPI pode ser diagnosticada com base nos crit&#233;rios ATS&#47;ERS &#8211; grupo de crit&#233;rios cl&#237;nicos&#44; radiol&#243;gicos e fisiol&#243;gicos&#44; internacionalmente aceites e validados&#44; nos quais os aspetos t&#237;picos na tomografia computorizada tor&#225;cica de alta resolu&#231;&#227;o &#40;TCAR&#41; t&#234;m um papel proeminente<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A hist&#243;ria natural da doen&#231;a &#233; altamente vari&#225;vel&#44; ocorrendo geralmente uma deteriora&#231;&#227;o fisiol&#243;gica lenta e progressiva&#46; Contudo&#44; nalguns doentes observa-se um decl&#237;nio r&#225;pido da fun&#231;&#227;o pulmonar e o &#243;bito ocorre 6 a 12 meses ap&#243;s o diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46; Noutros doentes ainda&#44; observa-se uma exacerba&#231;&#227;o aguda durante a evolu&#231;&#227;o da doen&#231;a &#8211; agravamento respirat&#243;rio s&#250;bito&#44; com hipoxemia e aparecimento de novos infiltrados radiol&#243;gicos&#44; sem causa identific&#225;vel<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Apesar dos diferentes tipos de evolu&#231;&#227;o cl&#237;nica&#44; a FPI est&#225; inevitavelmente associada a um mau progn&#243;stico&#44; com uma sobreviv&#234;ncia mediana de 2-3 anos<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;13</span></a>&#46; N&#227;o existe ainda uma terap&#234;utica farmacol&#243;gica de efic&#225;cia comprovada<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Est&#227;o j&#225; descritos alguns fatores progn&#243;sticos&#44; o que tem implica&#231;&#245;es terap&#234;uticas&#44; nomeadamente no que respeita ao tempo de referencia&#231;&#227;o para transplante pulmonar&#44; a &#250;nica terap&#234;utica at&#233; ao presente associada a um benef&#237;cio na sobreviv&#234;ncia<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Recentemente&#44; a pirfenidona&#44; um f&#225;rmaco com propriedades antifibr&#243;ticas e anti-inflamat&#243;rias&#44; foi aprovado pela EMEA <span class="elsevierStyleItalic">&#40;European Medicines Agency&#41;</span> no tratamento da FPI&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O objetivo deste estudo foi a descri&#231;&#227;o da apresenta&#231;&#227;o cl&#237;nica e da evolu&#231;&#227;o dos doentes com FPI observados na consulta de doen&#231;as pulmonares difusas &#40;DPD&#41;&#44; e a an&#225;lise de fatores relacionados com a sobreviv&#234;ncia e o tipo de evolu&#231;&#227;o&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Foram avaliados os doentes com FPI&#44; observados na consulta de DPD do Hospital de S&#227;o Jo&#227;o&#44; um centro de refer&#234;ncia terci&#225;rio no Porto&#44; Portugal&#46; Em 56 doentes &#40;69&#44;1&#37;&#41;&#44; o diagn&#243;stico foi baseado nos crit&#233;rios ATS&#47;ERS &#40;de acordo com o consenso de 2002&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Sempre que existiam d&#250;vidas no diagn&#243;stico&#44; ou por altera&#231;&#245;es at&#237;picos na TCAR&#44; ou por outras caracter&#237;sticas at&#237;picas&#44; os doentes eram referenciados para realiza&#231;&#227;o de bi&#243;psia pulmonar cir&#250;rgica&#44; que foi efetuada em 25 doentes &#40;30&#44;9&#37;&#41;&#46; Aqueles cujo padr&#227;o radiol&#243;gico ou histol&#243;gico de UIP pudesse ser explicado por outras patologias &#40;nomeadamente doen&#231;as do tecido conjuntivo&#44; pneumonite de hipersensibilidade&#44; toxicidade pulmonar a f&#225;rmacos ou outras DPD cujo estadio final &#233; fibrose pulmonar&#41; foram exclu&#237;dos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os registos cl&#237;nicos foram analisados retrospetivamente&#46; Os doentes foram caracterizados &#224; data do diagn&#243;stico&#44; do ponto de vista cl&#237;nico&#44; fisiol&#243;gico e imagiol&#243;gico&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os par&#226;metros fisiol&#243;gicos em repouso e no exerc&#237;cio &#40;espirometria&#44; capacidade pulmonar total &#8211; CPT&#44; difus&#227;o pulmonar do mon&#243;xido de carbono &#8211; DLCO&#44; prova da marcha dos 6 minutos &#8211; PM6<span class="elsevierStyleHsp" style=""></span>M e prova de exerc&#237;cio cardiopulmonar&#41; foram avaliados de acordo com as recomenda&#231;&#245;es da <span class="elsevierStyleItalic">European Respiratory Society</span> &#40;ERS&#41; e <span class="elsevierStyleItalic">American Thoracic Society</span> &#40;ATS&#41;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;20</span></a>&#44; sendo os resultados expressos como percentagens dos valores normais previstos&#46; Foram exclu&#237;dos os par&#226;metros fisiol&#243;gicos obtidos ap&#243;s qualquer medica&#231;&#227;o que pudesse eventualmente modificar o curso natural da doen&#231;a&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Em alguns doentes n&#227;o foi poss&#237;vel a avalia&#231;&#227;o da capacidade de exerc&#237;cio devido a um elevado grau de incapacidade ao esfor&#231;o&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Todos os doentes realizaram TCAR na altura do diagn&#243;stico&#46; Contudo&#44; tratando-se de um estudo retrospetivo&#44; alguns doentes n&#227;o tinham imagens de TCAR dispon&#237;veis para an&#225;lise&#46; Para a caracteriza&#231;&#227;o imagiol&#243;gica&#44; as imagens da TCAR foram avaliadas por 2 radiologistas&#44; que classificaram a extens&#227;o da doen&#231;a atrav&#233;s de um <span class="elsevierStyleItalic">score</span> fibr&#243;tico<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; o mesmo utilizado na valida&#231;&#227;o do <span class="elsevierStyleItalic">Composite Physiologic Index</span>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O lavado broncoalveolar &#40;LBA&#41; foi efetuado em regime de ambulat&#243;rio&#44; sendo de referir que&#44; na altura da realiza&#231;&#227;o deste&#44; n&#227;o havia sinais ou sintomas de infe&#231;&#227;o respirat&#243;ria ou de exacerba&#231;&#227;o da doen&#231;a&#46; Quer a realiza&#231;&#227;o do LBA&#44; quer o seu processamento&#44; obedeceram &#224;s recomenda&#231;&#245;es do grupo de trabalho de LBA da ERS<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; A contagem celular total e diferencial foi classificada de acordo com os valores propostos por este grupo de trabalho &#40;linfocitose &#62; 15&#37;&#44; neutrofilia &#62; 3&#37;&#44; eosinofilia &#62; 0&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A bi&#243;psia pulmonar aberta foi realizada sob anestesia geral&#44; sendo a abordagem mais comummente utilizada a toracotomia &#226;ntero-lateral atrav&#233;s de uma incis&#227;o submam&#225;ria de 4-10<span class="elsevierStyleHsp" style=""></span>cm&#44; incis&#227;o esta que permite o acesso a diferentes segmentos e lobos pulmonares&#44; de forma a obter m&#250;ltiplas amostras de biopsia&#46; O local de realiza&#231;&#227;o da bi&#243;psia foi escolhido com base na TCAR&#46; As amostras de biopsia foram posteriormente observadas e avaliadas de forma independente por 2 an&#225;tomo-patologistas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para averiguar a exist&#234;ncia de hipertens&#227;o pulmonar&#44; todos os doentes realizaram ecocardiograma&#46; Apenas os doentes referenciados para transplante pulmonar foram submetidos a cateteriza&#231;&#227;o card&#237;aca direita&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A evolu&#231;&#227;o cl&#237;nica foi classificada em evolu&#231;&#227;o lenta&#44; evolu&#231;&#227;o r&#225;pida e exacerba&#231;&#227;o aguda &#40;EA-FPI&#41;&#46; A evolu&#231;&#227;o r&#225;pida foi diferenciada da evolu&#231;&#227;o lenta por uma menor dura&#231;&#227;o de sintomas pr&#233;vios ao diagn&#243;stico &#40;&#60;6 meses&#41; e uma deteriora&#231;&#227;o cl&#237;nica rapidamente progressiva<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; A EA-FPI foi definida como um agravamento s&#250;bito dos sintomas respirat&#243;rios com hipoxemia e aparecimento de infiltrados pulmonares <span class="elsevierStyleItalic">de novo</span>&#44; sem etiologia identific&#225;vel<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Nos doentes inclu&#237;dos neste estudo&#44; a FPI foi diagnosticada entre 2000 e 2010&#46; Foi feito o seguimento da evolu&#231;&#227;o da doen&#231;a at&#233; &#224; data de &#243;bito ou de transplante pulmonar&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lise estat&#237;stica</span><p id="par0080" class="elsevierStylePara elsevierViewall">A normalidade da distribui&#231;&#227;o de todas as vari&#225;veis cont&#237;nuas foi testada atrav&#233;s do teste de Kolmogorov-Sminorv&#46; Quanto aos fatores estudados&#44; foram analisadas as suas percentagens e medianas das covariadas e as diferen&#231;as entre os doentes com evolu&#231;&#245;es lenta e r&#225;pida foram averiguadas atrav&#233;s dos testes U Mann-Whitney&#44; Qui Quadrado ou Teste Exato de Fisher&#44; conforme apropriado&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A sobreviv&#234;ncia mediana dos doentes foi estimada atrav&#233;s das curvas de sobreviv&#234;ncia de Kaplan-Meier&#44; sendo estes censurados &#224; data de &#243;bito ou de transplante pulmonar&#46; Para aumento do poder estat&#237;stico do estudo&#44; o seguimento dos doentes foi suspenso aos 48 meses&#46; Para avaliar os fatores progn&#243;sticos&#44; os <span class="elsevierStyleItalic">Hazard Ratios</span> &#40;e seus respetivos intervalos de confian&#231;a a 95&#37;&#41; foram analisados usando os modelos de regress&#227;o univariados de Cox&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Todas as an&#225;lises estat&#237;sticas foram efetuadas com recurso ao SPSS<span class="elsevierStyleSup">&#174;</span> software v&#46; 18&#44; para um n&#237;vel de signific&#226;ncia estat&#237;stica de 0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Caracteriza&#231;&#227;o dos doentes &#224; data do diagn&#243;stico</span><p id="par0095" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 81 doentes&#44; 56 &#40;69&#44;1&#37;&#41; do sexo masculino e 25 &#40;30&#44;9&#37;&#41; do sexo feminino&#46; A m&#233;dia de idade ao diagn&#243;stico foi de 63&#44;8&#177;10&#44;2 anos&#46; Dois doentes &#40;2&#44;5&#37;&#41; apresentaram FPI familiar&#46; Foi identificada hist&#243;ria tab&#225;gica em 51&#44;9&#37; &#40;27&#44;5&#37; fumadores e 72&#44;5&#37; ex-fumadores&#41;&#44; com uma carga tab&#225;gica m&#233;dia de 37&#44;5 unidades ma&#231;o&#47;ano &#40;UMA&#41;&#46; O principal sintoma &#224; apresenta&#231;&#227;o foi a dispneia &#40;96&#44;3&#37;&#41;&#44; seguido de tosse &#40;7&#44;9&#37;&#41;&#46; O tempo mediano entre o in&#237;cio dos sintomas e a data do diagn&#243;stico foi de 12 meses&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As principais altera&#231;&#245;es funcionais encontradas foram uma altera&#231;&#227;o ventilat&#243;ria restritiva e a redu&#231;&#227;o da DLCO&#44; bem como a redu&#231;&#227;o da capacidade de exerc&#237;cio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; A PM6<span class="elsevierStyleHsp" style=""></span>M foi considerada para an&#225;lise em 40 doentes&#44; com uma m&#233;dia &#40;DP &#8211; desvio-padr&#227;o&#41; de dist&#226;ncia percorrida de 369&#44;6 &#40;149&#44;4&#41; metros e uma m&#233;dia &#40;DP&#41; de satura&#231;&#227;o m&#237;nima de oxig&#233;nio de 81&#44;5 &#40;8&#44;1&#41; &#37;&#46; A prova de exerc&#237;cio cardiopulmonar foi considerada para an&#225;lise em apenas 15 doentes&#44; com uma m&#233;dia &#40;DP&#41; de pico de consumo