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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall">In recent years&#44; substance abuse has become a serious and growing problem worldwide and has threatened economic&#44; social&#44; legal&#44; and health systems as an essential health problem and social problem in developed and developing countries&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> It is estimated that one in four people in developed countries uses illicit drugs at some time in their life while one in six to seven people are at the risk of substance use disorder &#40;SUD&#41; in developing countries&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> The number of studies investigating the adverse effects of the substances in health is gradually increasing&#46;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4-6</span></a> Besides&#44; SUD causes conditions such as cognitive and behavioral disorders&#44; anxiety&#44; depression&#44; and social isolation it also causes acute airway inflammation by affecting airway bronchial dynamics and by preparing the ground for important histological changes in the airway mucosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0007"><span class="elsevierStyleSup">7-9</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">The current studies&#44; investigating the acute and chronic effects of SUD on the respiratory system&#44; showed that the acute effect of substances on the respiratory system is mostly on bronchial dynamics&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> Moreover&#44; it has been reported that short-term substance use causes decreased airway resistance due to bronchodilation&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> Long-term substance use might result in symptoms such as cough and abnormal sputum production&#44; causing obstruction&#44; hyperinflation&#44; and changes in respiratory functions in the airways&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Recent studies have suggested that substance use for a long time may lead to chronic bronchitis by causing airway inflammation and infection&#46; Also&#44; individuals who use cannabis and cocaine for a long time become susceptible to bacterial and viral infections since these substances cause tracheobronchial mucosal damage in the airway&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Moreover&#44; substance use has been reported to cause respiratory symptoms such as wheezing&#44; cough&#44; shortness of exercise&#44; increased sputum production&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Substance use also affects pulmonary functions and leads to obstruction in the airways during long-term use&#46;<a class="elsevierStyleCrossRefs" href="#bib0018"><span class="elsevierStyleSup">18-22</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">Many countries have national data showing the effect of substance use on respiratory functions&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0019"><span class="elsevierStyleSup">19-23</span></a> In recent years&#44; substance use has been increasing among young people in Turkey&#46; <a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> To date&#44; there are very limited studies on substance use in Turkey&#46; Those studies reported data on substance use disorder prevalence&#44; risk factors&#44; sociodemographic determinants&#44; and cognitive status&#46;<a class="elsevierStyleCrossRefs" href="#bib0026"><span class="elsevierStyleSup">26-29</span></a> Studies on respiratory parameters in these individuals seem to be quite limited&#44; and the need for such a study gains importance when the lack of research in this area is taken into account&#46; However&#44; accurate data to show the current situation in terms of the effects of substance use on the respiratory system is not available in Turkey&#46; To the best of our knowledge&#44; this is the first study to evaluate the respiratory muscle strength in patients with SUD&#46; We therefore aimed to conduct a field study to obtain accurate data regarding lung functions&#44; respiratory muscle strength&#44; and exercise capacity in patients with SUD&#46; We hypothesized that lung functions&#44; respiratory muscle strength&#44; and exercise capacity will be more affected in patients with SUD than in cigarette smokers and non-smokers&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><p id="para0008" class="elsevierStylePara elsevierViewall">A prospective&#44; cross-sectional observational study was conducted in Bakirkoy Prof&#46; Dr&#46; Mazhar Osman Research and Training Hospital for Psychiatry&#44; Neurology&#44; and Neurosurgery&#44; Research&#44; Treatment&#44; and Training Center for Alcohol and Substance Dependence from June 2018 to June 2019&#46; Ethical approval was obtained from the Human Research Ethics Committee of Bakirkoy Dr&#46; Sadi Konuk Training and Research Hospital &#40;Approval number&#58; 2018&#47;42&#41; and conducted in conformity with the Declaration of Helsinki&#46; Verbal and written explanations about the study were provided to all the participants and written informed consents were obtained&#46;</p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Participants</span><p id="para0009" class="elsevierStylePara elsevierViewall">The study sample consisted of 183 patients with SUD&#44; a total of 119 healthy controls&#44; 54 of whom were cigarette smokers and 65 of whom were non-smokers&#46; Age-matched healthy controls consisted of hospital staff who met the eligibility criteria from the hospital staff list&#46; Participants who were volunteers and met the inclusion criteria were enrolled in the study&#46; The eligibility criteria for SUD participants were as follows&#59; &#40;1&#41; age over 18 years old&#59; &#40;2&#41; meeting current Diagnostic and Statistical Manual of Mental Disorders&#44; 5<span class="elsevierStyleSup">th</span> edition &#40;DSM-V&#41; criteria for SUD<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a>&#59; &#40;3&#41; using substances for over a year&#59; &#40;4&#41; able to follow simple instructions&#59; and &#40;5&#41; no pathology in visual ability and hearing&#46; The eligibility criteria for cigarette smoker participants were as follows&#59; &#40;1&#41; age over 18 years old&#59; &#40;2&#41; smoking for over a year &#40;active smokers&#41;&#59; &#40;3&#41; able to follow simple instructions&#59; and &#40;4&#41; no pathology in visual ability and hearing&#46; The eligibility criteria for non-cigarette smoker participants were as follows&#59; &#40;1&#41; age over 18 years old&#59; &#40;2&#41; never smoked tobacco products &#40;never smokers&#41;&#59; &#40;3&#41; able to follow simple instructions&#59; and &#40;4&#41; no pathology in visual ability and hearing&#46; For all participants&#44; the exclusion criteria were as follows&#58; &#40;1&#41; current psychotic symptoms&#44; &#40;2&#41; no physical disabilities &#40;e&#46;g&#46;&#44; lower limb fractures&#44; contractures&#41; or medical problems &#40;e&#46;g&#46;&#44; hypertension&#44; heart attack&#44; diabetes&#41;&#44; or &#40;3&#41; respiratory system problems such as bronchiectasis&#44; asthma&#44; and tuberculosis&#44; infectious health problem &#40;e&#46;g&#46;&#44; HIV&#44; hepatitis B&#41;&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Measurements</span><p id="para0010" class="elsevierStylePara elsevierViewall">The socio-demographic information of the participants was recorded&#46; In addition&#44; pulmonary function tests&#44; respiratory muscle strength&#44; and 6-Minute Walk Test &#40;6-MWT&#41; were evaluated in the study&#46; Furthermore&#44; the dyspnea severity was assessed using the Modified Medical Research Council Dyspnoea &#40;mMRC&#41;&#44; and nicotine dependence was assessed using the Fagerstr&#246;m Test for Nicotine Dependence &#40;FTND&#41; among current cigarette smokers&#46; The III National Health and Nutrition Examination Survey &#40;NHANES III&#41; was used to evaluate respiratory symptoms in patients with SUD and cigarette smokers&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Dyspnea</span><p id="para0011" class="elsevierStylePara elsevierViewall">All participants&#39; perceptions of dyspnea in daily living were evaluated using