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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic Obstructive Pulmonary Disease &#40;COPD&#41; was the sixth-most common cause of death worldwide in 1990&#44; but is projected to become the third-most common cause by the year 2030<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#59; it is already ranked fourth in developed countries&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> with approximately 2&#46;75 million deaths per year&#44; or 4&#46;8&#37; of all deaths&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of COPD in the general population across all ages rises steeply to above 10&#37; amongst people who are aged over 40&#46; The prevalence increases considerably with age&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Portugal&#44; the previously reported prevalence was 5&#46;34&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> based on a study of 2002&#46; However&#44; this study had some methodological limitations related not only to the age range of the individuals studied &#40;35&#8211;69 years old&#41;&#44; but also to the criteria used for airway obstruction definition &#40;pre-bronchodilator fixed ratio criteria&#41; due to the absence of a bronchodilator test&#46; In fact&#44; epidemiological studies should not exclude older individuals because life expectancy in Portugal&#44; is higher than 70 years old &#40;respectively 76 and 82 years for males and females&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">COPD prevalence across the world varies considerably&#44; due to differences in methodologies&#44; sampling and diagnostic criteria for COPD&#44; and also to differences in patterns of cigarette smoking&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Accurate prevalence studies are needed to guide future projections of the burden of this disease in each country&#44; and to assist public health officials in the planning to meet the growing demand for health care resources&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The Burden of Obstructive Lung Disease &#40;BOLD&#41; Initiative developed standardized methods for estimating of COPD prevalence&#46; These methods can be used in countries at all levels of development to measure the worldwide prevalence of COPD and its risk factors in adults aged 40 years and older&#44; and to investigate variation in prevalence across countries by age&#44; gender&#44; and smoking status&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Overall 20 countries have completed their study participation and other sites are in progress&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of our study was to estimate the prevalence of COPD based on a representative sample of non-institutionalized adults aged 40 years and over&#44; carried out in Lisbon&#44; Portugal&#44; using standardized post-bronchodilator &#40;post-BD&#41; spirometry&#44; as per the BOLD protocols&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional population survey following BOLD protocol&#44; as described in detail elsewhere&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Study fieldworkers were trained and certified in study methodology&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample size</span><p id="par0045" class="elsevierStylePara elsevierViewall">A minimum sample size of 600 individuals was considered to provide an acceptable level of precision for prevalence estimates&#44; assuming simple random sampling&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population</span><p id="par0050" class="elsevierStylePara elsevierViewall">The survey was conducted among the residents of Lisbon region&#44; whose population represents nearly 27&#37; of the total Portuguese inhabitants&#44; according to the 2007 census&#46; The survey area was divided into two broad zones which are distinct regarding the demographic structure&#44; socio-economic status&#44; population density and environmental stress&#58; the inner city zone&#44; with about 800&#44;000 residents&#44; and the suburbs with about 1&#44;900&#44;000 residents&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We used a stratified&#44; multi-stage random sampling procedure&#46; In the first sampling stage&#44; 8 suburban and 4 inner-city districts were randomly selected from a total of 173 suburban and 53 inner-city districts of Lisbon&#46; In the second sampling stage&#44; households from the selected districts were randomly selected using a phone list that covered over 90&#37; of the inhabitants of the districts selected&#46; In the third sampling stage&#44; individuals from the households selected were invited to participate if they were aged 40&#43;&#46; There was also a Minimal Data&#47;Refusal questionnaire for participants who were not willing to participate in the full protocol &#40;non responders&#41;&#46; A professional survey-specialized phone-call centre was contracted to make contacts and invite participation&#46; Data were collected between 16<span class="elsevierStyleSup">th</span> of June and 7<span class="elsevierStyleSup">th</span> of November 2008&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 7123 individuals&#44; whom we attempted to contact&#44; 2776 agreed &#40;over the phone&#41; to take part in the survey&#46; From those&#44; 745 &#40;27&#37;&#41; completed the protocol &#40;core questionnaire plus post-BD spirometry&#41;&#44; but 35 participants did not meet the American Thoracic Society &#40;ATS&#41; spirometry quality control criteria&#46; Therefore&#44; 710 responders &#40;331 men and 379 women&#41; constituted the final sample for this analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Written informed consent was obtained from each participant and ethics approval was granted by Ethics Committee of Hospital Pulido Valente and by the Portuguese Data Protection Authority&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Spirometry</span><p id="par0070" class="elsevierStylePara elsevierViewall">At survey centres located in each county&#44; pre and post-BD spirometry tests were performed according to the ATS guidelines<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> by trained and certified technicians using the nddEasyOne&#8482; Spirometer &#40;ndd Medizintechnik&#59; Zurich&#44; Switzerland&#41;&#46; At least three technically acceptable manoeuvres were performed&#44; in a seated position&#44; to obtain a minimum of two reproducible spirometry tests&#44; with variability less than 200<span class="elsevierStyleHsp" style=""></span>mL&#44; for both the forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; and forced vital capacity &#40;FVC&#41;&#46; Two puffs of salbutamol &#40;200<span class="elsevierStyleHsp" style=""></span>&#956;g&#41; were administered with a metered dose inhaler connected to a spacer &#40;15<span class="elsevierStyleHsp" style=""></span>cm length&#47;2&#46;1<span class="elsevierStyleHsp" style=""></span>cm diameter&#41; and 20<span class="elsevierStyleHsp" style=""></span>min later the test &#40;post-BD spirometry&#41; was repeated&#46; Spirometry tests were defined as acceptable&#44; if they were free from artefacts&#44; sudden stops&#44; and back-extrapolated volumes greater than 5&#46;0&#37; of FVC or 150<span class="elsevierStyleHsp" style=""></span>mL&#44; whichever was greater&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Spirometry data were sent electronically to the Pulmonary Function Quality Control Centre &#40;Co-ordinating Centre in UK&#41; where each spirometry was reviewed and graded according to its quality&#44; based on criteria from the BOLD project&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Study technicians were continuously monitored and if a technician&#39;s quality-score dropped below a pre-set level&#44; he&#47;she had to stop testing and be re-trained and re-certified&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Questionnaire data</span><p id="par0080" class="elsevierStylePara elsevierViewall">All participants answered BOLD questionnaires with demographic and clinical data&#44; including doctor-diagnosed respiratory conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The original BOLD questionnaires were translated from English to Portuguese and then back-translated to assure accuracy and conceptual equivalence&#46; Questionnaires were obtained by face-to-face interview with trained and certified staff&#46; A core questionnaire was completed for all individuals considered as responders&#46; A minimal data&#47;refusal questionnaire was collected from the non-responders group&#46; Non-responders were eligible individuals who missed the core questionnaire and&#47;or post-BD spirometry&#46; By contrast responders completed both items&#46; All the questionnaires were revised for completeness&#44; accuracy and consistency within 48<span class="elsevierStyleHsp" style=""></span>hours of the interview by a team of seven certified physicians&#46; All data were sent and quality controlled by the BOLD Co-ordinating Centre in UK&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Definitions</span><p id="par0090" class="elsevierStylePara elsevierViewall">COPD was defined based on post-BD spirometry&#46; In accordance with the Global Initiative for COPD &#40;GOLD&#41; guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> a not fully reversible airway obstruction was defined&#44; as a post-BD FEV<span class="elsevierStyleInf">1</span>&#47;FVC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#46; This definition was also used for COPD stage I&#43; in the analysis&#46; Severity of COPD was defined as stage II&#43; if post-BD FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37; predicted&#44; as stage III&#43; if post-BD FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37; predicted and stage IV if post-BD FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#37;&#46; Percent predicted values<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> for Caucasian men and women were calculated using the National Health and Nutrition Examination Survey &#40;NHANES&#41; III reference equations&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">COPD diagnosis was considered based on the post-BD lung function criteria without requiring the presence of symptoms or documented exposure to a known causative agent&#44; as per BOLD protocol&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">COPD doctor&#39;s diagnosis &#40;dx&#41; was defined as the self-reported physician&#39;s diagnosis of emphysema&#44; chronic bronchitis or COPD&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Subjects were classified as current smokers&#44; ever smokers or never smokers&#46; Ever-smokers &#40;including former and current smokers&#41; were defined as individuals who smoke more than 20 packs of cigarettes in a lifetime or more than 1 cigarette per day during one year&#46; The number of pack-years of cigarette smoking was defined as the average number of cigarettes smoked per day divided by 20 &#40;i&#46;e&#46; packs per day&#41; times the duration of smoking in years&#46; Because of the low occurrence