de oxig&#233;nio de 66&#44;6 &#40;18&#44;4&#41; &#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> fibr&#243;tico na TCAR foi medido em 42 doentes&#44; com uma m&#233;dia &#40;DP&#41; de 10&#44;8 &#40;2&#44;3&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A preval&#234;ncia de enfisema foi de 26&#44;4&#37; &#40;14&#47;53 TCAR dispon&#237;veis para avalia&#231;&#227;o&#41;&#46; Nos doentes com enfisema&#44; verificou-se uma idade inferior &#8211; 61&#44;8 vs&#46; 69&#44;9 anos &#40;p&#61;0&#44;042&#41;&#44; uma maior carga tab&#225;gica &#8211; 28&#44;3 vs&#46; 10&#44;7 UMA &#40;p&#61;0&#44;035&#41;&#44; uma menor rela&#231;&#227;o VEMS&#47;CVF &#8211; 79 vs&#46; 86&#44;9&#37; &#40;p&#61;0&#44;001&#41; e um maior compromisso na capacidade de difus&#227;o &#8211; 36&#44;8 vs&#46; 49&#44;9&#37; &#40;p&#61;0&#44;016&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Na abordagem diagn&#243;stica&#44; foi realizado LBA em 56 doentes&#44; identificando-se neutrofilia &#40;m&#233;dia&#61;10&#44;8&#44; DP&#61;2&#46;3&#41; em 52 &#40;92&#44;9&#37;&#41; doentes&#44; eosinofilia &#40;m&#233;dia&#61;5&#44;1&#44; DP&#61;5&#44;0&#41; em 48 &#40;85&#44;7&#37;&#41; doentes e uma linfocitose ligeira em 14 &#40;25&#37;&#41; doentes &#40;m&#233;dia&#61;12&#44; DP&#61;7&#44;8&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Evolu&#231;&#227;o cl&#237;nica</span><p id="par0120" class="elsevierStylePara elsevierViewall">No que respeita &#224; abordagem terap&#234;utica&#44; foram seguidas as normas ATS&#47;ERS &#224; data &#8211; na aus&#234;ncia de contraindica&#231;&#245;es&#44; tendo esta consistido em doses baixas de corticosteroides &#40;86&#44;4&#37;&#41; e f&#225;rmacos imunossupressores &#40;65&#44;4&#37;&#41;&#44; preferencialmente azatioprina ou ciclofosfamida&#46; Ap&#243;s a publica&#231;&#227;o do ensaio cl&#237;nico IFIGENIA<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> em 2005&#44; foi adicionado a este regime terap&#234;utico a N-Acetilciste&#237;na &#40;1800<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#41; &#8211; 51&#44;9&#37;&#46; At&#233; &#224; data de realiza&#231;&#227;o deste estudo&#44; a Pirfenidona n&#227;o estava ainda dispon&#237;vel em Portugal&#46; &#192; data de diagn&#243;stico dos doentes&#44; este f&#225;rmaco n&#227;o estava ainda aprovado pela EMEA nem havia centros portugueses a participar nos seus ensaios cl&#237;nicos&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Ap&#243;s o estabelecimento de um protocolo&#44; em 2007&#44; com o Hospital Juan Canalejo &#40;A Coru&#241;a&#41; e com o Hospital de Santa Marta &#40;Lisboa&#41;&#44; os doentes com idade inferior a 65 anos foram considerados para a realiza&#231;&#227;o de transplante pulmonar&#46; Uma vez que esta s&#233;rie inclui apenas doentes diagnosticados a partir de 2000&#44; h&#225; ainda uma percentagem baixa de doentes transplantados&#46; Nove doentes &#40;7&#44;4&#37;&#41; foram referenciados para a realiza&#231;&#227;o de transplante pulmonar&#44; tendo sido realizado o transplante unipulmonar em 6 doentes &#40;2 foram exclu&#237;dos por infe&#231;&#227;o por <span class="elsevierStyleItalic">Aspergillus fumigatus</span>&#41;&#46; O outro doente encontra-se em lista de espera&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A evolu&#231;&#227;o cl&#237;nica &#40;n&#61;76&#41; foi&#44; na maioria dos casos&#44; lentamente progressiva &#40;72&#44;3&#37;&#41;&#46; Em 10 doentes &#40;13&#44;2&#37;&#41;&#44; a FPI teve uma progress&#227;o r&#225;pida e 11 &#40;14&#44;5&#37;&#41; doentes apresentaram uma EA-FPI durante a evolu&#231;&#227;o da doen&#231;a&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A progress&#227;o r&#225;pida da FPI &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41; esteve associada &#224; maior gravidade funcional ao diagn&#243;stico&#44; nomeadamente no que respeita &#224; CVF &#40;p&#61;0&#44;003&#41; e &#224; CPT &#40;p&#61;0&#44;032&#41;&#46; A hist&#243;ria tab&#225;gica esteve associada a uma evolu&#231;&#227;o lentamente progressiva &#40;p&#61;0&#44;020&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">A morte da maioria dos doentes com FPI &#40;69&#44;6&#37;&#41; esteve relacionada diretamente com a doen&#231;a &#8211; insufici&#234;ncia respirat&#243;ria&#44; enquanto 13 doentes &#40;23&#44;2&#37;&#41; morreram por causas n&#227;o relacionadas com a doen&#231;a&#46; Quatro doentes &#40;7&#44;1&#37;&#41; morreram por complica&#231;&#245;es p&#243;s-transplante pulmonar&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Ocorreu uma EA-FPI em 11 doentes&#46; Entre estes&#44; 6 &#40;54&#44;5&#37;&#41; morreram no decurso deste epis&#243;dio e 2 foram submetidos a transplante pulmonar&#44; falecendo por complica&#231;&#245;es p&#243;s-transplante&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sobreviv&#234;ncia</span><p id="par0150" class="elsevierStylePara elsevierViewall">A sobreviv&#234;ncia mediana foi de 36 meses &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; &#192; data de avalia&#231;&#227;o&#44; 25 doentes permaneciam vivos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Os fatores associados &#224; redu&#231;&#227;o da sobreviv&#234;ncia&#44; em an&#225;lise univariada &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; foram valores inferiores de CVF &#40;p&#61;0&#44;000&#41;&#44; CPT &#40;p&#61;0&#44;001&#41;&#44; dist&#226;ncia da PM6<span class="elsevierStyleHsp" style=""></span>M &#40;p&#61;0&#44;014&#41; e PaO2 &#40;Press&#227;o arterial de Oxig&#233;nio&#41; em repouso &#40;p&#61;0&#44;008&#41;&#44; bem como o aumento da contagem de neutr&#243;filos no LBA &#40;p&#61;0&#44;039&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">N&#227;o foi poss&#237;vel estabelecer pontos de corte para cada um dos fatores progn&#243;sticos encontrados&#44; devido ao baixo poder estat&#237;stico associado &#224; pequena dimens&#227;o da amostra&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Foram testados os pontos de corte dos fatores progn&#243;sticos basais descritos no &#250;ltimo documento de consenso<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> &#40;DLCO &#60;40&#37; do valor previsto&#59; dessatura&#231;&#227;o &#8804;88&#37; durante a PM6<span class="elsevierStyleHsp" style=""></span>M&#59; presen&#231;a de hipertens&#227;o pulmonar&#41; &#8211; verificando-se que&#44; apesar de seguirem a tend&#234;ncia esperada&#44; n&#227;o foram encontradas associa&#231;&#245;es estatisticamente significativas&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrada diferen&#231;a estatisticamente significativa na sobreviv&#234;ncia entre os doentes com FPI com ou sem enfisema&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A sobreviv&#234;ncia mediana foi de 41 meses nos doentes com evolu&#231;&#227;o lenta e de 9 meses nos de evolu&#231;&#227;o r&#225;pida &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Entre os doentes com evolu&#231;&#227;o lentamente progressiva&#44; valores inferiores de CVF &#40;p&#61;0&#44;001&#41;&#44; CPT &#40;p&#61;0&#44;012&#41; e dist&#226;ncia na PM6<span class="elsevierStyleHsp" style=""></span>M &#40;p&#61;0&#44;026&#41; estiveram associados &#224; redu&#231;&#227;o da sobreviv&#234;ncia&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">N&#227;o foram encontrados fatores progn&#243;sticos nos doentes de evolu&#231;&#227;o r&#225;pida &#40;baixo poder estat&#237;stico pela reduzida dimens&#227;o da amostra&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discuss&#227;o</span><p id="par0190" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o desta coorte de doentes com FPI provenientes da regi&#227;o norte de Portugal mostrou as caracter&#237;sticas habituais associadas a esta patologia&#44; nomeadamente no que concerne aos seus par&#226;metros cl&#237;nicos&#44; funcionais e radiol&#243;gicos&#44; bem como ao seu progn&#243;stico&#46; Nesta s&#233;rie&#44; apesar da associa&#231;&#227;o entre alguns fatores progn&#243;sticos &#224; data do diagn&#243;stico e a sobreviv&#234;ncia global&#44; o principal enfoque est&#225; no tipo de evolu&#231;&#227;o cl&#237;nica&#44; mais precisamente na distin&#231;&#227;o entre os doentes de evolu&#231;&#227;o lenta e de evolu&#231;&#227;o r&#225;pida&#44; dado o seu progn&#243;stico e sobreviv&#234;ncia serem totalmente distintos&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">A idade m&#233;dia ao diagn&#243;stico &#233; consistente com o que est&#225; descrito na literatura<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;24</span></a>&#44; tal como a maior preval&#234;ncia no sexo masculino&#46; A FPI familiar pode estar subvalorizada pelo facto de alguns doentes referirem morte de familiares por doen&#231;a respirat&#243;ria n&#227;o especificada&#46; O tabaco est&#225; fortemente associado &#224; FPI&#44; nomeadamente naqueles com maior carga tab&#225;gica &#40;&#62;20 UMA&#41;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Neste estudo&#44; a propor&#231;&#227;o de fumadores e ex-fumadores foi inferior ao esperado&#44; embora resultados semelhantes estejam descritos noutras s&#233;ries<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; Contudo&#44; nos 15 doentes diagnosticados em idade inferior a 60 anos&#44; 80&#37; apresentava h&#225;bitos tab&#225;gicos presentes ou pr&#233;vios&#44; podendo assim especular-se que&#44; excluindo a idade&#44; a hist&#243;ria tab&#225;gica pode ter sido um fator de risco para a FPI nesta amostra&#46; O tempo mediano entre a data de in&#237;cio dos sintomas e o diagn&#243;stico foi de 12 meses&#46; Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> descreveram um per&#237;odo sintom&#225;tico de 6 meses a 2 anos a preceder o diagn&#243;stico de FPI&#46; De facto&#44; n&#227;o s&#243; os doentes tendem a atribuir inicialmente a dispneia ao envelhecimento&#44; mas tamb&#233;m os m&#233;dicos de Cuidados de Sa&#250;de Prim&#225;rios tendem a focar a sua investiga&#231;&#227;o etiol&#243;gica em patologias mais prevalentes&#44; tais como a patologia card&#237;aca e outras patologias pulmonares como a DPOC&#46; Contudo&#44; nesta coorte est&#225; representado um n&#250;mero crescente de doentes referenciados atrav&#233;s dos Cuidados de Sa&#250;de Prim&#225;rios&#44; o que poder&#225; estar relacionado com uma maior generaliza&#231;&#227;o no pedido de TC tor&#225;cicas&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Foi descrita recentemente uma nova s&#237;ndrome&#44; a fibrose pulmonar combinada com enfisema &#40;CPFE&#41;&#44; que resulta da associa&#231;&#227;o entre FPI e enfisema<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a>&#46; A percentagem da CPFE est&#225; de acordo com outras publica&#231;&#245;es<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Neste estudo&#44; foram observadas algumas caracter&#237;sticas particulares desta s&#237;ndrome&#44; nomeadamente uma maior associa&#231;&#227;o aos h&#225;bitos tab&#225;gicos&#44; n&#237;veis inferiores de VEMS&#47;CVF e um maior compromisso na capacidade de difus&#227;o&#46; Alguns autores descrevem ainda um impacto negativo no progn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#44; o qual est&#225; fortemente associado &#224; ocorr&#234;ncia de hipertens&#227;o pulmonar<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Neste estudo&#44; entre os doentes com CPFE e os restantes doentes com FPI&#44; n&#227;o foi encontrada uma diferen&#231;a significativa na sobreviv&#234;ncia nem na ocorr&#234;ncia de