Bronchiectasis: A retrospective study of clinical and aetiological investigation in a general respiratory department

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Borro" "autores" => array:1 [ 0 => array:2 [ "Iniciales" => "J.M." "apellidos" => "Borro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915856087?idApp=UINPBA00004E" "url" => "/08732159/0000002100000001/v0_201604141151/X0873215915856087/v0_201604141151/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Bronchiectasis: A retrospective study of clinical and aetiological investigation in a general respiratory department" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "5" "paginaFinal" => "10" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Amorim, J. Bento, A.P. Vaz, I. Gomes, J. de Gracia, V. Hespanhol, A. Marques" "autores" => array:7 [ 0 => array:4 [ "Iniciales" => "A." "apellidos" => "Amorim" "email" => array:1 [ 0 => "adelinamorim@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] 2 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 1 => array:3 [ "Iniciales" => "J." "apellidos" => "Bento" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "A.P." "apellidos" => "Vaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 3 => array:3 [ "Iniciales" => "I." "apellidos" => "Gomes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 4 => array:3 [ "Iniciales" => "J." "apellidos" => "de Gracia" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "affc" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "affd" ] ] ] 5 => array:3 [ "Iniciales" => "V." "apellidos" => "Hespanhol" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 6 => array:3 [ "Iniciales" => "A." "apellidos" => "Marques" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Faculty of Medicine, University of Porto, Portugal" "etiqueta" => "a" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Pneumology, Centro Hospitalar de S. João, EPE, Porto, Portugal" "etiqueta" => "b" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Faculty of Medicine, Autonomous University of Barcelona, Spain" "etiqueta" => "c" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Pneumology, CIBER Enfermedades Respiratorias (CIBERES) Hospital Vall d’Hebron, Barcelona, Spain" "etiqueta" => "d" "identificador" => "affd" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Corresponding author. adelinamorim@gmail.com" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "420v21n01-90385609fig1.jpg" "Alto" => 1088 "Ancho" => 1526 "Tamanyo" => 211021 ] ] "descripcion" => array:1 [ "en" => "Aetiological investigation. AAT, ¿1-antitrypsin." ] ] ] "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a>IntroductionBronchiectasis (BE) results from a large number of diseases and is associated with high morbidity and significant costs for health-care systems.<a href="#bib32" class="elsevierStyleCrossRefs">1</a>, <a href="#bib33" class="elsevierStyleCrossRefs">2</a>For many years respiratory infections were the main identifiable cause. However, post-infectious BE has been decreasing mainly in developed countries due to vaccination programmes, antibiotic therapy and better social-hygienic conditions while other congenital or acquired causes have been described now that we have more accurate diagnosis methods.<a href="#bib34" class="elsevierStyleCrossRefs">3</a>In recent years, a number of studies have shown that an aetiological diagnosis can change the therapeutic approach in a relevant percentage of patients.<a href="#bib35" class="elsevierStyleCrossRefs">4</a>, <a href="#bib36" class="elsevierStyleCrossRefs">5</a>, <a href="#bib37" class="elsevierStyleCrossRefs">6</a>Research carried out in units with great experience in BE and with specialized resources may not be typical of the assessment which is carried out in the majority of general respiratory services. There is some evidence that the study and follow-up of patients in specialized centres probably contribute to a larger number of aetiological diagnoses and more appropriate treatment.<a href="#bib36" class="elsevierStyleCrossRefs">5</a>, <a href="#bib37" class="elsevierStyleCrossRefs">6</a>The local characteristics of BE patients were unknown, namely the level of research, BE aetiologies, functional severity and microbiological characteristics.The aim of this study was to evaluate how accurate and extensive the clinical and aetiological research was for BE patients followed in the pulmonology outpatient service of a central hospital which did not routinely use a thorough, pre-existing protocol for it.<a name="sec0010" class="elsevierStyleCrossRefs"></a>Materials and methodsA retrospective analysis of the clinical records of adult patients with BE diagnosis who were seen and managed in the pulmonology outpatient service, from January 2008 to January 2009, was carried out. The patients concerned had to be followed-up for at least 1 year.The diagnosis of BE was established by the characteristic features of the high-resolution computed tomography (HRCT) of the thorax (bronchoarterial ratio ≥1, dilated bronchi visible ≤1 cm from parietal pleura, cystic changes and a lack of normal bronchial tapering) or the CT, if unequivocal evidence of BE existed.Patients with CF and interstitial pathology were excluded.Each pulmonologist involved was totally responsible for the clinical records, the follow-up and aetiological research, without having to comply with any predefined protocol. We arrived at an aetiological diagnosis based on the clinical records and the results of earlier diagnostic tests done by the patient's clinician. There was no subsequent research done to complement our study.The demographical, clinical, functional, radiological and microbiological data were reviewed. The exams that had been performed to explain the BE aetiology, namely, the sweat test, cystic fibrosis (CF) genotyping, measurement of serum immunoglobulins (Igs), α1-antitrypsin (AAT) and the semen analysis were recorded.The sweat test was performed by conductivity method and the CF genotyping test screened the 33 most frequent CFTR mutations in Portuguese population. In some cases a complete analysis of the CFTR gene was performed.The respiratory function tests were done according to standard international recommendations.<a href="#bib38" class="elsevierStyleCrossRefs">7</a>The isolation of the same pathogen in at least 3 sputum samples, for at least one year and with a minimal interval of one month, was considered by the authors as the definition of chronic airway colonization.Statistical analysis was done with SPSS 19, 2010 software program (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL, USA). Descriptive statistics (mean, standard deviation) were used to summarize the data. The Kolmogorov–Sminorv test was used to analyze the distribution of variables. Variables with a normal distribution were analyzed using the student t-test, while in the abnormal ones the Mann–Whitney U test was employed. The significance level was set at p < 0.05.The project was approved by the Ethics Committee for Local Health of the CHSJ.<a name="sec0015" class="elsevierStyleCrossRefs"></a>ResultsThe clinical records of 202 patients with BE diagnosis were reviewed.The diagnosis was established by HRCT in 94% of the patients and by CT scan in the remaining patients.The patients’ general characteristics are shown in <a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>.Table 1. General characteristics.<a name="t0005" class="elsevierStyleCrossRefs"></a><table><tr align="left"><td>Characteristics</td><td> </td></tr><tr align="left"><td colspan="2">Sexn(%)</td></tr><tr align="left"><td>Female</td><td>129 (63.9)</td></tr><tr align="left"><td>Age, years (mean ± SD), n = 202</td><td>54.4 ± 15.8</td></tr><tr align="left"><td>Diagnosis age (mean ± SD), n = 167</td><td>47.4 ± 17</td></tr><tr align="left"><td>Follow up, years (mean ± SD), n = 202</td><td>5.61 ± 7.1</td></tr><tr align="left"><td>Years elapsed from symptoms onset and diagnosis (mean ± SD), n = 133</td><td>16.9 ± 15</td></tr><tr align="left"><td colspan="2"> </td></tr><tr align="left"><td colspan="2">Smoking habits, n = 169 (%)</td></tr><tr align="left"><td>Non-smokers</td><td>119 (70.4)</td></tr><tr align="left"><td>Smokers</td><td>19 (11.2)</td></tr><tr align="left"><td>Ex-smokers</td><td>31 (18.3)</td></tr><tr align="left"><td colspan="2"> </td></tr><tr align="left"><td colspan="2">Sputum, n = 187 (%)</td></tr><tr align="left"><td>Daily</td><td>110 (58.8)</td></tr><tr align="left"><td>Purulent/mucopurulent</td><td>83 (75.5)</td></tr><tr align="left"><td>Exacerbations</td><td>77 (41.2)</td></tr><tr align="left"><td>Dyspnea, n = 176 (%)</td><td>74.4</td></tr><tr align="left"><td>Hemoptysis, n = 202 (%)</td><td>61 (30.2)</td></tr></table>Fertility information was missing for 40 (54.7%) of the male patients. The upper airway symptoms were also rarely mentioned, as well as, occupational exposure to toxic chemicals, family history of BE, non respiratory symptoms and consanguinity data.<a name="sec0020" class="elsevierStyleCrossRefs"></a>RadiologyBE had a bilateral distribution in 89% of the patients. In 6% of the cases only 1 lobe was affected and in 80.4% 4 or more lobes were affected or there were cystic changes in 2 or more lobes. The predominant morphology was cylindrical (47%), followed by cylindrical associated with cystic (34%). The lower lobes (LL) were the most frequently affected (right LL in 88% and left LL in 86%).<a name="sec0025" class="elsevierStyleCrossRefs"></a>MicrobiologyThirty-four patients (16.8%) did not have a record of a sputum microbiological examination.Out of 168 patients with at least one sputum microbiological examination, the most frequently isolated bacteria once or intermittently was Haemophilus influenzae (26.8%), followed by Streptococcus pneumoniae (16.7%) and Pseudomonas aeruginosa (14.9%).Eighty-seven patients (43.1%) had done 3 or more sputum examinations during the period of one year, of which 43 (49.4%) met the chronic colonization criteria. The most commonly isolated bacteria in this set of patients was P. aeruginosa (81.4%), associated in 3 cases with other bacteria, followed by H. influenzae (9.1%) and Achromobacter xylosoxidans (4.7%) (<a href="#t0010" class="elsevierStyleCrossRefs">Table 2</a>).Table 2. Chronic airway colonization.<a name="t0010" class="elsevierStyleCrossRefs"></a><table><tr align="left"><td>Microbiological agent</td><td>n = 43 (%)</td></tr><tr align="left"><td>Pseudomonas aeruginosa</td><td>32 (74.4)</td></tr><tr align="left"><td>Haemophilus influenzae</td><td>3 (7)</td></tr><tr align="left"><td>Achromobacter xylosoxidans</td><td>2 (4.7)</td></tr><tr align="left"><td>P. aeruginosa + Proteus mirabilis</td><td>1</td></tr><tr align="left"><td>P. aeruginosa + Haemophilus influenzae</td><td>1</td></tr><tr align="left"><td>P. aeruginosa + MRSA</td><td>1</td></tr><tr align="left"><td>Streptococcus pneumoniae</td><td>1</td></tr><tr align="left"><td>Enterobacter cloacae</td><td>1</td></tr><tr align="left"><td>Aspergillus fumigatus</td><td>1</td></tr></table>MRSA, methicilin-resistant Staphylococcus aureus. Atypical mycobacteria were identified in 20 patients, corresponding to 23 different isolations, as 2 different species were isolated in 3 patients on different occasions. The species belonging to Mycobacterium avium-complex (MAC) were the most common (65.2%), followed by M. kansasii (17.4%), M. gordonae (8.7%), M. fortuitum (4.3%) and M. peregrinum (4.3%). In most cases (60.9%) only one positive culture was identified. Ten patients underwent treatment, 9 for MAC and 1 for M. Kansasii infection, of which 2 did not meet the nontuberculosis mycobacterial infection published criteria.<a href="#bib39" class="elsevierStyleCrossRefs">8</a>After the BE diagnosis, 5 patients had pulmonary tuberculosis (PT).<a name="sec0030" class="elsevierStyleCrossRefs"></a>Respiratory functionThe results of the functional assessments, based on the most recent records, are presented in <a href="#t0010" class="elsevierStyleCrossRefs">Table 2</a>. Overall, the FEV1 was 65% of predicted, of which 32% had FEV1 <50%, 31% had between 50 and 70% and 37% reached >70%.Thirteen percent of the patients had type II and 5% type I respiratory failure.In a comparative analysis of pulmonary function of chronic and non-chronic colonized patients the figures (<a href="#t0015" class="elsevierStyleCrossRefs">Table 3</a>) showed statistically significant lower values of FVC, FEV1, FEV1/FVC ratio and RV in colonized patients. The differences between the TLC did not reach statistical significance.Table 3. Pulmonary function.<a name="t0015" class="elsevierStyleCrossRefs"></a><table><tr align="left"><td>Parameter</td><td>Total (n = 195)</td><td>Chronic colonized (n = 43)</td><td>Non-chronic colonized (n = 152)</td><td>p value</td></tr><tr align="left"><td> </td><td>(liters), mean and SD % of predicted and SD</td><td>(liters), mean and SD % of predicted and SD</td><td>(liters), mean and SD % of predicted and SD</td><td> </td></tr><tr align="left"><td>FVC a</td><td>2.51 ± 0.87</td><td>1.94 ± 0.75</td><td>2.67 ± 0.84</td><td><0.01</td></tr><tr align="left"><td> </td><td>84.9 ± 23.5</td><td>69.5 ± 22</td><td>89.4 ± 22.1</td><td><0.01</td></tr><tr align="left"><td>FEV1 b</td><td>1.78 ± 2.7</td><td>1.12 ± 0.48</td><td>1.74 ± 0.75</td><td><0.01</td></tr><tr align="left"><td> </td><td>65.1 ± 25.4</td><td>48.4 ± 16.2</td><td>70.1 ± 25.3</td><td><0.01</td></tr><tr align="left"><td>FEV1/FVC</td><td>63 ± 14.3</td><td>58.8 ± 11.2</td><td>64.3 ± 14.7</td><td><0.01</td></tr><tr align="left"><td>TLC c</td><td>5.02 ± 1.2</td><td>4.73 ± 1.2</td><td>5.08 ± 1.2</td><td>ns e (0.121)</td></tr><tr align="left"><td> </td><td>101.4 ± 19.2</td><td>98.3 ± 22</td><td>102 ± 18.3</td><td>ns (0.219)</td></tr><tr align="left"><td>RV d</td><td>2.48 ± 0.9</td><td>2.6 ± 0.93</td><td>2.41 ± 2.67</td><td>0.033</td></tr><tr align="left"><td> </td><td>137.2 ± 49.4</td><td>153.9 ± 62</td><td>132 ± 153.9</td><td>0.012</td></tr></table>a Forced vital capacity. b Forced expiratory volume in 1 s. c Total lung capacity. d Residual volume. e Not significant. <a name="sec0035" class="elsevierStyleCrossRefs"></a>Aetiological investigationThe exams carried out to investigate the BE aetiology are shown in <a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>.<a name="f0005" class="elsevierStyleCrossRefs"></a><img src="420v21n01-90385609fig1.jpg" alt="Aetiological investigation. AAT, α1-antitrypsin."