of stage IV COPD in the population samples&#44; stages III and IV were combined in this paper&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">This analysis included 710 Portuguese participants who completed the core questionnaire and who had acceptable post-BD spirometry measures&#46; Results are presented stratified by gender&#44; age-groups&#44; pack-years smoked and as totals&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Prevalence estimates were calculated for the overall Lisbon population&#44; as well as for subgroups defined by gender and either age or pack-years of cigarette smoking&#46; Because the distribution of participants in the responders&#8217; data differed slightly from that for Lisbon population&#44; the data were weighted according to age and gender group&#44; so that there would be a better match of the resulting prevalence estimates with those of Lisbon as a whole&#46; In the weighting process each subject had a weight attached to him&#44; where the weight corresponds to the number of people this subject represents in the population&#46; The weighting was used in order to overcome limitations of sample survey&#44; such as differential non-response rates&#44; or under coverage of some sub-populations&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Weighted population-based estimates of COPD prevalence and their respective 95&#37; confidence intervals &#40;C&#46;I&#46;&#41; were computed using survey data methods in STATA &#40;STATA Corporation&#44; College Station&#44; TX&#44; USA&#41;&#46; These calculations were made to assure that the estimated prevalence and the respective 95&#37; C&#46;I&#46; properly reflected the sampling design&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows that there were no differences between responders and non-responders who completed minimal data questionnaire&#44; except for gender&#44; where non-responders were predominantly male&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the main characteristics of the participants&#8217; final sample&#46; More than half of the subjects &#40;63&#46;0&#37;&#41; were 60 years or older and 53&#46;4&#37; were female&#46; Current or former smoking was more frequent in men&#44; while never smoking was more prevalent in women&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents weighted population estimate of smoking habits by age and gender &#40;unweighted data are shown in Table 3a of the electronic appendix&#41;&#46; The prevalence of total current smokers was 17&#46;9&#37; &#40;95&#37; C&#46;I&#46; 12&#46;5&#44; 25&#46;0&#41;&#46; The highest current smoking prevalence occurred in the female 40&#8211;49 year age-group &#40;33&#46;1&#37;&#44; 95&#37; C&#46;I&#46; 21&#46;0&#44; 48&#46;0&#41;&#44; decreasing with age&#46; Among men&#44; the highest prevalence was in the 50&#8211;59 year age-group&#46; Ever smoking showed the highest prevalence in men aged 70&#43; years old&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Table 4a &#40;electronic appendix&#41; shows the unweighted estimated prevalence of COPD by gender and pack years as 20&#46;2&#37; &#40;95&#37; C&#46;I&#46; 17&#46;4&#44; 23&#46;3&#41; and 9&#46;5&#37; &#40;95&#37; C&#46;I&#46; 7&#46;6&#44; 11&#46;9&#41; respectively for COPD stage I&#43; and II&#43;&#46; Overall&#44; the weighted estimated-population prevalence for GOLD stage I&#43; COPD was 14&#46;2&#37; &#40;95&#37; C&#46;I&#46; 11&#46;1&#44; 18&#46;1&#41;&#44; 18&#46;7&#37; &#40;95&#37; C&#46;I&#46; 12&#46;6&#44; 26&#46;8&#41; for males and 10&#46;5&#37; &#40;95&#37; C&#46;I&#46; 7&#46;5&#44; 14&#46;7&#41; for females &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In individuals reporting respiratory symptoms the estimated population prevalence for GOLD stage I&#43; COPD was higher&#44; respectively 19&#46;9&#37; &#40;95&#37; C&#46;I&#46; 8&#46;7&#44; 39&#46;3&#41; for chronic cough&#44; 21&#46;7&#37; &#40;95&#37; C&#46;I&#46; 13&#46;1&#44; 33&#46;7&#41; for chronic phlegm&#44; 23&#37; &#40;95&#37; C&#46;I&#46; 17&#46;3&#44; 29&#46;8&#41; for wheezing and 22&#46;7&#37; &#40;95&#37; C&#46;I&#46; 11&#46;5&#44; 39&#46;9&#41; for dyspnoea &#40;data not shown&#41;&#46; Concerning GOLD stage II&#43; COPD the estimated prevalence was 7&#46;3&#37; &#40;95&#37; C&#46;I&#46; 4&#46;7&#44; 11&#46;3&#41;&#44; and 1&#46;4&#37; &#40;95&#37; C&#46;I&#46; 0&#46;23&#44; 2&#46;47&#41; for GOLD stage III&#43;&#44; with higher levels in older people &#40;70&#43; years&#58; 5&#37;&#41;&#59; it was absent in the age group 40&#8211;49 years &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">According to <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#44; the population-estimated prevalence of GOLD stage I&#43; COPD was 9&#46;2&#37; &#40;95&#37; C&#46;I&#46; 5&#46;9&#44; 14&#46;0&#41; in participants who had never smoked and increased with the number of pack-years&#59; it was 27&#46;4&#37; &#40;95&#37; C&#46;I&#46; 18&#46;5&#44; 38&#46;5&#41; in those with a smoking history of &#8805;20 pack-years&#46; Similarly&#44; the population-estimated prevalence of GOLD stage II&#43; COPD was 4&#46;3&#37; &#40;95&#37; C&#46;I&#46; 2&#46;6&#44; 7&#46;1&#41; in never smokers and 15&#46;4&#37; &#40;95&#37; C&#46;I&#46; 7&#46;9&#44; 27&#46;8&#41; in participants with &#8805;20 pack-year&#39;s smoking history&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Overall&#44; the population-estimated prevalence of reported COPD doctor&#39;s diagnosis was much lower than COPD spirometrically defined &#40;6&#46;3&#37; versus 14&#46;2&#37;&#41;&#46; The prevalence of COPD doctor&#39;s dx was not associated with an increase of pack years of smoking &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">From the total group with COPD spirometric diagnosis&#44; 86&#46;8&#37; did not report previous COPD doctor&#39;s dx &#40;underdiagnosis&#41;&#46; On the other hand&#44; from the total group that reported previous COPD doctor&#39;s dx&#44; 61&#46;2&#37; were not confirmed by spirometric analysis &#40;overdiagnosis&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The main finding of our study is that COPD is a highly prevalent disease in Lisbon-Portugal&#44; with an estimated prevalence of 14&#46;2&#37; in adults&#44; aged 40 years or older&#46; The overall prevalence of GOLD-defined COPD was higher in men than in women&#46; COPD prevalence increased with age and smoking habits&#44; with the highest estimated prevalence in men &#40;47&#46;2&#37;&#41; 70&#43; years old&#46; Our data also support a high level of underdiagnosis &#40;86&#46;8&#37;&#41; and an unexpected high prevalence &#40;9&#46;2&#37;&#41; in never smokers&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">It is necessary to quantify COPD prevalence&#44; so as to document the effects of COPD effects on disability&#44; quality of life and health care costs&#44; and also to inform governments and public health authorities in planning to meet the growing demand for services&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;10</span></a> The BOLD initiative was developed standardized methods for estimating COPD prevalence and for obtaining data about risk factors&#46; The first BOLD report of COPD prevalence across the world showed heterogeneity between countries and genders&#46; Moreover&#44; the reported prevalence tended to be greater than those previously known&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The Lisbon BOLD survey is the first Portuguese study about COPD prevalence with a standardized methodology implemented internationally allowing comparison across countries&#46; The main strength of this survey was the use of BOLD protocol&#44; with a rigorous methodology to achieve the maximum accuracy and completeness of the survey and a high-quality post-BD spirometry&#46; This methodology ensured that data were as easy to compare as possible with other BOLD studies&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The reported low response rate &#40;27&#37;&#41; of our study was one of the main limitations&#59; this can be justified as a reactive attitude of participants to the high number of calls made by marketing companies in Portugal&#46; Nevertheless&#44; our response rate was similar to other published data sites &#40;Vancouver and Kentucky&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> which also used random-digit-dialling&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In order to make sure that the studied sample was representative of the whole target population&#44; a minimal data questionnaire was collected from the non responders&#44; making it possible to compare both groups &#40;responders&#47;non responders&#41;&#46; Except for gender&#44; there were no differences between the groups in relation to age&#44; risk factors and clinical profile&#46; To deal with the high non-response rate and also gender differences&#44; more telephone contacts were made to obtain data from at least 300 females and 300 males&#46; In addition&#44; in order to overcome the potential for response bias&#44; we used weighting for the adjustment of prevalence to the target population&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Before the BOLD results became available&#44; Portuguese official prevalence of COPD was 5&#46;34&#37;&#44; based on a study from 2002&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> Portugal Lisbon BOLD data revealed a higher value of COPD prevalence &#40;14&#46;2&#37;&#41;&#46; So far&#44; all the projections and health planning regarding COPD have been based on the previous prevalence figures meaning that the real burden of COPD has been underestimated&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Because the two studies used different methodologies&#44; their results should not be compared&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Regarding the 2002 study&#44; there were some methodological issues that make comparison impracticable&#46; In fact&#44; this study used a different source population&#44; a restrictive sample in relation to age range and also different COPD diagnosis criteria &#40;without post-BD spirometry&#41; and reference equations&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Comparing our data to the international BOLD studies we conclude that Portuguese COPD prevalence is lower than many countries prevalence&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;16&#8211;19</span></a> although similar to the prevalence of some European countries like Germany &#40;13&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and Sweden &#40;16&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> These differences could be attributed to different levels of smoking in the population&#44; or possibly other risk factors&#44; which are not analyzed here and might need further investigation &#40;e&#46;g&#46; occupation&#44; biomass&#44; air pollution&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study&#44; NHANES III equations were used to estimate the prevalence of COPD Stage II&#43;&#44; in order to allow comparisons between countries&#46; However it should be noted that the choice of the right setting of predicted