hipertens&#227;o pulmonar ao diagn&#243;stico&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Foi verificada linfocitose em 14 doentes &#40;25&#37;&#41;&#46; Estes apresentaram uma linfocitose ligeira &#40;m&#233;dia de 22&#44;8&#37;&#41;&#44; n&#227;o tendo sido verificada qualquer exposi&#231;&#227;o a agentes suspeitos&#46; &#201; de salientar que 50&#37; destes doentes realizaram bi&#243;psia pulmonar para excluir outros diagn&#243;sticos diferenciais&#44; para al&#233;m de n&#227;o terem sido detetadas altera&#231;&#245;es cl&#237;nicas&#44; anal&#237;ticas ou imagiol&#243;gicas que sugerissem outras patologias associadas a UIP durante a sua evolu&#231;&#227;o&#46; N&#227;o foram igualmente encontradas diferen&#231;as na sobreviv&#234;ncia entre os doentes com ou sem linfocitose no LBA&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">N&#227;o &#233; poss&#237;vel ainda prever a evolu&#231;&#227;o cl&#237;nica na FPI&#46; Nesta amostra&#44; 13&#44;2&#37; dos doentes apresentou um decl&#237;nio acelerado&#44; j&#225; descrito na literatura<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Contudo&#44; n&#227;o est&#227;o ainda bem estabelecidos os crit&#233;rios de classifica&#231;&#227;o dos diferentes tipos de progress&#227;o&#46; A defini&#231;&#227;o para a evolu&#231;&#227;o rapidamente progressiva baseia-se num tempo entre o in&#237;cio dos sintomas e o diagn&#243;stico inferior a 6 meses&#44; associado a um decl&#237;nio cl&#237;nico e funcional acelerado<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10</span></a>&#46; &#201; not&#225;vel a diferen&#231;a na sobreviv&#234;ncia entre os doentes com evolu&#231;&#227;o lenta e r&#225;pida &#40;41 e 9 meses&#44; respetivamente&#41;&#46; Apesar de n&#227;o estar ainda bem esclarecido&#44; estes grupos poder&#227;o representar diferentes fen&#243;tipos na FPI&#46; Em an&#225;lise univariada&#44; valores inferiores de CVF e CPT estiveram associados a uma evolu&#231;&#227;o rapidamente progressiva&#46; Os doentes n&#227;o fumadores estiveram tamb&#233;m associados a uma progress&#227;o r&#225;pida&#46; Este facto foi j&#225; descrito noutros estudos&#44; alguns mostrando mesmo uma melhor sobreviv&#234;ncia em fumadores<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#44; n&#227;o existindo para tal uma explica&#231;&#227;o clara&#46; Alguns dados sugerem que a inala&#231;&#227;o de tabaco inibe a prolifera&#231;&#227;o dos fibroblastos no pulm&#227;o&#44; bem como a quimiotaxia&#44; podendo assim&#44; de alguma forma&#44; comprometer o mecanismo de repara&#231;&#227;o patol&#243;gico que se verifica ap&#243;s a les&#227;o do epit&#233;lio alveolar<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; Um estudo recente contradiz este facto&#44; mostrando um melhor progn&#243;stico nos n&#227;o fumadores&#44; e assumindo que o melhor progn&#243;stico previamente descrito nos fumadores se deve ao facto de estes apresentarem uma doen&#231;a menos grave na altura do diagn&#243;stico&#44; dado estarem mais alertados para eventuais sintomas respirat&#243;rios <span class="elsevierStyleItalic">&#40;healthy smoker lead-time effect&#41;</span><a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A EA-FPI &#233; um dos eventos mais enigm&#225;ticos e tem&#237;veis neste contexto&#46; Os resultados deste estudo est&#227;o de acordo com a literatura publicada&#44; quer no que respeita &#224; incid&#234;ncia&#44; quer na mortalidade&#46; De facto&#44; de acordo com 2 dos estudos de maior relev&#226;ncia<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a>&#44; a incid&#234;ncia da EA-FPI &#233; de 10-15&#37; dos doentes com FPI&#44; e apresenta uma mortalidade elevada&#44; entre os 50 e os 100&#37;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;36&#8211;38</span></a>&#46; Excluindo os doentes submetidos a transplante pulmonar&#44; a mortalidade intra-hospitalar da EA-FPI neste estudo foi de 66&#44;7&#37;&#46; T&#234;m sido procurados fatores preditores da ocorr&#234;ncia de EA-FPI&#44; sem sucesso<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#46; De facto&#44; a ocorr&#234;ncia de EA-FPI n&#227;o parece estar relacionada com a gravidade das altera&#231;&#245;es funcionais<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#46; Neste estudo&#44; nenhum dos fatores estudados conseguiu prever a sua ocorr&#234;ncia&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">A sobreviv&#234;ncia mediana da amostra estudada est&#225; em linha com os outros estudos publicados<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;40</span></a>&#46; Os preditores de mortalidade na FPI t&#234;m sido divididos em preditores basais &#40;na altura do diagn&#243;stico&#41; e din&#226;micos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#46; De facto&#44; o progn&#243;stico da FPI deve integrar par&#226;metros&#44; quer basais&#44; quer longitudinais&#46; Neste estudo&#44; foram apenas avaliados os preditores basais&#46; Em an&#225;lise univariada&#44; os fatores associados &#224; redu&#231;&#227;o da sobreviv&#234;ncia nesta coorte estiveram relacionados com uma maior gravidade funcional &#40;CVF&#44; CPT&#41;&#44; pior oxigena&#231;&#227;o &#40;PaO2&#41;&#44; redu&#231;&#227;o da toler&#226;ncia ao exerc&#237;cio &#40;dist&#226;ncia na PM6<span class="elsevierStyleHsp" style=""></span>M&#41; e maior contagem de neutr&#243;filos no LBA&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Pela revis&#227;o da literatura&#44; &#233; not&#243;ria a grande variabilidade de fatores progn&#243;sticos&#46; V&#225;rios fatores contribuem para isso&#44; nomeadamente a an&#225;lise de s&#233;ries com um pequeno n&#250;mero de doentes ou a inclus&#227;o de doentes com comorbilidades que poder&#227;o atuar como fatores confundidores&#46; Por outro lado&#44; a maioria dos estudos tem diferentes abordagens diagn&#243;sticas e terap&#234;uticas no que respeita aos doentes inclu&#237;dos n&#227;o devendo este facto afetar o rigor dos resultados&#44; dada a aus&#234;ncia de terap&#234;utica farmacol&#243;gica de efic&#225;cia comprovada&#46; Esta coorte foi dividida de acordo com os fen&#243;tipos dos doentes&#44; uma vez que os fatores progn&#243;sticos devem ser adaptados a cada um dos 3 tipos de evolu&#231;&#227;o cl&#237;nica descritos&#44; dada a sua discrep&#226;ncia&#46; Os fatores progn&#243;sticos encontrados&#44; mais precisamente valores inferiores de CVF&#44; CPT e dist&#226;ncia na PM6<span class="elsevierStyleHsp" style=""></span>M&#44; permaneceram como fatores progn&#243;sticos estatisticamente significativos no grupo de doentes com evolu&#231;&#227;o lentamente progressiva&#46; O facto de n&#227;o haver fatores progn&#243;sticos identificados no grupo de progress&#227;o r&#225;pida pode ser explicado pelo pequeno n&#250;mero de doentes&#44; insuficiente para um resultado com significado estat&#237;stico&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">V&#225;rios estudos t&#234;m descrito o valor progn&#243;stico do estudo funcional respirat&#243;rio basal&#44; indicando que uma maior gravidade funcional est&#225; significativamente associada &#224; redu&#231;&#227;o da sobreviv&#234;ncia&#46; Os fatores habitualmente descritos s&#227;o a CVF<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;42&#8211;44</span></a> e a CPT<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;44</span></a>&#44; com maior evid&#234;ncia no que respeita ao primeiro&#46; A associa&#231;&#227;o da DLCO &#224; redu&#231;&#227;o da sobreviv&#234;ncia &#233; um dado consistente na literatura<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#8211;45</span></a>&#46; De facto&#44; a menor capacidade de difus&#227;o reflete uma maior extens&#227;o da fibrose e&#44; desta forma&#44; a maior gravidade da doen&#231;a&#46; Contudo&#44; neste estudo&#44; n&#227;o apresentou impacto no progn&#243;stico&#46; Alguns estudos referem a PaO2 basal em repouso como um preditor de mortalidade<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;27&#44;43&#44;46</span></a>&#44; embora existam tamb&#233;m alguns resultados contradit&#243;rios<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">44&#44;47</span></a>&#46; N&#237;veis mais graves de hipoxemia ocorrem em estadios mais avan&#231;ados da doen&#231;a&#44; n&#227;o estando ainda bem estabelecido se este pode ou n&#227;o ser considerado um fator progn&#243;stico&#46; V&#225;rios estudos descreveram ainda o impacto progn&#243;stico dos par&#226;metros da PM6<span class="elsevierStyleHsp" style=""></span>M na sobreviv&#234;ncia<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#8211;51</span></a>&#44; quer no que respeita &#224; dist&#226;ncia percorrida&#44; quer &#224; dessatura&#231;&#227;o&#46; Contudo&#44; estes resultados est&#227;o provavelmente subestimados pela falta de estandardiza&#231;&#227;o e reprodutibilidade deste teste&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">A neutrofilia no LBA tem sido associada &#224; gravidade da doen&#231;a&#44; tal como ocorre noutras DPD como a sarcoidose<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a>&#46; Existe ainda evid&#234;ncia de que um maior grau de neutrofilia pode estar associado &#224; redu&#231;&#227;o da sobreviv&#234;ncia<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#46; Embora ela esteja constantemente descrita como um fator progn&#243;stico em an&#225;lise univariada&#44; v&#225;rios estudos publicados n&#227;o confirmam esta associa&#231;&#227;o em an&#225;lise multivariada<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">54&#44;55</span></a>&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">No contexto da FPI&#44; a hipertens&#227;o pulmonar tem uma patogenia multifatorial&#44; sendo&#44; em alguns estudos&#44; geralmente longitudinais&#44; apontada como um preditor de mortalidade<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56&#44;57</span></a>&#46; Nesta amostra&#44; a presen&#231;a de hipertens&#227;o pulmonar ao diagn&#243;stico n&#227;o teve valor progn&#243;stico&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Foram propostos alguns coeficientes<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;58</span></a> de forma a combinar diferentes par&#226;metros&#46; Por exemplo&#44; o <span class="elsevierStyleItalic">Composite Physiologic Index</span>&#44; que inclui a CVF&#44; VEMS&#44; DLCO e a extens&#227;o da fibrose na TCAR&#44; tem-se mostrado eficaz em v&#225;rios estudos<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;59</span></a>&#46; O uso destes coeficientes poder&#225; prever com maior rigor o progn&#243;stico e constituir uma medida mais precisa da progress&#227;o da doen&#231;a&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; a FPI est&#225; inevitavelmente associada a um mau progn&#243;stico&#46; Diferentes fen&#243;tipos parecem estar a emergir&#44; como se pode concluir das substanciais diferen&#231;as na evolu&#231;&#227;o cl&#237;nica&#46; Na altura do estabelecimento do diagn&#243;stico&#44; uma previs&#227;o mais exata do progn&#243;stico e evolu&#231;&#227;o da doen&#231;a poderia melhorar a abordagem dos doentes&#44; particularmente no momento de referencia&#231;&#227;o para o transplante pulmonar&#44; a &#250;nica terap&#234;utica com benef&#237;cio comprovado na sobreviv&#234;ncia&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflito de interesses</span><p id="par0255" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres547862"
          "titulo" => array:5 [
            0 => "Resumo"
