Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers: Preliminary study

array:23 ["pii" => "S2173511515000330" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2014.07.007" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1035" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2014" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:126-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1562 "formatos" => array:3 [ "EPUB" => 228 "HTML" => 821 "PDF" => 513 ] ] "itemSiguiente" => array:18 [ "pii" => "S2173511515000366" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2014.08.005" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1037" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:132-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1564 "formatos" => array:3 [ "EPUB" => 235 "HTML" => 726 "PDF" => 603 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Clinical impact of adaptive servoventilation compared to other ventilatory modes in patients with treatment-emergent sleep apnea, central sleep apnea and Cheyne–Stokes respiration" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "132" "paginaFinal" => "137" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1578 "Ancho" => 1593 "Tamanyo" => 70996 ] ] "descripcion" => array:1 [ "en" => "Impact of adaptive servoventilation (ASV) treatment on apnea hipbones index (AHI) (events/h)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sílvia Correia, Vitória Martins, Liliana Sousa, Joaquim Moita, Fátima Teixeira, José Moutinho dos Santos" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Sílvia" "apellidos" => "Correia" ] 1 => array:2 [ "nombre" => "Vitória" "apellidos" => "Martins" ] 2 => array:2 [ "nombre" => "Liliana" "apellidos" => "Sousa" ] 3 => array:2 [ "nombre" => "Joaquim" "apellidos" => "Moita" ] 4 => array:2 [ "nombre" => "Fátima" "apellidos" => "Teixeira" ] 5 => array:2 [ "nombre" => "José Moutinho" "apellidos" => "dos Santos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000366?idApp=UINPBA00004E" "url" => "/21735115/0000002100000003/v2_201505070217/S2173511515000366/v2_201505070217/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S217351151500038X" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2014.09.009" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1039" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:113-25" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1885 "formatos" => array:3 [ "EPUB" => 201 "HTML" => 1174 "PDF" => 510 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Lung adenocarcinoma: Sustained subtyping with immunohistochemistry and EGFR, HER2 and KRAS mutational status" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113" "paginaFinal" => "125" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 586 "Ancho" => 995 "Tamanyo" => 57900 ] ] "descripcion" => array:1 [ "en" => "Case 7: FISH positive for EGFR/chromosome 7 centromere. Gene high polysomy; EGFR – red signal, chromosome 7-green. 1000×." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vitor Sousa, Carolina Rodrigues, Maria Silva, Ana Maria Alarcão, Lina Carvalho" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Vitor" "apellidos" => "Sousa" ] 1 => array:2 [ "nombre" => "Carolina" "apellidos" => "Rodrigues" ] 2 => array:2 [ "nombre" => "Maria" "apellidos" => "Silva" ] 3 => array:2 [ "nombre" => "Ana Maria" "apellidos" => "Alarcão" ] 4 => array:2 [ "nombre" => "Lina" "apellidos" => "Carvalho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151500038X?idApp=UINPBA00004E" "url" => "/21735115/0000002100000003/v2_201505070217/S217351151500038X/v2_201505070217/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers: Preliminary study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "126" "paginaFinal" => "131" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Gomes, F. Luís, A. Tavares, N. Sousa, S. Correia, M. Reis" "autores" => array:6 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Gomes" "email" => array:2 [ 0 => "gomes.rita.dm@gmail.com" 1 => "ritad_gomes@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Luís" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Tavares" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "N." "apellidos" => "Sousa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Correia" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Reis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionSmoking has devastating health effects and is a recognized risk factor for the development of cardiovascular, cerebrovascular, respiratory, and oncological diseases.<a class="elsevierStyleCrossRef" href="#bib0040">1</a> The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the diagnosis of chronic obstructive pulmonary disease (COPD) based on a reduction in the FEV1/FVC ratio.<a class="elsevierStyleCrossRef" href="#bib0045">2</a> However, this diagnostic criterion is valid only for advanced COPD, leading to the underdiagnosis of early functional changes in chronic smoking.<a class="elsevierStyleCrossRef" href="#bib0050">3</a> There are few studies concerning pulmonary function alterations in smokers and the deleterious effects of smoking on functional parameters vary, depending on the studies.Cigarette smoking has a detrimental effect on the airways, causing inflammation and, consequently, airflow limitations and lung hyperinflation.<a class="elsevierStyleCrossRefs" href="#bib0055">4,5</a> In thoracic radiographs, one sign of lung hyperinflation is the reduction in the cardiothoracic index (‘heart in gout’). Some authors claim that a reduction in FEV1 is more than just a measure of airflow limitation, that it is, in fact, a marker of premature death, with a wideranging utility in assessing the risks of COPD, lung cancer, coronary artery disease, and stroke, which collectively account for 70–80% of premature deaths in smokers.<a class="elsevierStyleCrossRef" href="#bib0065">6</a> Some studies have encouraged the use of new methods in the detection of precursory anomalies of pulmonary disease during the subclinical phase in patients at risk.The authors present a case control study developed in outpatient clinic with the smoking cessation program at Sousa Martins Hospital (HSM), Local Health Unit, Guarda (Portugal). The main objective of our study was to investigate the respiratory function and lung hyperinflation in asymptomatic smokers without a history of lung pathology and with normal chest radiographs. Secondary objectives consisted of identifying tobacco-related diseases and correlating tobacco consumption, duration of exposure to tobacco smoke, and urinary cotinine with the existence of tobacco-related disease.Materials and methodsThe authors developed a case-controlled study paired by sex, age and body mass index. The cases were defined as smokers (with a smoking habit for at least one year), who presented for their first appointment at the smoking cessation program at HSM during the period of 11 December 2012 to 8 December 2013, without respiratory symptoms and with normal chest radiographs. Smoking subgroups were integrated using evidence of the history of tobacco-related pathology. The exclusion criterion was applied to cases previously diagnosed with pulmonary pathology.The controls were participants who exhibited normal examination in plethysmography and chest radiographs in HSM. The following exclusion criteria were applied to the controls: known prior history of pulmonary pathology and current and/or past smoking. In the controls, maximum passive exposure was assumed for the determination of carbon monoxide (CO) in the exhaled air (0–6ppm) and urinary cotinine (<150ng/mL).The pulmonary function tests were performed using the Plethysmograph Autobox DI SensorMedics 6200 (California, USA) at the Department of Pathophysiology of Respiratory Diseases at HSM. The technical recommendations and standardized reference values of the American Thoracic Society were used to perform the functional tests. A chest X-ray was obtained while the patient was in the standing and forward positions at maximal inspiration, which complies with the criteria for good technical quality. The ratio between the maximum transverse diameter of the heart and the maximum internal diameter of the chest (the calculation of the cardiothoracic index) was determined. A normal thoracic radiograph was considered to be one without pleuroparenchymal alterations and with a cardiothoracic index below 0.5.As a biomarker of current smoking, a determination of the CO in the exhaled air was used. Cotinine in the urine was used as a marker for the cumulative consumption of tobacco intake. The measurement of the CO in the exhaled air was performed during the consultation period of smoking cessation in the Micro Medical smoke check (Kent, England). Assays were stratified into the following CO levels: 0–6ppm, green=no smoking; 7–10ppm, yellow=light smoker; 11–20ppm, red=strong smoker; and >20ppm, red with beep=very strong smoker. The assay of urinary cotinine was executed