equations is a matter of debate and might influence prevalence estimates&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Our data showed that COPD prevalence increases with age&#44; being higher above 70 years old&#46; It is worth noting that&#44; with ageing&#44; the prevalence in men becomes twice the prevalence in women of the same age group&#44; probably reflecting ever smoking prevalence that corresponds to the cumulative effect of tobacco&#46; Taking into account that COPD stage I&#43; is defined by the fixed ratio FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; and that this ratio falls with age in healthy individuals&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> the high prevalence found in older people could also represent overdiagnosis &#40;47&#46;2&#37; in stage I&#43; versus 17&#46;2&#37; in stage II&#43;&#41;&#46; Nevertheless&#44; we still found the same tendency for age related increase in COPD prevalence in stage II&#43;&#44; although less pronounced&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In the group of females with 10&#8211;20 pack-yr the prevalence is exactly the same for GOLD stage COPD I&#43; and II&#43; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; meaning that&#44; in our sample&#44; there were no women in the group with a FEV1&#47;FVC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>70&#37; and FEV1<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>80&#37; predicted&#46; Although unusual&#44; this data was double-checked and confirmed&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">As found in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;15&#44;18&#8211;20</span></a> there was also a positive trend with the increasing of pack-years&#44; confirming smoking as an important risk factor for the development of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In fact&#44; above 20 pack-years COPD prevalence doubles &#40;27&#46;4&#37; versus 14&#46;2&#37;&#41;&#44; representing an even higher burden of healthcare resources utilization and costs&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Another important issue of this study was the estimate of 17&#46;9&#37; for the prevalence of current smoking in Portuguese people older than 40 years old&#46; This data is consistent with the official prevalence data &#40;17&#46;2&#37;&#41; from the National Health survey of 2005&#47;2006&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The highest prevalence of smoking habits found in younger women &#40;40&#8211;49 years&#41; strengthens the future projection of an increase of COPD in women&#44; and also the need to target teenagers and young women in smoking cessation campaigns&#46; Concerning never smokers&#44; an unexpected COPD prevalence of 9&#46;2&#37; was found&#44; suggesting a possible overdiagnosis by spirometric parameters&#46; Nevertheless&#44; the COPD prevalence of 4&#46;3&#37; for stage II&#43;&#44; could be the expression of other risk factors that should also be investigated &#40;e&#46;g&#46; biomass exposure&#44; childhood respiratory tract infections&#44; past tuberculosis&#41;&#46; Moreover in some people&#44; this high prevalence might indicate asthma with remodelling in the small airways&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Similar findings have been described in other countries&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">The finding of higher levels of COPD prevalence in symptomatic subjects than in the general population was also expected<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and the need for a spirometry should be brought to the attention of primary care physicians&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In this study&#44; a gap was found between the presence of airflow obstruction defined by GOLD criteria and doctor&#39;s diagnosis&#46; Overall&#44; only 6&#46;3&#37; of the participants reported COPD doctor&#39;s diagnosis&#44; while GOLD stage I&#43; registered 14&#46;2&#37;&#46; Moreover&#44; the difference is even greater if we base our analysis on the degree of concordance between COPD doctor diagnosis and spirometric diagnosis&#46; In fact&#44; only 13&#46;2&#37; of spirometrically diagnosed COPD had been previously diagnosed &#40;underdiagnosis&#41;&#46; These data are consistent with those of Spain where&#44; despite an eventual decrease in COPD prevalence&#44; there are still high levels of underdiagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;27</span></a> Furthermore&#44; 61&#46;2&#37; of the reported cases of &#8220;COPD&#8221; declared by the participants to have been &#8220;doctor diagnosed&#8221; were not confirmed by spirometry &#40;overdiagnosis&#41;&#46; These numbers clearly show a high degree of COPD misdiagnosis and highlight the urgency to improve physicians&#8217; knowledge about COPD diagnosis&#44; and the need to emphasize the use of spirometry&#44; particularly with symptomatic subjects&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">The 14&#46;2&#37; estimated-prevalence indicates that COPD is a common disease in the Lisbon region&#46; The high prevalence of COPD with a large proportion of undiagnosed disease&#44; highlights the importance of raising awareness of COPD among health professionals&#44; and requires more use of spirometry in the primary care setting&#46; Despite ageing and smoking remain major risk factors for COPD&#44; other risk factors contributing to the presence of disease in never smokers should be investigated in future studies&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0235" class="elsevierStylePara elsevierViewall">The BOLD project in Portugal was conducted by the Respiratory Portuguese Society to the Co-ordinating Centre located at the Imperial College&#44; UK and funded by Boehringer Ingelheim and Pfizer&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The BOLD project in Portugal was conducted by the Respiratory Portuguese Society to the Co-ordinating Centre located at the Imperial College&#44; UK and funded by Boehringer Ingelheim and Pfizer&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There is a great heterogeneity in the prevalence of Chronic Obstructive Pulmonary Disease &#40;COPD&#41; across the world&#46; The Burden of Obstructive Lung Disease &#40;BOLD&#41; initiative was started to measure the prevalence of COPD in a standardized way&#46; We aimed to estimate the prevalence of COPD in Portuguese adults aged 40 years or older of a target population of 2&#44;700&#44;000 in the Lisbon region&#44; in accordance with BOLD protocol&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A stratified&#44; multi-stage random sampling procedure was used which included 12 districts&#46; The survey included a questionnaire with information on risk factors for COPD and reported respiratory disease and a post-bronchodilator spirometry performed at survey centres&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">For the 710 participants with questionnaires and acceptable spirometry&#44; the overall weighted prevalence of GOLD stage I&#43; COPD was 14&#46;2&#37; &#40;95&#37; C&#46;I&#46; 11&#46;1&#44; 18&#46;1&#41;&#44; and stage II&#43; was 7&#46;3&#37; &#40;95&#37; C&#46;I&#46; 4&#46;7&#44; 11&#46;3&#41;&#46; Unweighted prevalence was 20&#46;2&#37; &#40;95&#37; C&#46;I&#46;17&#46;4&#44; 23&#46;3&#41; for stage I&#43; and 9&#46;5&#37; &#40;95&#37; C&#46;I&#46; 7&#46;6&#44; 11&#46;9&#41; for stage II&#43;&#46; Prevalence of COPD in GOLD stage II&#43; increased with age and was higher in men&#46; The prevalence of GOLD stage I&#43; COPD was 9&#46;2&#37; &#40;95&#37; C&#46;I&#46; 5&#46;9&#44; 14&#46;0&#41; in never smokers versus 27&#46;4&#37; &#40;95&#37; C&#46;I&#46; 18&#46;5&#44; 38&#46;5&#41; in those who had smoked &#8805;20 pack-years&#46; The agreement between previous doctor diagnosis and spirometric diagnosis was low&#44; with 86&#46;8&#37; of underdiagnosed individuals&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The 14&#46;2&#37; of COPD estimated prevalence indicates that COPD is a common disease in the Lisbon region&#46; In addition&#44; a large proportion of underdiagnosed disease was detected&#46; The high prevalence of COPD with a high level of underdiagnosis&#44; points to the need of raising awareness of COPD among health professionals&#44; and requires more use of spirometry in the primary care setting&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia da doen&#231;a pulmonar obstrutiva cr&#243;nica &#40;DPOC&#41; apresenta valores muito heterog&#233;neos em todo o mundo&#46; A iniciativa <span class="elsevierStyleItalic">Burden of Obstructive Lung Disease</span> &#40;BOLD&#41; foi desenvolvida para que a preval&#234;ncia da DPOC possa ser avaliada com metodologia normalizada&#46; O objetivo deste estudo foi estimar a preval&#234;ncia da DPOC em adultos com 40 ou mais anos numa popula&#231;&#227;o alvo de 2<span class="elsevierStyleHsp" style=""></span>700<span class="elsevierStyleHsp" style=""></span>000 habitantes na regi&#227;o de Lisboa&#44; de acordo com o protocolo BOLD&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A amostra foi estratificada de forma aleat&#243;ria multifaseada selecionando-se 12 freguesias&#46; O inqu&#233;rito compreendia um question&#225;rio com informa&#231;&#227;o sobre fatores de risco para a DPOC e doen&#231;a respirat&#243;ria autoreportada&#59; adicionalmente&#44; foi efetuada espirometria com prova de broncodilata&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 710 participantes com question&#225;rio e espirometria aceit&#225;veis&#46; A preval&#234;ncia estimada da DPOC na popula&#231;&#227;o no est&#225;dio GOLD <span class="elsevierStyleSmallCaps">I</span>&#43; foi de 14&#44;2&#37; &#40;IC 95&#37;&#58; 11&#44;1&#59; 18&#44;1&#41; e de 7&#44;3&#37; no est&#225;dio <span class="elsevierStyleSmallCaps">ii</span>&#43; &#40;IC 95&#37;&#58; 4&#44;7&#59; 11&#44;3&#41;&#46; A preval&#234;ncia n&#227;o ajustada foi de 20&#44;2&#37; &#40;IC 95&#37;&#58; 17&#44;4&#59; 23&#44;3&#41; no est&#225;dio <span class="elsevierStyleSmallCaps">i</span>&#43; e de 9&#44;5&#37; &#40;IC 95&#37;&#58; 7&#44;6&#59; 11&#44;9&#41; no est&#225;dio <span class="elsevierStyleSmallCaps">ii</span>&#43;&#46; A preval&#234;ncia da DPOC no est&#225;dio GOLD <span class="elsevierStyleSmallCaps">II</span>&#43; aumentou com a idade&#44; sendo mais elevada no sexo masculino&#46; A preval&#234;ncia estimada da DPOC no est&#225;dio GOLD <span class="elsevierStyleSmallCaps">I</span>&#43; foi de 9&#44;2&#37; &#40;IC 95&#37;&#58; 5&#44;9&#59; 14&#44;0&#41; nos n&#227;o fumadores versus 27&#44;4&#37; &#40;IC 95&#37;&#58; 18&#44;5&#59; 38&#44;5&#41; nos fumadores com carga tab&#225;gica de &#8805;&#160;20 Unidades Ma&#231;o Ano&#46; Detetou-se uma fraca concord&#226;ncia entre a refer&#234;ncia a diagn&#243;stico m&#233;dico pr&#233;vio e o diagn&#243;stico espirom&#233;trico&#44; com 86&#44;8&#37; de subdiagn&#243;sticos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O achado de uma preval&#234;ncia estimada da DPOC de 14&#44;2&#37; sugere que esta &#233; uma doen&#231;a comum na regi&#227;o de Lisboa&#44; contudo com uma elevada