Research letter
Cystic fibrosis – How we reach adult life
Fibrose Quistica – Como chegamos à idade adulta
a Serviço de Pediatria, Centro Hospitalar Universitário do Algarve, Unidade de Portimão, Estrada do Poço Seco, 8500-338 Portimão, Portugal
b Departamento de Pediatria, Hospital de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
c Centro Especializado de Fibrose Quística, Hospital de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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Peribronchovascular micronodules and dilated and thick-walled bronchioles with a fluffy tree-in-bud similar to “cotton-in-bud” present at diagnosis (A, B), resolved after treatment with steroids in association with 4 months of clarithromycin (C, D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.C. Duarte, A. Cordeiro, J. Soares, P. Gonçalves" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.C." "apellidos" => "Duarte" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Cordeiro" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Soares" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Gonçalves" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043719300170?idApp=UINPBA00004E" "url" => "/25310437/0000002500000001/v1_201902260629/S2531043719300170/v1_201902260629/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2531043718301612" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2018.10.007" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1322" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2019;25:58-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1703 "formatos" => array:3 [ "EPUB" => 169 "HTML" => 1093 "PDF" => 441 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pleural effusion negatively impacts survival of patients undergoing maintenance hemodialysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "58" "paginaFinal" => "60" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 729 "Ancho" => 2093 "Tamanyo" => 125701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier survival plots for long-term mortality for pleural effusion vs. no pleural effusion (A) and for severity of pleural effusion (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Hamada, T. Sano, Y. Nagatani, M. Tsukino" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Hamada" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Sano" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Nagatani" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Tsukino" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043718301612?idApp=UINPBA00004E" "url" => "/25310437/0000002500000001/v1_201902260629/S2531043718301612/v1_201902260629/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research letter</span>" "titulo" => "Cystic fibrosis – How we reach adult life" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "60" "paginaFinal" => "61" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Serras, J.A. Oliveira, L. Pereira, C. Barreto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Serras" "email" => array:1 [ 0 => "inesserrasped@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.A." "apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Pereira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Barreto" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Pediatria, Centro Hospitalar Universitário do Algarve, Unidade de Portimão, Estrada do Poço Seco, 8500-338 Portimão, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Pediatria, Hospital de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro Especializado de Fibrose Quística, Hospital de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fibrose Quistica – Como chegamos à idade adulta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 769 "Ancho" => 1665 "Tamanyo" => 72703 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bacterial colonization in the year of transition to adult care (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Until recently, cystic fibrosis (CF) was considered a paediatric disease, and transition of patients to adult care was rarely performed due to low life expectancy and reduced experience from adult Medicine in the follow-up of this disease. Nowadays, due to significant improvement of CF survival rates, almost all of these patients reach adulthood.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> The transference of teenagers with a chronic disease like CF to adult care is a very stressful phase, sometimes faced with some anxiety by both parents and patients. Therefore, a transition period is fundamental for both, with the aim of promoting the patient's autonomy and acceptance of new roles, but also giving continuity of care. In the Specialized Centre of Cystic Fibrosis (SCCF) of the Hospital Santa Maria (Lisbon), this transition happens over three appointments, where both paediatric and adult physicians are present. Since the implementation of this programme in 2000, 54 young adults have been transferred to adult care.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study was to characterize the clinical status of CF patients during the year of transition to adult care in a 7-year period.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a retrospective, descriptive study of all patients transferred to adult care between January 2010 and December 2016. Clinical records were reviewed and the following data were obtained: sex, age at diagnosis, genotype, treatment performed, complications, airway bacterial colonization, lung function (forced expiratory volume in 1s (FEV<span class="elsevierStyleInf">1</span>)) and nutritional status (body mass index – BMI) in the year of transition. IBM SPSS v21.0<span class="elsevierStyleSup">®</span> and Microsoft Excel 2013<span class="elsevierStyleSup">®</span> were used for the descriptive analysis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">From a total of 87 patients followed at the SCCF during the study period, 25 had reached adult age, of which 19 were transferred to adult Pulmonology. The main reasons for delay in transfer to adult care were either clinical instability or personal reasons (e.g. waiting for placement in University in another city). Nine (47%) patients were male, median age at diagnosis was 2.8 years [minimum 34 days; maximum 14 years] and 9 were homozygous for F508del mutation. Most patients (79%, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) presented exocrine pancreatic insufficiency, six (32%) had liver disease, two (11%) CF-related diabetes and four (21%) had only pulmonary manifestations (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). All patients were transferred to adult care up to the age of 21 years, the majority (63%, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12) at 18 years.