the modified Medical Research Council &#40;mMRC&#41; scale&#44; which consists of five statements that describe almost the entire range of dyspnea from none &#40;Grade 0&#41; to almost complete incapacity &#40;Grade 4&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a></p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Nicotine dependence</span><p id="para0012" class="elsevierStylePara elsevierViewall">The FTND&#44; which is a standard instrument for assessing the intensity of physical addiction to nicotine&#44; is used to measure the nicotine dependence related to cigarette smoking&#46; It contains six items that evaluate the quantity of cigarette consumption&#44; the compulsion to use&#44; and dependence&#46; The items are summed to yield a total score of 0-10 with a higher score indicating higher nicotine dependence&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a></p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Lung function tests</span><p id="para0013" class="elsevierStylePara elsevierViewall">Lung function was measured using portable spirometry &#40;Spirobank II&#59; MIR&#44; Rome&#44; Italy&#41;&#46; Measurements were performed according to the criteria of the American Thoracic Society &#40;ATS&#41; and the European Respiratory Society &#40;ERS&#41; guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> Instructions and demonstrations were given to the participants before the spirometry measurements were taken&#46; After three acceptable maneuvers&#44; the highest values were selected for analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> Measurements were specified as percentages of the predicted values&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Respiratory muscle strength</span><p id="para0014" class="elsevierStylePara elsevierViewall">The respiratory muscle strength was evaluated by the maximum inspiratory pressure &#40;MIP&#41; and maximum expiratory pressure &#40;MEP&#41; according to ATS&#47;ERS criteria using a portable MicroRPM device &#40;Micro Medical&#44; Basingstoke&#44; UK&#41;&#46; The highest value from five acceptable and reproducible attempts was recorded &#40;i&#46;e&#46;&#44; a difference of &#8804; 10&#37; among values&#41; and is expressed as an absolute value &#40;cmH<span class="elsevierStyleInf">2</span>O&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> A percentage of the predicted values of MIP and MEP was specified as described by Black and Hyatt&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a></p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Exercise capacity</span><p id="para0015" class="elsevierStylePara elsevierViewall">The 6-MWT&#44; which is a reliable and valid test for evaluating exercise capacity&#44; was performed according to the guideline of the ERS&#47;ATS&#46;<a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> Systolic blood pressure &#40;SBP&#41;&#44; diastolic blood pressure &#40;DBP&#41;&#44; heart rate &#40;HR&#41;&#44; perceived dyspnoea&#44; and fatigue as measured using modified Borg scale &#40;mBorg&#41; were assessed before and after the 6-MWTs&#46; The distance in meters covered over the 6 minutes was recorded&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> Also&#44; the percentage of the predicted values was specified as described by Enright and Sherril&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Statistical analysis</span><p id="para0016" class="elsevierStylePara elsevierViewall">Statistical Package for Social Science &#40;SPSS&#41; version 21&#46;0 for Windows software &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; was used for all statistical analyses&#46; Descriptive statistics&#44; including frequency&#44; the percentage for nominal variables&#44; and mean and standard deviation for continuous variables were calculated&#46; The Kolmogorov-Smirnov test was used to test the normality of data distribution&#46; Demographic data were compared among the three groups by one-way analysis of variance &#40;one-way ANOVA&#41; for continuous variables and Chi-squared test for categorical variables&#46; Dependent variables &#40;lung function test&#44; respiratory muscle strength&#44; and the 6-MWT&#41; were compared among the three groups by multivariate analysis of variance &#40;MANOVA&#41;&#46; In addition&#44; covariance analysis &#40;MANCOVA&#41; was used in statistical analysis&#46; The sex&#44; age&#44; weight&#44; height&#44; BMI&#44; number of cigarettes smoked per day&#44; duration of smoking&#44; and score of the FTND were used as covariates&#44; as they have an impact on the dependent variables&#46; Once differences among the means were determined&#44; the least significant difference &#40;LSD&#41; post hoc test was used&#46; The significance level was set at <span class="elsevierStyleItalic">p &#60;</span> 0&#46;05&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">The estimated sample size was derived from the online Raosoft sample size calculator &#40;RaoSoft&#44; Inc&#46;&#44; Seattle&#44; WA&#59; <a href="http://www.raosoft.com/samplesize.html">http&#58;&#47;&#47;www&#46;raosoft&#46;com&#47;samplesize&#46;html</a>&#41;&#46; Raosof online calculator is designed specifically for population surveys to calculate the sample size and determine how many responses are needed&#44; to meet the desired confidence level with the margin of error &#40;usually 5&#37;&#41;&#46; Therefore&#44; it is highly recommended to be used for such a study with the consideration of the population size&#46;<a class="elsevierStyleCrossRef" href="#bib0041"><span class="elsevierStyleSup">41</span></a> The total population of heroin users in Istanbul is approximately 46&#46;500&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Therefore&#44; in order to achieve a confidence level of 90&#37;&#44; a response rate of 50&#37;&#44; and a 5&#37; margin of error&#44; a minimum sample size of 271 was required&#46; However&#44; from a total of only 217 patients with SUD screened for eligibility criteria&#44; only 183 patients with SUD were enrolled in the study&#46; A sample of 183 patients with SUD would provide a confidence level of 90&#37; and a 6&#46;08&#37; margin of error which may affect the power of the study&#46;</p></span></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Results</span><p id="para0018" class="elsevierStylePara elsevierViewall">A total of 217 patients with SUD who met the inclusion criteria were enrolled in the study&#46; A total of 34 patients with SUD patients were excluded from the study because 26 of the participants could not comply with the spirometry test and 8 people refused to participate in the study voluntarily&#46; As a result&#44; a total of 302 volunteers&#44; including 183 patients with SUD&#44; a total of 119 healthy controls&#44; 54 of whom were cigarette smokers and 65 of whom were non-smokers in the same age group were included in the study &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Demographic and clinical characteristics</span><p id="para0019" class="elsevierStylePara elsevierViewall">A comparison of the demographic and clinical characteristics of the participants is given in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46; The weight and BMI of SUD patients were significantly less than cigarette smokers and non-smokers &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;013 and <span class="elsevierStyleItalic">p &#61;</span> 0&#46;042&#59; <span class="elsevierStyleItalic">p &#61;</span> 0&#46;018 and <span class="elsevierStyleItalic">p &#61;</span> 0&#46;048&#44; respectively&#41;&#46; The mMRC score of SUD patients was significantly higher than cigarette smokers and non-smokers &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001 and <span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#44; respectively&#41;&#46; In addition to cigarette smoking&#44; 86&#46;3&#37; of SUD patients were using heroin&#44; 9&#46;2&#37; cannabis&#44; and 5&#46;5&#37; spices&#46; However&#44; it is seen that some of the SUD patients in the study were polysubstance users&#44; 37&#46;1&#37; of the patients used more than one type of substance&#44; and 16&#46;9&#37; used at least 3 types of substances&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Respiratory related