propor&#231;&#227;o de subdiagn&#243;sticos&#46; Estes dados apontam para a necessidade de aumentar o grau de conhecimento dos profissionais de sa&#250;de sobre a DPOC&#44; bem como a necessidade de maior utiliza&#231;&#227;o da espirometria nos cuidados de sa&#250;de prim&#225;rios&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40&#8211;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">252 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>50&#8211;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">473 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>60&#8211;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">217 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">581 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>70&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">255 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">720 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">349 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1086 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">396 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">944 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Smoking status</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Former&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">197 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">449 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Doctor previous diagnosed asthma&#44; emphysema&#44; CB or COPD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>743&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">630 &#40;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250 &#40;88&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Other co-morbid conditions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">40&#8211;49 yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">50&#8211;59 yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">60&#8211;69 yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">70&#43; yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;1 &#40;20&#46;6&#44; 34&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;5 &#40;12&#46;8&#44; 54&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5 &#40;8&#46;3&#44; 27&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;0 &#40;3&#46;8&#44; 28&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;1 &#40;13&#46;5&#44; 34&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ever smokers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">57&#46;7 &#40;34&#46;5&#44; 77&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;6 &#40;49&#46;7&#44; 81&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;0 &#40;40&#46;4&#44; 65&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;4 &#40;50&#46;5&#44; 76&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;7 &#40;54&#46;3&#44; 66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;0 &#40;34&#46;7&#44; 59&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;6 &#40;23&#46;8&#44; 49&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;3 &#40;33&#46;3&#44; 45&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Female</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;1 &#40;21&#46;0&#44; 48&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;3 &#40;7&#46;3&#44; 19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;0 &#40;2&#46;7&#44; 16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;0 &#40;1&#46;0&#44; 8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4 &#40;10&#46;0&#44; 20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ever smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;0 &#40;34&#46;4&#44; 67&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1 &#40;13&#46;1&#44; 42&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;6 &#40;15&#46;4&#44; 29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;5 &#40;5&#46;9&#44; 27&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;3 &#40;21&#46;3&#44; 36&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;0 &#40;32&#46;7&#44; 65&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;9 &#40;57&#46;4&#44; 86&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;4 &#40;70&#46;6&#44; 84&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;5 &#40;72&#46;1&#44; 94&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;2 &#40;21&#46;4&#44; 40&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;4 &#40;12&#46;9&#44; 30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;9 &#40;6&#46;8&#44; 17&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0 &#40;3&#46;1&#44; 11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;9 &#40;12&#46;5&#44; 25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ever smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;2 &#40;40&#46;7&#44; 67&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;1 &#40;37&#46;1&#44; 53&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;0 &#40;30&#46;2&#44; 42&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8 &#40;24&#46;5&#44; 42&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;9 &#40;36&#46;6&#44; 49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;8 &#40;33&#46;0&#44; 59&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;9 &#40;46&#46;5&#44; 62&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0 &#40;57&#46;8&#44; 69&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;2 &#40;57&#46;7&#44; 75&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;1 &#40;50&#46;6&#44; 63&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Never smokers &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;10 pack-yr &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">10&#8211;20 pack-yr &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">20&#43; pack-yr &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">GOLD stage I&#43;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;2 &#40;5&#46;5&#44; 21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;8 &#40;6&#46;8&#44; 45&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;6 &#40;2&#46;2&#44; 28&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;9 &#40;20&#46;4&#44; 40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;7 &#40;12&#46;6&#44; 26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2 &#40;4&#46;5&#44; 12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0 &#40;0&#46;9&#44; 22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;6 &#40;6&#46;3&#44; 55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;0 &#40;8&#46;1&#44; 58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;5 &#40;7&#46;5&#44; 14&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;2 &#40;5&#46;9&#44; 14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;5 &#40;4&#46;7&#44; 25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;4 &#40;6&#46;4&#44; 26&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;4 &#40;18&#46;5&#44; 38&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;2 &#40;11&#46;1&#44; 18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">GOLD stage II&#43;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7 &#40;1&#46;4&#44; 9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6 &#40;0&#46;7&#44; 17&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3 &#40;0&#46;5&#44; 18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2 &#40;8&#46;6&#44; 31&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1 &#40;4&#46;4&#44; 17&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6 &#40;2&#46;7&#44; 7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3 &#40;0&#46;7&#44; 14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;6 &#40;6&#46;3&#44; 55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;4 &#40;3&#46;5&#44; 27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;8 &#40;3&#46;8&#44; 8&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3 &#40;2&#46;6&#44; 7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4 &#40;1&#46;3&#44; 8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;9 &#40;3&#46;4&#44; 25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;4 &#40;7&#46;9&#44; 27&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;3 &#40;4&#46;7&#44; 11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;3 &#40;0&#46;4&#44; 4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;5 &#40;0&#46;4&#44; 23&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;3 &#40;5&#46;0&#44; 58&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#46;8 &#40;5&#46;1&#44; 18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;8 &#40;3&#46;8&#44; 11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;0 &#40;3&#46;1&#44; 8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#46;4 &#40;3&#46;6&#44; 18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10&#46;9 &#40;3&#46;1&#44; 32&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#46;0 &#40;1&#46;6&#44; 20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#46;8 &#40;4&#46;4&#44; 7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;2 &#40;2&#46;4&#44; 15&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#46;1 &#40;4&#46;8&#44; 45&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;3 &#40;4&#46;7&#44; 8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0245" class="elsevierStylePara elsevierViewall">The BOLD investigators would like to thank&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0250" class="elsevierStylePara elsevierViewall">Sonia Buist &#40;Oregon Health and Sciences University&#44; Portland&#44; OR&#44; USA&#41;&#44; William Vollmer&#44; Mary Ann McBurnie and Suzanne Gillespie &#40;Kaiser Permanente Center for Health Research&#44; Portland&#44; OR&#44; USA&#41; and Robert Jensen &#40;Latter Day Saints Hospital&#44; Salt Lake City&#44; UT&#44; USA&#41; for all the support to F&#225;tima Rodrigues and Herm&#237;nia Dias in BOLD protocol&#44; including questionnaires and spirometry certification and questionnaires validation for Portuguese language&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0255" class="elsevierStylePara elsevierViewall">The UK Co-ordinating Centre staff particularly Richard Hooper&#44; Anamika Jithoo&#59; and Sonia Coton&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0260" class="elsevierStylePara elsevierViewall">The certified interviewers&#58; Ana Bandarra&#44; Andreia Machado&#44; Jo&#227;o Silva&#44; T&#226;nia Fonseca and &#194;ngela Antunes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0265" class="elsevierStylePara elsevierViewall">The certified physicians&#58; In&#234;s Faria&#44; Ana Sofia Oliveira&#44; M&#225;rcia Man&#44; Patr&#237;cia Garrido&#44; Ana Margarida Alves and Susana Carreira&#44; who participated with F&#225;tima Rodrigues in the revision of questionnaires and submission of data to <span class="elsevierStyleItalic">BOLD UK Centre</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0270" class="elsevierStylePara elsevierViewall">The certified cardiopulmonology technicians&#58; Ana Cristina Lutas&#44; Ana Sofia Cachola&#44; Andreia Carina de Jesus Cola&#231;o&#44; Andreia Descal&#231;o&#44; C&#225;tia L&#237;gia Oliveira&#44; Cl&#225;udia Pereira&#44; Daniela Ricardo&#44; Joana Quaresma&#44; Marta Landeiro&#44; Sara Matos&#44; Sara Serranho and Susana Filipa Gomes Marcelino&#44; from Escola Superior de Tecnologia da Sa&#250;de de Lisboa&#47;Instituto Polit&#233;cnico de Lisboa&#46;</p></li></ul></p> <p id="par0275" class="elsevierStylePara elsevierViewall">BOLD investigators would also like to thank Prof&#46; Doutor Ant&#243;nio Gouveia for the statistical support and Carlos Capela&#44; as sponsor project leader&#44; and everybody at Boehringer Ingelheim Portugal and Pfizer who were involved and collaborated in this project&#46;</p>"