></img>Figure 1. Aetiological investigation. AAT, α1-antitrypsin.The CF genetic analysis was performed in 34 (16.8%) of the cases, and 1 patient was found to have 1 mutation (R334W). The extensive genetic test was performed in 4.9% of the patients. One mutation (V754M) was detected in 1 of the patients and 2 mutations [G576A; R668C] were detected in another patient which after family screening was confirmed to be in cis. The sweat test in these patients was negative.Five patients did a semen analysis, and infertility was confirmed in 3 cases (one was diagnosed as PCD and the other two were considered as of unknown cause).In relation to the upper airways, 45 patients (22.3%) did nasal CT and findings were suggestive of chronic sinusitis in 24 (11.9%).The aetiologies shown in <a href="#t0020" class="elsevierStyleCrossRefs">Table 4</a> were based on the clinical records and the results of the exams carried out. A definitive aetiological diagnosis was not established in 57.4% of the patients. In 30.3% BE was post-infectious, mostly secondary to tuberculosis (27.2%).Table 4. Aetiological diagnosis and comparison with prospective studies.<a name="t0020" class="elsevierStyleCrossRefs"></a><table><tr align="left"><td>Aetiology</td><td>Amorim et al. (n = 202) %</td><td>Pasteur et al. 4 (n = 150) %</td><td>Shoemark et al. 5 (n = 165) %</td><td>McShane et al. 8 (n = 106) %</td></tr><tr align="left"><td>Unknown/idiopathic</td><td>116 (57.4)</td><td>80 (53)</td><td>43 (26)</td><td>7 (6.6)</td></tr><tr align="left"><td>Pos-infection (PT a and others)</td><td>62 (30.3)</td><td>44 (29)</td><td>54 (32.8)</td><td>10 (9.4)</td></tr><tr align="left"><td>Primary ciliary dyskinesia</td><td>1 (<1) e</td><td>3 (1.5)</td><td>17 (10)</td><td>3 (2.8)</td></tr><tr align="left"><td>ABPA b</td><td>1 (<1)</td><td>11 (7)</td><td>13 (8)</td><td>1 (0.9)</td></tr><tr align="left"><td>Immunodeficiency</td><td>7 (3.5)</td><td>12 (8)</td><td>11 (7)</td><td>33 (31.1)</td></tr><tr align="left"><td>Intestinal inflammatory disease</td><td>1 (<1)</td><td>2 (<1)</td><td>5 (3)</td><td>2 (2.8)</td></tr><tr align="left"><td>α1-Antitrypsin deficiency</td><td>3 (1.4)</td><td>0</td><td>0</td><td>12 (11.3)</td></tr><tr align="left"><td>Young's syndrome</td><td>0</td><td>5 (3)</td><td>5 (3)</td><td>0</td></tr><tr align="left"><td>Panbronchiolitis</td><td>0</td><td>1 (1)</td><td>4 (2)</td><td>0</td></tr><tr align="left"><td>Yellow nail syndrome</td><td>0</td><td>0</td><td>4 (2)</td><td>0</td></tr><tr align="left"><td>Nodular bronchiectatic disease</td><td>2 (<1)</td><td>0</td><td>2 (1.2)</td><td>10 (9.4)</td></tr><tr align="left"><td>Autoimmune disease</td><td>3 (1.4) f</td><td>4 (3) f</td><td>3 (2) f</td><td>30 (28.3)</td></tr><tr align="left"><td>Aspiration</td><td>2 (<1)</td><td>6 (4)</td><td>2 (1)</td><td>12 (11.3)</td></tr><tr align="left"><td>CF c /CFRD d</td><td>3 (1.4)</td><td>4 (3)</td><td>2 (1)</td><td>0</td></tr><tr align="left"><td>Congenital anatomical defects</td><td>1 (<1) g</td><td>1 (<1)</td><td>0</td><td>1 (0.9) h</td></tr><tr align="left"><td>Others</td><td> </td><td> </td><td> </td><td>3</td></tr></table>a Pulmonary tuberculosis. b Allergic bronchopulmonary aspergillosis. c Cystic fibrosis. d Cystic fibrosis related disease. e Diagnosis not based on gold standard exams. f Rheumatoid arthritis. g Bronchial atresia. h Mounier–Kuhn syndrome. The 7 cases of immunodeficiency include 2 IgA deficiencies (with IgG4 deficiency), 3 common variable immunodeficiencies and 2 hematologic malignancies.<a name="sec0040" class="elsevierStyleCrossRefs"></a>DiscussionThe 202 patients in the study were followed in the pulmonology outpatient service. There was a predominance of female and non-smoker patients in the evaluated population, which is consistent with most published series.<a href="#bib40" class="elsevierStyleCrossRefs">9</a>, <a href="#bib41" class="elsevierStyleCrossRefs">10</a>There was a long delay in diagnosis. This could be due to the lack of specificity of BE symptoms which, on many occasions, can lead to a misdiagnosis of COPD or asthma<a href="#bib42" class="elsevierStyleCrossRefs">11</a>, <a href="#bib43" class="elsevierStyleCrossRefs">12</a> with prognostic implications.<a href="#bib35" class="elsevierStyleCrossRefs">4</a>, <a href="#bib36" class="elsevierStyleCrossRefs">5</a>, <a href="#bib44" class="elsevierStyleCrossRefs">13</a>The patient information was recorded and follow-ups carried out without a predefined protocol, based on existing guidelines, which certainly contributed to the absence of important clinical historic data, subjective descriptions of some symptoms and the lack of appropriate investigation tests.The result of the functional assessment was compatible with an obstructive pattern, as described in the literature.<a href="#bib45" class="elsevierStyleCrossRefs">14</a>, <a href="#bib46" class="elsevierStyleCrossRefs">15</a>The HRCT is considered the gold standard diagnostic test for BE and in this review it was chosen as the confirmatory diagnostic method. In most cases BE was bilateral and the predominant morphology was cylindrical, followed by cylindrical in association with cystic. This result is partly a consequence of a more generalized use of HRCT and its high sensitivity.<a href="#bib47" class="elsevierStyleCrossRefs">16</a>, <a href="#bib48" class="elsevierStyleCrossRefs">17</a>According to current recommendations, sputum culture should be carried out regularly.<a href="#bib41" class="elsevierStyleCrossRefs">10</a>, <a href="#bib49" class="elsevierStyleCrossRefs">18</a> It was not quite clear why 115 (56.9%) patients had not had one or had fewer than 3 samples per year. This may have led to an underestimation of the real number of chronic colonizations. The bacteria most commonly isolated, intermittently or only once, was H. influenzae and the bacteria most frequently associated with chronic colonization was P. aeruginosa. The presence of the latter has been linked to greater clinical and functional severity, greater numbers of exacerbations and worse quality of life.<a href="#bib33" class="elsevierStyleCrossRefs">2</a>, <a href="#bib50" class="elsevierStyleCrossRefs">19</a> This fact could explain why further bacteriological sputum tests had been requested for this subset of patients, which means that P. aeruginosa may not be the bacteria most frequently associated with chronic colonization.The pulmonary function was significantly worse in the chronic colonized patients, which reflects the severity usually associated with the chronic infection.The prevalence of mycobacteria in BE patients is relatively low, ranging between 2% and 10%.<a href="#bib51" class="elsevierStyleCrossRefs">20</a>, <a href="#bib52" class="elsevierStyleCrossRefs">21</a> In this series the prevalence was in this range, MAC being the most common.<a href="#bib53" class="elsevierStyleCrossRefs">22</a>The assessment of BE patients must always include the investigation of the primary cause.<a href="#bib41" class="elsevierStyleCrossRefs">10</a>, <a href="#bib49" class="elsevierStyleCrossRefs">18</a>, <a href="#bib54" class="elsevierStyleCrossRefs">23</a><a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a> shows the diagnostic tests carried out in total patients and in the cases of BE of unknown cause. The percentage of tests done is similar between the two groups, which suggests that further research could be done, using our local resources.According to current recommendations, a conductivity sweat test value >60 mmol/l should be confirmed by chloride measurement<a href="#bib55" class="elsevierStyleCrossRefs">24</a>; this is not available in our hospital.The CF genetic test allowed the detection of mutations in 3 patients who were considered to have a CFTR-related disorder because the sweat test was negative and only one mutation or two mutations in cis were detected.<a href="#bib56" class="elsevierStyleCrossRefs">25</a>, <a href="#bib57" class="elsevierStyleCrossRefs">26</a> However, to exclude CF with accuracy the quantitative sweat test should have been carried out on these patients and, if necessary, the nasal potential difference, which is not done in our country.In this review, an aetiological diagnosis was obtained in 42.1% (<a href="#t0020" class="elsevierStyleCrossRefs">Table 4</a>) and the post-infectious cause was the most common, like other published series.<a href="#bib33" class="elsevierStyleCrossRefs">2</a>, <a href="#bib45" class="elsevierStyleCrossRefs">14</a>, <a href="#bib58" class="elsevierStyleCrossRefs">27</a> Compared with studies in which a diagnostic algorithm was applied prospectively (<a href="#t0020" class="elsevierStyleCrossRefs">Table 4</a>) our result is lower.<a href="#bib35" class="elsevierStyleCrossRefs">4</a>, <a href="#bib36" class="elsevierStyleCrossRefs">5</a>, <a href="#bib59" class="elsevierStyleCrossRefs">28</a>COPD was not considered as a cause of BE, despite the fact that some studies have shown an unexpectedly high incidence of BE in this disease.<a href="#bib59" class="elsevierStyleCrossRefs">28</a>, <a href="#bib60" class="elsevierStyleCrossRefs">29</a>, <a href="#bib61" class="elsevierStyleCrossRefs">30</a>, <a href="#bib62" class="elsevierStyleCrossRefs">31</a> In light of current knowledge,<a href="#bib41" class="elsevierStyleCrossRefs">10</a> BE associated with COPD should only be established after a careful aetiological work-up to exclude other associated diseases.The reduced percentage or even absence of some pathologies in our study, namely ABPA, immunodeficiency and PCD<a href="#bib35" class="elsevierStyleCrossRefs">4</a>, <a href="#bib36" class="elsevierStyleCrossRefs">5</a>, <a href="#bib37" class="elsevierStyleCrossRefs">6</a> suggest that the implementation of an algorithmic investigation and the availability of specific tests could facilitate the achievement of rare and/or complex diagnosis.<a name="sec0045" class="elsevierStyleCrossRefs"></a>ConclusionIn the recent years there has been a resurgence of interest in BE and it is urgent to set out our practice in the latest existing guidelines and to review our standards of care.In our country there are no specialized centres for BE; not even in central hospitals.As BE can result from several diseases, a detailed clinical history and physical examination is fundamental in order to establish the diagnostic hypothesis and to guide the research in the most appropriate way.Our results show how important, useful clinical and aetiological findings could be missed when a pre-existing protocol is not being used. If the investigation and medical follow-ups were done with a pre-defined protocol based on current published guidelines,<a href="#bib41" class="elsevierStyleCrossRefs">10</a>, <a href="#bib49" class="elsevierStyleCrossRefs">18</a> we would probably have a higher percentage of accurate diagnoses and a better clinical characterization of the patients.The establishment of dedicated outpatient clinics may help to improve the global management of these patients, from diagnosis to therapeutic interventions, and consequently improve prognosis and understanding of the natural course of the disease.<a name="sec0050" class="elsevierStyleCrossRefs"></a>Ethical disclosures<a name="sec0055" class="elsevierStyleCrossRefs"></a>Protection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.<a name="sec0060" class="elsevierStyleCrossRefs"></a>Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.<a name="sec0065" class="elsevierStyleCrossRefs"></a>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<a name="sec0070" class="elsevierStyleCrossRefs"></a>Conflicts of interestDr. Javier de Gracia declare the following conflicts of interest: received industry-sponsored grand funding from Grifolds, Gilead, Novartis for participating in clinical trials and received fees for lectures and other educational activities from Praxis.AcknowledgementsI would like to thank the collaboration of all colleagues from the Pneumology Service who referred patients, accompanied in outpatient care, to be included in the investigation.Received 12 November 2013 Accepted 15 June 2014 Corresponding author. adelinamorim@gmail.com" "pdfFichero" => "320v21n01a90385610pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec640997" "palabras" => array:5 [ 0 => "Adult" 1 => "Bronchiectasis" 2 => "Clinical investigation" 3 => "Aetiology" 4 => "Respiratory service" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:1 [ "resumen" => " Background Bronchiectasis can result from many diseases, which makes the aetiological investigation a complex process demanding special resources and experience. The aetiological diagnosis has been proven to be useful for the therapeutic approach. Objective Evaluate how accurately and extensive the clinical and aetiological research was for adult bronchiectasis patients in pulmonology outpatient service which were not following a pre-existing protocol. Methods We retrospectively reviewed the records of 202 adult patients with bronchiectasis, including the examinations performed to explain the aetiology. Results The mean age of the patients was 54 ± 15 years, there was a predominance of female (63.9%) and non-smoker (70%) patients. Functional evaluation showed a mild airway obstruction. The sputum microbiological examination was available for 168 patients (43.1% had 3 or more sputum examinations during one year). Immunoglobulins and α1-antitrypsin were measured in around 50% of the patients. The sweat test and the CF genotyping test were performed in 18% and 17% of the patients, respectively. The most commonly identified cause was post-infectious (30.3%), mostly tuberculosis (27.2%). No definitive aetiological diagnosis was established in 57.4% of the patients. We achieved a lower aetiological diagnosis if we compare our series with studies in which a diagnostic algorithm was applied prospectively. Conclusions The general characteristics of our patients were similar with other series. Detailed investigation of bronchiectasis is not a standard practice in our outpatient service. These results suggest that the use of a predefined protocol, based on current guidelines, could improve the assessment of these patients and facilitate the achievement of a definitive aetiology." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "420v21n01-90385609fig1.jpg" "Alto" => 1088 "Ancho" => 1526 "Tamanyo" => 211021 ] ] "descripcion" => array:1 [ "en" => "Aetiological investigation. AAT, ¿1-antitrypsin." ] ] 1 => array:6 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Aetiological investigation. AAT, α1-antitrypsin." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib32" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005; 12:205-9." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Prevalence and economic burden of bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Weycker D" 1 => "Edelsberg J" 2 => "Oster G" 3 => "Tino G." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Pulm Med. " "fecha" => "2005" "volumen" => "12" "paginaInicial" => "205" "paginaFinal" => "209" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib33" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J. 2009; 34:843-9." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Mortality in bronchiectasis: a long-term study assessing the factors influencing survival." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Loebinger MR" 1 => "Wells AU" 2 => "Hansell DM" 3 => "Chinyanganya N" 4 => "Devaraj A" 5 => "Meister M" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00003709" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J. " "fecha" => "2009" "volumen" => "34" "paginaInicial" => "843" "paginaFinal" => "849" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19357155" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib34" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronchiectasis in secondary care: a comprehensive profile of a neglected disease. Eur J Int Med. 2003; 14:488-92." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronchiectasis in secondary care: a comprehensive profile of a neglected disease." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Kelly MG" 1 => "Murphy S" 2 => "Elborn JS." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Int Med. " "fecha" => "2003" "volumen" => "14" "paginaInicial" => "488" "paginaFinal" => "492" "itemHostRev" => array:3 [ "pii" => "S2213260014702917" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib35" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000; 162:1277-84." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "An investigation into causative factors in patients with bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Pasteur MC" 1 => "Helliwell SM" 2 => "Houghton SJ" 3 => "Webb SC" 4 => "Foweraker JE" 5 => "Coulden RA" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.162.4.9906120" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med. " "fecha" => "2000" "volumen" => "162" "paginaInicial" => "1277" "paginaFinal" => "1284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11029331" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S221326001470205X" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib36" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Aetiology in adult patients with bronchiectasis. Respir Med. 2007; 101:1163-70." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Aetiology in adult patients with bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Shoemark A" 1 => "Ozerovitch L" 2 => "Wilson R." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2006.11.008" "Revista" => array:6 [ "tituloSerie" => "Respir Med. " "fecha" => "2007" "volumen" => "101" "paginaInicial" => "1163" "paginaFinal" => "1170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17223027" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib37" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Non-CF bronchiectasis: does knowing the aetiology lead to changes in management?. Eur Respir J. 2005; 26:8-14." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Non-CF bronchiectasis: does knowing the aetiology lead to changes in management?." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Li AM" 1 => "Sonnappa S" 2 => "Lex C" 3 => "Wong E" 4 => "Zacharasiewicz A" 5 => "Bush A" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.05.00127704" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J. " "fecha" => "2005" "volumen" => "26" "paginaInicial" => "8" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15994383" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib38" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lung volumes and forced ventilator flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993; 6(Suppl. 16):5-40." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Lung volumes and forced ventilator flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Quanjer PH" 1 => "Tammeling GJ" 2 => "Cotes JE" 3 => "Pedersen OF" 4 => "Peslin R" 5 => "Yernault JC." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09041950.005s1693" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J. " "fecha" => "1993" "volumen" => "6" "paginaInicial" => "5" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24576915" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib39" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175:367-416." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Griffith DE" 1 => "Aksamit T" 2 => "Brown-Elliott BA" 3 => "Catanzaro A" 4 => "Daley C" 5 => "Gordin F" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200604-571ST" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med. " "fecha" => "2007" "volumen" => "175" "paginaInicial" => "367" "paginaFinal" => "416" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17277290" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib40" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronchiectasis: sex and gender considerations. Clin Chest Med. 2004; 25:361-72." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronchiectasis: sex and gender considerations." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Morrissey BM" 1 => "Harper RW." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2004.01.011" "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med. " "fecha" => "2004" "volumen" => "25" "paginaInicial" => "361" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15099895" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib41" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010; 65:i1-i58." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "British Thoracic Society guideline for non-CF bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Pasteur MC" 1 => "Bilton D" 2 => "Hill AT." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2010.136119" "Revista" => array:6 [ "tituloSerie" => "Thorax. " "fecha" => "2010" "volumen" => "65" "paginaInicial" => "i1" "paginaFinal" => "i58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20627931" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib42" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "The need to redefine non-cystic fibrosis bronchiectasis in childhood. Thorax. 2004; 59:324-7." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The need to redefine non-cystic fibrosis bronchiectasis in childhood." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Eastham KM" 1 => "Fall AJ" 2 => "Mitchell L" 3 => "Spencer DA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax. " "fecha" => "2004" "volumen" => "59" "paginaInicial" => "324" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15047953" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib43" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Assessment and investigation of adults with bronchiectasis. Eur Respir Monogr. 2011; 4:32-43." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Assessment and investigation of adults with bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Drain M" 1 => "Elborn JS." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir Monogr. " "fecha" => "2011" "volumen" => "4" "paginaInicial" => "32" "paginaFinal" => "43" "itemHostRev" => array:3 [ "pii" => "S221326001470298X" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib44" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Immunoglobulin therapy to control lung damage in patients with common variable immunodeficiency. Int Immunopharmacol. 2004; 4:745-53." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Immunoglobulin therapy to control lung damage in patients with common variable immunodeficiency." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "De Gracia J" 1 => "Vendrell M" 2 => "Álvarez A" 3 => "Pallisa E" 4 => "Rodrigo MJ" 5 => "de la Rosa D" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.intimp.2004.02.011" "Revista" => array:7 [ "tituloSerie" => "Int Immunopharmacol. " "fecha" => "2004" "volumen" => "4" "paginaInicial" => "745" "paginaFinal" => "753" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15135316" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S221326001470205X" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib45" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort. Chest. 1995; 108:955-61." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Nicotra MB" 1 => "Rivera M" 2 => "Dale AM" 3 => "Shepherd R" 4 => "Carter R." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest. " "fecha" => "1995" "volumen" => "108" "paginaInicial" => "955" "paginaFinal" => "961" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7555168" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib46" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006; 100:2183-9." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Characterisation of the onset and presenting clinical features of adult bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "King PT" 1 => "Holsworth ST" 2 => "Freezer NJ" 3 => "Villanueva E" 4 => "Holmes PW." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2006.03.012" "Revista" => array:6 [ "tituloSerie" => "Respir Med. " "fecha" => "2006" "volumen" => "100" "paginaInicial" => "2183" "paginaFinal" => "2189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16650970" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib47" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronquiectasias no debidas a fibrosis quística. Monografías en Neumología. Diagnóstico por la Imagem en las Bronquiectasias. 2008; 3:47-68." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronquiectasias no debidas a fibrosis quística. Monografías en Neumología." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Fuster CO" 1 => "Diaz ED" 2 => "Ríos JLDLC." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Diagnóstico por la Imagem en las Bronquiectasias. " "fecha" => "2008" "volumen" => "3" "paginaInicial" => "47" "paginaFinal" => "68" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib48" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dissociation of lung function, dyspnea ratings and pulmonary extension in bronchiectasis. Respir Med. 2007; 101:2248-53." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Dissociation of lung function, dyspnea ratings and pulmonary extension in bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Martínez-Garcia MA" 1 => "Perpiñá-Tordera M" 2 => "Soler-Catalunã JJ" 3 => "Román-Sánches P" 4 => "Lloris-Bayo A" 5 => "González-Molina A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2007.06.028" "Revista" => array:7 [ "tituloSerie" => "Respir Med. " "fecha" => "2007" "volumen" => "101" "paginaInicial" => "2248" "paginaFinal" => "2253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17698334" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109708018330" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib49" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Diagnosis and treatment of bronchiectasis. Spanish Society of Pneumology and Thoracic Surgery. Arch Bronconeumol. 2008; 44:629-40." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Diagnosis and treatment of bronchiectasis. Spanish Society of Pneumology and Thoracic Surgery." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Vendrell M" 1 => "Gracia J" 2 => "Olveira C" 3 => "Martínez MA" 4 => "Girón R" 5 => "Máiz L" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol. " "fecha" => "2008" "volumen" => "44" "paginaInicial" => "629" "paginaFinal" => "640" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19007570" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib50" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007; 132:1565-72." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Martínez-Garcia MA" 1 => "Soler-Catalunã JJ" 2 => "Perpiñá-Tordera" 3 => "Román-Sánches P" 4 => "Soriano J." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.07-0490" "Revista" => array:6 [ "tituloSerie" => "Chest. " "fecha" => "2007" "volumen" => "132" "paginaInicial" => "1565" "paginaFinal" => "1572" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17998359" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib51" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nontuberculous mycobacteria in patients with bronchiectasis. Thorax. 2005; 60:1045-51." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Nontuberculous mycobacteria in patients with bronchiectasis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Wickremasinghe M" 1 => "Ozerovitch LJ" 2 => "Davies G" 3 => "Wodehouse T" 4 => "Chadwick MV" 5 => "Abdallah S" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2005.046631" "Revista" => array:6 [ "tituloSerie" => "Thorax. " "fecha" => "2005" "volumen" => "60" "paginaInicial" => "1045" "paginaFinal" => "1051" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16227333" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib52" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics. Eur Respir J. 2006; 28:1204-10." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Fowler SJ" 1 => "French J" 2 => "Screaton NJ" 3 => "Foweraker J" 4 => "Condliffe A" 5 => "Haworth CS" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.06.00149805" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J. " "fecha" => "2006" "volumen" => "28" "paginaInicial" => "1204" "paginaFinal" => "1210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16807259" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib53" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pulmonary disease due to nontuberculous mycobacteria. Chest. 2008; 133:243-51." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Pulmonary disease due to nontuberculous mycobacteria." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Glassroth J." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.07-0358" "Revista" => array:6 [ "tituloSerie" => "Chest. " "fecha" => "2008" "volumen" => "133" "paginaInicial" => "243" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18187749" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib54" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. Med J Aust. 2010; 193:356-65." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Chang AB" 1 => "Bell SC" 2 => "Byrnes CA" 3 => "Grimwood K" 4 => "Holmes PW" 5 => "King PT" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Med J Aust. " "fecha" => "2010" "volumen" => "193" "paginaInicial" => "356" "paginaFinal" => "365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20854242" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S000291491400719X" "estado" => "S300" "issn" => "00029149" ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib55" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Evidence based guidelines for the performance of the sweat test for the investigation of cystic fibrosis in the UK. Arch Dis Child. 2003; 88:1126-7." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Evidence based guidelines for the performance of the sweat test for the investigation of cystic fibrosis in the UK." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Baumer JH." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child. " "fecha" => "2003" "volumen" => "88" "paginaInicial" => "1126" "paginaFinal" => "1127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14670787" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib56" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Recommendations for the classification of diseases as CFTR-related disorders. J Cyst Fibros. 2011; 10(Suppl. 2):86-102." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Recommendations for the classification of diseases as CFTR-related disorders." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Bombieri C" 1 => "Claustres M" 2 => "De Boeck K" 3 => "Derichs N" 4 => "Dodge J" 5 => "Girodon E" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcf.2010.10.004" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros. " "fecha" => "2011" "volumen" => "10" "paginaInicial" => "86" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21075063" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib57" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronchiectasis in adult patients: an expression of heterozygosity for CFTR gene mutations?. Clin Genet. 2004; 65:490-5." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronchiectasis in adult patients: an expression of heterozygosity for CFTR gene mutations?." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Casals T" 1 => "De-Gracia J" 2 => "Gallego M" 3 => "Dorca J" 4 => "Rodríguez-Sanchón B" 5 => "Ramos MD" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0009-9163.2004.00265.x" "Revista" => array:6 [ "tituloSerie" => "Clin Genet. " "fecha" => "2004" "volumen" => "65" "paginaInicial" => "490" "paginaFinal" => "495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15151509" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib58" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronchiectasis in Central Australia: a young face to an old disease. Respir Med. 2008; 102:574-8." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronchiectasis in Central Australia: a young face to an old disease." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Steinfort DP" 1 => "Brady Stephen" 2 => "Weisinger HS" 3 => "Einsiedel L." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2007.11.007" "Revista" => array:6 [ "tituloSerie" => "Respir Med. " "fecha" => "2008" "volumen" => "102" "paginaInicial" => "574" "paginaFinal" => "578" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18086522" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib59" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronchiectasis in a diverse US population. Chest. 2012; 142:159-67." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronchiectasis in a diverse US population." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "McShane PJ" 1 => "Naureckas ET" 2 => "Strek ME." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-1024" "Revista" => array:6 [ "tituloSerie" => "Chest. " "fecha" => "2012" "volumen" => "142" "paginaInicial" => "159" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22267679" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib60" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Physiological and radiological characterization of patients diagnosis with chronic obstructive pulmonary disease in primary care. Thorax. 2000; 55:635-42." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Physiological and radiological characterization of patients diagnosis with chronic obstructive pulmonary disease in primary care." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O’Brien CO" 1 => "Guest PJ" 2 => "Hill SL" 3 => "Stockley RA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax. " "fecha" => "2000" "volumen" => "55" "paginaInicial" => "635" "paginaFinal" => "642" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10899238" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib61" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004; 170:400-7." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Patel IS" 1 => "Vlahos I" 2 => "Wilkinson TM" 3 => "Lloyd-Owen SF" 4 => "Donaldson GC" 5 => "Wilks M" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200305-648OC" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med. " "fecha" => "2004" "volumen" => "170" "paginaInicial" => "400" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15130905" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673612616808" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib62" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "EPOC y bronquiectasias. Arch Bronconeumol. 2010; 46(Suppl. 3):11-7." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "EPOC y bronquiectasias." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Martínez-Garcia MA" 1 => "Soler-Catalunã JJ." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(10)70021-1" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol. 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A.. Amorima,

,b, J.. Bentob, A.P.. Vazb, I.. Gomesb, J.. de Graciac,d, V.. Hespanhola,b, A.. Marquesa,b

a Faculty of Medicine, University of Porto, Portugal

b Pneumology, Centro Hospitalar de S. João, EPE, Porto, Portugal

c Faculty of Medicine, Autonomous University of Barcelona, Spain

d Pneumology, CIBER Enfermedades Respiratorias (CIBERES) Hospital Vall d’Hebron, Barcelona, Spain

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    "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Bronchiectasis &#40;BE&#41; results from a large number of diseases and is associated with high morbidity and significant costs for health-care systems&#46;<a href="&#35;bib32" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib33" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a></p><p class="elsevierStylePara">For many years respiratory infections were the main identifiable cause&#46; However&#44; post-infectious BE has been decreasing mainly in developed countries due to vaccination programmes&#44; antibiotic therapy and better social-hygienic conditions while other congenital or acquired causes have been described now that we have more accurate diagnosis methods&#46;<a href="&#35;bib34" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a></p><p class="elsevierStylePara">In recent years&#44; a number of studies have shown that an aetiological diagnosis can change the therapeutic approach in a relevant percentage of patients&#46;<a href="&#35;bib35" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib36" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib37" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a></p><p class="elsevierStylePara">Research carried out in units with great experience in BE and with specialized resources may not be typical of the assessment which is carried out in the majority of general respiratory services&#46; There is some evidence that the study and follow-up of patients in specialized centres probably contribute to a larger number of aetiological diagnoses and more appropriate treatment&#46;<a href="&#35;bib36" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib37" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a></p><p class="elsevierStylePara">The local characteristics of BE patients were unknown&#44; namely the level of research&#44; BE aetiologies&#44; functional severity and microbiological characteristics&#46;</p><p class="elsevierStylePara">The aim of this study was to evaluate how accurate and extensive the clinical and aetiological research was for BE patients followed in the pulmonology outpatient service of a central hospital which did not routinely use a thorough&#44; pre-existing protocol for it&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Materials and methods</span><p class="elsevierStylePara">A retrospective analysis of the clinical records of adult patients with BE diagnosis who were seen and managed in the pulmonology outpatient service&#44; from January 2008 to January 2009&#44; was carried out&#46; The patients concerned had to be followed-up for at least 1 year&#46;</p><p class="elsevierStylePara">The diagnosis of BE was established by the characteristic features of the high-resolution computed tomography &#40;HRCT&#41; of the thorax &#40;bronchoarterial ratio &#8805;1&#44; dilated bronchi visible &#8804;1&#160;cm from parietal pleura&#44; cystic changes and a lack of normal bronchial tapering&#41; or the CT&#44; if unequivocal evidence of BE existed&#46;</p><p class="elsevierStylePara">Patients with CF and interstitial pathology were excluded&#46;</p><p class="elsevierStylePara">Each pulmonologist involved was totally responsible for the clinical records&#44; the follow-up and aetiological research&#44; without having to comply with any predefined protocol&#46; We arrived at an aetiological diagnosis based on the clinical records and the results of earlier diagnostic tests done by the patient&#39;s clinician&#46; There was no subsequent research done to complement our study&#46;</p><p class="elsevierStylePara">The demographical&#44; clinical&#44; functional&#44; radiological and microbiological data were reviewed&#46; The exams that had been performed to explain the BE aetiology&#44; namely&#44; the sweat test&#44; cystic fibrosis &#40;CF&#41; genotyping&#44; measurement of serum immunoglobulins &#40;Igs&#41;&#44; &#945;1-antitrypsin &#40;AAT&#41; and the semen analysis were recorded&#46;</p><p class="elsevierStylePara">The sweat test was performed by conductivity method and the CF genotyping test screened the 33 most frequent <span class="elsevierStyleItalic">CFTR</span> mutations in Portuguese population&#46; In some cases a complete analysis of the <span class="elsevierStyleItalic">CFTR</span> gene was performed&#46;</p><p class="elsevierStylePara">The respiratory function tests were done according to standard international recommendations&#46;<a href="&#35;bib38" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">The isolation of the same pathogen in at least 3 sputum samples&#44; for at least one year and with a minimal interval of one month&#44; was considered by the authors as the definition of chronic airway colonization&#46;</p><p class="elsevierStylePara">Statistical analysis was done with SPSS 19&#44; 2010 software program &#40;Statistical Package for Social Sciences&#44; SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Descriptive statistics &#40;mean&#44; standard deviation&#41; were used to summarize the data&#46; The Kolmogorov&#8211;Sminorv test was used to analyze the distribution of variables&#46; Variables with a normal distribution were analyzed using the student <span class="elsevierStyleItalic">t</span>-test&#44; while in the abnormal ones the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was employed&#46; The significance level was set at <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46;</p><p class="elsevierStylePara">The project was approved by the Ethics Committee for Local Health of the CHSJ&#46;</p><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">The clinical records of 202 patients with BE diagnosis were reviewed&#46;</p><p class="elsevierStylePara">The diagnosis was established by HRCT in 94&#37; of the patients and by CT scan in the remaining patients&#46;</p><p class="elsevierStylePara">The patients&#8217; general characteristics are shown in <a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#46;</p><p class="elsevierStylePara">Table 1&#46; General characteristics&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Characteristics</td><td>&#160;</td></tr><tr align="left"><td colspan="2"><span class="elsevierStyleBold">Sex</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Female</span></td><td>129 &#40;63&#46;9&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Age&#44; years</span> &#40;<span class="elsevierStyleItalic">mean</span>&#160;&#177;&#160;<span class="elsevierStyleItalic">SD</span>&#41;<span class="elsevierStyleItalic">&#44; n</span>&#160;&#61;&#160;<span class="elsevierStyleItalic">202</span></td><td>54&#46;4&#160;&#177;&#160;15&#46;8</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Diagnosis age</span> &#40;<span class="elsevierStyleItalic">mean</span>&#160;&#177;&#160;<span class="elsevierStyleItalic">SD</span>&#41;&#44; <span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;<span class="elsevierStyleItalic">167</span></td><td>47&#46;4&#160;&#177;&#160;17</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Follow up&#44; years</span> &#40;<span class="elsevierStyleItalic">mean</span>&#160;&#177;&#160;<span class="elsevierStyleItalic">SD</span>&#41;&#44; <span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;202</td><td>5&#46;61&#160;&#177;&#160;7&#46;1</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Years elapsed from symptoms onset and diagnosis</span> &#40;<span class="elsevierStyleItalic">mean</span>&#160;&#177;&#160;<span class="elsevierStyleItalic">SD</span>&#41;&#44; <span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;133</td><td>16&#46;9&#160;&#177;&#160;15</td></tr><tr