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding pulmonary function, six (32%) patients presented FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>70%, of which only 1 had severe obstruction (FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>40%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Concerning nutritional status, three patients (16%) had a BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">As for airway bacterial colonization, the most common microorganisms isolated during the year of transition were <span class="elsevierStyleItalic">Staphylococcus aureus</span> (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12) and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), which were responsible for chronic colonization in 57.9% and 31.6% of patients, respectively.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">In terms of treatment, 13 (68%) patients had inhaled antibiotics, 16 (84%) dornase alfa and 16 (84%) pancreatic enzymes. No patients were on home oxygen therapy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">With improvements in healthcare in the last decades, nowadays 85% of chronic paediatric patients reach adulthood,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> highlighting the importance of continued care and transition programmes to adult Medicine. Understanding the clinical condition in which patients reach adulthood is of utmost importance, as an audit of paediatric clinical care and for future comparison of outcomes.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In CF patients, not only has life expectancy increased, but nutritional status and quality of life have also improved, which are known to correlate to better respiratory function.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">To our knowledge, this is the first study published in Portugal to describe this reality.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We hope these results can be used for future comparison and evaluation of outcome improvements in CF patients, namely the ones who were lately diagnosed through the neonatal screening programme, most of which began follow-up and treatment even before onset of symptoms. We hypothesize that they will have better nutritional status and pulmonary function at transition to adult care, as has been previously reported.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4–6</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 769 "Ancho" => 1665 "Tamanyo" => 72703 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bacterial colonization in the year of transition to adult care (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array: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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male gender, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age at diagnosis, median (min; max)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.8 years (34 days; 14 years) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Age at transition to adult care, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>17 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (10.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>18 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (63.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>19 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (15.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>20 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>21 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Genotype, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>F508del/F508del \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>F508del/R334W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3272-26A-G/3007delG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A561E/A561E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>F508del/R1066C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>F508del/51235R-IVS8-6(5t) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>R334W/smi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Complications, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exocrine pancreatic insufficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (79) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Liver disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CF-related diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Only pulmonary manifestations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Pulmonary function, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV1<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV1 40–69% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV1 >70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (63) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1972943.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sample characterization (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19). 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 3 | 13 |
| 2024 October | 33 | 25 | 58 |
| 2024 September | 46 | 28 | 74 |
| 2024 August | 51 | 36 | 87 |
| 2024 July | 49 | 33 | 82 |
| 2024 June | 41 | 25 | 66 |
| 2024 May | 52 | 29 | 81 |
| 2024 April | 57 | 34 | 91 |
| 2024 March | 40 | 27 | 67 |
| 2024 February | 49 | 18 | 67 |
| 2024 January | 38 | 29 | 67 |
| 2023 December | 34 | 19 | 53 |
| 2023 November | 44 | 38 | 82 |
| 2023 October | 28 | 43 | 71 |
| 2023 September | 17 | 28 | 45 |
| 2023 August | 13 | 21 | 34 |
| 2023 July | 26 | 30 | 56 |
| 2023 June | 18 | 20 | 38 |
| 2023 May | 37 | 27 | 64 |
| 2023 April | 19 | 21 | 40 |
| 2023 March | 41 | 24 | 65 |
| 2023 February | 27 | 16 | 43 |
| 2023 January | 31 | 13 | 44 |
| 2022 December | 31 | 23 | 54 |
| 2022 November | 35 | 31 | 66 |
| 2022 October | 49 | 34 | 83 |
| 2022 September | 34 | 42 | 76 |
| 2022 August | 27 | 32 | 59 |
| 2022 July | 38 | 57 | 95 |
| 2022 June | 27 | 37 | 64 |
| 2022 May | 25 | 38 | 63 |
| 2022 April | 35 | 38 | 73 |
| 2022 March | 37 | 49 | 86 |
| 2022 February | 32 | 36 | 68 |
| 2022 January | 39 | 51 | 90 |
| 2021 December | 32 | 51 | 83 |
| 2021 November | 18 | 37 | 55 |
| 2021 October | 45 | 38 | 83 |
| 2021 September | 30 | 41 | 71 |
| 2021 August | 30 | 21 | 51 |
| 2021 July | 29 | 13 | 42 |
| 2021 June | 36 | 31 | 67 |
| 2021 May | 38 | 49 | 87 |
| 2021 April | 75 | 83 | 158 |
| 2021 March | 39 | 39 | 78 |
| 2021 February | 33 | 37 | 70 |
| 2021 January | 29 | 21 | 50 |
| 2020 December | 30 | 24 | 54 |
| 2020 November | 40 | 18 | 58 |
| 2020 October | 32 | 38 | 70 |
| 2020 September | 46 | 40 | 86 |
| 2020 August | 37 | 28 | 65 |
| 2020 July | 40 | 27 | 67 |
| 2020 June | 54 | 24 | 78 |
| 2020 May | 40 | 22 | 62 |
| 2020 April | 44 | 10 | 54 |
| 2020 March | 43 | 27 | 70 |
| 2020 February | 33 | 21 | 54 |
| 2020 January | 48 | 28 | 76 |
| 2019 December | 37 | 17 | 54 |
| 2019 November | 36 | 20 | 56 |
| 2019 October | 53 | 22 | 75 |
| 2019 September | 39 | 25 | 64 |
| 2019 August | 46 | 25 | 71 |
| 2019 July | 37 | 21 | 58 |
| 2019 June | 40 | 27 | 67 |
| 2019 May | 46 | 26 | 72 |
| 2019 April | 56 | 33 | 89 |
| 2019 March | 133 | 71 | 204 |
| 2019 February | 40 | 21 | 61 |
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