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Original article
Chronic obstructive pulmonary disease prevalence in Lisbon, Portugal: The burden of obstructive lung disease study
Prevalência da doença pulmonar obstrutiva crónica em Lisboa, Portugal: estudo burden of obstructive lung disease
C. Bárbaraa,c,
Corresponding author
, F. Rodriguesa,c, H. Diasa,d, J. Cardosoa,e, J. Almeidaa,f, M.J. Matosa,g, P. Simãoa,h, M. Santosa,i, J.R. Ferreiraa,j, M. Gaspark, L. Gnatiucb, P. Burneyb
a Advisory Board do Projeto Burden of Obstructive Lung Disease-Portugal, Sociedade Portuguesa de Pneumologia, Portugal
b National Heart and Lung Institute, Imperial College, London, UK
c Serviço de Pneumologia II, Centro de Estudos Doenças Crónicas, Hospital Pulido Valente, Centro Hospitalar de Lisboa Norte – E.P.E., Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
d Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
e Serviço de Pneumologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central – E.P.E., Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
f Serviço de Pneumologia, Hospital de São João, Porto, Portugal
g Serviço de Pneumologia, Hospitais Universitários de Coimbra, Coimbra, Portugal
h Serviço de Pneumologia, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
i Serviço de Pneumologia, Centro Hospitalar de Coimbra, Coimbra, Portugal
j Serviço de Pneumologia, Laboratório de Função Pulmonar, Hospital das Forças Armadas, Lisboa, Portugal
k Departamento de Medicina, Boehringer Ingelheim Lda., Lisboa, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic Obstructive Pulmonary Disease &#40;COPD&#41; was the sixth-most common cause of death worldwide in 1990&#44; but is projected to become the third-most common cause by the year 2030<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#59; it is already ranked fourth in developed countries&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> with approximately 2&#46;75 million deaths per year&#44; or 4&#46;8&#37; of all deaths&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of COPD in the general population across all ages rises steeply to above 10&#37; amongst people who are aged over 40&#46; The prevalence increases considerably with age&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Portugal&#44; the previously reported prevalence was 5&#46;34&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> based on a study of 2002&#46; However&#44; this study had some methodological limitations related not only to the age range of the individuals studied &#40;35&#8211;69 years old&#41;&#44; but also to the criteria used for airway obstruction definition &#40;pre-bronchodilator fixed ratio criteria&#41; due to the absence of a bronchodilator test&#46; In fact&#44; epidemiological studies should not exclude older individuals because life expectancy in Portugal&#44; is higher than 70 years old &#40;respectively 76 and 82 years for males and females&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">COPD prevalence across the world varies considerably&#44; due to differences in methodologies&#44; sampling and diagnostic criteria for COPD&#44; and also to differences in patterns of cigarette smoking&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Accurate prevalence studies are needed to guide future projections of the burden of this disease in each country&#44; and to assist public health officials in the planning to meet the growing demand for health care resources&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The Burden of Obstructive Lung Disease &#40;BOLD&#41; Initiative developed standardized methods for estimating of COPD prevalence&#46; These methods can be used in countries at all levels of development to measure the worldwide prevalence of COPD and its risk factors in adults aged 40 years and older&#44; and to investigate variation in prevalence across countries by age&#44; gender&#44; and smoking status&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Overall 20 countries have completed their study participation and other sites are in progress&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of our study was to estimate the prevalence of COPD based on a representative sample of non-institutionalized adults aged 40 years and over&#44; carried out in Lisbon&#44; Portugal&#44; using standardized post-bronchodilator &#40;post-BD&#41; spirometry&#44; as per the BOLD protocols&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional population survey following BOLD protocol&#44; as described in detail elsewhere&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Study fieldworkers were trained and certified in study methodology&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample size</span><p id="par0045" class="elsevierStylePara elsevierViewall">A minimum sample size of 600 individuals was considered to provide an acceptable level of precision for prevalence estimates&#44; assuming simple random sampling&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population</span><p id="par0050" class="elsevierStylePara elsevierViewall">The survey was conducted among the residents of Lisbon region&#44; whose population represents nearly 27&#37; of the total Portuguese inhabitants&#44; according to the 2007 census&#46; The survey area was divided into two broad zones which are distinct regarding the demographic structure&#44; socio-economic status&#44; population density and environmental stress&#58; the inner city zone&#44; with about 800&#44;000 residents&#44; and the suburbs with about 1&#44;900&#44;000 residents&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We used a stratified&#44; multi-stage random sampling procedure&#46; In the first sampling stage&#44; 8 suburban and 4 inner-city districts were randomly selected from a total of 173 suburban and 53 inner-city districts of Lisbon&#46; In the second sampling stage&#44; households from the selected districts were randomly selected using a phone list that covered over 90&#37; of the inhabitants of the districts selected&#46; In the third sampling stage&#44; individuals from the households selected were invited to participate if they were aged 40&#43;&#46; There was also a Minimal Data&#47;Refusal questionnaire for participants who were not willing to participate in the full protocol &#40;non responders&#41;&#46; A professional survey-specialized phone-call centre was contracted to make contacts and invite participation&#46; Data were collected between 16<span class="elsevierStyleSup">th</span> of June and 7<span class="elsevierStyleSup">th</span> of November 2008&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 7123 individuals&#44; whom we attempted to contact&#44; 2776 agreed &#40;over the phone&#41; to take part in the survey&#46; From those&#44; 745 &#40;27&#37;&#41; completed the protocol &#40;core questionnaire plus post-BD spirometry&#41;&#44; but 35 participants did not meet the American Thoracic Society &#40;ATS&#41; spirometry quality control criteria&#46; Therefore&#44; 710 responders &#40;331 men and 379 women&#41; constituted the final sample for this analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Written informed consent was obtained from each participant and ethics approval was granted by Ethics Committee of Hospital Pulido Valente and by the Portuguese Data Protection Authority&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Spirometry</span><p id="par0070" class="elsevierStylePara elsevierViewall">At survey centres located in each county&#44; pre and post-BD spirometry tests were performed according to the ATS guidelines<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> by trained and certified technicians using the nddEasyOne&#8482; Spirometer &#40;ndd Medizintechnik&#59; Zurich&#44; Switzerland&#41;&#46; At least three technically acceptable manoeuvres were performed&#44; in a seated position&#44; to obtain a minimum of two reproducible spirometry tests&#44; with variability less than 200<span class="elsevierStyleHsp" style=""></span>mL&#44; for both the forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; and forced vital capacity &#40;FVC&#41;&#46; Two puffs of salbutamol &#40;200<span class="elsevierStyleHsp" style=""></span>&#956;g&#41; were administered with a metered dose inhaler connected to a spacer &#40;15<span class="elsevierStyleHsp" style=""></span>cm length&#47;2&#46;1<span class="elsevierStyleHsp" style=""></span>cm diameter&#41; and 20<span class="elsevierStyleHsp" style=""></span>min later the test &#40;post-BD spirometry&#41; was repeated&#46; Spirometry tests were defined as acceptable&#44; if they were free from artefacts&#44; sudden stops&#44; and back-extrapolated volumes greater than 5&#46;0&#37; of FVC or 150<span class="elsevierStyleHsp" style=""></span>mL&#44; whichever was greater&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Spirometry data were sent electronically to the Pulmonary Function Quality Control Centre &#40;Co-ordinating Centre in UK&#41; where each spirometry was reviewed and graded according to its quality&#44; based on criteria from the BOLD project&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Study technicians were continuously monitored and if a technician&#39;s quality-score dropped below a pre-set level&#44; he&#47;she had to stop testing and be re-trained and re-certified&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Questionnaire data</span><p id="par0080" class="elsevierStylePara elsevierViewall">All participants answered BOLD questionnaires with demographic and clinical data&#44; including doctor-diagnosed respiratory conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The original BOLD questionnaires were translated from English to Portuguese and then back-translated to assure accuracy and conceptual equivalence&#46; Questionnaires were obtained by face-to-face interview with trained and certified staff&#46; A core questionnaire was completed for all individuals considered as responders&#46; A minimal data&#47;refusal questionnaire was collected from the non-responders group&#46; Non-responders were eligible individuals who missed the core questionnaire and&#47;or post-BD spirometry&#46; By contrast responders completed both items&#46; All the questionnaires were revised for completeness&#44; accuracy and consistency within 48<span class="elsevierStyleHsp" style=""></span>hours of the interview by a team of seven certified physicians&#46; All data were sent and quality controlled by the BOLD Co-ordinating Centre in UK&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Definitions</span><p