align="left"><td colspan="2">&#160;</td></tr><tr align="left"><td colspan="2"><span class="elsevierStyleBold">Smoking habits</span>&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span>&#160;&#61;&#160;<span class="elsevierStyleBold">169 &#40;&#37;&#41;</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Non-smokers</span></td><td>119 &#40;70&#46;4&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Smokers</span></td><td>19 &#40;11&#46;2&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Ex-smokers</span></td><td>31 &#40;18&#46;3&#41;</td></tr><tr align="left"><td colspan="2">&#160;</td></tr><tr align="left"><td colspan="2"><span class="elsevierStyleBold">Sputum</span>&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span>&#160;&#61;&#160;<span class="elsevierStyleBold">187 &#40;&#37;&#41;</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Daily</span></td><td>110 &#40;58&#46;8&#41;</td></tr><tr align="left"><td>Purulent&#47;mucopurulent</td><td>83 &#40;75&#46;5&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Exacerbations</span></td><td>77 &#40;41&#46;2&#41;</td></tr><tr align="left"><td><span class="elsevierStyleBold">Dyspnea</span>&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span>&#160;&#61;&#160;<span class="elsevierStyleBold">176 &#40;&#37;&#41;</span></td><td>74&#46;4</td></tr><tr align="left"><td><span class="elsevierStyleBold">Hemoptysis</span>&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span>&#160;&#61;&#160;<span class="elsevierStyleBold">202 &#40;&#37;&#41;</span></td><td>61 &#40;30&#46;2&#41;</td></tr></table><p class="elsevierStylePara">Fertility information was missing for 40 &#40;54&#46;7&#37;&#41; of the male patients&#46; The upper airway symptoms were also rarely mentioned&#44; as well as&#44; occupational exposure to toxic chemicals&#44; family history of BE&#44; non respiratory symptoms and consanguinity data&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Radiology</span><p class="elsevierStylePara">BE had a bilateral distribution in 89&#37; of the patients&#46; In 6&#37; of the cases only 1 lobe was affected and in 80&#46;4&#37; 4 or more lobes were affected or there were cystic changes in 2 or more lobes&#46; The predominant morphology was cylindrical &#40;47&#37;&#41;&#44; followed by cylindrical associated with cystic &#40;34&#37;&#41;&#46; The lower lobes &#40;LL&#41; were the most frequently affected &#40;right LL in 88&#37; and left LL in 86&#37;&#41;&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Microbiology</span><p class="elsevierStylePara">Thirty-four patients &#40;16&#46;8&#37;&#41; did not have a record of a sputum microbiological examination&#46;</p><p class="elsevierStylePara">Out of 168 patients with at least one sputum microbiological examination&#44; the most frequently isolated bacteria once or intermittently was <span class="elsevierStyleItalic">Haemophilus influenzae</span> &#40;26&#46;8&#37;&#41;&#44; followed by <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> &#40;16&#46;7&#37;&#41; and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;14&#46;9&#37;&#41;&#46;</p><p class="elsevierStylePara">Eighty-seven patients &#40;43&#46;1&#37;&#41; had done 3 or more sputum examinations during the period of one year&#44; of which 43 &#40;49&#46;4&#37;&#41; met the chronic colonization criteria&#46; The most commonly isolated bacteria in this set of patients was <span class="elsevierStyleItalic">P&#46; aeruginosa</span> &#40;81&#46;4&#37;&#41;&#44; associated in 3 cases with other bacteria&#44; followed by <span class="elsevierStyleItalic">H&#46; influenzae</span> &#40;9&#46;1&#37;&#41; and <span class="elsevierStyleItalic">Achromobacter xylosoxidans</span> &#40;4&#46;7&#37;&#41; &#40;<a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a>&#41;&#46;</p><p class="elsevierStylePara">Table 2&#46; Chronic airway colonization&#46;</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Microbiological agent</td><td><span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;43 &#40;&#37;&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span></td><td>32 &#40;74&#46;4&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Haemophilus influenzae</span></td><td>3 &#40;7&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Achromobacter xylosoxidans</span></td><td>2 &#40;4&#46;7&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">P&#46; 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as 2 different species were isolated in 3 patients on different occasions&#46; The species belonging to <span class="elsevierStyleItalic">Mycobacterium avium-complex</span> &#40;MAC&#41; were the most common &#40;65&#46;2&#37;&#41;&#44; followed by <span class="elsevierStyleItalic">M&#46; kansasii</span> &#40;17&#46;4&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; gordonae</span> &#40;8&#46;7&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; fortuitum</span> &#40;4&#46;3&#37;&#41; and <span class="elsevierStyleItalic">M&#46; peregrinum</span> &#40;4&#46;3&#37;&#41;&#46; In most cases &#40;60&#46;9&#37;&#41; only one positive culture was identified&#46; Ten patients underwent treatment&#44; 9 for MAC and 1 for <span class="elsevierStyleItalic">M&#46; Kansasii</span> infection&#44; of which 2 did not meet the nontuberculosis mycobacterial infection published criteria&#46;<a href="&#35;bib39" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a></p><p class="elsevierStylePara">After the BE diagnosis&#44; 5 patients had pulmonary tuberculosis &#40;PT&#41;&#46;</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Respiratory function</span><p class="elsevierStylePara">The results of the functional assessments&#44; based on the most recent records&#44; are presented in <a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a>&#46; Overall&#44; the FEV1 was 65&#37; of predicted&#44; of which 32&#37; had FEV1 &#60;50&#37;&#44; 31&#37; had between 50 and 70&#37; and 37&#37; reached &#62;70&#37;&#46;</p><p class="elsevierStylePara">Thirteen percent of the patients had type II and 5&#37; type I respiratory failure&#46;</p><p class="elsevierStylePara">In a comparative analysis of pulmonary function of chronic and non-chronic colonized patients the figures &#40;<a href="&#35;t0015" class="elsevierStyleCrossRefs">Table 3</a>&#41; showed statistically significant lower values of FVC&#44; FEV1&#44; FEV1&#47;FVC ratio and RV in colonized patients&#46; The differences between the TLC did not reach statistical significance&#46;</p><p class="elsevierStylePara">Table 3&#46; Pulmonary function&#46;</p><a name="t0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Parameter</td><td>Total &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;195&#41;</td><td>Chronic colonized &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;43&#41;</td><td>Non-chronic colonized &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;152&#41;</td><td><span class="elsevierStyleItalic">p</span> value</td></tr><tr align="left"><td>&#160;</td><td>&#40;liters&#41;&#44; mean and SD<br></br>&#37; of predicted and SD</td><td>&#40;liters&#41;&#44; mean and SD<br></br>&#37; of predicted and SD</td><td>&#40;liters&#41;&#44; mean and SD<br></br>&#37; of predicted and SD</td><td>&#160;</td></tr><tr align="left"><td>FVC  <span class="elsevierStyleSup">a</span></td><td>2&#46;51&#160;&#177;&#160;0&#46;87</td><td>1&#46;94&#160;&#177;&#160;0&#46;75</td><td>2&#46;67&#160;&#177;&#160;0&#46;84</td><td>&#60;0&#46;01</td></tr><tr align="left"><td>&#160;</td><td>84&#46;9&#160;&#177;&#160;23&#46;5</td><td>69&#46;5&#160;&#177;&#160;22</td><td>89&#46;4&#160;&#177;&#160;22&#46;1</td><td>&#60;0&#46;01</td></tr><tr align="left"><td>FEV1  <span class="elsevierStyleSup">b</span></td><td>1&#46;78&#160;&#177;&#160;2&#46;7</td><td>1&#46;12&#160;&#177;&#160;0&#46;48</td><td>1&#46;74&#160;&#177;&#160;0&#46;75</td><td>&#60;0&#46;01</td></tr><tr align="left"><td>&#160;</td><td>65&#46;1&#160;&#177;&#160;25&#46;4</td><td>48&#46;4&#160;&#177;&#160;16&#46;2</td><td>70&#46;1&#160;&#177;&#160;25&#46;3</td><td>&#60;0&#46;01</td></tr><tr align="left"><td>FEV1&#47;FVC</td><td>63&#160;&#177;&#160;14&#46;3</td><td>58&#46;8&#160;&#177;&#160;11&#46;2</td><td>64&#46;3&#160;&#177;&#160;14&#46;7</td><td>&#60;0&#46;01</td></tr><tr align="left"><td>TLC  <span class="elsevierStyleSup">c</span></td><td>5&#46;02&#160;&#177;&#160;1&#46;2</td><td>4&#46;73&#160;&#177;&#160;1&#46;2</td><td>5&#46;08&#160;&#177;&#160;1&#46;2</td><td>ns  <span class="elsevierStyleSup">e</span><br></br>&#40;0&#46;121&#41;</td></tr><tr align="left"><td>&#160;</td><td>101&#46;4&#160;&#177;&#160;19&#46;2</td><td>98&#46;3&#160;&#177;&#160;22</td><td>102&#160;&#177;&#160;18&#46;3</td><td>ns<br></br>&#40;0&#46;219&#41;</td></tr><tr align="left"><td>RV  <span class="elsevierStyleSup">d</span></td><td>2&#46;48&#160;&#177;&#160;0&#46;9</td><td>2&#46;6&#160;&#177;&#160;0&#46;93</td><td>2&#46;41&#160;&#177;&#160;2&#46;67</td><td>0&#46;033</td></tr><tr align="left"><td>&#160;</td><td>137&#46;2&#160;&#177;&#160;49&#46;4</td><td>153&#46;9&#160;&#177;&#160;62</td><td>132&#160;&#177;&#160;153&#46;9</td><td>0&#46;012</td></tr></table><p class="elsevierStylePara">a Forced vital capacity&#46;<br></br>b Forced expiratory volume in 1&#160;s&#46;<br></br>c Total lung capacity&#46;<br></br>d Residual volume&#46;<br></br>e Not significant&#46;<br></br></p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Aetiological investigation</span><p class="elsevierStylePara">The exams carried out to investigate the BE aetiology are shown in <a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a>&#46;</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385609fig1.jpg" alt="Aetiological investigation&#46; AAT&#44; &#945;1-antitrypsin&#46;"></img></p><p class="elsevierStylePara">Figure 1&#46; Aetiological investigation&#46; AAT&#44; &#945;1-antitrypsin&#46;</p><p class="elsevierStylePara">The CF genetic analysis was performed in 34 &#40;16&#46;8&#37;&#41; of the cases&#44; and 1 patient was found to have 1 mutation &#40;R334W&#41;&#46; The extensive genetic test was performed in 4&#46;9&#37; of the patients&#46; One mutation &#40;V754M&#41; was detected in 1 of the patients and 2 mutations &#91;G576A&#59; R668C&#93; were detected in another patient which after family screening was confirmed to be in <span class="elsevierStyleItalic">cis&#46;</span> The sweat test in these patients was negative&#46;</p><p class="elsevierStylePara">Five patients did a semen analysis&#44; and infertility was confirmed in 3 cases &#40;one was diagnosed as PCD and the other two were considered as of unknown cause&#41;&#46;</p><p class="elsevierStylePara">In relation to the upper airways&#44; 45 patients &#40;22&#46;3&#37;&#41; did nasal CT and findings were suggestive of chronic sinusitis in 24 &#40;11&#46;9&#37;&#41;&#46;</p><p class="elsevierStylePara">The aetiologies shown in <a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a> were based on the clinical records and the results of the exams carried out&#46; A definitive aetiological diagnosis was not established in 57&#46;4&#37; of the patients&#46; In 30&#46;3&#37; BE was post-infectious&#44; mostly secondary to tuberculosis &#40;27&#46;2&#37;&#41;&#46;</p><p class="elsevierStylePara">Table 4&#46; Aetiological diagnosis and comparison with prospective studies&#46;</p><a name="t0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Aetiology</td><td>Amorim et al&#46; &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;202&#41; &#37;</td><td>Pasteur et al&#46;  <span class="elsevierStyleSup">4</span>  &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;150&#41; &#37;</td><td>Shoemark et al&#46;  <span class="elsevierStyleSup">5</span>  &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;165&#41; &#37;</td><td>McShane et al&#46;  <span class="elsevierStyleSup">8</span>  &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;106&#41; &#37;</td></tr><tr align="left"><td>Unknown&#47;idiopathic</td><td>116 &#40;57&#46;4&#41;</td><td>80 &#40;53&#41;</td><td>43 &#40;26&#41;</td><td>7 &#40;6&#46;6&#41;</td></tr><tr align="left"><td>Pos-infection &#40;PT  <span class="elsevierStyleSup">a</span>  and others&#41;</td><td>62 &#40;30&#46;3&#41;</td><td>44 &#40;29&#41;</td><td>54 &#40;32&#46;8&#41;</td><td>10 &#40;9&#46;4&#41;</td></tr><tr align="left"><td>Primary ciliary dyskinesia</td><td>1 &#40;&#60;1&#41;  <span class="elsevierStyleSup">e</span></td><td>3 &#40;1&#46;5&#41;</td><td>17 &#40;10&#41;</td><td>3 &#40;2&#46;8&#41;</td></tr><tr align="left"><td>ABPA  <span class="elsevierStyleSup">b</span></td><td>1 &#40;&#60;1&#41;</td><td>11 &#40;7&#41;</td><td>13 &#40;8&#41;</td><td>1 &#40;0&#46;9&#41;</td></tr><tr align="left"><td>Immunodeficiency</td><td>7 &#40;3&#46;5&#41;</td><td>12 &#40;8&#41;</td><td>11 &#40;7&#41;</td><td>33 &#40;31&#46;1&#41;</td></tr><tr align="left"><td>Intestinal inflammatory disease</td><td>1 &#40;&#60;1&#41;</td><td>2 &#40;&#60;1&#41;</td><td>5 &#40;3&#41;</td><td>2 &#40;2&#46;8&#41;</td></tr><tr align="left"><td>&#945;1-Antitrypsin deficiency</td><td>3 &#40;1&#46;4&#41;</td><td>0</td><td>0</td><td>12 &#40;11&#46;3&#41;</td></tr><tr align="left"><td>Young&#39;s syndrome</td><td>0</td><td>5 &#40;3&#41;</td><td>5 &#40;3&#41;</td><td>0</td></tr><tr align="left"><td>Panbronchiolitis</td><td>0</td><td>1 &#40;1&#41;</td><td>4 &#40;2&#41;</td><td>0</td></tr><tr align="left"><td>Yellow nail syndrome</td><td>0</td><td>0</td><td>4 &#40;2&#41;</td><td>0</td></tr><tr align="left"><td>Nodular bronchiectatic disease</td><td>2 &#40;&#60;1&#41;</td><td>0</td><td>2 &#40;1&#46;2&#41;</td><td>10 &#40;9&#46;4&#41;</td></tr><tr align="left"><td>Autoimmune disease</td><td>3 &#40;1&#46;4&#41;  <span class="elsevierStyleSup">f</span></td><td>4 &#40;3&#41;  <span class="elsevierStyleSup">f</span></td><td>3 &#40;2&#41;  <span class="elsevierStyleSup">f</span></td><td>30 &#40;28&#46;3&#41;</td></tr><tr align="left"><td>Aspiration</td><td>2 &#40;&#60;1&#41;</td><td>6 &#40;4&#41;</td><td>2 &#40;1&#41;</td><td>12 &#40;11&#46;3&#41;</td></tr><tr align="left"><td>CF  <span class="elsevierStyleSup">c</span> &#47;CFRD  <span class="elsevierStyleSup">d</span></td><td>3 &#40;1&#46;4&#41;</td><td>4 &#40;3&#41;</td><td>2 &#40;1&#41;</td><td>0</td></tr><tr align="left"><td>Congenital anatomical defects</td><td>1 &#40;&#60;1&#41;  <span class="elsevierStyleSup">g</span></td><td>1 &#40;&#60;1&#41;</td><td>0</td><td>1 &#40;0&#46;9&#41;  <span class="elsevierStyleSup">h</span></td></tr><tr align="left"><td>Others</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>3</td></tr></table><p class="elsevierStylePara">a Pulmonary tuberculosis&#46;<br></br>b Allergic bronchopulmonary aspergillosis&#46;<br></br>c Cystic fibrosis&#46;<br></br>d Cystic fibrosis related disease&#46;<br></br>e Diagnosis not based on gold standard exams&#46;<br></br>f Rheumatoid arthritis&#46;<br></br>g Bronchial atresia&#46;<br></br>h Mounier&#8211;Kuhn syndrome&#46;<br></br></p><p class="elsevierStylePara">The 7 cases of immunodeficiency include 2 IgA deficiencies &#40;with IgG4 deficiency&#41;&#44; 3 common variable immunodeficiencies and 2 hematologic malignancies&#46;</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">The 202 patients in the study were followed in the pulmonology outpatient service&#46; There was a predominance of female and non-smoker patients in the evaluated population&#44; which is consistent with most published series&#46;<a href="&#35;bib40" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib41" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a></p><p class="elsevierStylePara">There was a long delay in diagnosis&#46; This could be due to the lack of specificity of BE symptoms which&#44; on many occasions&#44; can lead to a misdiagnosis of COPD or asthma<a href="&#35;bib42" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib43" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a> with prognostic implications&#46;<a href="&#35;bib35" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib36" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib44" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a></p><p class="elsevierStylePara">The patient information was recorded and follow-ups carried out without a predefined protocol&#44; based on existing guidelines&#44; which certainly contributed to the absence of important clinical historic data&#44; subjective descriptions of some symptoms and the lack of appropriate investigation tests&#46;</p><p class="elsevierStylePara">The result of the functional assessment was compatible with an obstructive pattern&#44; as described in the literature&#46;<a href="&#35;bib45" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib46" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a></p><p class="elsevierStylePara">The HRCT is considered the <span class="elsevierStyleItalic">gold standard</span> diagnostic test for BE and in this review it was chosen as the confirmatory diagnostic method&#46; In most cases BE was bilateral and the predominant morphology was cylindrical&#44; followed by cylindrical in association with cystic&#46; This result is partly a consequence of a more generalized use of HRCT and its high sensitivity&#46;<a href="&#35;bib47" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib48" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a></p><p class="elsevierStylePara">According to current recommendations&#44; sputum culture should be carried out regularly&#46;<a href="&#35;bib41" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib49" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">18</span></a> It was not quite clear why 115 &#40;56&#46;9&#37;&#41; patients had not had one or had fewer than 3 samples per year&#46; This may have led to an underestimation of the real number of chronic colonizations&#46; The bacteria most commonly isolated&#44; intermittently or only once&#44; was <span class="elsevierStyleItalic">H&#46; influenzae</span> and the bacteria most frequently associated with chronic colonization was <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#46; The presence of the latter has been linked to greater clinical and functional severity&#44; greater numbers of exacerbations and worse quality of life&#46;<a href="&#35;bib33" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib50" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">19</span></a> This fact could explain why further bacteriological sputum tests had been requested for this subset of patients&#44; which means that <span class="elsevierStyleItalic">P&#46; aeruginosa</span> may not be the bacteria most frequently associated with chronic colonization&#46;</p><p class="elsevierStylePara">The pulmonary function was significantly worse in the chronic colonized patients&#44; which reflects the severity usually associated with the chronic infection&#46;</p><p class="elsevierStylePara">The prevalence of mycobacteria in BE patients is relatively low&#44; ranging between 2&#37; and 10&#37;&#46;<a href="&#35;bib51" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib52" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">21</span></a> In this series the prevalence was in this range&#44; MAC being the most common&#46;<a href="&#35;bib53" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">22</span></a></p><p class="elsevierStylePara">The assessment of BE patients must always include the investigation of the primary cause&#46;<a href="&#35;bib41" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib49" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib54" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">23</span></a></p><p class="elsevierStylePara"><a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a> shows the diagnostic tests carried out in total patients and in the cases of BE of unknown cause&#46; The percentage of tests done is similar between the two groups&#44; which suggests that further research could be done&#44; using our local resources&#46;</p><p class="elsevierStylePara">According to current recommendations&#44; a conductivity sweat test value &#62;60&#160;mmol&#47;l should be confirmed by chloride measurement<a href="&#35;bib55" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">24</span></a>&#59; this is not available in our hospital&#46;</p><p class="elsevierStylePara">The CF genetic test allowed the detection of mutations in 3 patients who were considered to have a CFTR-related disorder because the sweat test was negative and only one mutation or two mutations in cis were detected&#46;<a href="&#35;bib56" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib57" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">26</span></a> However&#44; to exclude CF with accuracy the quantitative sweat test should have been carried out on these patients and&#44; if necessary&#44; the nasal potential difference&#44; which is not done in our country&#46;</p><p class="elsevierStylePara">In this review&#44; an aetiological diagnosis was obtained in 42&#46;1&#37; &#40;<a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#41; and the post-infectious cause was the most common&#44; like other published series&#46;<a href="&#35;bib33" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib45" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib58" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">27</span></a> Compared with studies in which a diagnostic algorithm was applied prospectively &#40;<a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#41; our result is lower&#46;<a href="&#35;bib35" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib36" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib59" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">28</span></a></p><p class="elsevierStylePara">COPD was not considered as a cause of BE&#44; despite the fact that some studies have shown an unexpectedly high incidence of BE in this disease&#46;<a href="&#35;bib59" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib60" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib61" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib62" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">31</span></a> In light of current knowledge&#44;<a href="&#35;bib41" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> BE associated with COPD should only be established after a careful aetiological work-up to exclude other associated diseases&#46;</p><p class="elsevierStylePara">The reduced percentage or even absence of some pathologies in our study&#44; namely ABPA&#44; immunodeficiency and PCD<a href="&#35;bib35" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib36" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib37" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> suggest that the implementation of an algorithmic investigation and the availability of specific tests could facilitate the achievement of rare and&#47;or complex diagnosis&#46;</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStylePara">In the recent years there has been a resurgence of interest in BE and it is urgent to set out our practice in the latest existing guidelines and to review our standards of care&#46;</p><p class="elsevierStylePara">In our country there are no specialized centres for BE&#59; not even in central hospitals&#46;</p><p class="elsevierStylePara">As BE can result from several diseases&#44; a detailed clinical history and physical examination is fundamental in order to establish the diagnostic hypothesis and to guide the research in the most appropriate way&#46;</p><p class="elsevierStylePara">Our results show how important&#44; useful clinical and aetiological findings could be missed when a pre-existing protocol is not being used&#46; If the investigation and medical follow-ups were done with a pre-defined protocol based on current published guidelines&#44;<a href="&#35;bib41" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib49" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">18</span></a> we would probably have a higher percentage of accurate diagnoses and a better clinical characterization of the patients&#46;</p><p class="elsevierStylePara">The establishment of dedicated outpatient clinics may help to improve the global management of these patients&#44; from diagnosis to therapeutic interventions&#44; and consequently improve prognosis and understanding of the natural course of the disease&#46;</p><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study&#46;</p><a name="sec0060" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p><a name="sec0065" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">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</p><a name="sec0070" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">Dr&#46; Javier de Gracia declare the following conflicts of interest&#58; received industry-sponsored grand funding from Grifolds&#44; Gilead&#44; Novartis for participating in clinical trials and received fees for lectures and other educational activities from Praxis&#46;</p><p class="elsevierStylePara">Acknowledgements</p><p class="elsevierStylePara">I would like to thank the collaboration of all colleagues from the Pneumology Service who referred patients&#44; accompanied in outpatient care&#44; to be included in the investigation&#46;</p><p class="elsevierStylePara">Received 12 November 2013 <br></br>Accepted 15 June 2014 </p><p class="elsevierStylePara">Corresponding author&#46; adelinamorim&#64;gmail&#46;com</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle"> Background</span><br/><p class="elsevierStylePara"> Bronchiectasis can result from many diseases&#44; which makes the aetiological investigation a complex process demanding special resources and experience&#46; The aetiological diagnosis has been proven to be useful for the therapeutic approach&#46;</p><span class="elsevierStyleSectionTitle"> Objective</span><br/><p class="elsevierStylePara"> Evaluate how accurately and extensive the clinical and aetiological research was for adult bronchiectasis patients in pulmonology outpatient service which were not following a pre-existing protocol&#46;</p><span class="elsevierStyleSectionTitle"> Methods</span><br/><p class="elsevierStylePara"> We retrospectively reviewed the records of 202 adult patients with bronchiectasis&#44; including the examinations performed to explain the aetiology&#46;</p><span class="elsevierStyleSectionTitle"> Results</span><br/><p class="elsevierStylePara"> The mean age of the patients was 54&#160;&#177;&#160;15 years&#44; there was a predominance of female &#40;63&#46;9&#37;&#41; and non-smoker &#40;70&#37;&#41; patients&#46; Functional evaluation showed a mild airway obstruction&#46;</p><p class="elsevierStylePara"> The sputum microbiological examination was available for 168 patients &#40;43&#46;1&#37; had 3 or more sputum examinations during one year&#41;&#46; Immunoglobulins and &#945;1-antitrypsin were measured in around 50&#37; of the patients&#46; The sweat test and the CF genotyping test were performed in 18&#37; and 17&#37; of the patients&#44; respectively&#46;</p><p class="elsevierStylePara"> The most commonly identified cause was post-infectious &#40;30&#46;3&#37;&#41;&#44; mostly tuberculosis &#40;27&#46;2&#37;&#41;&#46; No definitive aetiological diagnosis was established in 57&#46;4&#37; of the patients&#46; We achieved a lower aetiological diagnosis if we compare our series with studies in which a diagnostic algorithm was applied prospectively&#46;</p><span class="elsevierStyleSectionTitle"> Conclusions</span><br/><p class="elsevierStylePara"> The general characteristics of our patients were similar with other series&#46; Detailed investigation of bronchiectasis is not a standard practice in our outpatient service&#46; These results suggest that the use of a predefined protocol&#44; based on current guidelines&#44; could improve the assessment of these patients and facilitate the achievement of a definitive aetiology&#46;</p>"
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      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005; 12:205&#x002D;9."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Prevalence and economic burden of bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Weycker D"
                            1 => "Edelsberg J"
                            2 => "Oster G"
                            3 => "Tino G&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Pulm Med. "
                        "fecha" => "2005"
                        "volumen" => "12"
                        "paginaInicial" => "205"