using gas/mass spectrophotometry chromatography. The assays of urinary cotinine were stratified as follows: <150ng/mL=passive smoking; 150–499ng/mL=light smoker; 500–2500ng/mL=moderate smoker; and >2500ng/mL=strong smoker.The criteria for hyperinflation included the presence of either a reduction in the cardiothoracic index or an increase in RV/TLC measured using plethysmography. The minimum value of the cardiothoracic index that defines hyperinflation is not yet clearly established in the literature.Statistical analyses were performed using IBM SPSS Statistics software 19®. Exploratory and descriptive analyses were applied to the variables, and in the continuous variables, such as the T-test (2 groups) and the Pearson correlation coefficient. The level of significance was set at p<0.05.ResultsDuring the study period, 64 subject samples were obtained: 32 cases and 32 controls. The 32 cases included smokers in the smoking cessation program at HSM: 65.6% were male, and 34.4% were female. The mean age of male subjects was 45.57 years, and that of female subjects was 37.27 years. There were statistically significant differences between the groups (p<0.05). The controls included 32 non-smoking individuals, matched with cases by sex, age, and body mass index. The lung function tests were performed at the Division of Respiratory Pathophysiology, HSM. <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> characterize the cases by gender in terms of age at onset of smoking, tobacco consumption, urinary cotinine assay, and CO in exhaled air.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>It was found that the age of onset of smoking was similar in both genders. Female smokers had a mean tobacco consumption (12.73 packs per year) and mean cotinine (699.91ng/mL), which was lower than that of the male subjects (30.33 packs per year and 1315.33ng/mL), with statistical significance (p<0.05). With regard to CO in exhaled air, 84.62% of the male subjects were considered to be strong smokers vs. 15.38% of the female subjects. The mean duration of exposure to smoking in male subjects was 28.9 years and 20.45 years for female subjects, with statistically significant differences (p<0.05).There was a weak correlation between urinary cotinine and tobacco consumption (r=0.124, p=0.5).A review of the cases and controls using plethysmography is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. In the cases identified, 9.38% (n=3) of the smokers exhibited spirometric COPD criteria: mean FEV1/FVC 65% and mean FEV1 89%. The mean FEV1/FVC of the cases was 77.78% (standard deviation [SD]=6.50%), with 81.41% in the controls (SD=5.84%), p<0.05. The means of the FEF 75% and FEF 25–75% were also lower. The mean FEF 75% was 63.78% (SD=26.44%) in the cases and 86.09% in the controls (SD=28.99%), p<0.05. The mean FEF 25–75% in the cases was 83.16% (SD=26.44%) and 97.19% (SD=23.82) in the controls (p<0.05). The reduction was greater in the FEF 75% and FEF 25–75% parameters.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The reductions in FEV1/FVC, FEF 75% and FEF 25–75% were correlated inversely with tobacco consumption, but this was not statistically significant (r=−0.305 and p=0.089, r=−0.203 and p=0.265, r=−0.15 and p=0.391, respectively).Regarding the assessment of the cardiothoracic index, the mean was 0.424 (SD=0.04) in the cases and 0.458 (SD=0.04) in the controls, with a statistically significant difference (p<0.05). A moderate correlation between the cardiothoracic index and TLC was found in the cases (r=−0.371, p<0.05).Approximately 31.2% (10) of the cases had a history of extra-pulmonary pathology associated with tobacco: 21.88% (seven patients) had hypertension, 6.25% (two cases) had stroke, 3.13% (one case) had acute myocardial infarction and 3.13% (one case) had repeated miscarriages. 9.38% (three smokers) were diagnosed with COPD. In 68.8% (22 smokers), there was no history of tobacco-related disease. <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the comparison of the cases in subgroups, with and without tobacco-related disease, in relation to age, age at smoking onset, tobacco consumption, duration of tobacco exposure, urinary cotinine assay, plethysmography variables, and cardiothoracic index. In relation to the distribution by gender in these two subgroups, it was verified that among the smokers with tobacco-related pathology (n=12), eight were male and six were female; among smokers without tobacco-related pathology (n=20), 13 were male and seven were female.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>It was found that the mean age of the patients with tobacco-related pathologies was 48.33 years (SD=10.13 years), which was higher than that of the group without pathologies (39.35 years, SD=10.05 years), with statistically significant differences between the two groups (p<0.05). The mean duration of exposure to tobacco was higher in the subgroup with tobacco-related pathologies (31.08 years, SD=11.12), compared with the subgroup without pathologies (22.95 years, SD=11.42), although without statistical significance.With regard to the RV/TLC ratio, the cases with tobacco-related diseases had a higher mean (31.92%, SD=7.80%) compared with the subgroup without pathologies (24.90%, SD=6.36%, p<0.05). The cases with the tobacco-related pathologies (12 cases) had higher tobacco consumption and lower cotinine compared with the subgroup without pathologies but without statistically significant differences (p>0.05).DiscussionThis study reflects a sample of asymptomatic smokers from the respiratory point of view, with high tobacco consumption. The age of onset of smoking was similar in both genders. The female subjects who presented to the HSM smoking cessation program were younger than the male subjects (mean age lower, p<0.05). Tobacco consumption, mean duration of exposure to tobacco smoke, and urinary cotinine levels of the female subjects were below in comparison with of the male subjects (p<0.05).There were reduced FEV1/FVC, FEF 75%, FEF 25–75%, and cardiothoracic indices in cases and moderate inverse correlations between the TLC and cardiothoracic index, with statistical significance. The potential value of these variables was validated using the statistical significance found in the reduced sample. At the time of our study, 31.2% of the smokers showed extra-pulmonary pathologies related to tobacco consumption. Three smokers (9.38%) were diagnosed with subclinical COPD. Smokers with tobacco-related diseases had a higher mean age, a lower FEV1, and greater RV/TLC compared with smokers without pathologies (p<0.05). These findings show individual susceptibility to the development of pulmonary disease in later life and/or show a decline of pulmonary function by age; this phenomenon was identified by Flecher. There was no statistical significance in terms of smoking history, mean duration of exposure to tobacco smoke, and urinary cotinine. This is determined by the homogeneity of the groups regarding tobacco consumption, because all the included smokers presented with high tobacco consumption.As indicated in the previous studies, the FEV1 and FEV1/FVC ratio are not sensitive markers of early changes in lung pathophysiology or the emergence of COPD in smokers. Structural and functional changes are present in the smoker's lungs before the onset of clinical signs of airway obstruction. Thus, the underdiagnosis of early functional changes in chronic smoking represents an opportunity for early intervention.<a class="elsevierStyleCrossRefs" href="#bib0050">3,7</a>Our sample reflects a population of smokers (young adults without underlying lung pathologies) with declining respiratory function parameters (reduction of mean values of FEV1/FVC, FEF 75% and FEF 25–75%) and lung hyperinflation compared with adult non-smokers in the same age group. In smokers with a history of tobacco-related extra-pulmonary disease, these changes may indicate pulmonary dysfunction at an early stage. We need to know which subgroup of individual susceptibility factors confer greater propensity for the harmful effects of tobacco; that is, which subgroup indicates that systemic disease with multiple organ involvement in COPD occurs as a late manifestation of the disease? The changes found in our study may reflect the premonitory signs of the progression to COPD at a later stage of disease in patients with extra-pulmonary pathologies related to tobacco.In conclusion, smoking must be considered a disease which has potentially multisystemic repercussions. The study of the subgroup of patients with previous extrapulmonary pathologies related to tobacco has particular relevance for the demonstration of a greater individual susceptibility to the development of pulmonary alterations in a later spectrum of the illness. These findings show that a reduction of the mean values of FEV1/FVC, FEF 75%, FEF 25–75% and the cardiothoracic index may be indicative variables for the precocious detection of these patients.This study has some limitations, in particular, the small sample size, the inclusion of a lower number of female smokers than male smokers, and the absence of evaluation of diffusing capacity for CO (DLCO).With this preliminary study, we have sought to increase awareness of the variables that should be included in a prospective study; we intend to conduct future comparisons in the respiratory function variables and the cardiothoracic index of smokers before and after smoking cessation. These studies will aim to assess the possible reversibility of the changes found after smoking cessation.