id="par0090" class="elsevierStylePara elsevierViewall">COPD was defined based on post-BD spirometry&#46; In accordance with the Global Initiative for COPD &#40;GOLD&#41; guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> a not fully reversible airway obstruction was defined&#44; as a post-BD FEV<span class="elsevierStyleInf">1</span>&#47;FVC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#46; This definition was also used for COPD stage I&#43; in the analysis&#46; Severity of COPD was defined as stage II&#43; if post-BD FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37; predicted&#44; as stage III&#43; if post-BD FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37; predicted and stage IV if post-BD FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#37;&#46; Percent predicted values<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> for Caucasian men and women were calculated using the National Health and Nutrition Examination Survey &#40;NHANES&#41; III reference equations&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">COPD diagnosis was considered based on the post-BD lung function criteria without requiring the presence of symptoms or documented exposure to a known causative agent&#44; as per BOLD protocol&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">COPD doctor&#39;s diagnosis &#40;dx&#41; was defined as the self-reported physician&#39;s diagnosis of emphysema&#44; chronic bronchitis or COPD&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Subjects were classified as current smokers&#44; ever smokers or never smokers&#46; Ever-smokers &#40;including former and current smokers&#41; were defined as individuals who smoke more than 20 packs of cigarettes in a lifetime or more than 1 cigarette per day during one year&#46; The number of pack-years of cigarette smoking was defined as the average number of cigarettes smoked per day divided by 20 &#40;i&#46;e&#46; packs per day&#41; times the duration of smoking in years&#46; Because of the low occurrence of stage IV COPD in the population samples&#44; stages III and IV were combined in this paper&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">This analysis included 710 Portuguese participants who completed the core questionnaire and who had acceptable post-BD spirometry measures&#46; Results are presented stratified by gender&#44; age-groups&#44; pack-years smoked and as totals&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Prevalence estimates were calculated for the overall Lisbon population&#44; as well as for subgroups defined by gender and either age or pack-years of cigarette smoking&#46; Because the distribution of participants in the responders&#8217; data differed slightly from that for Lisbon population&#44; the data were weighted according to age and gender group&#44; so that there would be a better match of the resulting prevalence estimates with those of Lisbon as a whole&#46; In the weighting process each subject had a weight attached to him&#44; where the weight corresponds to the number of people this subject represents in the population&#46; The weighting was used in order to overcome limitations of sample survey&#44; such as differential non-response rates&#44; or under coverage of some sub-populations&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Weighted population-based estimates of COPD prevalence and their respective 95&#37; confidence intervals &#40;C&#46;I&#46;&#41; were computed using survey data methods in STATA &#40;STATA Corporation&#44; College Station&#44; TX&#44; USA&#41;&#46; These calculations were made to assure that the estimated prevalence and the respective 95&#37; C&#46;I&#46; properly reflected the sampling design&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows that there were no differences between responders and non-responders who completed minimal data questionnaire&#44; except for gender&#44; where non-responders were predominantly male&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the main characteristics of the participants&#8217; final sample&#46; More than half of the subjects &#40;63&#46;0&#37;&#41; were 60 years or older and 53&#46;4&#37; were female&#46; Current or former smoking was more frequent in men&#44; while never smoking was more prevalent in women&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents weighted population estimate of smoking habits by age and gender &#40;unweighted data are shown in Table 3a of the electronic appendix&#41;&#46; The prevalence of total current smokers was 17&#46;9&#37; &#40;95&#37; C&#46;I&#46; 12&#46;5&#44; 25&#46;0&#41;&#46; The highest current smoking prevalence occurred in the female 40&#8211;49 year age-group &#40;33&#46;1&#37;&#44; 95&#37; C&#46;I&#46; 21&#46;0&#44; 48&#46;0&#41;&#44; decreasing with age&#46; Among men&#44; the highest prevalence was in the 50&#8211;59 year age-group&#46; Ever smoking showed the highest prevalence in men aged 70&#43; years old&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Table 4a &#40;electronic appendix&#41; shows the unweighted estimated prevalence of COPD by gender and pack years as 20&#46;2&#37; &#40;95&#37; C&#46;I&#46; 17&#46;4&#44; 23&#46;3&#41; and 9&#46;5&#37; &#40;95&#37; C&#46;I&#46; 7&#46;6&#44; 11&#46;9&#41; respectively for COPD stage I&#43; and II&#43;&#46; Overall&#44; the weighted estimated-population prevalence for GOLD stage I&#43; COPD was 14&#46;2&#37; &#40;95&#37; C&#46;I&#46; 11&#46;1&#44; 18&#46;1&#41;&#44; 18&#46;7&#37; &#40;95&#37; C&#46;I&#46; 12&#46;6&#44; 26&#46;8&#41; for males and 10&#46;5&#37; &#40;95&#37; C&#46;I&#46; 7&#46;5&#44; 14&#46;7&#41; for females &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In individuals reporting respiratory symptoms the estimated population prevalence for GOLD stage I&#43; COPD was higher&#44; respectively 19&#46;9&#37; &#40;95&#37; C&#46;I&#46; 8&#46;7&#44; 39&#46;3&#41; for chronic cough&#44; 21&#46;7&#37; &#40;95&#37; C&#46;I&#46; 13&#46;1&#44; 33&#46;7&#41; for chronic phlegm&#44; 23&#37; &#40;95&#37; C&#46;I&#46; 17&#46;3&#44; 29&#46;8&#41; for wheezing and 22&#46;7&#37; &#40;95&#37; C&#46;I&#46; 11&#46;5&#44; 39&#46;9&#41; for dyspnoea &#40;data not shown&#41;&#46; Concerning GOLD stage II&#43; COPD the estimated prevalence was 7&#46;3&#37; &#40;95&#37; C&#46;I&#46; 4&#46;7&#44; 11&#46;3&#41;&#44; and 1&#46;4&#37; &#40;95&#37; C&#46;I&#46; 0&#46;23&#44; 2&#46;47&#41; for GOLD stage III&#43;&#44; with higher levels in older people &#40;70&#43; years&#58; 5&#37;&#41;&#59; it was absent in the age group 40&#8211;49 years &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">According to <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#44; the population-estimated prevalence of GOLD stage I&#43; COPD was 9&#46;2&#37; &#40;95&#37; C&#46;I&#46; 5&#46;9&#44; 14&#46;0&#41; in participants who had never smoked and increased with the number of pack-years&#59; it was 27&#46;4&#37; &#40;95&#37; C&#46;I&#46; 18&#46;5&#44; 38&#46;5&#41; in those with a smoking history of &#8805;20 pack-years&#46; Similarly&#44; the population-estimated prevalence of GOLD stage II&#43; COPD was 4&#46;3&#37; &#40;95&#37; C&#46;I&#46; 2&#46;6&#44; 7&#46;1&#41; in never smokers and 15&#46;4&#37; &#40;95&#37; C&#46;I&#46; 7&#46;9&#44; 27&#46;8&#41; in participants with &#8805;20 pack-year&#39;s smoking history&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Overall&#44; the population-estimated prevalence of reported COPD doctor&#39;s diagnosis was much lower than COPD spirometrically defined &#40;6&#46;3&#37; versus 14&#46;2&#37;&#41;&#46; The prevalence of COPD doctor&#39;s dx was not associated with an increase of pack years of smoking &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">From the total group with COPD spirometric diagnosis&#44; 86&#46;8&#37; did not report previous COPD doctor&#39;s dx &#40;underdiagnosis&#41;&#46; On the other hand&#44; from the total group that reported previous COPD doctor&#39;s dx&#44; 61&#46;2&#37; were not confirmed by spirometric analysis &#40;overdiagnosis&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The main finding of our study is that COPD is a highly prevalent disease in Lisbon-Portugal&#44; with an estimated prevalence of 14&#46;2&#37; in adults&#44; aged 40 years or older&#46; The overall prevalence of GOLD-defined COPD was higher in men than in women&#46; COPD prevalence increased with age and smoking habits&#44; with the highest estimated prevalence in men &#40;47&#46;2&#37;&#41; 70&#43; years old&#46; Our data also support a high level of underdiagnosis &#40;86&#46;8&#37;&#41; and an unexpected high prevalence &#40;9&#46;2&#37;&#41; in never smokers&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">It is necessary to quantify COPD prevalence&#44; so as to document the effects of COPD effects on disability&#44; quality of life and health care costs&#44; and also to inform governments and public health authorities in planning to meet the growing demand for services&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;10</span></a> The BOLD initiative was developed standardized methods for estimating COPD prevalence and for obtaining data about risk factors&#46; The first BOLD report of COPD prevalence across the world showed heterogeneity between countries and genders&#46; Moreover&#44; the reported prevalence tended to be greater than those previously known&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The Lisbon BOLD survey is the first Portuguese study about COPD prevalence with a standardized methodology implemented internationally allowing comparison across countries&#46; The main strength of this survey was the use of BOLD protocol&#44; with a rigorous methodology to achieve the maximum accuracy and completeness of the survey and a high-quality post-BD spirometry&#46; This methodology ensured that data were as easy to compare as possible with other BOLD studies&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The reported low response rate &#40;27&#37;&#41; of our study was one of the main limitations&#59; this can be justified as a reactive attitude of participants to the high number of calls made by marketing companies in Portugal&#46; Nevertheless&#44; our response rate was similar to other published data sites &#40;Vancouver and Kentucky&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> which also used random-digit-dialling&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In order to make sure that the studied sample was representative of the whole target population&#44; a minimal data questionnaire was collected from the non responders&#44; making it possible to compare both groups &#40;responders&#47;non responders&#41;&#46; Except for gender&#44; there were no differences between the groups in relation to age&#44; risk factors and clinical profile&#46; To deal with the high non-response rate and also gender differences&#44; more telephone contacts were made to obtain data from at least 300 females and 300 males&#46; In addition&#44; in order to overcome the potential for response bias&#44; we used weighting for the adjustment of prevalence to the target