symptoms</span><p id="para0020" class="elsevierStylePara elsevierViewall">Self-reported respiratory symptoms in SUD patients and cigarette smokers are presented in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#46; It was observed that the most common symptoms in both SUD patients and cigarette smokers were shortness of breath when walking in a hurry or climbing slightly uphill&#44; wheezing or whistling sound&#44; and sputum&#46; Except for chronic bronchitis and pneumonia&#44; other respiratory-related symptoms in SUD patients were found to be statistically more common than cigarette smokers &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Lung function and respiratory muscle strength parameters</span><p id="para0021" class="elsevierStylePara elsevierViewall">There was a statistically significant difference between the mean scores of lung function test parameters between the groups &#91;Wilks&#8217; Lambda &#40;&#581;&#41;&#61;0&#46;80&#44; F&#61;4&#46;88&#59; <span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#44; &#544;<span class="elsevierStyleInf">2</span>&#61;0&#46;10&#93;&#46; After post-hoc tests&#44; the FVC &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;002&#41;&#44; FVC &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; FEV<span class="elsevierStyleInf">1</span> &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;002&#41;&#44; FEV1 &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#37;&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; PEF &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; and FEF<span class="elsevierStyleInf">&#37;25-75</span> &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; parameters were statistically significantly lower in SUD patients than non-smokers&#46; In addition&#44; it was found that FVC &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;016&#41;&#44; FEV1 &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;003&#41;&#44; FEV1&#47;FVC &#40;&#37;&#41; &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;013&#41;&#44; PEF &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;001&#41;&#44; and FEF<span class="elsevierStyleInf">25-75&#37;</span> &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;008&#41; values were significantly lower in cigarette smokers compared to non-smokers &#40;<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#41;&#46; Gender &#91;F&#61;5&#46;66&#44; <span class="elsevierStyleItalic">p</span> &#60; 0&#46;0001&#44; &#544;2&#61;0&#46;12&#93; and duration of cigarette smoking &#91;F&#61; 6&#46;70&#44; <span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#44; &#544;2&#61;0&#46;14&#93; were found as confounding factors for lung function test parameters&#46; Similarly&#44; there was a statistically significant difference between the groups in respiratory muscle strength values &#91;Wilks&#8217; Lambda &#40;&#581;&#41;&#61;0&#46;91&#44; F&#61;5&#46;75&#59; <span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#44; &#544;<span class="elsevierStyleInf">2</span>&#61;0&#46;04&#93;&#46; After post-hoc tests&#44; MIP &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; MIP &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; MEP &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; and MEP &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; values of SUD patients were significantly lower than non-smokers&#46; In addition&#44; it was found that MIP &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;024&#41; and MEP &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;027&#41; values were significantly lower in cigarette smokers compared to non-smokers &#40;<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#41;&#46; Duration of cigarette smoking was found to be a confounding factor for respiratory muscle strength parameters &#91;F&#61;6&#46;82&#44; <span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#44; &#544;2 &#61; 0&#46;04&#93; However&#44; other confounding factors had no effects on both lung functions and respiratory muscle strength&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0021">Exercise capacity</span><p id="para0022" class="elsevierStylePara elsevierViewall">A statistically significant difference was found between the groups in terms of 6-MWT &#91;Wilks&#8217; Lambda &#40;&#581;&#41;&#61;0&#46;54&#44; F&#61;17&#46;08&#59; <span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#44; &#544;<span class="elsevierStyleInf">2</span>&#61;0&#46;25&#93;&#46; After post-hoc tests&#44; a statistically significant difference was found between the SUD patients and non-smokers in terms of 6-MWD &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; 6-MWT &#40;&#37;predicted&#41;&#44; &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;006&#41;&#44; &#916;HR &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; &#916;SBP &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;005&#41;&#44; &#916;Dyspnea &#40;Borg&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; and &#916;Perceived Exertion &#40;Borg&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#46; It was observed that &#916;HR &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; and &#916;SBP &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;005&#41; were significantly higher in SUD patients compared to cigarette smokers&#46; In addition&#44; it was found that &#916;Dyspnea &#40;Borg&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; and &#916;Perceived Exertion &#40;Borg&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; were significantly higher in the cigarette smokers compared to the non-smokers &#40;<a class="elsevierStyleCrossRef" href="#tbl0004">Table 4</a>&#41;&#46; Duration of cigarette smoking was found to be a confounding factor for exercise capacity parameters &#91;F&#61;2&#46;29&#44; <span class="elsevierStyleItalic">p &#61;</span> 0&#46;035&#44; &#544;2&#61;0&#46;04&#93;&#46; However&#44; other confounding factors had no effects on exercise capacity parameters&#46;</p><elsevierMultimedia ident="tbl0004"></elsevierMultimedia></span></span><span id="sec0016" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0022">Discussion</span><p id="para0023" class="elsevierStylePara elsevierViewall">In this cross-sectional study&#44; we observed that SUD patients started smoking earlier&#44; smoked longer periods&#44; consumed more cigarettes during the day&#44; and had higher levels of nicotine addiction level than cigarette smokers&#46; It was found that the most common symptoms in both SUD patients and cigarette smokers were shortness of breath&#44; wheezing&#44; and sputum production&#46; In addition&#44; SUD patients&#39; lung function test parameters were significantly decreased compared to non-smokers&#44; gender and smoking duration were confounding factors for lung function test parameters&#46; Also&#44; SUD patients had significantly lower respiratory muscle strength and exercise capacity compared to non-smokers&#44; and smoking duration was found to be a confounding factor&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">In this study&#44; 91&#46;2&#37; of SUD patients were male&#46; Similarly&#44; Demirci et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> reported in their study that 82&#46;4&#37; of the participants were male&#46; Charitonidi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0042"><span class="elsevierStyleSup">42</span></a> also reported that 50&#46;1&#37; of SUD patients had primary and secondary education&#46; B&#252;ker et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0043"><span class="elsevierStyleSup">43</span></a> in their study on adolescent SUD patients&#44; reported that 90&#46;3&#37; of the cases did not attend school and the average education period of the participants was 7&#46;8 years&#46; Similarly&#44; in our study&#44; we found that the education period of the SUD patients was 8&#46;4 years&#46; According to these findings&#44; we can say that males constitute a significant portion of individuals using substances&#46; The addiction to substance use may cause disruptions in education as well as negatively affect their health&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">In the literature&#44; the age of initiation of substance was reported