            1 => "Introdu&#231;&#227;o"
            2 => "Material e m&#233;todos"
            3 => "Resultados"
            4 => "Conclus&#227;o"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec565732"
          "titulo" => "Palavras-chave"
        ]
        2 => array:2 [
          "identificador" => "xres547863"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusion"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec565731"
          "titulo" => "Keywords"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introdu&#231;&#227;o"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "M&#233;todos"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "An&#225;lise estat&#237;stica"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Resultados"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Caracteriza&#231;&#227;o dos doentes &#224; data do diagn&#243;stico"
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Evolu&#231;&#227;o cl&#237;nica"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Sobreviv&#234;ncia"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discuss&#227;o"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflito de interesses"
        ]
        9 => array:2 [
          "identificador" => "xack184955"
          "titulo" => "Agradecimentos"
        ]
        10 => array:1 [
          "titulo" => "Bibliografia"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-09-19"
    "fechaAceptado" => "2012-05-02"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec565732"
          "palabras" => array:3 [
            0 => "Fibrose pulmonar idiop&#225;tica"
            1 => "Sobreviv&#234;ncia"
            2 => "Progn&#243;stico"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec565731"
          "palabras" => array:3 [
            0 => "Idiopathic Pulmonary Fibrosis"
            1 => "Survival"
            2 => "Prognosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A Fibrose Pulmonar Idiop&#225;tica &#40;FPI&#41; &#233; a patologia mais comum no subgrupo das pneumonias intersticiais idiop&#225;ticas&#46; Apesar de uma grande variabilidade no tipo de evolu&#231;&#227;o cl&#237;nica&#44; est&#225; inexoravelmente associada a um mau progn&#243;stico&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Material e m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Foram identificados doentes com FPI&#44; observados na consulta de doen&#231;as pulmonares difusas do Centro Hospitalar de S&#227;o Jo&#227;o&#44; Porto&#44; e revistos os seus par&#226;metros cl&#237;nicos&#44; funcionais&#44; radiol&#243;gicos e do lavado broncoalveolar &#40;LBA&#41;&#46; A evolu&#231;&#227;o cl&#237;nica e sobreviv&#234;ncia foram avaliadas&#44; tendo sido igualmente identificados fatores progn&#243;sticos&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 81 doentes com uma m&#233;dia de idade de 63&#44;8 anos&#46; Na altura do diagn&#243;stico&#44; as principais altera&#231;&#245;es funcionais identificadas foram a restri&#231;&#227;o&#44; redu&#231;&#227;o da difus&#227;o pulmonar e da capacidade de exerc&#237;cio&#46; A maioria dos doentes &#40;72&#46;3&#37;&#41; apresentou uma evolu&#231;&#227;o cl&#237;nica lentamente progressiva&#46; Em 10 doentes &#40;13&#46;2&#37;&#41;&#44; foi observada uma evolu&#231;&#227;o rapidamente progressiva e 11 &#40;14&#46;&#44;5&#37;&#41; apresentaram exacerba&#231;&#227;o aguda&#46; Verificou-se uma associa&#231;&#227;o entre a evolu&#231;&#227;o rapidamente progressiva e uma maior gravidade funcional ao diagn&#243;stico&#44; nomeadamente na Capacidade Vital For&#231;ada &#40;CVF&#41; e Capacidade Pulmonar Total &#40;CPT&#41;&#46; A sobrevida mediana foi de 36 meses&#46; Verificou-se uma diferen&#231;a estatisticamente significativa na sobrevida entre os diferentes grupos de evolu&#231;&#227;o cl&#237;nica&#58; 41 meses para os doentes com evolu&#231;&#227;o lentamente progressiva e 9 meses para os doentes com evolu&#231;&#227;o rapidamente progressiva&#46; Valores inferiores de CVF&#44; CPT&#44; dist&#226;ncia na Prova da Marcha de 6 Minutos &#40;PM6 M&#41; e PaO2 em repouso&#44; bem como o maior grau de neutrofilia no LBA estiveram associados a uma sobreviv&#234;ncia inferior em an&#225;lise univariada&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A an&#225;lise deste grupo de doentes com FPI confirma a exist&#234;ncia de 2 fen&#243;tipos claramente distintos&#44; o de evolu&#231;&#227;o lenta e o de evolu&#231;&#227;o rapidamente progressiva&#46; Estes fen&#243;tipos t&#234;m uma diferente apresenta&#231;&#227;o cl&#237;nica e uma hist&#243;ria natural da doen&#231;a claramente distinta&#44; sugerindo a presen&#231;a de diferentes mecanismos fisiopatol&#243;gicos&#44; os quais poder&#227;o implicar diferentes abordagens terap&#234;uticas&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Idiopathic pulmonary fibrosis &#40;IPF&#41; is the most common disease in the subgroup of idiopathic interstitial pneumonias&#46; It is inevitably associated to a bad prognosis&#44; although assuming a highly variable clinical course&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Patients with IPF&#44; observed at Interstitial Lung Diseases outpatient clinic of Centro Hospitalar de S&#227;o Jo&#227;o &#8211; Porto&#44; Portugal&#44; were identified and clinical&#44; functional&#44; radiological and bronchoalveolar lavage &#40;BAL&#41; parameters were reviewed&#46; Their clinical course and survival were analyzed in order to identify prognostic factors&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Eighty-one patients were included&#44; with a mean age at diagnosis of 63&#46;8 years old&#46; At diagnosis&#44; the main functional abnormalities were restrictive physiology&#44; reduced lung diffusion and exercise capacity impairment&#46; Clinical course was mainly slowly progressive &#40;72&#46;3&#37;&#41;&#46; Ten patients &#40;13&#46;2&#37;&#41; had a rapid progression and 11 &#40;14&#46;5&#37;&#41; patients had an acute exacerbation during the course of the disease&#46; IPF&#39;s rapid progression was associated to a higher functional impairment at diagnosis&#44; namely in what is related with Forced Vital Capacity &#40;FVC&#41; and Total Lung Capacity &#40;TLC&#41;&#46; Median survival was 36 months&#46; A significant difference in survival was observed among different types of clinical course &#8211; 41 months for slow progressors and 9 months for rapid progressors&#46; Lower levels of FVC&#44; TLC&#44; 6th minute walk test distance and rest PaO2&#44; and higher BAL neutrophil count were associated with poorer survival in univariate analysis&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The analysis of this group of IPF patients confirms two clearly different phenotypes&#44; slow and rapid progressors&#46; Those phenotypes seem to have different presentations and a remarkably different natural history&#46; These results could mean different physiopathologic pathways&#44; which could implicate different therapeutic approaches&#46;</p></span>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1030
            "Ancho" => 2371
            "Tamanyo" => 107237
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curvas de sobreviv&#234;ncia de Kaplan-Meier para todos os doentes com FPI inclu&#237;dos &#40;esquerda&#41; e para os doentes com progress&#227;o lenta e r&#225;pida &#40;direita&#41; &#8211; meses&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">DP&#58; desvio-padr&#227;o&#59; PaCO<span class="elsevierStyleInf">2</span>&#58; press&#227;o arterial de di&#243;xido de carbono&#59; PaO<span class="elsevierStyleInf">2</span>&#58; press&#227;o arterial de oxig&#233;nio&#59; VEMS&#58; volume expirado m&#225;ximo no 1&#46;&#176; segundo&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Avalia&#231;&#227;o fisiol&#243;gica ao diagn&#243;stico&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">M&#233;dia&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">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CVF &#40;n&#61;71&#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&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#177; 20&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VEMS &#40;n&#61;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#177; 19&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VEMS&#47;CVF &#40;n&#61;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#177; 7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CPT &#40;n&#61;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#177; 15&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">DLCO &#40;n&#61;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#177; 16&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PaO<span class="elsevierStyleInf">2</span> &#40;n&#61;62&#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&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#177; 14&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PaCO2<span class="elsevierStyleInf">2</span> &#40;n&#61;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#177; 4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab884889.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o fisiol&#243;gica dos doentes com FPI no momento do diagn&#243;stico</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HTP&#58; hipertens&#227;o pulmonar&#59; SatO2&#58; satura&#231;&#227;o de oxig&#233;nio&#59; &#37; Eos&#58; percentagem de eosin&#243;filos na contagem diferencial do LBA&#59; &#37; Linf&#58; percentagem de linf&#243;citos na contagem diferencial do LBA&#59; &#37; Neut&#58; percentagem de neutr&#243;filos na contagem diferencial do LBA&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; &#40;&#37;&#41; ou m&#233;dia &#177; DP</th></tr><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">Doentes com progress&#227;o lenta &#40;n&#61;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Doentes com progress&#227;o r&#225;pida &#40;n&#61;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Idade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#44;2 &#177; 9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#44;4 &#177; 11&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;954&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="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="char" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#9794;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;67&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;346&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;32&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="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="char" valign="top"><span class="elsevierStyleItalic">Hist&#243;ria tab&#225;gica</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;40&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;59&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;11&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="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  " align="left" valign="top"><span class="elsevierStyleItalic">CVF</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#44;2 &#177; 21&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;5 &#177; 10&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CPT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#44;2 &#177; 16&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#44;8 &#177; 10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">DLCO</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#44;6 &#177; 14&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#44;1 &#177; 12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PaO2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;6 &#177; 16&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#44;3 &#177; 11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dist&#226;ncia PM6M &#40;m&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">377&#44;2 &#177; 131&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">265&#44;2 &#177; 226&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;318&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">SatO</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">m&#237;nima PM6M &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#44;7 &#177; 7&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#44;3 &#177; 8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Score fibr&#243;tico &#40;TCAR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;2 &#177; 2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;0 &#177; 2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="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="char" valign="top"><span class="elsevierStyleItalic">HTP</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;87&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;62&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;12&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;37&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="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  " align="left" valign="top"><span class="elsevierStyleItalic">&#37; Linf</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;5 &#177; 7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;9 &#177; 5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#37; Neut</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;5 &#177; 9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;6 &#177; 8&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#37; Eos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;9 &#177; 5&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;2 &#177; 5&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab884891.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Fatores na altura do diagn&#243;stico e sua associa&#231;&#227;o com a evolu&#231;&#227;o cl&#237;nica &#40;progress&#227;o lenta <span class="elsevierStyleItalic">versus</span> r&#225;pida&#41;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">VO<span class="elsevierStyleInf">2</span>&#58; consumo de oxig&#233;nio na prova de exerc&#237;cio cardiopulmonar&#46; HR&#58; Hazard ratio</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Idade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;01 &#40;0&#44;98-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;505&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span>&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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;78 &#40;0&#44;40-1&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;451&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hist&#243;ria tab&#225;gica</span>&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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;60 &#40;0&#44;33-1&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CVF</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;96 &#40;0&#44;94-0&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CPT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;96 &#40;0&#44;94-0&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">DLCO</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;98 &#40;0&#44;96-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLCO &#60;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;97 &#40;0&#44;96-4&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLCO &#8805;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PaO</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97 &#40;0&#44;94-0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" 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="3" align="char" valign="top"><span class="elsevierStyleItalic">PM6M</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;00 &#40;0&#44;99-1&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" 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="3" align="char" valign="top"><span class="elsevierStyleItalic">PM6M</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SatO<span class="elsevierStyleInf">2</span> m&#237;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;00 &#40;0&#44;95-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;894&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SatO<span class="elsevierStyleInf">2</span> m&#237;n &#8804;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;63 &#40;0&#44;38-6&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;512&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SatO<span class="elsevierStyleInf">2</span> m&#237;n &#62;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">VO</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97 &#40;0&#44;91-1&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;244&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Score fibr&#243;tico &#40;TCAR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;08 &#40;0&#44;90-1&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;407&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" 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="3" align="char" valign="top"><span class="elsevierStyleItalic">HTP</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;10 &#40;0&#44;39-3&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;854&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#37; Linf</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;00 &#40;0&#44;95-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;999&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#37; Neut</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;03 &#40;1&#44;00-1&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#37; Eos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97 &#40;0&#44;90-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;398&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab884890.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Fatores progn&#243;sticos na sobreviv&#234;ncia dos doentes com FPI</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:59 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification and natural history of idiopathic interstitial pneumonias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;S&#46; Kim"
                            1 => "H&#46;R&#46; Collard"
                            2 => "T&#46;E&#46; King Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/pats.200601-005TK"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Am Thorac Soc"
                        "fecha" => "2006"
                        "volumen" => "3"
                        "paginaInicial" => "285"
                        "paginaFinal" => "292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16738191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American Thoracic Society&#47;European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Thoracic Society&#44; European Respiratory Society"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.165.2.ats01"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "165"
                        "paginaInicial" => "277"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11790668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official ATS&#47;ERS&#47;JRS&#47;ALAT statement&#58; Idiopathic pulmonary fibrosis&#58; evidence-based guidelines for diagnosis and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Raghu"
                            1 => "H&#46;R&#46; Collard"
                            2 => "J&#46;J&#46; Egan"
                            3 => "F&#46;J&#46; Martinez"
                            4 => "J&#46; Behr"
                            5 => "K&#46;K&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2009-040GL"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "183"
                        "paginaInicial" => "788"
                        "paginaFinal" => "824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21471066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; prevalence and clinical course of idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;R&#46; Fern&#225;ndez P&#233;rez"
                            1 => "C&#46;E&#46; Daniels"
                            2 => "D&#46;R&#46; Schroeder"
                            3 => "J&#46; St Sauver"
                            4 => "T&#46;E&#46; Hartman"
                            5 => "B&#46;J&#46; Bartholmai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-1002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "129"
                        "paginaFinal" => "137"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19749005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;K&#46; Frankel"
                            1 => "M&#46;I&#46; Schwarz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0b013e32832ea4b3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "463"
                        "paginaFinal" => "469"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19550329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histologic spectrum of idiopathic interstitial pneumonias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;W&#46; Visscher"
                            1 => "J&#46;L&#46; Myers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/pats.200602-019TK"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Am Thorac Soc"
                        "fecha" => "2006"
                        "volumen" => "3"
                        "paginaInicial" => "322"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16738196"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interstitial lung disease guideline&#58; the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;U&#46; Wells"
                            1 => "N&#46; Hirani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2008.101691"
                      "Revista" => array:7 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2008"
                        "volumen" => "63"
                        "numero" => "Suppl V"
                        "paginaInicial" => "v1"
                        "paginaFinal" => "v58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18757459"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Crytogenic fibrosing alveolitis&#58; clinical features and their influence on survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Turner-Warwick"
                            1 => "B&#46; Burrows"
                            2 => "A&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1980"
                        "volumen" => "35"
                        "paginaInicial" => "171"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7385089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinants of survival in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;A&#46; Schwartz"
                            1 => "R&#46;A&#46; Helmers"
                            2 => "J&#46;R&#46; Galvin"
                            3 => "D&#46;S&#46; Van Fossen"
                            4 => "K&#46;L&#46; Frees"