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres496451" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec517706" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 8 => array:2 [ "identificador" => "xack159835" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-03-15" "fechaAceptado" => "2014-07-14" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec517706" "palabras" => array:6 [ 0 => "Smoking" 1 => "Spirometry" 2 => "Plethysmography" 3 => "Cotinine" 4 => "Radiography" 5 => "Thoracic" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesTo investigate the respiratory function and lung hyperinflation in asymptomatic smokers without previous pulmonary pathology and with normal chest radiography. To identify tobacco-related diseases and to correlate tobacco consumption, duration of exposure to tobacco smoke and urinary cotinine with the existence of tobacco-related disease. Material and methodsCase-controlled study with pairing by sex, age, and body mass index. Case definition: smokers who presented to the first appointment of smoking cessation at the Hospital Sousa Martins (HSM) without respiratory symptoms and with normal chest radiography. Definition of control: users without current and/or past tobacco exposition and with plethysmography and chest radiography at HSM within normal parameters. ResultsReductions in FEV1/FVC, FEF 75%, FEF 25–75% and the cardiothoracic index were detected in smokers and showed a moderated inverse correlation of TLC (with statistical meaning) compared with the control group. Approximately 31.2% of the smokers showed extrapulmonary disease related to tobacco, and 9.38% of the smokers exhibited subclinical chronic obstructive pulmonary disease (COPD). Smokers with tobacco-related diseases presented a mean age and RV/TLC ratio superior to smokers without pathology. DiscussionThe reduction of the mean values of FEV1/FVC, FEF 75%, FEF 25–75% and the cardiothoracic index seems to indicate precocious pulmonary dysfunction. This work aims to reveal the importance of detecting premonitory anomalies of pulmonary disease during the subclinical phase in patients at risk. Smoking must be considered a factor of multisystemic repercussion; thus, intervention opportunities in this particular group must not be wasted. This preliminary study identifies potentially promising variables with the aim of testing the hypothesis that there can be premonitory alterations in COPD, according to its evolution versus reversibility after smoking cessation. This work will be concluded in a future study." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers (n=32)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Male subjects(n=21)Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Female subjects(n=11)Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total(n=32)Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T test(p value) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Body mass index (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.45±4.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.06±5.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.97±4.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.57±11.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.27±6.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.72±10.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.038 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age of smoking initiation (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.67±4.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.83±3.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.72±4.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.927 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tobacco consumption (packs per year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.33±14.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.73±5.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.28±14.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.91×10−5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urinary cotinine (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1315.33±895.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">699.91±465.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1103.78±821.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab792827.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of smokers by gender." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Determination of CO in exhaled air (ppm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers (n=32)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Male subjects(n=21)n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Female subjects(n=11)n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total(n=32)n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">0–6=‘non-smoker’ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7–10=‘light smoker’ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (9.09%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3.13%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">11–20=‘strong smoker’ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (47.62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (72.73%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (56.25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">>20=‘very strong smoker’ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (52.38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (18.18%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (40.63%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab792826.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Determination of CO in exhaled air in smokers by gender." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Respiratory function tests \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers(n=32)Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls(n=32)Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T test(p value) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FVC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110.34±13.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108.84±14.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.674 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEV1 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102.78±12.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106.13±12.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.289 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEV1/FVC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.88±6.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.41±5.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 25% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.78±21.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.91±17.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.431 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 50% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.75±31.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105.34±26.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.154 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 75% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.78±26.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.09±28.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 25–75% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.16±26.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.19±23.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PEF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.41±17.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.59±16.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.379 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TLC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104.09±13.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.16±12.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.234 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.5±27.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.97±19.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.356 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV/TLC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.53±7.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.81±6.