as 14 years by Buchowski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0044"><span class="elsevierStyleSup">44</span></a> 16 years by Flemmen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0046"><span class="elsevierStyleSup">46</span></a> and 13&#46;8 years in the study of Demirci et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> In another study&#44; B&#252;ker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0043"><span class="elsevierStyleSup">43</span></a> reported the age of initiation substance use 14&#46;6 years and the duration of substance use was 3&#46;7 years&#46; In our study&#44; it was observed that the mean age of initiation of substance was 17&#46;9 years&#44; and the mean duration of use was 11&#46;2 years&#46; Flemmen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0046"><span class="elsevierStyleSup">46</span></a> reported in their studies that the preferred substances for use by the SUD patients were heroin&#44; cannabis&#44; benzodiazopem&#44; and ecstasy&#46; Roessler <a class="elsevierStyleCrossRef" href="#bib0047"><span class="elsevierStyleSup">47</span></a> determined that the substances used by the SUD patients were heroin&#44; ecstasy&#44; cannabis&#44; cocaine&#44; benzodiazopem&#44; while Demirci et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> reported that cannabis&#44; alcohol&#44; spice&#44; ecstasy&#44; solvent&#47;inhalants&#44; benzodiazopem&#44; and other substances&#46; Burhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0048"><span class="elsevierStyleSup">48</span></a> reported that 99&#37; of individuals participating in their studies used cigarettes&#44; 98&#37; used heroin&#44; 83&#37; crack cocaine&#44; and 83&#37; cannabis&#46; In our study&#44; 86&#46;3&#37; of the participants were using heroin&#44; 9&#46;2&#37; cannabis and 5&#46;5&#37; spice&#46; In addition&#44; 37&#46;1&#37; of the participants were found to use more than one type of substance &#40;cocaine&#44; ecstasy&#44; etc&#46;&#41;&#46; As seen in the literature&#44; SUD patients start using these substances from an early age and use more than one type of substance&#46; In addition to the use of cigarettes&#44; none of the participants in the study used a single type of substance&#44; but users preferred one of them &#40;heroin&#44; cannabis and spices&#44; etc&#46;&#41; more intensely than the others&#46; In this case&#44; it is seen that the SUD patients in the study were polysubstance users&#46; Thus&#44; it is impossible to determine from which substances the observed effects are caused&#46; This condition seriously threatens both the respiratory and physical health of individuals&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">Most&#44; although not all&#44; researchers have described increased reporting of respiratory symptoms among SUD patients similar to our findings&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0049"><span class="elsevierStyleSup">49</span></a> Macleod et al&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> reported that in the cannabis users&#44; the prevalence of chronic bronchitis is 14&#46;7&#37;&#44; sputum production is 38&#46;5&#37;&#44; shortness of breath is 47&#46;5&#37;&#44; wheezing is 66&#46;3&#37;&#44; and pneumonia is 3&#46;6&#37;&#46; Also&#44; Aldington et al&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> reported that 28&#46;6&#37; of cannabis users had a cough&#44; 34&#46;1&#37; wheezing&#44; and 30&#46;8&#37; chronic bronchitis&#46; In the current study&#44; 74&#46;9&#37; of the SUD patients had shortness of breath&#44; 66&#46;1&#37; had wheezing&#44; and 63&#46;9&#37; had sputum production&#46; Similarly&#44; 46&#46;93&#37; of cigarette smokers had shortness of breath&#44; 48&#46;1&#37; had wheezing&#44; and 38&#46;9&#37; had sputum production&#46; Boto de los Bueis et al<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">50</span></a> found a 41&#46;9&#37; prevalence of wheezing&#44; a 44&#46;4&#37; prevalence of bronchial hyperreactivity&#44; and a 22&#46;03&#37; prevalence of asthma among subjects who inhaled a mixture of heroin and cocaine vaporized on aluminum foil&#46; Besides&#44; Buster et al&#46;<a class="elsevierStyleCrossRef" href="#bib0049"><span class="elsevierStyleSup">49</span></a> reported that 45&#37; of individuals using heroin had mMRC dyspnea scale scores 0&#44; 15&#37; had 1&#44; 18&#37; had 2&#44; and 22&#37; had 3 and above&#46; In our study&#44; the distribution of mMRC dyspnea scale scores in SUD patients was 0 in 8&#46;2&#37;&#44; 1 in 39&#46;3&#37;&#44; 2 in 42&#46;1&#37;&#44; and 3 and above in 10&#46;4&#37;&#46; We think that the difference between the results of our study and the results of this study may be due to the presence of cannabis and spice users together with heroin in our study&#46; Inhaling heroin and other substances involves repeated exposure to irritants rather than a single exposure to high concentrations of vapor&#46; The physiopathogenic mechanism underlying the reactive airway is thought to cause an abnormal re-epithelialization and re-innervation of the bronchial mucosa after epithelial damage caused by initial exposure to the toxic substance&#46; This can result in hypersensitivity of subepithelial receptors and&#44; consequently&#44; to maintained airway hyperresponsiveness&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">50</span></a> Based on these possible mechanisms&#44; evidence from this study suggests that SUD patients report more respiratory symptoms than smokers&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">In recent years&#44; substance use has been increasing in Turkey and in the rest of the world&#46; Accordingly&#44; the number of studies investigating the harmful effects of substance use on health is increasing&#46; Substance use has been reported to affect lung functions&#44; decrease FVC and FEV<span class="elsevierStyleInf">1</span>&#44; and predispose to airway obstruction in long-term use&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">20-22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0051"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0052"><span class="elsevierStyleSup">52</span></a> Macleod et al&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> stated in their study that FVC was notably higher among cannabis users&#46; In another study&#44; Aldington et al&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> found that both cannabis and tobacco use were associated with a decrease in the FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; cannabis use did not affect FEV<span class="elsevierStyleInf">1</span>&#44; and tobacco use caused a decrease in FEV<span class="elsevierStyleInf">1</span>&#46; According to the authors&#44; smoking cannabis was associated with a dose-related impairment of large airways function resulting in airflow obstruction and hyperinflation Similarly&#44; Taylor et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> reported that there was a linear relationship between cannabis use and FEV<span class="elsevierStyleInf">1</span>&#47;VC&#44; and increased cannabis use over time was associated with a decrease in FEV<span class="elsevierStyleInf">1</span>&#47;VC over time&#46; It has been suggested that age&#44; smoking&#44; and weight are important determinants of FEV<span class="elsevierStyleInf">1</span>&#47;VC&#44; with marijuana use and daily smoking additionally affecting FEV<span class="elsevierStyleInf">1</span>&#47;VC&#46; Hancox et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> suggested that cannabis was associated with evidence of hyperinflation and increased large airway resistance&#44; with little evidence of airflow obstruction or impairment of gas transfer&#44; whereas tobacco was associated with airflow obstruction&#44; gas trapping&#44; and lower transfer factors&#46; According to the authors&#44; smoking cannabis and tobacco have different physiological consequences for the lungs&#46; Samoedro et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> reported that there was a weak correlation between declined FEV<span class="elsevierStyleInf">1</span>&#47;FVC with length of time of smoking&#44; the amount of cigarette consumption per day&#44; time of cannabis inhalation&#44; time