population&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Before the BOLD results became available&#44; Portuguese official prevalence of COPD was 5&#46;34&#37;&#44; based on a study from 2002&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> Portugal Lisbon BOLD data revealed a higher value of COPD prevalence &#40;14&#46;2&#37;&#41;&#46; So far&#44; all the projections and health planning regarding COPD have been based on the previous prevalence figures meaning that the real burden of COPD has been underestimated&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Because the two studies used different methodologies&#44; their results should not be compared&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Regarding the 2002 study&#44; there were some methodological issues that make comparison impracticable&#46; In fact&#44; this study used a different source population&#44; a restrictive sample in relation to age range and also different COPD diagnosis criteria &#40;without post-BD spirometry&#41; and reference equations&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Comparing our data to the international BOLD studies we conclude that Portuguese COPD prevalence is lower than many countries prevalence&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;16&#8211;19</span></a> although similar to the prevalence of some European countries like Germany &#40;13&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and Sweden &#40;16&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> These differences could be attributed to different levels of smoking in the population&#44; or possibly other risk factors&#44; which are not analyzed here and might need further investigation &#40;e&#46;g&#46; occupation&#44; biomass&#44; air pollution&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study&#44; NHANES III equations were used to estimate the prevalence of COPD Stage II&#43;&#44; in order to allow comparisons between countries&#46; However it should be noted that the choice of the right setting of predicted equations is a matter of debate and might influence prevalence estimates&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Our data showed that COPD prevalence increases with age&#44; being higher above 70 years old&#46; It is worth noting that&#44; with ageing&#44; the prevalence in men becomes twice the prevalence in women of the same age group&#44; probably reflecting ever smoking prevalence that corresponds to the cumulative effect of tobacco&#46; Taking into account that COPD stage I&#43; is defined by the fixed ratio FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; and that this ratio falls with age in healthy individuals&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> the high prevalence found in older people could also represent overdiagnosis &#40;47&#46;2&#37; in stage I&#43; versus 17&#46;2&#37; in stage II&#43;&#41;&#46; Nevertheless&#44; we still found the same tendency for age related increase in COPD prevalence in stage II&#43;&#44; although less pronounced&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In the group of females with 10&#8211;20 pack-yr the prevalence is exactly the same for GOLD stage COPD I&#43; and II&#43; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; meaning that&#44; in our sample&#44; there were no women in the group with a FEV1&#47;FVC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>70&#37; and FEV1<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>80&#37; predicted&#46; Although unusual&#44; this data was double-checked and confirmed&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">As found in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;15&#44;18&#8211;20</span></a> there was also a positive trend with the increasing of pack-years&#44; confirming smoking as an important risk factor for the development of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In fact&#44; above 20 pack-years COPD prevalence doubles &#40;27&#46;4&#37; versus 14&#46;2&#37;&#41;&#44; representing an even higher burden of healthcare resources utilization and costs&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Another important issue of this study was the estimate of 17&#46;9&#37; for the prevalence of current smoking in Portuguese people older than 40 years old&#46; This data is consistent with the official prevalence data &#40;17&#46;2&#37;&#41; from the National Health survey of 2005&#47;2006&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The highest prevalence of smoking habits found in younger women &#40;40&#8211;49 years&#41; strengthens the future projection of an increase of COPD in women&#44; and also the need to target teenagers and young women in smoking cessation campaigns&#46; Concerning never smokers&#44; an unexpected COPD prevalence of 9&#46;2&#37; was found&#44; suggesting a possible overdiagnosis by spirometric parameters&#46; Nevertheless&#44; the COPD prevalence of 4&#46;3&#37; for stage II&#43;&#44; could be the expression of other risk factors that should also be investigated &#40;e&#46;g&#46; biomass exposure&#44; childhood respiratory tract infections&#44; past tuberculosis&#41;&#46; Moreover in some people&#44; this high prevalence might indicate asthma with remodelling in the small airways&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Similar findings have been described in other countries&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">The finding of higher levels of COPD prevalence in symptomatic subjects than in the general population was also expected<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and the need for a spirometry should be brought to the attention of primary care physicians&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In this study&#44; a gap was found between the presence of airflow obstruction defined by GOLD criteria and doctor&#39;s diagnosis&#46; Overall&#44; only 6&#46;3&#37; of the participants reported COPD doctor&#39;s diagnosis&#44; while GOLD stage I&#43; registered 14&#46;2&#37;&#46; Moreover&#44; the difference is even greater if we base our analysis on the degree of concordance between COPD doctor diagnosis and spirometric diagnosis&#46; In fact&#44; only 13&#46;2&#37; of spirometrically diagnosed COPD had been previously diagnosed &#40;underdiagnosis&#41;&#46; These data are consistent with those of Spain where&#44; despite an eventual decrease in COPD prevalence&#44; there are still high levels of underdiagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;27</span></a> Furthermore&#44; 61&#46;2&#37; of the reported cases of &#8220;COPD&#8221; declared by the participants to have been &#8220;doctor diagnosed&#8221; were not confirmed by spirometry &#40;overdiagnosis&#41;&#46; These numbers clearly show a high degree of COPD misdiagnosis and highlight the urgency to improve physicians&#8217; knowledge about COPD diagnosis&#44; and the need to emphasize the use of spirometry&#44; particularly with symptomatic subjects&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">The 14&#46;2&#37; estimated-prevalence indicates that COPD is a common disease in the Lisbon region&#46; The high prevalence of COPD with a large proportion of undiagnosed disease&#44; highlights the importance of raising awareness of COPD among health professionals&#44; and requires more use of spirometry in the primary care setting&#46; Despite ageing and smoking remain major risk factors for COPD&#44; other risk factors contributing to the presence of disease in never smokers should be investigated in future studies&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0235" class="elsevierStylePara elsevierViewall">The BOLD project in Portugal was conducted by the Respiratory Portuguese Society to the Co-ordinating Centre located at the Imperial College&#44; UK and funded by Boehringer Ingelheim and Pfizer&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The BOLD project in Portugal was conducted by the Respiratory Portuguese Society to the Co-ordinating Centre located at the Imperial College&#44; UK and funded by Boehringer Ingelheim and Pfizer&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There is a great heterogeneity in the prevalence of Chronic Obstructive Pulmonary Disease &#40;COPD&#41; across the world&#46; The Burden of Obstructive Lung Disease &#40;BOLD&#41; initiative was started to measure the prevalence of COPD in a standardized way&#46; We aimed to estimate the prevalence of COPD in Portuguese adults aged 40 years or older of a target population of 2&#44;700&#44;000 in the Lisbon region&#44; in accordance with BOLD protocol&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A stratified&#44; multi-stage random sampling procedure was used which included 12 districts&#46; The survey included a questionnaire with information on risk factors for COPD and reported respiratory disease and a post-bronchodilator spirometry performed at survey centres&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">For the 710 participants with questionnaires and acceptable spirometry&#44; the overall weighted prevalence of GOLD stage I&#43; COPD was 14&#46;2&#37; &#40;95&#37; C&#46;I&#46; 11&#46;1&#44; 18&#46;1&#41;&#44; and stage II&#43; was 7&#46;3&#37; &#40;95&#37; C&#46;I&#46; 4&#46;7&#44; 11&#46;3&#41;&#46; Unweighted prevalence was 20&#46;2&#37; &#40;95&#37; C&#46;I&#46;17&#46;4&#44; 23&#46;3&#41; for stage I&#43; and 9&#46;5&#37; &#40;95&#37; C&#46;I&#46; 7&#46;6&#44; 11&#46;9&#41; for stage II&#43;&#46; Prevalence of COPD in GOLD stage II&#43; increased with age and was higher in men&#46; The prevalence of GOLD stage I&#43; COPD was 9&#46;2&#37; &#40;95&#37; C&#46;I&#46; 5&#46;9&#44; 14&#46;0&#41; in never smokers versus 27&#46;4&#37; &#40;95&#37; C&#46;I&#46; 18&#46;5&#44; 38&#46;5&#41; in those who had smoked &#8805;20 pack-years&#46; The agreement between previous doctor diagnosis and spirometric diagnosis was low&#44; with 86&#46;8&#37; of underdiagnosed individuals&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The 14&#46;2&#37; of COPD estimated prevalence indicates that COPD is a common disease in the Lisbon region&#46; In addition&#44; a large proportion of underdiagnosed disease was detected&#46; The high prevalence of COPD with a high level of underdiagnosis&#44; points to the need of raising awareness of COPD among health professionals&#44; and requires more use of spirometry in the primary care setting&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia da doen&#231;a pulmonar obstrutiva cr&#243;nica &#40;DPOC&#41; apresenta valores muito heterog&#233;neos em todo o mundo&#46; A iniciativa <span class="elsevierStyleItalic">Burden of Obstructive Lung Disease</span> &#40;BOLD&#41; foi desenvolvida para que a preval&#234;ncia da DPOC possa ser avaliada com metodologia normalizada&#46; O objetivo deste estudo foi estimar a preval&#234;ncia da DPOC em adultos com 40 ou mais anos numa popula&#231;&#227;o alvo de 2<span class="elsevierStyleHsp" style=""></span>700<span class="elsevierStyleHsp" style=""></span>000 habitantes na regi&#227;o de Lisboa&#44; de acordo com o protocolo BOLD&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A amostra foi estratificada de forma aleat&#243;ria multifaseada selecionando-se 12 freguesias&#46; O inqu&#233;rito compreendia um question&#225;rio com informa&#231;&#227;o sobre fatores de risco para a DPOC e doen&#231;a respirat&#243;ria autoreportada&#59; adicionalmente&#44; foi efetuada espirometria com prova de broncodilata&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 710 participantes com question&#225;rio e espirometria aceit&#225;veis&#46; A preval&#234;ncia estimada da DPOC na popula&#231;&#227;o no est&#225;dio GOLD <span class="elsevierStyleSmallCaps">I</span>&#43; foi de 14&#44;2&#37; &#40;IC 95&#37;&#58; 11&#44;1&#59; 18&#44;1&#41; e de 7&#44;3&#37; no est&#225;dio <span class="elsevierStyleSmallCaps">ii</span>&#43; &#40;IC 95&#37;&#58; 4&#44;7&#59; 11&#44;3&#41;&#46; A preval&#234;ncia n&#227;o ajustada foi de 20&#44;2&#37; &#40;IC 95&#37;&#58; 17&#44;4&#59; 23&#44;3&#41; no est&#225;dio <span class="elsevierStyleSmallCaps">i</span>&#43; e de 9&#44;5&#37; &#40;IC 95&#37;&#58; 7&#44;6&#59; 11&#44;9&#41; no est&#225;dio <span class="elsevierStyleSmallCaps">ii</span>&#43;&#46; A preval&#234;ncia da DPOC no est&#225;dio GOLD <span class="elsevierStyleSmallCaps">II</span>&#43; aumentou com a idade&#44; sendo mais elevada no sexo masculino&#46; A preval&#234;ncia estimada da DPOC no est&#225;dio GOLD <span class="elsevierStyleSmallCaps">I</span>&#43; foi de 9&#44;2&#37; &#40;IC 95&#37;&#58; 5&#44;9&#59; 14&#44;0&#41; nos n&#227;o fumadores versus 27&#44;4&#37; &#40;IC 95&#37;&#58; 18&#44;5&#59; 38&#44;5&#41; nos fumadores com carga tab&#225;gica de &#8805;&#160;20 Unidades Ma&#231;o Ano&#46; Detetou-se uma fraca concord&#226;ncia entre a refer&#234;ncia a diagn&#243;stico m&#233;dico pr&#233;vio e o diagn&#243;stico espirom&#233;trico&#44; com 86&#44;8&#37; de subdiagn&#243;sticos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O achado de uma preval&#234;ncia estimada da DPOC de 14&#44;2&#37; sugere que esta &#233; uma doen&#231;a comum na regi&#227;o de Lisboa&#44; contudo com uma elevada propor&#231;&#227;o de subdiagn&#243;sticos&#46; Estes dados apontam para a necessidade de aumentar o grau de conhecimento dos profissionais de sa&#250;de sobre a DPOC&#44; bem como a necessidade de maior utiliza&#231;&#227;o da espirometria nos cuidados de sa&#250;de prim&#225;rios&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Non-responders<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40&#8211;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">252 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>50&#8211;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">473 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>60&#8211;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">217 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">581 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>70&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">255 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">720 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">349 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1086 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">396 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">944 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Smoking status</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Former&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">197 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">449 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Doctor previous diagnosed asthma&#44; emphysema&#44; CB or COPD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>743&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">630 &#40;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250 &#40;88&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Other co-morbid conditions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>745&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">40&#8211;49 yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">50&#8211;59 yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">60&#8211;69 yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">70&#43; yr&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;1 &#40;20&#46;6&#44; 34&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;5 &#40;12&#46;8&#44; 54&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5 &#40;8&#46;3&#44; 27&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;0 &#40;3&#46;8&#44; 28&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;1 &#40;13&#46;5&#44; 34&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;7 &#40;34&#46;5&#44; 77&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;6 &#40;49&#46;7&#44; 81&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;0 &#40;40&#46;4&#44; 65&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;4 &#40;50&#46;5&#44; 76&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;7 &#40;54&#46;3&#44; 66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never smokers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;0 &#40;34&#46;7&#44; 59&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;6 &#40;23&#46;8&#44; 49&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;3 &#40;33&#46;3&#44; 45&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Female</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;1 &#40;21&#46;0&#44; 48&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;3 &#40;7&#46;3&#44; 19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;0 &#40;2&#46;7&#44; 16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;0 &#40;1&#46;0&#44; 8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4 &#40;10&#46;0&#44; 20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ever smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;0 &#40;34&#46;4&#44; 67&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1 &#40;13&#46;1&#44; 42&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;6 &#40;15&#46;4&#44; 29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;5 &#40;5&#46;9&#44; 27&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;3 &#40;21&#46;3&#44; 36&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;0 &#40;32&#46;7&#44; 65&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;9 &#40;6&#46;8&#44; 17&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;9 &#40;12&#46;5&#44; 25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ever smokers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;2 &#40;40&#46;7&#44; 67&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;1 &#40;37&#46;1&#44; 53&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;0 &#40;30&#46;2&#44; 42&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8 &#40;24&#46;5&#44; 42&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;9 &#40;36&#46;6&#44; 49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never smokers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;9 &#40;46&#46;5&#44; 62&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0 &#40;57&#46;8&#44; 69&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;2 &#40;57&#46;7&#44; 75&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;1 &#40;50&#46;6&#44; 63&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;10 pack-yr &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">10&#8211;20 pack-yr &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;2 &#40;5&#46;5&#44; 21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;9 &#40;20&#46;4&#44; 40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;2 &#40;11&#46;1&#44; 18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">GOLD stage II&#43;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7 &#40;1&#46;4&#44; 9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6 &#40;0&#46;7&#44; 17&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3 &#40;0&#46;5&#44; 18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2 &#40;8&#46;6&#44; 31&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1 &#40;4&#46;4&#44; 17&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6 &#40;2&#46;7&#44; 7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3 &#40;0&#46;7&#44; 14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;6 &#40;6&#46;3&#44; 55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;4 &#40;3&#46;5&#44; 27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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        "texto" => "<p id="par0245" class="elsevierStylePara elsevierViewall">The BOLD investigators would like to thank&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0250" class="elsevierStylePara elsevierViewall">Sonia Buist &#40;Oregon Health and Sciences University&#44; Portland&#44; OR&#44; USA&#41;&#44; William Vollmer&#44; Mary Ann McBurnie and Suzanne Gillespie &#40;Kaiser Permanente Center for Health Research&#44; Portland&#44; OR&#44; USA&#41; and Robert Jensen &#40;Latter Day Saints Hospital&#44; Salt Lake City&#44; UT&#44; USA&#41; for all the support to F&#225;tima Rodrigues and Herm&#237;nia Dias in BOLD protocol&#44; including questionnaires and spirometry certification and questionnaires validation for Portuguese language&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0255" class="elsevierStylePara elsevierViewall">The UK Co-ordinating Centre staff particularly Richard Hooper&#44; Anamika Jithoo&#59; and Sonia Coton&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0260" class="elsevierStylePara elsevierViewall">The certified interviewers&#58; Ana Bandarra&#44; Andreia Machado&#44; Jo&#227;o Silva&#44; T&#226;nia Fonseca and &#194;ngela Antunes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0265" class="elsevierStylePara elsevierViewall">The certified physicians&#58; In&#234;s Faria&#44; Ana Sofia Oliveira&#44; M&#225;rcia Man&#44; Patr&#237;cia Garrido&#44; Ana Margarida Alves and Susana Carreira&#44; who participated with F&#225;tima Rodrigues in the revision of questionnaires and submission of data to <span class="elsevierStyleItalic">BOLD UK Centre</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0270" class="elsevierStylePara elsevierViewall">The certified cardiopulmonology technicians&#58; Ana Cristina Lutas&#44; Ana Sofia Cachola&#44; Andreia Carina de Jesus Cola&#231;o&#44; Andreia Descal&#231;o&#44; C&#225;tia L&#237;gia Oliveira&#44; Cl&#225;udia Pereira&#44; Daniela Ricardo&#44; Joana Quaresma&#44; Marta Landeiro&#44; Sara Matos&#44; Sara Serranho and Susana Filipa Gomes Marcelino&#44; from Escola Superior de Tecnologia da Sa&#250;de de Lisboa&#47;Instituto Polit&#233;cnico de Lisboa&#46;</p></li></ul></p> <p id="par0275" class="elsevierStylePara elsevierViewall">BOLD investigators would also like to thank Prof&#46; Doutor Ant&#243;nio Gouveia for the statistical support and Carlos Capela&#44; as sponsor project leader&#44; and everybody at Boehringer Ingelheim Portugal and Pfizer who were involved and collaborated in this project&#46;</p>"
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Article information
ISSN: 21735115
Original language: English
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Pulmonology

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