                            5 => "C&#46;S&#46; Dayton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.149.2.8306044"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1994"
                        "volumen" => "149"
                        "numero" => "2 Pt 1"
                        "paginaInicial" => "450"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8306044"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accelerated variant of idiopathic pulmonary fibrosis&#58; clinical behavior and gene expression pattern"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Selman"
                            1 => "G&#46; Carrillo"
                            2 => "A&#46; Estrada"
                            3 => "M&#46; Mejia"
                            4 => "C&#46; Becerril"
                            5 => "J&#46; Cisneros"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0000482"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2007"
                        "volumen" => "2"
                        "paginaInicial" => "e482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17534432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute exacerbations of idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;R&#46; Collard"
                            1 => "B&#46;B&#46; Moore"
                            2 => "K&#46;R&#46; Flaherty"
                            3 => "K&#46;K&#46; Brown"
                            4 => "R&#46;J&#46; Kaner"
                            5 => "T&#46;E&#46; King Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200703-463PP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "176"
                        "paginaInicial" => "636"
                        "paginaFinal" => "643"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17585107"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute exacerbation of idiopathic pulmonary fibrosis&#58; incidence&#44; risk factors and outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;W&#46; Song"
                            1 => "S&#46;B&#46; Hong"
                            2 => "C&#46;M&#46; Lim"
                            3 => "Y&#46; Koh"
                            4 => "D&#46;S&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00159709"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "356"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20595144"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in clinical and physiologic variables predict survival in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;R&#46; Collard"
                            1 => "T&#46;E&#46; King Jr&#46;"
                            2 => "B&#46;B&#46; Bartelson"
                            3 => "J&#46;S&#46; Vourlekis"
                            4 => "M&#46;I&#46; Schwarz"
                            5 => "K&#46;K&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200211-1311OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "168"
                        "paginaInicial" => "538"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12773325"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung transplantation&#58; disease-specific considerations for referral"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;D&#46; Nathan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.127.3.1006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2005"
                        "volumen" => "127"
                        "paginaInicial" => "1006"
                        "paginaFinal" => "1016"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15764787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Registry of the International Society for Heart and Lung Transplantation&#58; twenty-third official adult lung and heart-lung transplantation report &#8211; 2006"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;P&#46; Trulock"
                            1 => "L&#46;B&#46; Edwards"
                            2 => "D&#46;O&#46; Taylor"
                            3 => "M&#46;M&#46; Boucek"
                            4 => "B&#46;M&#46; Keck"
                            5 => "M&#46;I&#46; Hertz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2006.06.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "880"
                        "paginaFinal" => "892"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16890108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Standardisation of spirometry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Miller"
                            1 => "J&#46; Hankinson"
                            2 => "V&#46; Brusasco"
                            3 => "F&#46; Burgos"
                            4 => "R&#46; Casaburi"
                            5 => "A&#46; Coates"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00034805"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "319"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16055882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Standardisation of the measurement of lung volumes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Wanger"
                            1 => "J&#46;L&#46; Clausen"
                            2 => "A&#46; Coates"
                            3 => "O&#46;F&#46; Pedersen"
                            4 => "V&#46; Brusasco"
                            5 => "F&#46; Burgos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00035005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "511"
                        "paginaFinal" => "522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16135736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Standardisation of the single-breath determination of carbon monoxide uptake in the lung"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; MacIntyre"
                            1 => "R&#46;O&#46; Crapo"
                            2 => "G&#46; Viegi"
                            3 => "D&#46;C&#46; Johnson"
                            4 => "C&#46;P&#46; van der Grinten"
                            5 => "V&#46; Brusasco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00034905"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "720"
                        "paginaFinal" => "735"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16204605"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ATS statement&#58; guidelines for the six-minute walk test&#46; Am J Respir Crit Care Med 2002&#59;166&#58;111&#8211;7&#46;"
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ERS Task Force on Standardization of Clinical Exercise Testing&#44; Clinical exercise testing with reference to lung diseases&#58; indications&#44; standardization and interpretation strategies&#46; Eur Respir J 1997&#59;10&#58;2662&#8211;89&#46;"
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic Pulmonary Fibrosis&#46; A Composite Physiologic Index derived from disease extent observed by computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;U&#46; Wells"
                            1 => "S&#46;R&#46; Desai"
                            2 => "M&#46;B&#46; Rubens"
                            3 => "N&#46;S&#46; Goh"
                            4 => "D&#46; Cramer"
                            5 => "A&#46;G&#46; Nicholson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2111053"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "167"
                        "paginaInicial" => "962"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12663338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical guidelines and indications for bronchoalveolar lavage &#40;BAL&#41;&#58; Report of the European Society of Pneumology Task Force on BAL"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Klech"
                            1 => "C&#46; Hutter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1990"
                        "volumen" => "3"
                        "paginaInicial" => "937"
                        "paginaFinal" => "976"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2292291"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S014067360208649X"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "IFIGENIA Study Group High-dose acetylcysteine in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Demedts"
                            1 => "J&#46; Behr"
                            2 => "R&#46; Buhl"
                            3 => "U&#46; Costabel"
                            4 => "R&#46; Dekhuijzen"
                            5 => "H&#46;M&#46; Jansen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa042976"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "353"
                        "paginaInicial" => "2229"
                        "paginaFinal" => "2242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16306520"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary fibrosis&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46;J&#46; Dempsey"
                            1 => "K&#46;M&#46; Kerr"
                            2 => "L&#46; Gomersall"
                            3 => "H&#46; Remmen"
                            4 => "G&#46;P&#46; Currie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Q J Med"
                        "fecha" => "2006"
                        "volumen" => "99"
                        "paginaInicial" => "643"
                        "paginaFinal" => "654"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cigarette smoking&#58; a risk factor for idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;B&#46; Baumgartner"
                            1 => "J&#46;M&#46; Samet"
                            2 => "C&#46;A&#46; Stidley"
                            3 => "T&#46;V&#46; Colby"
                            4 => "J&#46;A&#46; Waldron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.155.1.9001319"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1997"
                        "volumen" => "155"
                        "paginaInicial" => "242"
                        "paginaFinal" => "248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9001319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of smoking on mechanical properties of the lungs in idiopathic pulmonary fibrosis and sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;E&#46; Hanley"
                            1 => "T&#46;E&#46; King Jr&#46;"
                            2 => "M&#46;I&#46; Schwartz"
                            3 => "L&#46;C&#46; Watters"
                            4 => "A&#46;S&#46; Shen"
                            5 => "R&#46;M&#46; Cherniack"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/144.5.1102"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1991"
                        "volumen" => "144"
                        "paginaInicial" => "1102"
                        "paginaFinal" => "1106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1952439"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fatores progn&#243;sticos em fibrose pulmonar idiop&#225;tica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Rubin"
                            1 => "J&#46;S&#46; Moreira"
                            2 => "N&#46;S&#46; Porto"
                            3 => "K&#46;L&#46; Irion"
                            4 => "R&#46;F&#46; Moreira"
                            5 => "B&#46; Scheidt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pneumol"
                        "fecha" => "2000"
                        "volumen" => "26"
                        "paginaInicial" => "227"