of methamphetamine inhalation&#44; and time of heroin injection&#46; Buster et al&#46;<a class="elsevierStyleCrossRef" href="#bib0049"><span class="elsevierStyleSup">49</span></a> reported a difference in FEV<span class="elsevierStyleInf">1</span> from predicted values&#44; finding that heroin smokers had an FEV<span class="elsevierStyleInf">1</span> of 260 ml less than predicted FEV<span class="elsevierStyleInf">1</span>&#46; Nightingale et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0053"><span class="elsevierStyleSup">53</span></a> found that lung function measured by FEV<span class="elsevierStyleInf">1</span> declined by 90 ml annually&#44; which was both statistically and clinically significant&#46; Walker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0054"><span class="elsevierStyleSup">54</span></a> found heroin smokers developed early-onset emphysema&#44; with a mean age of diagnosis being 41 years&#44; suggesting likely early progression of disease compared with non heroin smokers&#46; Burhan et al<a class="elsevierStyleCrossRef" href="#bib0048"><span class="elsevierStyleSup">48</span></a> reported that just under one-half of 753 heroin smoker people had fixed airflow obstruction with an FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#60;0&#46;7&#46; In our study&#44; it was observed that the FVC&#44; FVC &#40;&#37;predicted&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">1</span> &#40;&#37;predicted&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; PEF&#44; and FEF<span class="elsevierStyleInf">25-75&#37;</span> were decreased in SUD patients compared to non-smokers&#46; In addition&#44; cigarette smokers were found to be significantly lower in FVC &#40;&#37;predicted&#41;&#44; FEV<span class="elsevierStyleInf">1</span> &#40;&#37;predicted&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; PEF&#44; and FEF<span class="elsevierStyleInf">25-75&#37;</span> compared to non-smokers&#46; Sex and duration of smoking were found to be confounding factors for lung function test parameters in SUD patients&#46; In addition to cigarette smoking&#44; the possible effect of heroin on the respiratory system is an increase in histamine release that causes pulmonary vein constriction&#44; an increase in pulmonary capillary permeability&#44; leading to pulmonary edema&#44; bronchospasm&#44; and hypersensitivity pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">55</span></a> Another possible mechanism is that it affects respiratory control centers&#44; which can lead to fatal pulmonary depression&#46;<a class="elsevierStyleCrossRef" href="#bib0056"><span class="elsevierStyleSup">56</span></a> The rapid decline in lung functions and the increase in respiratory symptoms in this population suggest heroin smoking is a driver of the decline in lung function&#46; Some of the discrepancies between the present findings and those of previous studies may be attributable to the relatively high levels of cumulative exposure seen in the present study population&#46; In addition&#44; in the current study&#44; MIP&#44; MIP &#40;&#37;predicted&#41;&#44; MEP&#44; and MEP &#40;&#37;predicted&#41; values of the SUD patients significantly lower than the non-smokers&#46; Although both MIP and MEP values were lower in SUD patients compared to cigarette smokers&#44; this decrease was not significant&#46; In addition&#44; MIP &#40;&#37;predicted&#41;&#44; and MEP &#40;&#37;predicted&#41; were significantly lower in cigarette smokers compared to non-smokers&#46; The smoking duration was found to be a confounding factor for respiratory muscle strength parameters&#46; There is no study evaluating the respiratory muscle strength of SUD patients in the literature&#44; and in this respect&#44; our study is the first in this regard&#46; The possible mechanism of decrease in respiratory muscle strength is the release of free radicals that occur in cigarette smoking and substance use into the vascular system&#44; resulting in decreased blood flow and gas exchange to the respiratory muscle&#44; which adversely affects respiratory muscle performance&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">The number of studies investigating exercise capacity in SUD patients is limited in the literature&#46; Patients with SUD are generally physically incompetent&#46; This situation is associated with both unhealthy living habits and the effects of the substances used&#46;<a class="elsevierStyleCrossRefs" href="#bib0057"><span class="elsevierStyleSup">57-59</span></a> Dolezal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0056"><span class="elsevierStyleSup">56</span></a> reported that VO<span class="elsevierStyleInf">2</span>max levels for men and women using methamphetamine were 30&#46;6 and 23&#46;2 mL&#47;kg&#47;min respectively&#46; These values&#44; based on the well-established reference values for age and sex&#44; are classified as having poor cardiorespiratory fitness&#44; with average rankings below 10&#37; percentile for age and sex&#46; Gimenez-Meseguer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0059"><span class="elsevierStyleSup">59</span></a> similar to our study&#44; evaluated the exercise capacities of the participants with the 6-MWT&#46; It was reported that 6-MWT results before treatment in the experimental group were 618&#46;8 meters and 623&#46;2 meters in the control group&#46; In our study&#44; the 6-MWT results of SUD patients were found to be 512&#46;17 meters&#44; this value was 535&#46;46 meters for cigarette smokers and 577&#46;45 meters for non-smokers&#46; In addition&#44; there were significant differences in 6-MWT&#44; mean heart rate&#44; mean systolic blood pressure&#44; shortness of breath&#44; and fatigue scores of SUD patients compared to non-smokers&#46; In this population&#44; this may be due to decreased lung function and respiratory muscle strength&#44; resulting in decreased exercise capacity&#46; As a result&#44; many SUD patients show physical impairment and a low level of fitness compared to the general population due to the nature of the substances they use&#46; Improved exercise capacity may be important for SUD patients for the prevention or mitigation of a wide range of physical comorbidities&#46;</p><span id="sec0017" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0023">Strengths and limitations</span><p id="para0029" class="elsevierStylePara elsevierViewall">The main strengths of this study are that it is a general practice-based sample of non-smokers&#44; cigarette smokers&#44; and SUD patients&#46; This study is also the first study in the literature to evaluate respiratory muscle strength in patients with SUD&#46; The main limitations were that the study was cross-sectional and limited causality inference&#46; Another limitation of the study is the inability to perform other laboratory and field measurements such as lower limb muscle strength&#44; physical activity&#44; cardiopulmonary exercise test to better define the limitations of SUD patients&#46; In addition&#44; we lacked data on the possible effects of substance use over the lifetime of the participants&#44; individual differences in inhalation methods used by cigarette smokers only&#44; and both cigarette and substance smokers&#46;</p></span><span id="sec0018" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0024">Clinical implications of the study and future research</span><p id="para0030" class="elsevierStylePara elsevierViewall">This is the first study from Turkey providing data on the potential impact of SUD on lung functions&#44; respiratory muscle strength&#44; and exercise capacity&#46; It is also the first study in the literature to provide results on respiratory muscle strength in SUD patients&#46; The study findings indicate that there are some adverse respiratory effects from smoking substances and cigarettes&#46; Limited data suggested that smoking both tobacco and substance may have additive adverse respiratory effects and long term substance use has been linked to an increase in respiratory symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">60</span></a> In the current study the most common respiratory symptoms in both SUD patients and cigarette smokers were shortness of breath&#44; wheezing&#44; and