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.870 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Airway resistance – raw (L/s/cmH2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2440±0.091 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2615±0.120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.513 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Specific airway conductance – sGaw (cmH2O/L/s)</td><td class="td" title="table-entry " align="char" valign="top">♂1.122±0.564 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">♂1.1057±0.477 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">♂0.920 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">♀1.300±0.4306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">♀1.543±0.640 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">♀0.309 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab792828.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Evaluation by plethysmography of smokers and controls." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers with tobacco-related pathology and COPD(n=12)Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers without tobacco-related pathology(n=20)Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T test(p value) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.33±10.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.35±10.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age of smoking initiation (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.25±4.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.40±4.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.599 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tobacco consumption (packs per year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.75±14.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.20±14.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.309 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tobacco exposure time (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.08±11.147 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.95±11.422 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.058 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urinary cotinine (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1075±979.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1121.05±738.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.881 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FVC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106.33±10.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112.75±14.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.197 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEV1 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.17±7.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106.15±13.176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEV1/FVC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.08±8.607 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.95±4.774 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.306 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 25% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.25±23.336 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.90±20.843 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.770 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 50% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.92±35.367 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.25±29.963 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.431 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 75% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.17±29.634 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.75±24.253 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.280 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEF 25–75% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.67±30.312 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.46±23.676 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.368 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PEF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93±20.657 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.45±16.011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.698 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TLC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101.47±9.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105.7±15.448 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.391 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.67±23.153 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.80±29.163 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.327 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV/TLC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.92±7.798 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.90±6.357 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Raw (L/s/cmH2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.205±0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2674±0.1028 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.061 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">sGaw (cmH2O/L/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2867±0.445 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.121±0.565 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.393 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cardiothoracic index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.45±0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41±0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.056 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab792825.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Analysis of subgroups of smokers with and without tobacco-related pathology." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health effects of cigarette smoking" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.B. Sherman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "1991" "volumen" => "12" "paginaInicial" => "643" "paginaFinal" => "658" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1747984" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global Initiative for Chronic Obstructive Lung Disease (GOLD)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Global Strategy for the Diagnosis MaPoC" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2014" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung dysfunction of chronic smokers with no signs of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Nagelmann" 1 => "A. Tonnov" 2 => "T. Laks" 3 => "R. Sepper" 4 => "K. Prikk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/15412555.2011.565090" "Revista" => array:6 [ "tituloSerie" => "COPD" "fecha" => "2011" "volumen" => "8" "paginaInicial" => "189" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21513442" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic inflammation, chronic obstructive pulmonary disease, and lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Lee" 1 => "T.C. Walser" 2 => "S.M. Dubinett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0b013e32832c975a" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "303" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19417670" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathobiology of cigarette smoke-induced chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Yoshida" 1 => "R.M. Tuder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/physrev.00048.2006" "Revista" => array:6 [ "tituloSerie" => "Physiol Rev" "fecha" => "2007" "volumen" => "87" "paginaInicial" => "1047" "paginaFinal" => "1082" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17615396" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.P. Young" 1 => "R. Hopkins" 2 => "T.E. Eaton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00021707" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "616" "paginaFinal" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17906084" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Underdiagnosis of chronic obstructive pulmonary disease: a rationale for spirometry as a screening tool" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.A. McIvor" 1 => "D.P. Tashkin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Can Thorac Soc" "fecha" => "2001" "volumen" => "8" "paginaInicial" => "153" "paginaFinal" => "158" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack159835" "titulo" => "Acknowledgments" "texto" => "The authors of this study would like to thank all of their colleagues and the technicians at the Sousa Martins Hospital, Local Health Unit, Guarda who participated in this study." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000002100000003/v2_201505070217/S2173511515000330/v2_201505070217/en/main.assets" "Apartado" => array:4 [ "identificador" => "9710" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002100000003/v2_201505070217/S2173511515000330/v2_201505070217/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000330?idApp=UINPBA00004E"]