                        "paginaFinal" => "209"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mortality in bronchiectasis: a long&#x002D;term study assessing the factors influencing survival. Eur Respir J. 2009; 34:843&#x002D;9."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Mortality in bronchiectasis&#58; a long-term study assessing the factors influencing survival&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Loebinger MR"
                            1 => "Wells AU"
                            2 => "Hansell DM"
                            3 => "Chinyanganya N"
                            4 => "Devaraj A"
                            5 => "Meister M"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00003709"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J. "
                        "fecha" => "2009"
                        "volumen" => "34"
                        "paginaInicial" => "843"
                        "paginaFinal" => "849"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19357155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bronchiectasis in secondary care: a comprehensive profile of a neglected disease. Eur J Int Med. 2003; 14:488&#x002D;92."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Bronchiectasis in secondary care&#58; a comprehensive profile of a neglected disease&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Kelly MG"
                            1 => "Murphy S"
                            2 => "Elborn JS&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Int Med. "
                        "fecha" => "2003"
                        "volumen" => "14"
                        "paginaInicial" => "488"
                        "paginaFinal" => "492"
                        "itemHostRev" => array:3 [
                          "pii" => "S2213260014702917"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000; 162:1277&#x002D;84."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "An investigation into causative factors in patients with bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Pasteur MC"
                            1 => "Helliwell SM"
                            2 => "Houghton SJ"
                            3 => "Webb SC"
                            4 => "Foweraker JE"
                            5 => "Coulden RA"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.162.4.9906120"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med. "
                        "fecha" => "2000"
                        "volumen" => "162"
                        "paginaInicial" => "1277"
                        "paginaFinal" => "1284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11029331"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S221326001470205X"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Aetiology in adult patients with bronchiectasis. Respir Med. 2007; 101:1163&#x002D;70."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Aetiology in adult patients with bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Shoemark A"
                            1 => "Ozerovitch L"
                            2 => "Wilson R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2006.11.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med. "
                        "fecha" => "2007"
                        "volumen" => "101"
                        "paginaInicial" => "1163"
                        "paginaFinal" => "1170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17223027"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Non&#x002D;CF bronchiectasis: does knowing the aetiology lead to changes in management?. Eur Respir J. 2005; 26:8&#x002D;14."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Non-CF bronchiectasis&#58; does knowing the aetiology lead to changes in management&#63;&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Li AM"
                            1 => "Sonnappa S"
                            2 => "Lex C"
                            3 => "Wong E"
                            4 => "Zacharasiewicz A"
                            5 => "Bush A"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00127704"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J. "
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "8"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15994383"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lung volumes and forced ventilator flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993; 6(Suppl. 16):5&#x002D;40."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Lung volumes and forced ventilator flows&#46; Report Working Party Standardization of Lung Function Tests&#44; European Community for Steel and Coal&#46; Official Statement of the European Respiratory Society&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Quanjer PH"
                            1 => "Tammeling GJ"
                            2 => "Cotes JE"
                            3 => "Pedersen OF"
                            4 => "Peslin R"
                            5 => "Yernault JC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09041950.005s1693"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J. "
                        "fecha" => "1993"
                        "volumen" => "6"
                        "paginaInicial" => "5"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24576915"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175:367&#x002D;416."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "An official ATS&#47;IDSA statement&#58; diagnosis&#44; treatment&#44; and prevention of nontuberculous mycobacterial diseases&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Griffith DE"
                            1 => "Aksamit T"
                            2 => "Brown-Elliott BA"
                            3 => "Catanzaro A"
                            4 => "Daley C"
                            5 => "Gordin F"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200604-571ST"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med. "
                        "fecha" => "2007"
                        "volumen" => "175"
                        "paginaInicial" => "367"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17277290"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bronchiectasis: sex and gender considerations. Clin Chest Med. 2004; 25:361&#x002D;72."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Bronchiectasis&#58; sex and gender considerations&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Morrissey BM"
                            1 => "Harper RW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccm.2004.01.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chest Med. "
                        "fecha" => "2004"
                        "volumen" => "25"
                        "paginaInicial" => "361"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15099895"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "British Thoracic Society guideline for non&#x002D;CF bronchiectasis. Thorax. 2010; 65:i1&#x002D;i58."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "British Thoracic Society guideline for non-CF bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Pasteur MC"
                            1 => "Bilton D"
                            2 => "Hill AT&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2010.136119"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax. "
                        "fecha" => "2010"
                        "volumen" => "65"
                        "paginaInicial" => "i1"
                        "paginaFinal" => "i58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20627931"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "The need to redefine non&#x002D;cystic fibrosis bronchiectasis in childhood. Thorax. 2004; 59:324&#x002D;7."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The need to redefine non-cystic fibrosis bronchiectasis in childhood&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Eastham KM"
                            1 => "Fall AJ"
                            2 => "Mitchell L"
                            3 => "Spencer DA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax. "
                        "fecha" => "2004"
                        "volumen" => "59"
                        "paginaInicial" => "324"
                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15047953"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Assessment and investigation of adults with bronchiectasis. Eur Respir Monogr. 2011; 4:32&#x002D;43."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Assessment and investigation of adults with bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Drain M"
                            1 => "Elborn JS&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir Monogr. "
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "32"
                        "paginaFinal" => "43"
                        "itemHostRev" => array:3 [
                          "pii" => "S221326001470298X"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Immunoglobulin therapy to control lung damage in patients with common variable immunodeficiency. Int Immunopharmacol. 2004; 4:745&#x002D;53."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Immunoglobulin therapy to control lung damage in patients with common variable immunodeficiency&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "De Gracia J"
                            1 => "Vendrell M"
                            2 => "&#193;lvarez A"
                            3 => "Pallisa E"
                            4 => "Rodrigo MJ"
                            5 => "de la Rosa D"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.intimp.2004.02.011"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int Immunopharmacol. "
                        "fecha" => "2004"
                        "volumen" => "4"
                        "paginaInicial" => "745"
                        "paginaFinal" => "753"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15135316"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S221326001470205X"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort. Chest. 1995; 108:955&#x002D;61."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Clinical&#44; pathophysiologic&#44; and microbiologic characterization of bronchiectasis in an aging cohort&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Nicotra MB"
                            1 => "Rivera M"
                            2 => "Dale AM"
                            3 => "Shepherd R"
                            4 => "Carter R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest. "
                        "fecha" => "1995"
                        "volumen" => "108"
                        "paginaInicial" => "955"
                        "paginaFinal" => "961"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7555168"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006; 100:2183&#x002D;9."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Characterisation of the onset and presenting clinical features of adult bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "King PT"
                            1 => "Holsworth ST"
                            2 => "Freezer NJ"
                            3 => "Villanueva E"
                            4 => "Holmes PW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2006.03.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med. "
                        "fecha" => "2006"
                        "volumen" => "100"
                        "paginaInicial" => "2183"
                        "paginaFinal" => "2189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16650970"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bronquiectasias no debidas a fibrosis quística. Monografías en Neumología. Diagnóstico por la Imagem en las Bronquiectasias. 2008; 3:47&#x002D;68."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Bronquiectasias no debidas a fibrosis qu&#237;stica&#46; Monograf&#237;as en Neumolog&#237;a&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Fuster CO"
                            1 => "Diaz ED"
                            2 => "R&#237;os JLDLC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Diagnóstico por la Imagem en las Bronquiectasias. "
                        "fecha" => "2008"
                        "volumen" => "3"
                        "paginaInicial" => "47"
                        "paginaFinal" => "68"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dissociation of lung function, dyspnea ratings and pulmonary extension in bronchiectasis. Respir Med. 2007; 101:2248&#x002D;53."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Dissociation of lung function&#44; dyspnea ratings and pulmonary extension in bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Mart&#237;nez-Garcia MA"
                            1 => "Perpi&#241;&#225;-Tordera M"
                            2 => "Soler-Catalun&#227; JJ"
                            3 => "Rom&#225;n-S&#225;nches P"
                            4 => "Lloris-Bayo A"
                            5 => "Gonz&#225;lez-Molina A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2007.06.028"
                      "Revista" => array:7 [
                        "tituloSerie" => "Respir Med. "
                        "fecha" => "2007"
                        "volumen" => "101"
                        "paginaInicial" => "2248"
                        "paginaFinal" => "2253"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17698334"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109708018330"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Diagnosis and treatment of bronchiectasis. Spanish Society of Pneumology and Thoracic Surgery. Arch Bronconeumol. 2008; 44:629&#x002D;40."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Diagnosis and treatment of bronchiectasis&#46; Spanish Society of Pneumology and Thoracic Surgery&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Vendrell M"
                            1 => "Gracia J"
                            2 => "Olveira C"
                            3 => "Mart&#237;nez MA"
                            4 => "Gir&#243;n R"
                            5 => "M&#225;iz L"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol. "
                        "fecha" => "2008"
                        "volumen" => "44"