sputum production&#46; The adverse effects of cigarette smoking on the lungs are well established&#46; By contrast&#44; the potential impact on lung health of substance use&#44; with its wide range of toxins&#44; is poorly understood&#46; Smoking both cigarettes and substances may synergistically increase the risk of respiratory symptoms&#46; Future studies with larger cohorts are needed&#44; possibly in the context of a targeted public health intervention&#44; to understand how best to avoid the personal and health costs associated with chronic respiratory disease&#46; Moreover&#44; studies should examine user characteristics associated with use trajectory groupings across primary drug types&#44; and identifying factors associated with different lifetime drug use patterns will assist in the development of more targeted treatment services and policies&#46; However&#44; randomized controlled clinical trials will be needed to assess whether treatment services will be clinically and cost-effective in this population and how they will impact respiratory-related problems&#46;</p></span></span><span id="sec0019" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0025">Conclusion</span><p id="para0031" class="elsevierStylePara elsevierViewall">This study is the first study from Turkey providing data on the potential impact of SUD on the prevalence of respiratory symptoms&#44; lung functions&#44; and exercise capacity in a general practice population&#46; The study findings indicate that substance use has an effect on lung functions and the most commonly reported symptoms are shortness of breath&#44; wheezing&#44; and sputum production&#46; In addition&#44; a decrease was observed in respiratory muscle strength and exercise capacity compared to non-smokers&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0026">Ethical approval</span><p id="para0032" class="elsevierStylePara elsevierViewall">All procedures were in accordance with the ethical standards of the institutional and&#47;or national research committee and with the Helsinki Declaration of Helsinki &#40;1964&#41; and its later amendments or comparable ethical standards&#46; Moreover&#44; informed consent was obtained from all individuals included in the study &#40;Approval number&#58; 2018&#47;42&#41;&#46;</p></span><span id="sec0021" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0027">Funding</span><p id="para0033" class="elsevierStylePara elsevierViewall">This study was supported by the <span class="elsevierStyleGrantSponsor" id="gs0001">Turkish Thoracic Society</span> &#40;Project No&#58; <span class="elsevierStyleGrantNumber" refid="gs0001">Y-110&#47;2018</span>&#41;&#59; however&#44; it did not influence the interpretation of the results and conclusions obtained in the present study&#46;</p></span></span>"
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              "titulo" => "Demographic and clinical characteristics"
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              "titulo" => "Lung function and respiratory muscle strength parameters"
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    "fechaAceptado" => "2021-12-20"
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            2 => "Maximal respiratory pressure"
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          "titulo" => "Abbreviations"
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          "palabras" => array:7 [
            0 => "SUD"
            1 => "6-MWT"
            2 => "MIP"
            3 => "MEP"
            4 => "DSM-V"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Background</span><p id="spara015" class="elsevierStyleSimplePara elsevierViewall">Substance use disorder &#40;SUD&#41; causes conditions such as cognitive and behavioral disorders&#44; anxiety&#44; depression&#44; and social isolation it also causes acute airway inflammation by affecting airway bronchial dynamics&#46; The current study aimed to investigate the lung function&#44; respiratory muscle strength&#44; and exercise capacity in patients with SUD&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara016" class="elsevierStyleSimplePara elsevierViewall">One hundred-eighty three patients with SUD&#44; a total of 119 healthy controls&#44; 54 of whom were cigarette smokers and 65 of whom were non-smokers were included in the study&#46; <span class="elsevierStyleBold">S</span>pirometric tests&#44; respiratory muscle strength &#40;MIP and MEP&#41;&#44; and the 6-Minute Walk Test &#40;6-MWT&#41; were assessed&#46; The III National Health and Nutrition Examination Survey were used to evaluate respiratory symptoms in patients with SUD and cigarette smokers&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara017" class="elsevierStyleSimplePara elsevierViewall">86&#46;3&#37; of the SUD patients included in the study were using heroin&#44; 9&#46;2&#37; were cannabis&#44; and 5&#46;5&#37; were spice&#46; The most common symptom in both SUD patients and cigarette smokers was shortness of breath&#44; wheezing&#44; and sputum production&#46; After post-hoc tests&#44; the FVC &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;002&#41;&#44; FVC &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p</span> &#60; 0&#46;0001&#41;&#44; FEV<span class="elsevierStyleInf">1</span> &#40;<span class="elsevierStyleItalic">p &#61;</span> 0&#46;002&#41;&#44; FEV1 &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#37;&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; PEF &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; and FEF<span class="elsevierStyleInf">&#37;25-75</span> &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; lung function parameters were significantly lower in SUD patients than non-smokers&#46; In addition&#44; it was found that MIP &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; MIP &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; MEP &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41;&#44; and MEP &#40;&#37;predicted&#41; &#40;<span class="elsevierStyleItalic">p &#60;</span> 0&#46;0001&#41; values of SUD patients were significantly lower than non-smokers&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusion</span><p id="spara018" class="elsevierStyleSimplePara elsevierViewall">The study findings indicate that substance use has an effect on lung functions and the most commonly reported symptoms are shortness of breath&#44; wheezing&#44; and sputum production&#46; In addition&#44; respiratory muscle strength and exercise capacity were decreased in SUD patients compared to non-smokers&#46;</p></span>"
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                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SUDs &#40;<span class="elsevierStyleItalic">n</span> &#61; 183&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Cigarette Smokers &#40;<span class="elsevierStyleItalic">n &#61;</span> 54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Non-smokers &#40;<span class="elsevierStyleItalic">n &#61;</span> 65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tb1fn1">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tb1fn2"><span class="elsevierStyleSup">&#35;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0006"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Gender -Female&#47;Male</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&#40;8&#46;2&#41;&#47;168&#40;91&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#40;9&#46;3&#41;&#47;49&#40;90&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#40;9&#46;2&#41;&#47;59&#40;90&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;951&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Age &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;77&#177;8&#44;&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;61&#177;9&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">28&#46;71&#177;9&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;692&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Height &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">173&#46;72&#177;7&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">175&#46;09&#177;7&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">175&#46;46&#177;7&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;60&#177;10&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;59&#177;11&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">73&#46;08&#177;12&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;002</span><a class="elsevierStyleCrossRef" href="#tb1fn3"><span class="elsevierStyleBold"><span class="elsevierStyleSup">a</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0026"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">BMI &#40;kg&#47;cm<span class="elsevierStyleSup">2</span>&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;71&#177;3&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;94&#177;2&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">23&#46;78&#177;4&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;011</span><a class="elsevierStyleCrossRef" href="#tb1fn4"><span class="elsevierStyleBold"><span class="elsevierStyleSup">b</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Education period &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;43&#177;2&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;65&#177;2&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14&#46;45&#177;2&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span><a class="elsevierStyleCrossRef" href="#tb1fn5"><span class="elsevierStyleBold"><span class="elsevierStyleSup">c</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Age of starting substance use &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;99&#177;5&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Duration of substance use &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;28&#177;6&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0046"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Distribution of the substances used</span></td></tr><tr title="table-row"><a name="en0047"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Heroin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158 &#40;86&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0052"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Cannabis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Spice</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0062"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Age of starting smoking cigarette &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;28&#177;3&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;30&#177;2&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Duration of cigarette smoking &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;24&#177;7&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;33&#177;8&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0072"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Cigarette smoking &#40;packs&#47;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;7&#177;15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&#177;12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FTND score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;81&#177;1&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;90&#177;1&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0082"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">mMRC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;54&#177;0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&#177;0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;00&#177;0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span><a class="elsevierStyleCrossRef" href="#tb1fn6"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              ]
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              "etiqueta" => "&#35;"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0004">One way ANOVA</p>"
            ]
            2 => array:3 [
              "identificador" => "tb1fn3"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0005">The weight of SUD patients was statistically significantly lower than cigarette smokers and non-smokers &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;013 and <span class="elsevierStyleItalic">p</span> &#61; 0&#46;018&#44; respectively&#41;&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tb1fn4"
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              "nota" => "<p class="elsevierStyleNotepara" id="notep0006">The SUD patients BMI was significantly lower than those cigarette smokers and no-smokers &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;042 and <span class="elsevierStyleItalic">p</span> &#61; 0&#46;048&#44; respectively&#41;&#46;</p>"
            ]
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              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0007">Education period of the SUD patients was statistically significantly lower than cigarette smokers and non-smokers &#40;<span class="elsevierStyleItalic">p</span> &#60; 0&#46;0001 and <span class="elsevierStyleItalic">p</span> &#60; 0&#46;0001&#44; respectively&#41;&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tb1fn6"
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              "nota" => "<p class="elsevierStyleNotepara" id="notep0008">The SUD patients mMRC score was significantly higher than those cigarette smokers and no-smokers &#40;<span class="elsevierStyleItalic">p</span> &#60; 0&#46;0001 and <span class="elsevierStyleItalic">p</span> &#60; 0&#46;0001&#44; respectively&#41;</p>"
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          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Comparison of the clinical and socio-demographic characteristics of the participants&#46;</p>"
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          "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Data expressed as number &#40;percentage&#41;&#46;</p><p id="spara007" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Abbreviations&#58;</span> NHANES&#58; National Health Nutrition Examination Survey&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0087"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0088"></a><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SUDs &#40;<span class="elsevierStyleItalic">n &#61;</span> 183&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Cigarette Smokers &#40;<span class="elsevierStyleItalic">n &#61;</span> 54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0090"></a><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Non-Smokers &#40;<span class="elsevierStyleItalic">n &#61;</span> 65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0091"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0092"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Has a doctor ever told you that you have chronic bronchitis&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19 &#40;10&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Do you usually cough on most days for 3 consecutive months or more during the year&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;39&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;24&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;040</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0102"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Do you bring up phlegm on most days for 3 consecutive months or more during the year&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">117 &#40;63&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;38&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Are you troubled by shortness of breath when hurrying on level ground or walking up a slight hill&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;74&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;46&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0112"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Have you had wheezing or whistling in your chest at any time during the past 12 months&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;66&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;48&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;017</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0117"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Apart from when you have a cold does your chest ever sound wheezy or whistling&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;61&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0122"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">During the past 12 months have you had pneumonia&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;3&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;956&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">The NHANES III respiratory symptoms in SUD patients&#44; cigarette smokers&#44; and non-smokers&#46;</p>"
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        "etiqueta" => "Table 3"
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        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Data expressed as mean &#177;SD for qualitative variables&#46;</p><p id="spara010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Abbreviations&#58;</span> FVC&#58; Forced Vital Capacity&#59; FEV<span class="elsevierStyleInf">1</span>&#58; Forced Expiratory Volume in the First Second&#59; PEF&#58; Peak Expiratory Flow&#59; FEF<span class="elsevierStyleInf">25-75&#37;</span>&#58; Forced Mid-Expiratory Flow&#59; FEV3&#58; Forced Expiratory Volume in 3 Seconds&#59; FEV6&#58; Forced Expiratory Volume in 6 Seconds&#59; MIP&#58; Maximum Inspiratory Pressure&#59; MEP&#58; Maximum Expiratory Pressure&#59; SUD&#58; Substance Use Disorders&#59; CS&#58; Cigarette Smokers&#59; NS&#58; Non-Smokers&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0127"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0128"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SUDs &#40;<span class="elsevierStyleItalic">n &#61;</span> 183&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0129"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Cigarette Smokers&#40;<span class="elsevierStyleItalic">n &#61;</span> 54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0130"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Non-smokers &#40;<span class="elsevierStyleItalic">n &#61;</span> 65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0131"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0132"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">&#35;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0133"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Post-hoc analysis <span class="elsevierStyleItalic">p</span>- values&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0134"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FVC &#40;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;74&#177;0&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;86&#177;1&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;19&#177;0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;576SUD-NS&#58; <span class="elsevierStyleBold">0&#46;002</span>CS-NS&#58; 0&#46;059&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FVC&#44; &#37; predicted</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;50&#177;17&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;21&#177;21&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&#46;40&#177;18&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;105SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; <span class="elsevierStyleBold">0&#46;016</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0148"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FEV<span class="elsevierStyleInf">1</span> &#40;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;93&#177;0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;01&#177;0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;32&#177;0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;520SUD-NS&#58; <span class="elsevierStyleBold">0&#46;002</span>CS-NS&#58; 0&#46;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FEV<span class="elsevierStyleInf">1&#44;</span> &#37; predicted</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;50&#177;17&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;50&#177;17&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;50&#177;17&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;598SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; <span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0162"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FEV<span class="elsevierStyleInf">1</span>&#47;FEVC &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;22&#177;8&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;58&#177;7&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;91&#177;7&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;127SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; <span class="elsevierStyleBold">0&#46;013</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0169"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">PEF &#40;L&#47;s&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;34&#177;2&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;54&#177;2&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;93&#177;1&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;126SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0176"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FEF&#37;25-75 &#40;L&#47;s&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;17&#177;1&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;33&#177;1&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;06&#177;1&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;373SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; <span class="elsevierStyleBold">0&#46;008</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0183"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FEV3 &#40;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;78&#177;0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;66&#177;1&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;90&#177;0&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">FEV6 &#40;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;75&#177;0&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;72&#177;1&#46;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0197"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">MIP &#40;cmH<span class="elsevierStyleInf">2</span>O&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;51&#177;26&#46;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;88&#177;24&#46;87&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#46;61&#177;30&#46;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;072SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; 0&#46;672&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">MIP&#44; &#37;predicted</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;393SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; <span class="elsevierStyleBold">0&#46;024</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0211"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">MEP &#40;cmH<span class="elsevierStyleInf">2</span>O&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0212"></a><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">110&#46;23&#177;36&#46;96&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;72&#177;28&#46;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136&#46;24&#177;38&#46;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">MEP&#44; &#37;predicted</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">57&#46;26&#177;11&#46;56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SUD-CS&#58; 0&#46;132SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; <span class="elsevierStyleBold">0&#46;027</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Post-hoc analysis<span class="elsevierStyleItalic">p</span>- values&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">6-MWT &#40;m&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">SUD-CS&#58;0&#46;091SUD-NS&#58; <span class="elsevierStyleBold">&#60;0&#46;0001</span>CS-NS&#58; 0&#46;059&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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        "identificador" => "xack742293"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="para0035" class="elsevierStylePara elsevierViewall">The authors would like to thank Dr&#46; Ishtiaq Ahmed PT for his editing support&#46;</p><p id="para0036" class="elsevierStylePara elsevierViewall">We are grateful to our patients who participated in the study&#46;</p>"
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