Statistics

Original Article

Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers: Preliminary study

R. Gomesa,b,

Corresponding author

gomes.rita.dm@gmail.com
ritad_gomes@hotmail.com

Corresponding author.

, F. Luísa,b, A. Tavaresa,b, N. Sousaa,b, S. Correiaa,b, M. Reisa

a Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal

b Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal

Read

1057

Times
was read the article

511

Total PDF

546

Total HTML

Share statistics

 array:23 [
  "pii" => "S2173511515000330"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2014.07.007"
  "estado" => "S300"
  "fechaPublicacion" => "2015-05-01"
  "aid" => "1035"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2015;21:126-31"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1562
    "formatos" => array:3 [
      "EPUB" => 228
      "HTML" => 821
      "PDF" => 513
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2173511515000366"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2014.08.005"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "1037"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2015;21:132-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1564
      "formatos" => array:3 [
        "EPUB" => 235
        "HTML" => 726
        "PDF" => 603
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Clinical impact of adaptive servoventilation compared to other ventilatory modes in patients with treatment-emergent sleep apnea&#44; central sleep apnea and Cheyne&#8211;Stokes respiration"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "132"
          "paginaFinal" => "137"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1578
              "Ancho" => 1593
              "Tamanyo" => 70996
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Impact of adaptive servoventilation &#40;ASV&#41; treatment on apnea hipbones index &#40;AHI&#41; &#40;events&#47;h&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#237;lvia Correia, Vit&#243;ria Martins, Liliana Sousa, Joaquim Moita, F&#225;tima Teixeira, Jos&#233; Moutinho dos Santos"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "S&#237;lvia"
              "apellidos" => "Correia"
            ]
            1 => array:2 [
              "nombre" => "Vit&#243;ria"
              "apellidos" => "Martins"
            ]
            2 => array:2 [
              "nombre" => "Liliana"
              "apellidos" => "Sousa"
            ]
            3 => array:2 [
              "nombre" => "Joaquim"
              "apellidos" => "Moita"
            ]
            4 => array:2 [
              "nombre" => "F&#225;tima"
              "apellidos" => "Teixeira"
            ]
            5 => array:2 [
              "nombre" => "Jos&#233; Moutinho"
              "apellidos" => "dos Santos"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000366?idApp=UINPBA00004E"
    "url" => "/21735115/0000002100000003/v2_201505070217/S2173511515000366/v2_201505070217/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S217351151500038X"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2014.09.009"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "1039"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2015;21:113-25"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1885
      "formatos" => array:3 [
        "EPUB" => 201
        "HTML" => 1174
        "PDF" => 510
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Lung adenocarcinoma&#58; Sustained subtyping with immunohistochemistry and EGFR&#44; HER2 and KRAS mutational status"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "113"
          "paginaFinal" => "125"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0030"
          "etiqueta" => "Figure 6"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr6.jpeg"
              "Alto" => 586
              "Ancho" => 995
              "Tamanyo" => 57900
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Case 7&#58; FISH positive for EGFR&#47;chromosome 7 centromere&#46; Gene high polysomy&#59; <span class="elsevierStyleItalic">EGFR &#8211;</span> red signal&#44; chromosome 7-green&#46; 1000&#215;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Vitor Sousa, Carolina Rodrigues, Maria Silva, Ana Maria Alarc&#227;o, Lina Carvalho"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Vitor"
              "apellidos" => "Sousa"
            ]
            1 => array:2 [
              "nombre" => "Carolina"
              "apellidos" => "Rodrigues"
            ]
            2 => array:2 [
              "nombre" => "Maria"
              "apellidos" => "Silva"
            ]
            3 => array:2 [
              "nombre" => "Ana Maria"
              "apellidos" => "Alarc&#227;o"
            ]
            4 => array:2 [
              "nombre" => "Lina"
              "apellidos" => "Carvalho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151500038X?idApp=UINPBA00004E"
    "url" => "/21735115/0000002100000003/v2_201505070217/S217351151500038X/v2_201505070217/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers&#58; Preliminary study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "126"
        "paginaFinal" => "131"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "R&#46; Gomes, F&#46; Lu&#237;s, A&#46; Tavares, N&#46; Sousa, S&#46; Correia, M&#46; Reis"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "R&#46;"
            "apellidos" => "Gomes"
            "email" => array:2 [
              0 => "gomes&#46;rita&#46;dm&#64;gmail&#46;com"
              1 => "ritad&#95;gomes&#64;hotmail&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Lu&#237;s"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Tavares"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "N&#46;"
            "apellidos" => "Sousa"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Correia"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Reis"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Pulmonology Service&#44; Sousa Martins Hospital&#44; Local Health Unit&#44; Guarda&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Faculty of Health Sciences of the University of Beira Interior&#44; Covilh&#227;&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Smoking has devastating health effects and is a recognized risk factor for the development of cardiovascular&#44; cerebrovascular&#44; respiratory&#44; and oncological diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; recommends the diagnosis of chronic obstructive pulmonary disease &#40;COPD&#41; based on a reduction in the FEV1&#47;FVC ratio&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> However&#44; this diagnostic criterion is valid only for advanced COPD&#44; leading to the underdiagnosis of early functional changes in chronic smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> There are few studies concerning pulmonary function alterations in smokers and the deleterious effects of smoking on functional parameters vary&#44; depending on the studies&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Cigarette smoking has a detrimental effect on the airways&#44; causing inflammation and&#44; consequently&#44; airflow limitations and lung hyperinflation&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4&#44;5</span></a> In thoracic radiographs&#44; one sign of lung hyperinflation is the reduction in the cardiothoracic index &#40;&#8216;heart in gout&#8217;&#41;&#46; Some authors claim that a reduction in FEV1 is more than just a measure of airflow limitation&#44; that it is&#44; in fact&#44; a marker of premature death&#44; with a wideranging utility in assessing the risks of COPD&#44; lung cancer&#44; coronary artery disease&#44; and stroke&#44; which collectively account for 70&#8211;80&#37; of premature deaths in smokers&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Some studies have encouraged the use of new methods in the detection of precursory anomalies of pulmonary disease during the subclinical phase in patients at risk&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The authors present a case control study developed in outpatient clinic with the smoking cessation program at Sousa Martins Hospital &#40;HSM&#41;&#44; Local Health Unit&#44; Guarda &#40;Portugal&#41;&#46; The main objective of our study was to investigate the respiratory function and lung hyperinflation in asymptomatic smokers without a history of lung pathology and with normal chest radiographs&#46; Secondary objectives consisted of identifying tobacco-related diseases and correlating tobacco consumption&#44; duration of exposure to tobacco smoke&#44; and urinary cotinine with the existence of tobacco-related disease&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors developed a case-controlled study paired by sex&#44; age and body mass index&#46; The cases were defined as smokers &#40;with a smoking habit for at least one year&#41;&#44; who presented for their first appointment at the smoking cessation program at HSM during the period of 11 December 2012 to 8 December 2013&#44; without respiratory symptoms and with normal chest radiographs&#46; Smoking subgroups were integrated using evidence of the history of tobacco-related pathology&#46; The exclusion criterion was applied to cases previously diagnosed with pulmonary pathology&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The controls were participants who exhibited normal examination in plethysmography and chest radiographs in HSM&#46; The following exclusion criteria were applied to the controls&#58; known prior history of pulmonary pathology and current and&#47;or past smoking&#46; In the controls&#44; maximum passive exposure was assumed for the determination of carbon monoxide &#40;CO&#41; in the exhaled air &#40;0&#8211;6<span class="elsevierStyleHsp" style=""></span>ppm&#41; and urinary cotinine &#40;&#60;150<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The pulmonary function tests were performed using the Plethysmograph Autobox DI SensorMedics 6200 &#40;California&#44; USA&#41; at the Department of Pathophysiology of Respiratory Diseases at HSM&#46; The technical recommendations and standardized reference values of the American Thoracic Society were used to perform the functional tests&#46; A chest X-ray was obtained while the patient was in the standing and forward positions at maximal inspiration&#44; which complies with the criteria for good technical