                        "paginaInicial" => "629"
                        "paginaFinal" => "640"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19007570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Factors associated with lung function decline in adult patients with stable non&#x002D;cystic fibrosis bronchiectasis. Chest. 2007; 132:1565&#x002D;72."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Mart&#237;nez-Garcia MA"
                            1 => "Soler-Catalun&#227; JJ"
                            2 => "Perpi&#241;&#225;-Tordera"
                            3 => "Rom&#225;n-S&#225;nches P"
                            4 => "Soriano J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-0490"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest. "
                        "fecha" => "2007"
                        "volumen" => "132"
                        "paginaInicial" => "1565"
                        "paginaFinal" => "1572"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17998359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Nontuberculous mycobacteria in patients with bronchiectasis. Thorax. 2005; 60:1045&#x002D;51."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Nontuberculous mycobacteria in patients with bronchiectasis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Wickremasinghe M"
                            1 => "Ozerovitch LJ"
                            2 => "Davies G"
                            3 => "Wodehouse T"
                            4 => "Chadwick MV"
                            5 => "Abdallah S"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.046631"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax. "
                        "fecha" => "2005"
                        "volumen" => "60"
                        "paginaInicial" => "1045"
                        "paginaFinal" => "1051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16227333"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics. Eur Respir J. 2006; 28:1204&#x002D;10."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Nontuberculous mycobacteria in bronchiectasis&#58; prevalence and patient characteristics&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Fowler SJ"
                            1 => "French J"
                            2 => "Screaton NJ"
                            3 => "Foweraker J"
                            4 => "Condliffe A"
                            5 => "Haworth CS"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00149805"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J. "
                        "fecha" => "2006"
                        "volumen" => "28"
                        "paginaInicial" => "1204"
                        "paginaFinal" => "1210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16807259"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pulmonary disease due to nontuberculous mycobacteria. Chest. 2008; 133:243&#x002D;51."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Pulmonary disease due to nontuberculous mycobacteria&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Glassroth J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-0358"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest. "
                        "fecha" => "2008"
                        "volumen" => "133"
                        "paginaInicial" => "243"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18187749"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib54"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. Med J Aust. 2010; 193:356&#x002D;65."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Chang AB"
                            1 => "Bell SC"
                            2 => "Byrnes CA"
                            3 => "Grimwood K"
                            4 => "Holmes PW"
                            5 => "King PT"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Med J Aust. "
                        "fecha" => "2010"
                        "volumen" => "193"
                        "paginaInicial" => "356"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20854242"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S000291491400719X"
                          "estado" => "S300"
                          "issn" => "00029149"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib55"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Evidence based guidelines for the performance of the sweat test for the investigation of cystic fibrosis in the UK. Arch Dis Child. 2003; 88:1126&#x002D;7."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Evidence based guidelines for the performance of the sweat test for the investigation of cystic fibrosis in the UK&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Baumer JH&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child. "
                        "fecha" => "2003"
                        "volumen" => "88"
                        "paginaInicial" => "1126"
                        "paginaFinal" => "1127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14670787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib56"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Recommendations for the classification of diseases as CFTR&#x002D;related disorders. J Cyst Fibros. 2011; 10(Suppl. 2):86&#x002D;102."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Recommendations for the classification of diseases as CFTR-related disorders&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Bombieri C"
                            1 => "Claustres M"
                            2 => "De Boeck K"
                            3 => "Derichs N"
                            4 => "Dodge J"
                            5 => "Girodon E"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcf.2010.10.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cyst Fibros. "
                        "fecha" => "2011"
                        "volumen" => "10"
                        "paginaInicial" => "86"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21075063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib57"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bronchiectasis in adult patients: an expression of heterozygosity for CFTR gene mutations?. Clin Genet. 2004; 65:490&#x002D;5."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Bronchiectasis in adult patients&#58; an expression of heterozygosity for CFTR gene mutations&#63;&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Casals T"
                            1 => "De-Gracia J"
                            2 => "Gallego M"
                            3 => "Dorca J"
                            4 => "Rodr&#237;guez-Sanch&#243;n B"
                            5 => "Ramos MD"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.0009-9163.2004.00265.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Genet. "
                        "fecha" => "2004"
                        "volumen" => "65"
                        "paginaInicial" => "490"
                        "paginaFinal" => "495"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15151509"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib58"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bronchiectasis in Central Australia: a young face to an old disease. Respir Med. 2008; 102:574&#x002D;8."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Bronchiectasis in Central Australia&#58; a young face to an old disease&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Steinfort DP"
                            1 => "Brady Stephen"
                            2 => "Weisinger HS"
                            3 => "Einsiedel L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2007.11.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med. "
                        "fecha" => "2008"
                        "volumen" => "102"
                        "paginaInicial" => "574"
                        "paginaFinal" => "578"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18086522"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib59"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bronchiectasis in a diverse US population. Chest. 2012; 142:159&#x002D;67."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Bronchiectasis in a diverse US population&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "McShane PJ"
                            1 => "Naureckas ET"
                            2 => "Strek ME&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.11-1024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest. "
                        "fecha" => "2012"
                        "volumen" => "142"
                        "paginaInicial" => "159"
                        "paginaFinal" => "167"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22267679"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib60"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Physiological and radiological characterization of patients diagnosis with chronic obstructive pulmonary disease in primary care. Thorax. 2000; 55:635&#x002D;42."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Physiological and radiological characterization of patients diagnosis with chronic obstructive pulmonary disease in primary care&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "O&#8217;Brien CO"
                            1 => "Guest PJ"
                            2 => "Hill SL"
                            3 => "Stockley RA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax. "
                        "fecha" => "2000"
                        "volumen" => "55"
                        "paginaInicial" => "635"
                        "paginaFinal" => "642"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10899238"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib61"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004; 170:400&#x002D;7."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Bronchiectasis&#44; exacerbation indices&#44; and inflammation in chronic obstructive pulmonary disease&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Patel IS"
                            1 => "Vlahos I"
                            2 => "Wilkinson TM"
                            3 => "Lloyd-Owen SF"
                            4 => "Donaldson GC"
                            5 => "Wilks M"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200305-648OC"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med. "
                        "fecha" => "2004"
                        "volumen" => "170"
                        "paginaInicial" => "400"
                        "paginaFinal" => "407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15130905"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612616808"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib62"
              "etiqueta" => "31"
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                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "EPOC y bronquiectasias&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Mart&#237;nez-Garcia MA"
                            1 => "Soler-Catalun&#227; JJ&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "doi" => "10.1016/S0300-2896(10)70021-1"
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                        "tituloSerie" => "Arch Bronconeumol. "
                        "fecha" => "2010"
                        "volumen" => "46"
                        "paginaInicial" => "11"
                        "paginaFinal" => "17"
                        "link" => array:1 [
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Article information

ISSN: 08732159
Original language: English

DOI:10.1016/j.rppnen.2014.06.009

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	10	4	14
2024 October	70	46	116
2024 September	91	48	139
2024 August	127	50	177
2024 July	110	52	162
2024 June	114	28	142
2024 May	76	32	108
2024 April	85	49	134
2024 March	80	29	109
2024 February	75	23	98
2024 January	78	34	112
2023 December	56	34	90
2023 November	82	45	127
2023 October	70	43	113
2023 September	66	42	108
2023 August	43	17	60
2023 July	59	35	94
2023 June	55	21	76
2023 May	97	31	128
2023 April	79	30	109
2023 March	141	26	167
2023 February	109	30	139
2023 January	48	22	70
2022 December	79	25	104
2022 November	118	37	155
2022 October	108	43	151
2022 September	52	34	86
2022 August	85	51	136
2022 July	78	52	130
2022 June	70	58	128
2022 May	65	39	104
2022 April	48	35	83
2022 March	50	45	95
2022 February	56	31	87
2022 January	48	34	82
2021 December	23	32	55
2021 November	40	38	78
2021 October	50	41	91
2021 September	37	30	67
2021 August	33	31	64
2021 July	39	32	71
2021 June	50	32	82
2021 May	76	29	105
2021 April	86	75	161
2021 March	88	19	107
2021 February	101	25	126
2021 January	53	22	75
2020 December	34	9	43
2020 November	44	22	66
2020 October	35	17	52
2020 September	58	26	84
2020 August	76	26	102
2020 July	76	22	98
2020 June	63	15	78
2020 May	61	20	81
2020 April	58	14	72
2020 March	48	12	60
2020 February	56	20	76
2020 January	53	12	65
2019 December	58	26	84
2019 November	67	17	84
2019 October	65	25	90
2019 September	55	19	74
2019 August	297	19	316
2019 July	327	13	340
2019 June	340	10	350
2019 May	292	14	306
2019 April	293	24	317
2019 March	445	16	461
2019 February	395	8	403
2019 January	422	26	448
2018 December	113	9	122
2018 November	92	0	92
2018 October	133	14	147
2018 September	41	4	45
2018 August	40	70	110
2018 July	49	15	64
2018 June	70	20	90
2018 May	135	17	152
2018 April	78	19	97
2018 March	132	25	157
2018 February	53	11	64
2018 January	117	14	131
2017 December	181	20	201
2017 November	62	14	76
2017 October	10	14	24
2017 September	21	14	35
2017 August	21	21	42
2017 July	17	14	31
2017 June	20	18	38
2017 May	24	18	42
2017 April	8	5	13
2017 March	10	5	15
2017 February	4	5	9
2017 January	13	12	25
2016 December	6	6	12
2016 November	9	5	14
2016 October	1	4	5
2016 September	2	2	4
2016 August	4	5	9
2016 July	5	8	13
2016 June	2	8	10
2016 May	6	3	9
2016 April	27	3	30
2016 March	46	29	75
2016 February	37	42	79
2016 January	21	33	54
2015 December	25	23	48
2015 November	30	22	52
2015 October	24	26	50
2015 September	25	25	50
2015 August	20	17	37
2015 July	25	6	31
2015 June	13	11	24
2015 May	44	19	63
2015 April	56	33	89
2015 March	108	60	168
2015 February	8	80	88

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