                        "paginaFinal" => "234"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spectrum and Diagnosis of Idiopathic Pulmonary Fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "U&#46; Maheshwari"
                            1 => "D&#46; Gupta"
                            2 => "A&#46;N&#46; Aggarwal"
                            3 => "S&#46;K&#46; Jindal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Indian J Chest Allied Sci"
                        "fecha" => "2004"
                        "volumen" => "46"
                        "paginaInicial" => "23"
                        "paginaFinal" => "26"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Combined pulmonary fibrosis and emphysema&#58; a distinct underrecognised entity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Cottin"
                            1 => "H&#46; Nunes"
                            2 => "P&#46;Y&#46; Brillet"
                            3 => "P&#46; Delaval"
                            4 => "G&#46; Devouassoux"
                            5 => "I&#46; Tillie-Leblond"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00021005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "586"
                        "paginaFinal" => "593"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16204587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary fibrosis and emphysema&#58; decreased survival associated with severe pulmonary arterial hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Mej&#237;a"
                            1 => "G&#46; Carrillo"
                            2 => "J&#46; Rojas-Serrano"
                            3 => "A&#46; Estrada"
                            4 => "T&#46; Su&#225;rez"
                            5 => "D&#46; Alonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.08-2306"
                      "Revista" => array:7 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2009"
                        "volumen" => "136"
                        "paginaInicial" => "10"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19225068"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204508702857"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting survival in idiopathic pulmonary fibrosis&#58; scoring system and survival model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;E&#46; King Jr&#46;"
                            1 => "J&#46;A&#46; Tooze"
                            2 => "M&#46;I&#46; Schwartz"
                            3 => "K&#46;R&#46; Brown"
                            4 => "R&#46;M&#46; Cherniak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.164.7.2003140"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "164"
                        "paginaInicial" => "1171"
                        "paginaFinal" => "1181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11673205"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cigarette smoke inhibits lung fibroblast proliferation and chemotaxis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Nakamura"
                            1 => "D&#46;J&#46; Romberger"
                            2 => "L&#46; Tate"
                            3 => "R&#46;F&#46; Ertl"
                            4 => "M&#46; Kawamoto"
                            5 => "Y&#46; Adachi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.151.5.7735606"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "151"
                        "paginaInicial" => "1497"
                        "paginaFinal" => "1503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7735606"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary fibrosis Outcome in relation to smoking status"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;M&#46; Antoniou"
                            1 => "D&#46;M&#46; Hansell"
                            2 => "M&#46;B&#46; Rubens"
                            3 => "K&#46; Marten"
                            4 => "S&#46;R&#46; Desai"
                            5 => "N&#46;M&#46; Siafakas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200612-1759OC"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "177"
                        "paginaInicial" => "190"
                        "paginaFinal" => "194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17962635"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0959804908008733"
                          "estado" => "S300"
                          "issn" => "09598049"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Double-blind&#44; placebo-controlled trial of pirfenidone in patients with idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Azuma"
                            1 => "T&#46; Nukiwa"
                            2 => "E&#46; Tsuboi"
                            3 => "M&#46; Suga"
                            4 => "S&#46; Abe"
                            5 => "K&#46; Nakata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200404-571OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "1040"
                        "paginaFinal" => "1047"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15665326"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical course of patients with idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Martinez"
                            1 => "S&#46; Safrin"
                            2 => "D&#46; Weycker"
                            3 => "K&#46;M&#46; Starko"
                            4 => "W&#46;Z&#46; Bradford"
                            5 => "T&#46;E&#46; King Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2005"
                        "volumen" => "142"
                        "numero" => "12 Pt I"
                        "paginaInicial" => "963"
                        "paginaFinal" => "967"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15968010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute exacerbation of idiopathic pulmonary fibrosis&#58; report of a series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Ambrosini"
                            1 => "A&#46; Cancellieri"
                            2 => "M&#46; Chilosi"
                            3 => "M&#46; Zompatori"
                            4 => "R&#46; Trisolini"
                            5 => "L&#46; Saragoni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "821"
                        "paginaFinal" => "826"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14621091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute exacerbation of idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46; Melo"
                            1 => "C&#46; Damas"
                            2 => "C&#46; Souto Moura"
                            3 => "A&#46; Morais"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "305"
                        "paginaFinal" => "312"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19280075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute exacerbation of idiopathic pulmonary fibrosis&#58; frequency and clinical features"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;S&#46; Kim"
                            1 => "J&#46;H&#46; Park"
                            2 => "B&#46;K&#46; Park"
                            3 => "J&#46;S&#46; Lee"
                            4 => "A&#46;G&#46; Nicholson"
                            5 => "T&#46; Colby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00114004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "143"
                        "paginaFinal" => "150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16387947"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical significance of histological classification of idiopathic interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;R&#46; Flaherty"
                            1 => "G&#46;B&#46; Toews"
                            2 => "W&#46;D&#46; Travis"
                            3 => "T&#46;V&#46; Colby"
                            4 => "E&#46;A&#46; Kazerooni"
                            5 => "B&#46;H&#46; Gross"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2002"
                        "volumen" => "19"
                        "paginaInicial" => "275"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11866008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fibrosing Alveolitis Sucomittee of the Research Committee of the British Thoracic Society British Thoracic Society Study on cryptogenic fibrosing alveolitis&#58; response to treatment and survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;M&#46; Rudd"
                            1 => "R&#46;J&#46; Prescott"
                            2 => "J&#46;C&#46; Chalmers"
                            3 => "I&#46;D&#46;A&#46; Johnston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.045591"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "62"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16769717"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of mortality of idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Carbone"
                            1 => "E&#46; Balleari"
                            2 => "M&#46; Grosso"
                            3 => "F&#46; Montanaro"
                            4 => "G&#46; Bottino"
                            5 => "R&#46; Ghio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Rev Med Pharmacol Sci"
                        "fecha" => "2008"
                        "volumen" => "12"
                        "paginaInicial" => "97"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18575159"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic significance of histopathologic subsets in idiopathic pulmnary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Bjoraker"
                            1 => "J&#46;H&#46; Ryu"
                            2 => "M&#46;K&#46; Edwin"
                            3 => "J&#46;L&#46; Myers"
                            4 => "H&#46;D&#46; Tazelaar"
                            5 => "D&#46;R&#46; Schroeder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.157.1.9704130"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "157"
                        "paginaInicial" => "199"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9445300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oxygen desaturation during a 4-minute step test&#58; predicting survival in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Stephan"
                            1 => "C&#46;A&#46; De Castro Pereira"
                            2 => "E&#46;M&#46; Coletta"
                            3 => "R&#46;G&#46; Ferreira"
                            4 => "J&#46;S&#46; Otta"
                            5 => "L&#46;E&#46; Nery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sarcoidosis Vasc Diffuse Lung Dis"
                        "fecha" => "2007"
                        "volumen" => "24"
                        "paginaInicial" => "70"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18069422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung function tests in patients with idiopathic pulmonary fibrosis&#46; Are they helpful for predicting outcome&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Erbes"
                            1 => "T&#46; Schaberg"
                            2 => "R&#46; Loddenkemper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1997"
                        "volumen" => "111"
                        "paginaInicial" => "51"
                        "paginaFinal" => "57"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8995992"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physiology is a stronger predictor of survival than pathology in fibrotic interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Jegal"
                            1 => "D&#46;S&#46; Kim"
                            2 => "T&#46;S&#46; Shim"
                            3 => "C&#46;M&#46; Lim"
                            4 => "S&#46; Do Lee"
                            5 => "Y&#46; Koh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200403-331OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "639"
                        "paginaFinal" => "644"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15640368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis of idiopathic pulmonary fibrosis in patients with mucous hypersecretion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Hiwatari"
                            1 => "S&#46; Shimura"
                            2 => "T&#46; Sasaki"
                            3 => "T&#46; Aikawa"
                            4 => "Y&#46; Ando"
                            5 => "H&#46; Ishihara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/143.1.182"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1991"
                        "volumen" => "143"
                        "paginaInicial" => "182"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1986676"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0959804911003248"
                          "estado" => "S300"
                          "issn" => "09598049"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impairments and prognostic factors for survival in patients with pulmonary idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Miki"
                            1 => "R&#46; Maekura"
                            2 => "T&#46; Hiraga"
                            3 => "Y&#46; Okuda"
                            4 => "T&#46; Okamoto"
                            5 => "A&#46; Hirotani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2003"
                        "volumen" => "97"
                        "paginaInicial" => "482"
                        "paginaFinal" => "490"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12735664"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary fibrosis&#58; Prognostic value of changes in physiology and six-minute-walk test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;R&#46; Flaherty"
                            1 => "A&#46;C&#46; Andrei"
                            2 => "S&#46; Murray"
                            3 => "C&#46; Fraley"
                            4 => "T&#46;V&#46; Colby"
                            5 => "W&#46;D&#46; Travis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200604-488OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "174"
                        "paginaInicial" => "803"
                        "paginaFinal" => "809"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16825656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic value of desaturation during a 6-minute-walk test in idiopathic interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;N&#46; Lama"
                            1 => "K&#46;R&#46; Flaherty"
                            2 => "G&#46;B&#46; Toews"
                            3 => "T&#46;V&#46; Colby"
                            4 => "W&#46;D&#46; Travis"
                            5 => "Q&#46; Long"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200302-219OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "168"
                        "paginaInicial" => "1084"
                        "paginaFinal" => "1090"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12917227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Six-minute-walk distance predicts waiting list survival in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;J&#46; Lederer"
                            1 => "S&#46;M&#46; Arcasoy"
                            2 => "J&#46;S&#46; Wilt"
                            3 => "F&#46; D&#8217;Ovidio"
                            4 => "J&#46;R&#46; Sonnet"
                            5 => "S&#46;M&#46; Kawut"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200604-520OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "174"
                        "paginaInicial" => "659"
                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16778159"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Walking distance on 6-MWT is a prognostic factor in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Caminati"
                            1 => "A&#46; Bianchi"
                            2 => "R&#46; Cassandro"
                            3 => "M&#46;R&#46; Mirenda"
                            4 => "S&#46; Harari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2008.07.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2009"
                        "volumen" => "103"
                        "paginaInicial" => "117"
                        "paginaFinal" => "123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18786822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Drent"
                            1 => "J&#46;A&#46; Jacobs"
                            2 => "J&#46; de Vries"
                            3 => "R&#46;J&#46; Lamers"
                            4 => "I&#46;H&#46; Liem"
                            5 => "E&#46;F&#46; Wouters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Eur Resp J"
                        "fecha" => "1999"
                        "volumen" => "13"
                        "paginaInicial" => "1344"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Baseline BAL neutrophilia predicts early mortality in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;W&#46; Kinder"
                            1 => "K&#46;K&#46; Brown"
                            2 => "M&#46;I&#46; Schwartz"
                            3 => "J&#46;H&#46; Ix"
                            4 => "A&#46; Kervitsky"
                            5 => "T&#46;E&#46; King Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-1948"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2008"
                        "volumen" => "133"
                        "paginaInicial" => "226"
                        "paginaFinal" => "232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18071016"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cell profiles of bronchoalveolar lavage fluid as prognosticators of idiopathic pulmonary fibrosis&#47;usual interstitial pneumonia among Japanese Patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Tabuena"
                            1 => "S&#46; Nagai"
                            2 => "T&#46; Tsutsumi"
                            3 => "T&#46; Handa"
                            4 => "T&#46; Minoru"
                            5 => "T&#46; Mikunyia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000087673"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2005"
                        "volumen" => "72"
                        "paginaInicial" => "490"
                        "paginaFinal" => "498"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16210888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BAL findings in idiopathic nonspecific interstitial pneumonia and usual interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Veeraraghavan"
                            1 => "P&#46;I&#46; Latsi"
                            2 => "A&#46;U&#46; Wells"
                            3 => "P&#46; Pantelidis"
                            4 => "A&#46;G&#46; Nicholson"
                            5 => "T&#46;V&#46; Colby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "239"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12952254"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;J&#46; Lettieri"
                            1 => "S&#46;D&#46; Nathan"
                            2 => "S&#46;D&#46; Barnett"
                            3 => "S&#46; Ahmad"
                            4 => "A&#46;F&#46; Shorr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.129.3.746"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "129"
                        "paginaInicial" => "746"
                        "paginaFinal" => "752"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16537877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary hypertension in patients with idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;F&#46; Nadrous"
                            1 => "P&#46;A&#46; Pellikka"
                            2 => "M&#46;J&#46; Krowka"
                            3 => "K&#46;L&#46; Swanson"
                            4 => "N&#46; Chaowalit"
                            5 => "P&#46;A&#46; Decker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.128.4.2393"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "2393"
                        "paginaFinal" => "2399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236900"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ascertainment if individual risk of mortality for patients with idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Du Bois"
                            1 => "D&#46; Weycker"
                            2 => "C&#46; Albera"
                            3 => "W&#46;Z&#46; Bradford"
                            4 => "U&#46; Costabel"
                            5 => "A&#46; Kartashov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201011-1790OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "184"
                        "paginaInicial" => "459"
                        "paginaFinal" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21616999"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary function measures predict mortality differently in IPF <span class="elsevierStyleItalic">versus</span> combined pulmonary fibrosis and emphysema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Schmidt"
                            1 => "A&#46;M&#46; Nambiar"
                            2 => "N&#46; Tayob"
                            3 => "B&#46; Sundaram"
                            4 => "M&#46;K&#46; Han"
                            5 => "B&#46;H&#46; Gross"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00114010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2011"
                        "volumen" => "38"
                        "paginaInicial" => "176"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21148225"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:3 [
        "identificador" => "xack184955"
        "titulo" => "Agradecimentos"
        "texto" => "<p id="par0260" class="elsevierStylePara elsevierViewall">Agradecimento especial &#224; Dra&#46; Carla Damas&#44; respons&#225;vel pela consulta de Transplante Pulmonar do Hospital de S&#227;o Jo&#227;o&#44; pela estreita coopera&#231;&#227;o na referencia&#231;&#227;o dos doentes com FPI para transplante&#44; quando indicado&#46;</p>"
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/08732159/0000001900000001/v2_201509041433/S0873215912000918/v2_201509041433/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9575"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Artigos originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001900000001/v2_201509041433/S0873215912000918/v2_201509041433/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000918?idApp=UINPBA00004E"
]