quality&#46; The ratio between the maximum transverse diameter of the heart and the maximum internal diameter of the chest &#40;the calculation of the cardiothoracic index&#41; was determined&#46; A normal thoracic radiograph was considered to be one without pleuroparenchymal alterations and with a cardiothoracic index below 0&#46;5&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As a biomarker of current smoking&#44; a determination of the CO in the exhaled air was used&#46; Cotinine in the urine was used as a marker for the cumulative consumption of tobacco intake&#46; The measurement of the CO in the exhaled air was performed during the consultation period of smoking cessation in the Micro Medical smoke check &#40;Kent&#44; England&#41;&#46; Assays were stratified into the following CO levels&#58; 0&#8211;6<span class="elsevierStyleHsp" style=""></span>ppm&#44; green<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no smoking&#59; 7&#8211;10<span class="elsevierStyleHsp" style=""></span>ppm&#44; yellow<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>light smoker&#59; 11&#8211;20<span class="elsevierStyleHsp" style=""></span>ppm&#44; red<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>strong smoker&#59; and &#62;20<span class="elsevierStyleHsp" style=""></span>ppm&#44; red with beep<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>very strong smoker&#46; The assay of urinary cotinine was executed using gas&#47;mass spectrophotometry chromatography&#46; The assays of urinary cotinine were stratified as follows&#58; &#60;150<span class="elsevierStyleHsp" style=""></span>ng&#47;mL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>passive smoking&#59; 150&#8211;499<span class="elsevierStyleHsp" style=""></span>ng&#47;mL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>light smoker&#59; 500&#8211;2500<span class="elsevierStyleHsp" style=""></span>ng&#47;mL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>moderate smoker&#59; and &#62;2500<span class="elsevierStyleHsp" style=""></span>ng&#47;mL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>strong smoker&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The criteria for hyperinflation included the presence of either a reduction in the cardiothoracic index or an increase in RV&#47;TLC measured using plethysmography&#46; The minimum value of the cardiothoracic index that defines hyperinflation is not yet clearly established in the literature&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using IBM SPSS Statistics software 19<span class="elsevierStyleSup">&#174;</span>&#46; Exploratory and descriptive analyses were applied to the variables&#44; and in the continuous variables&#44; such as the <span class="elsevierStyleItalic">T</span>-test &#40;2 groups&#41; and the Pearson correlation coefficient&#46; The level of significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">During the study period&#44; 64 subject samples were obtained&#58; 32 cases and 32 controls&#46; The 32 cases included smokers in the smoking cessation program at HSM&#58; 65&#46;6&#37; were male&#44; and 34&#46;4&#37; were female&#46; The mean age of male subjects was 45&#46;57 years&#44; and that of female subjects was 37&#46;27 years&#46; There were statistically significant differences between the groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The controls included 32 non-smoking individuals&#44; matched with cases by sex&#44; age&#44; and body mass index&#46; The lung function tests were performed at the Division of Respiratory Pathophysiology&#44; HSM&#46; <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> characterize the cases by gender in terms of age at onset of smoking&#44; tobacco consumption&#44; urinary cotinine assay&#44; and CO in exhaled air&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">It was found that the age of onset of smoking was similar in both genders&#46; Female smokers had a mean tobacco consumption &#40;12&#46;73 packs per year&#41; and mean cotinine &#40;699&#46;91<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#44; which was lower than that of the male subjects &#40;30&#46;33 packs per year and 1315&#46;33<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#44; with statistical significance &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; With regard to CO in exhaled air&#44; 84&#46;62&#37; of the male subjects were considered to be strong smokers vs&#46; 15&#46;38&#37; of the female subjects&#46; The mean duration of exposure to smoking in male subjects was 28&#46;9 years and 20&#46;45 years for female subjects&#44; with statistically significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">There was a weak correlation between urinary cotinine and tobacco consumption &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;124&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A review of the cases and controls using plethysmography is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; In the cases identified&#44; 9&#46;38&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; of the smokers exhibited spirometric COPD criteria&#58; mean FEV1&#47;FVC 65&#37; and mean FEV1 89&#37;&#46; The mean FEV1&#47;FVC of the cases was 77&#46;78&#37; &#40;standard deviation &#91;SD&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;50&#37;&#41;&#44; with 81&#46;41&#37; in the controls &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;84&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The means of the FEF 75&#37; and FEF 25&#8211;75&#37; were also lower&#46; The mean FEF 75&#37; was 63&#46;78&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#46;44&#37;&#41; in the cases and 86&#46;09&#37; in the controls &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#46;99&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The mean FEF 25&#8211;75&#37; in the cases was 83&#46;16&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#46;44&#37;&#41; and 97&#46;19&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#46;82&#41; in the controls &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The reduction was greater in the FEF 75&#37; and FEF 25&#8211;75&#37; parameters&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The reductions in FEV1&#47;FVC&#44; FEF 75&#37; and FEF 25&#8211;75&#37; were correlated inversely with tobacco consumption&#44; but this was not statistically significant &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;305 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;089&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;203 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;265&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;15 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;391&#44; respectively&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the assessment of the cardiothoracic index&#44; the mean was 0&#46;424 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; in the cases and 0&#46;458 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; in the controls&#44; with a statistically significant difference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; A moderate correlation between the cardiothoracic index and TLC was found in the cases &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;371&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Approximately 31&#46;2&#37; &#40;10&#41; of the cases had a history of extra-pulmonary pathology associated with tobacco&#58; 21&#46;88&#37; &#40;seven patients&#41; had hypertension&#44; 6&#46;25&#37; &#40;two cases&#41; had stroke&#44; 3&#46;13&#37; &#40;one case&#41; had acute myocardial infarction and 3&#46;13&#37; &#40;one case&#41; had repeated miscarriages&#46; 9&#46;38&#37; &#40;three smokers&#41; were diagnosed with COPD&#46; In 68&#46;8&#37; &#40;22 smokers&#41;&#44; there was no history of tobacco-related disease&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the comparison of the cases in subgroups&#44; with and without tobacco-related disease&#44; in relation to age&#44; age at smoking onset&#44; tobacco consumption&#44; duration of tobacco exposure&#44; urinary cotinine assay&#44; plethysmography variables&#44; and cardiothoracic index&#46; In relation to the distribution by gender in these two subgroups&#44; it was verified that among the smokers with tobacco-related pathology &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; eight were male and six were female&#59; among smokers without tobacco-related pathology &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; 13 were male and seven were female&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">It was found that the mean age of the patients with tobacco-related pathologies was 48&#46;33 years &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46;13 years&#41;&#44; which was higher than that of the group without pathologies &#40;39&#46;35 years&#44; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46;05 years&#41;&#44; with statistically significant differences between the two groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The mean duration of exposure to tobacco was higher in the subgroup with tobacco-related pathologies &#40;31&#46;08 years&#44; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;12&#41;&#44; compared with the subgroup without pathologies &#40;22&#46;95 years&#44; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;42&#41;&#44; although without statistical significance&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to the RV&#47;TLC ratio&#44; the cases with tobacco-related diseases had a higher mean &#40;31&#46;92&#37;&#44; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#46;80&#37;&#41; compared with the subgroup without pathologies &#40;24&#46;90&#37;&#44; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;36&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The cases with the tobacco-related pathologies &#40;12 cases&#41; had higher tobacco consumption and lower cotinine compared with the subgroup without pathologies but without statistically significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">This study reflects a sample of asymptomatic smokers from the respiratory point of view&#44; with high tobacco consumption&#46; The age of onset of smoking was similar in both genders&#46; The female subjects who presented to the HSM smoking cessation program were younger than the male subjects &#40;mean age lower&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Tobacco consumption&#44; mean duration of exposure to tobacco smoke&#44; and urinary cotinine levels of the female subjects were below in comparison with of the male subjects &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">There were reduced FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37;&#44; and cardiothoracic indices in cases and moderate inverse correlations between the TLC and cardiothoracic index&#44; with statistical significance&#46; The potential value of these variables was validated using the statistical significance found in the reduced sample&#46; At the time of our study&#44; 31&#46;2&#37; of the smokers showed extra-pulmonary pathologies related to tobacco consumption&#46; Three smokers &#40;9&#46;38&#37;&#41; were diagnosed with subclinical COPD&#46; Smokers with tobacco-related diseases had a higher mean age&#44; a lower FEV1&#44; and greater RV&#47;TLC compared with smokers without pathologies &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; These findings show individual susceptibility to the development of pulmonary disease in later life and&#47;or show a decline of pulmonary function by age&#59; this phenomenon was identified by Flecher&#46; There was no statistical significance in terms of smoking history&#44; mean duration of exposure to tobacco smoke&#44; and urinary cotinine&#46; This is determined by the homogeneity of the groups regarding tobacco consumption&#44; because all the included smokers presented with high tobacco consumption&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As indicated in the previous studies&#44; the FEV1 and FEV1&#47;FVC ratio are not sensitive markers of early changes in lung pathophysiology or the emergence of COPD in smokers&#46; Structural and functional changes are present in the smoker&#39;s lungs before the onset of clinical signs of airway obstruction&#46; Thus&#44; the underdiagnosis of early functional changes in chronic smoking represents an opportunity for early intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#44;7</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Our sample reflects a population of smokers &#40;young adults without underlying lung pathologies&#41; with declining respiratory function parameters &#40;reduction of mean values of FEV1&#47;FVC&#44; FEF 75&#37; and FEF 25&#8211;75&#37;&#41; and lung hyperinflation compared with adult non-smokers in the same age group&#46; In smokers with a history of tobacco-related extra-pulmonary disease&#44; these changes may indicate pulmonary dysfunction at an early stage&#46; We need to know which subgroup of individual susceptibility factors confer greater propensity for the harmful effects of tobacco&#59; that is&#44; which subgroup indicates that systemic disease with multiple organ involvement in COPD occurs as a late manifestation of the disease&#63; The changes found in our study may reflect the premonitory signs of the progression to COPD at a later stage of disease in patients with extra-pulmonary pathologies related to tobacco&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion&#44; smoking must be considered a disease which has potentially multisystemic repercussions&#46; The study of the subgroup of patients with previous extrapulmonary pathologies related to tobacco has particular relevance for the demonstration of a greater individual susceptibility to the development of pulmonary alterations in a later spectrum of the illness&#46; These findings show that a reduction of the mean values of FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index may be indicative variables for the precocious detection of these patients&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">This study has some limitations&#44; in particular&#44; the small sample size&#44; the inclusion of a lower number of female smokers than male smokers&#44; and the absence of evaluation of diffusing capacity for CO &#40;DLCO&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">With this preliminary study&#44; we have sought to increase awareness of the variables that should be included in a prospective study&#59; we intend to conduct future comparisons in the respiratory function variables and the cardiothoracic index of smokers before and after smoking cessation&#46; These studies will aim to assess the possible reversibility of the changes found after smoking cessation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of human and animal subjects</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidentiality of data</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Right to privacy and informed consent</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres496451"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Discussion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec517706"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        6 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:2 [
          "identificador" => "xack159835"
          "titulo" => "Acknowledgments"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-03-15"
    "fechaAceptado" => "2014-07-14"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec517706"
          "palabras" => array:6 [
            0 => "Smoking"
            1 => "Spirometry"
            2 => "Plethysmography"
            3 => "Cotinine"
            4 => "Radiography"
            5 => "Thoracic"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To investigate the respiratory function and lung hyperinflation in asymptomatic smokers without previous pulmonary pathology and with normal chest radiography&#46; To identify tobacco-related diseases and to correlate tobacco consumption&#44; duration of exposure to tobacco smoke and urinary cotinine with the existence of tobacco-related disease&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case-controlled study with pairing by sex&#44; age&#44; and body mass index&#46; Case definition&#58; smokers who presented to the first appointment of smoking cessation at the Hospital Sousa Martins &#40;HSM&#41; without respiratory symptoms and with normal chest radiography&#46; Definition of control&#58; users without current and&#47;or past tobacco exposition and with plethysmography and chest radiography at HSM within normal parameters&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reductions in FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index were detected in smokers and showed a moderated inverse correlation of TLC &#40;with statistical meaning&#41; compared with the control group&#46; Approximately 31&#46;2&#37; of the smokers showed extrapulmonary disease related to tobacco&#44; and 9&#46;38&#37; of the smokers exhibited subclinical chronic obstructive pulmonary disease &#40;COPD&#41;&#46; Smokers with tobacco-related diseases presented a mean age and RV&#47;TLC ratio superior to smokers without pathology&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The reduction of the mean values of FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index seems to indicate precocious pulmonary dysfunction&#46; This work aims to reveal the importance of detecting premonitory anomalies of pulmonary disease during the subclinical phase in patients at risk&#46; Smoking must be considered a factor of multisystemic repercussion&#59; thus&#44; intervention opportunities in this particular group must not be wasted&#46; This preliminary study identifies potentially promising variables with the aim of testing the hypothesis that there can be premonitory alterations in COPD&#44; according to its evolution versus reversibility after smoking cessation&#46; This work will be concluded in a future study&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Discussion"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Male subjects&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Female subjects&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">T</span> test&#40;<span class="elsevierStyleItalic">p</span> value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age of smoking initiation &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;927&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tobacco consumption &#40;packs per year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;91<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">&#8722;5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Urinary cotinine &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1315&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>895&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">699&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>465&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1103&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>821&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab792827.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Characteristics of smokers by gender&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Determination of CO in exhaled air &#40;ppm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Male subjects&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Female subjects&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">0&#8211;6<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;non-smoker&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">7&#8211;10<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;light smoker&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;9&#46;09&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#46;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">11&#8211;20<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;strong smoker&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;47&#46;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;72&#46;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;56&#46;25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#62;20<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;very strong smoker&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;52&#46;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;18&#46;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;40&#46;63&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab792826.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Determination of CO in exhaled air in smokers by gender&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Respiratory function tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">T</span> test&#40;<span class="elsevierStyleItalic">p</span> value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FVC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;674&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEV1 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEV1&#47;FVC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 25&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;431&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 50&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 75&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 25&#8211;75&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PEF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">TLC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RV&#47;TLC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;870&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Airway resistance &#8211; raw &#40;L&#47;s&#47;cmH<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2440<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2615<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;513&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Specific airway conductance &#8211; sGaw &#40;cmH<span class="elsevierStyleInf">2</span>O&#47;L&#47;s&#41;</td><td class="td" title="table-entry  " align="char" valign="top">&#9794;<span class="elsevierStyleHsp" style=""></span>1&#46;122<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#9794;<span class="elsevierStyleHsp" style=""></span>1&#46;1057<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;477&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#9794;<span class="elsevierStyleHsp" style=""></span>0&#46;920&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#9792;<span class="elsevierStyleHsp" style=""></span>1&#46;300<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#9792;<span class="elsevierStyleHsp" style=""></span>1&#46;543<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#9792;<span class="elsevierStyleHsp" style=""></span>0&#46;309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab792828.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluation by plethysmography of smokers and controls&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers with tobacco-related pathology and COPD&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers without tobacco-related pathology&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">T</span> test&#40;<span class="elsevierStyleItalic">p</span> value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age of smoking initiation &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;599&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tobacco consumption &#40;packs per year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tobacco exposure time &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;422&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Urinary cotinine &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1075<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>979&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1121&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>738&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;881&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FVC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEV1 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEV1&#47;FVC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;607&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;774&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 25&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;336&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;843&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;770&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 50&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#46;367&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;963&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;431&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 75&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;634&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FEF 25&#8211;75&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;676&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;368&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PEF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;657&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;698&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">TLC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;448&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RV&#47;TLC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;798&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Raw &#40;L&#47;s&#47;cmH<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;205<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2674<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">sGaw &#40;cmH<span class="elsevierStyleInf">2</span>O&#47;L&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2867<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;445&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;121<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;565&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cardiothoracic index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab792825.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Analysis of subgroups of smokers with and without tobacco-related pathology&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health effects of cigarette smoking"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;B&#46; Sherman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "1991"
                        "volumen" => "12"
                        "paginaInicial" => "643"
                        "paginaFinal" => "658"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1747984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Global Strategy for the Diagnosis MaPoC"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung dysfunction of chronic smokers with no signs of COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Nagelmann"
                            1 => "A&#46; Tonnov"
                            2 => "T&#46; Laks"
                            3 => "R&#46; Sepper"
                            4 => "K&#46; Prikk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/15412555.2011.565090"
                      "Revista" => array:6 [
                        "tituloSerie" => "COPD"
                        "fecha" => "2011"
                        "volumen" => "8"
                        "paginaInicial" => "189"
                        "paginaFinal" => "195"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21513442"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic inflammation&#44; chronic obstructive pulmonary disease&#44; and lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Lee"
                            1 => "T&#46;C&#46; Walser"
                            2 => "S&#46;M&#46; Dubinett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0b013e32832c975a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "303"
                        "paginaFinal" => "307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19417670"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathobiology of cigarette smoke-induced chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Yoshida"
                            1 => "R&#46;M&#46; Tuder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/physrev.00048.2006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Physiol Rev"
                        "fecha" => "2007"
                        "volumen" => "87"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1082"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17615396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Forced expiratory volume in one second&#58; not just a lung function test but a marker of premature death from all causes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;P&#46; Young"
                            1 => "R&#46; Hopkins"
                            2 => "T&#46;E&#46; Eaton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00021707"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "616"
                        "paginaFinal" => "622"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17906084"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Underdiagnosis of chronic obstructive pulmonary disease&#58; a rationale for spirometry as a screening tool"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;A&#46; McIvor"
                            1 => "D&#46;P&#46; Tashkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Can Thorac Soc"
                        "fecha" => "2001"
                        "volumen" => "8"
                        "paginaInicial" => "153"
                        "paginaFinal" => "158"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack159835"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0150" class="elsevierStylePara elsevierViewall">The authors of this study would like to thank all of their colleagues and the technicians at the Sousa Martins Hospital&#44; Local Health Unit&#44; Guarda who participated in this study&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000002100000003/v2_201505070217/S2173511515000330/v2_201505070217/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9710"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002100000003/v2_201505070217/S2173511515000330/v2_201505070217/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000330?idApp=UINPBA00004E"
]

Article information

ISSN: 21735115
Original language: English

DOI:10.1016/j.rppnen.2014.07.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	10	18
2024 October	26	35	61
2024 September	42	20	62
2024 August	53	29	82
2024 July	41	33	74
2024 June	31	27	58
2024 May	27	39	66
2024 April	22	29	51
2024 March	24	23	47
2024 February	20	30	50
2024 January	20	22	42
2023 December	20	26	46
2023 November	23	31	54
2023 October	21	37	58
2023 September	58	24	82
2023 August	28	20	48
2023 July	21	28	49
2023 June	22	16	38
2023 May	27	23	50
2023 April	12	9	21

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter