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Factors that determine the loss of control when reducing therapy by steps in the treatment of moderate-severe asthma in standard clinical practice: A multicentre Spanish study
Factores que condicionan la pérdida de control al reducir escalones terapéuticos en el tratamiento del asma moderada-grave en la práctica clínica habitual: estudio español multicéntrico
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Solo aparecen aquellas variables con significación estadística en la gráfica. Las categorías de referencia aparecen entre paréntesis. n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>363 pacientes. m: meses. *Factor estudiado como variable continua.</p>" ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "E. Martínez-Moragón, J. Delgado, S. Mogrovejo, T. Fernández-Sánchez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Martínez-Moragón" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Delgado" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Mogrovejo" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Fernández-Sánchez" ] 4 => array:1 [ "colaborador" => "en nombre del grupo de investigación STEP" ] ] ] 1 => array:2 [ "autoresLista" => "Jiménez López Jesús, Moscardó Orenes Miguel Ángel, Prieto Montaño Patricia, Torrecillas Toro Miguel, Cueva Oliver Begoña, Ferrer Torres Ángel, González Delgado Purificación, Jiménez Rodríguez Teodorikez Wilfox, Vila Auli Brian, Zapata Yebenes Juan José, Audicana Berasategui María Teresa, Frias Jiménez Marta, Hurtado de Mendoza Ruibio Nieves, Velasco Azagra Marta, Álvarez Fernández Jose Antonio, Acero Sainz Sara, Blanco González M. Rosa, Gómez Nieves María Estela, Aisa Carpio Diego, Angrill Sellés Núria, Berastegui García Cristina, Crespo Lessmann Astrid, De La Rosa Carrillo David, Juanola Pla Jordi, López Giraldo Alejandra, Luengo Sánchez Olga, Martínez Rivera Carlos, Martínez Olondris Pilar, Muñoz Gall Xavier, Pinto Nogués Ester, Planas Coimerma Francisco, Portillo Carroz Karina, Riba Blanch Antoni, Rivera Ortún M. Luisa, Sánchez Berenguer Dan, Serra Batlles Joan, Serra Mitjà Pere, Sogo Sagardía Ana, Soto Retes Lorena, Valldeperas Combas Joan, Vila Giralte Xavier, Ansotegui Zubeldia Ignacio, Antepara Ercoreca Ignacio, Herrerías Peña Miguel, Iriberri Pascual María Milagros, Jaca Michelena Carmen, Lahuerta Castro Adolfo, Laita Legarreta Amaia, Losada Llorente Paula, Prieto Prieto Joaquina, Zorrilla Lorenzo Vanessa, Alonso Gil Lidia, García Muñoz Juan Pablo, Marcos Durantez Marisa, Peña Miguel Teresa, Ahmida Tahar, Alvarado Izquierdo María Isabel, Alwakil Olbah Michael, Arnedillo Muñoz Aurelio, García Núñez Ignacio, Gutiérrez Fernández Diego, Letran Camacho Antonio, Fernández Pellon Luis, Morchon Miguel Eva Maria, Ortiz Portal Félix, Raducan Isabela, Royo Prats Juan Antonio, Salvador Segarra María Dolores, Tatay Soler Frederic, Levy Naon Alberto, Galindo Bonilla Pedro, Gil Muñoz Francisco Luis, Mata Calderón Patricia, Entrenas Costa Luis Manuel, Blanco Aparicio Marina, García Pazos Jose Manuel, García Paz Vanessa, González Barcala Francisco-Javier, Iriarte Sotes Pilar, Marcos Rodríguez Pedro Jorge, Molina Nieto Fernando, Nuñez Orjales Ramón, Sevillano Martín Carracedo, Suárez Antelo Juan, Tábara Rodríguez Julia, Aparicio Español Santiago, Sabadell Nieto Carlos, Sabater Talaverano Gladis, Escribano Rodríguez M. Mar, Florido López José Fernando, Lara Jiménez María Ángeles, Rojas Vílchez María José, Chic Palacín Susana, Dorronsoro Quintana Silvia, Navarro Echeverria Jose Antonio, Figueroa de la Guardia Eduardo, Hinojosa Jara Belén, Moreno García Victoria, Valverde Vazquez Lucía, Cegoñino de Sus Joaquín, Compaired Villa Jose Santonio, Almagro López Juan Alfonso, Arcalá Campillo Eduardo, Cruz Molina Jose María, Soto Venegas Antonia Dolores, Benito Martínez Patricia, Blanco Reinosa Begoña, Fernández Parra Beatriz, Fernández García Domingo, Serrano Gutiérrez Virginia, Velez Ruiz de Lobera Adolfo, Lara Alcon Silvia, Carballada González Francisco, González Fernández Teresa, Martín Lázaro Joaquín, Mengual Macenlle Noemí, Alonso Viteri Soledad, Antolín Amerigo Darío, Bobolea Irina, Cano Aguirre M. del Puerto, Cardenas Contreras Remedios, Carrillo Arias Fernando, Cimarra Álvarez Mercedes, De Higes Martínez Eva Belén, Díaz Campos Rocío Magdalena, Gandolfo Cano María del Mar, García Rodríguez Leticia, García Romero de Tejada Jose Andrés, González Mancebo Eloina, González Seco Emma, González Torralba Fernando, Henríquez Santana Aythamy, Herráez Herrera Pilar de Lys, Herrero Mosquete María Ruth, Landete Rodríguez Pedro, López-Muñiz Ballesteros Belén, Mohedano Vicente Ester, Morales Chacón Beatriz, Moreno Fernández Antonio, Muñoz García Esther, Ojeda Castillejo Elena, Pedraza Serrano Fernando, Peña Acevedo Acevedo Yesenia, Pérez Rojo Raquel, Quílez Ruiz-Rico Natividad, Ramos Pinedo Ángela, Rodríguez Jiménez Beatriz, Rodríguez Rodríguez Mercedes, Rosado Ingelmo Ana, Ruiz Peña Antonio, Sánchez González María José, Trujillo Trujillo María Jesús, Vázquez Fuertes Laura, Vila Albelda Concepción, Yago Meniz Alexandra, Aguilar Perez Grovas Ricardo Ismael, Alcázar Ramírez Alcázar Ramírez José, Barceló Muñoz José Manuel, Bentabol Manzanares Miguel, De Luiz Martínez Gustavo, Linde de Luna Francisco, Miranda Paez Alfonso, Ortega Sáenz de Tejada Ezequiel, Padilla Galo Alicia, Pérez Estrada Cornejo Manuel, Soria Esojo Carmen, Abellán Alemán Ángel Francisco, Alcalde Rumayor María Consuelo, Andújar Espinosa Rubén, Bernabeu Mora Roberto, Campano Lancharro Francisco Javier, Gutiérrez Urra Tamara, Herrero Martín Sonia, Resano Lizaldre Alfredo, Dacal Quintas Raquel" "autores" => array:177 [ 0 => array:1 [ "colaborador" => "Los autores quieren agradecer su colaboración a los siguientes investigadores participantes ordenados alfabéticamente" ] 1 => array:2 [ "nombre" => "Jiménez López" "apellidos" => "Jesús" ] 2 => array:2 [ "nombre" => "Moscardó Orenes Miguel" "apellidos" => "Ángel" ] 3 => array:2 [ "nombre" => "Prieto Montaño" "apellidos" => "Patricia" ] 4 => array:2 [ "nombre" => "Torrecillas Toro" "apellidos" => "Miguel" ] 5 => array:2 [ "nombre" => "Cueva Oliver" "apellidos" => "Begoña" ] 6 => array:2 [ "nombre" => "Ferrer Torres" "apellidos" => "Ángel" ] 7 => array:2 [ "nombre" => "González Delgado" "apellidos" => "Purificación" ] 8 => array:2 [ "nombre" => "Jiménez Rodríguez Teodorikez" "apellidos" => "Wilfox" ] 9 => array:2 [ "nombre" => "Vila Auli" "apellidos" => "Brian" ] 10 => array:2 [ "nombre" => "Zapata Yebenes Juan" "apellidos" => "José" ] 11 => array:2 [ "nombre" => "Audicana Berasategui María" "apellidos" => "Teresa" ] 12 => array:2 [ "nombre" => "Frias Jiménez" "apellidos" => "Marta" ] 13 => array:2 [ "nombre" => "Hurtado de Mendoza Ruibio" "apellidos" => "Nieves" ] 14 => array:2 [ "nombre" => "Velasco Azagra" "apellidos" => "Marta" ] 15 => array:2 [ "nombre" => "Álvarez Fernández Jose" "apellidos" => "Antonio" ] 16 => array:2 [ "nombre" => "Acero Sainz" "apellidos" => "Sara" ] 17 => array:2 [ "nombre" => "Blanco González M." "apellidos" => "Rosa" ] 18 => array:2 [ "nombre" => "Gómez Nieves María" "apellidos" => "Estela" ] 19 => array:2 [ "nombre" => "Aisa Carpio" "apellidos" => "Diego" ] 20 => array:2 [ "nombre" => "Angrill Sellés" "apellidos" => "Núria" ] 21 => array:2 [ "nombre" => "Berastegui García" "apellidos" => "Cristina" ] 22 => array:2 [ "nombre" => "Crespo Lessmann" "apellidos" => "Astrid" ] 23 => array:2 [ "nombre" => "De La Rosa Carrillo" "apellidos" => "David" ] 24 => array:2 [ "nombre" => "Juanola Pla" "apellidos" => "Jordi" ] 25 => array:2 [ "nombre" => "López Giraldo" "apellidos" => "Alejandra" ] 26 => array:2 [ "nombre" => "Luengo Sánchez" "apellidos" => "Olga" ] 27 => array:2 [ "nombre" => "Martínez Rivera" "apellidos" => "Carlos" ] 28 => array:2 [ "nombre" => "Martínez Olondris" "apellidos" => "Pilar" ] 29 => array:2 [ "nombre" => "Muñoz Gall" "apellidos" => "Xavier" ] 30 => array:2 [ "nombre" => "Pinto Nogués" "apellidos" => "Ester" ] 31 => array:2 [ "nombre" => "Planas Coimerma" "apellidos" => "Francisco" ] 32 => array:2 [ "nombre" => "Portillo Carroz" "apellidos" => "Karina" ] 33 => array:2 [ "nombre" => "Riba Blanch" "apellidos" => "Antoni" ] 34 => array:2 [ "nombre" => "Rivera Ortún M." "apellidos" => "Luisa" ] 35 => array:2 [ "nombre" => "Sánchez Berenguer" "apellidos" => "Dan" ] 36 => array:2 [ "nombre" => "Serra Batlles" "apellidos" => "Joan" ] 37 => array:2 [ "nombre" => "Serra Mitjà" "apellidos" => "Pere" ] 38 => array:2 [ "nombre" => "Sogo Sagardía" "apellidos" => "Ana" ] 39 => array:2 [ "nombre" => "Soto Retes" "apellidos" => "Lorena" ] 40 => array:2 [ "nombre" => "Valldeperas Combas" "apellidos" => "Joan" ] 41 => array:2 [ "nombre" => "Vila Giralte" "apellidos" => "Xavier" ] 42 => array:2 [ "nombre" => "Ansotegui Zubeldia" "apellidos" => "Ignacio" ] 43 => array:2 [ "nombre" => "Antepara Ercoreca" "apellidos" => "Ignacio" ] 44 => array:2 [ "nombre" => "Herrerías Peña" "apellidos" => "Miguel" ] 45 => array:2 [ "nombre" => "Iriberri Pascual María" "apellidos" => "Milagros" ] 46 => array:2 [ "nombre" => "Jaca Michelena" "apellidos" => "Carmen" ] 47 => array:2 [ "nombre" => "Lahuerta Castro" "apellidos" => "Adolfo" ] 48 => array:2 [ "nombre" => "Laita Legarreta" "apellidos" => "Amaia" ] 49 => array:2 [ "nombre" => "Losada Llorente" "apellidos" => "Paula" ] 50 => array:2 [ "nombre" => "Prieto Prieto" "apellidos" => "Joaquina" ] 51 => array:2 [ "nombre" => "Zorrilla Lorenzo" "apellidos" => "Vanessa" ] 52 => array:2 [ "nombre" => "Alonso Gil" "apellidos" => "Lidia" ] 53 => array:2 [ "nombre" => "García Muñoz Juan" "apellidos" => "Pablo" ] 54 => array:2 [ "nombre" => "Marcos Durantez" "apellidos" => "Marisa" ] 55 => array:2 [ "nombre" => "Peña Miguel" "apellidos" => "Teresa" ] 56 => array:2 [ "nombre" => "Ahmida" "apellidos" => "Tahar" ] 57 => array:2 [ "nombre" => "Alvarado Izquierdo María" "apellidos" => "Isabel" ] 58 => array:2 [ "nombre" => "Alwakil Olbah" "apellidos" => "Michael" ] 59 => array:2 [ "nombre" => "Arnedillo Muñoz" "apellidos" => "Aurelio" ] 60 => array:2 [ "nombre" => "García Núñez" "apellidos" => "Ignacio" ] 61 => array:2 [ "nombre" => "Gutiérrez Fernández" "apellidos" => "Diego" ] 62 => array:2 [ "nombre" => "Letran Camacho" "apellidos" => "Antonio" ] 63 => array:2 [ "nombre" => "Fernández Pellon" "apellidos" => "Luis" ] 64 => array:2 [ "nombre" => "Morchon Miguel Eva" "apellidos" => "Maria" ] 65 => array:2 [ "nombre" => "Ortiz Portal" "apellidos" => "Félix" ] 66 => array:2 [ "nombre" => "Raducan" "apellidos" => "Isabela" ] 67 => array:2 [ "nombre" => "Royo Prats Juan" "apellidos" => "Antonio" ] 68 => array:2 [ "nombre" => "Salvador Segarra María" "apellidos" => "Dolores" ] 69 => array:2 [ "nombre" => "Tatay Soler" "apellidos" => "Frederic" ] 70 => array:2 [ "nombre" => "Levy Naon" "apellidos" => "Alberto" ] 71 => array:2 [ "nombre" => "Galindo Bonilla" "apellidos" => "Pedro" ] 72 => array:2 [ "nombre" => "Gil Muñoz Francisco" "apellidos" => "Luis" ] 73 => array:2 [ "nombre" => "Mata Calderón" "apellidos" => "Patricia" ] 74 => array:2 [ "nombre" => "Entrenas Costa Luis" "apellidos" => "Manuel" ] 75 => array:2 [ "nombre" => "Blanco Aparicio" "apellidos" => "Marina" ] 76 => array:2 [ "nombre" => "García Pazos Jose" "apellidos" => "Manuel" ] 77 => array:2 [ "nombre" => "García Paz" "apellidos" => "Vanessa" ] 78 => array:2 [ "nombre" => "González Barcala" "apellidos" => "Francisco-Javier" ] 79 => array:2 [ "nombre" => "Iriarte Sotes" "apellidos" => "Pilar" ] 80 => array:2 [ "nombre" => "Marcos Rodríguez Pedro" "apellidos" => "Jorge" ] 81 => array:2 [ "nombre" => "Molina Nieto" "apellidos" => "Fernando" ] 82 => array:2 [ "nombre" => "Nuñez Orjales" "apellidos" => "Ramón" ] 83 => array:2 [ "nombre" => "Sevillano Martín" "apellidos" => "Carracedo" ] 84 => array:2 [ "nombre" => "Suárez Antelo" "apellidos" => "Juan" ] 85 => array:2 [ "nombre" => "Tábara Rodríguez" "apellidos" => "Julia" ] 86 => array:2 [ "nombre" => "Aparicio Español" "apellidos" => "Santiago" ] 87 => array:2 [ "nombre" => "Sabadell Nieto" "apellidos" => "Carlos" ] 88 => array:2 [ "nombre" => "Sabater Talaverano" "apellidos" => "Gladis" ] 89 => array:2 [ "nombre" => "Escribano Rodríguez M." "apellidos" => "Mar" ] 90 => array:2 [ "nombre" => "Florido López José" "apellidos" => "Fernando" ] 91 => array:2 [ "nombre" => "Lara Jiménez María" "apellidos" => "Ángeles" ] 92 => array:2 [ "nombre" => "Rojas Vílchez María" "apellidos" => "José" ] 93 => array:2 [ "nombre" => "Chic Palacín" "apellidos" => "Susana" ] 94 => array:2 [ "nombre" => "Dorronsoro Quintana" "apellidos" => "Silvia" ] 95 => array:2 [ "nombre" => "Navarro Echeverria Jose" "apellidos" => "Antonio" ] 96 => array:2 [ "nombre" => "Figueroa de la Guardia" "apellidos" => "Eduardo" ] 97 => array:2 [ "nombre" => "Hinojosa Jara" "apellidos" => "Belén" ] 98 => array:2 [ "nombre" => "Moreno García" "apellidos" => "Victoria" ] 99 => array:2 [ "nombre" => "Valverde Vazquez" "apellidos" => "Lucía" ] 100 => array:2 [ "nombre" => "Cegoñino de Sus" "apellidos" => "Joaquín" ] 101 => array:2 [ "nombre" => "Compaired Villa Jose" "apellidos" => "Santonio" ] 102 => array:2 [ "nombre" => "Almagro López Juan" "apellidos" => "Alfonso" ] 103 => array:2 [ "nombre" => "Arcalá Campillo" "apellidos" => "Eduardo" ] 104 => array:2 [ "nombre" => "Cruz Molina Jose" "apellidos" => "María" ] 105 => array:2 [ "nombre" => "Soto Venegas Antonia" "apellidos" => "Dolores" ] 106 => array:2 [ "nombre" => "Benito Martínez" "apellidos" => "Patricia" ] 107 => array:2 [ "nombre" => "Blanco Reinosa" "apellidos" => "Begoña" ] 108 => array:2 [ "nombre" => "Fernández Parra" "apellidos" => "Beatriz" ] 109 => array:2 [ "nombre" => "Fernández García" "apellidos" => "Domingo" ] 110 => array:2 [ "nombre" => "Serrano Gutiérrez" "apellidos" => "Virginia" ] 111 => array:2 [ "nombre" => "Velez Ruiz de Lobera" "apellidos" => "Adolfo" ] 112 => array:2 [ "nombre" => "Lara Alcon" "apellidos" => "Silvia" ] 113 => array:2 [ "nombre" => "Carballada González" "apellidos" => "Francisco" ] 114 => array:2 [ "nombre" => "González Fernández" "apellidos" => "Teresa" ] 115 => array:2 [ "nombre" => "Martín Lázaro" "apellidos" => "Joaquín" ] 116 => array:2 [ "nombre" => "Mengual Macenlle" "apellidos" => "Noemí" ] 117 => array:2 [ "nombre" => "Alonso Viteri" "apellidos" => "Soledad" ] 118 => array:2 [ "nombre" => "Antolín Amerigo" "apellidos" => "Darío" ] 119 => array:2 [ "nombre" => "Bobolea" "apellidos" => "Irina" ] 120 => array:2 [ "nombre" => "Cano Aguirre M. del" "apellidos" => "Puerto" ] 121 => array:2 [ "nombre" => "Cardenas Contreras" "apellidos" => "Remedios" ] 122 => array:2 [ "nombre" => "Carrillo Arias" "apellidos" => "Fernando" ] 123 => array:2 [ "nombre" => "Cimarra Álvarez" "apellidos" => "Mercedes" ] 124 => array:2 [ "nombre" => "De Higes Martínez Eva" "apellidos" => "Belén" ] 125 => array:2 [ "nombre" => "Díaz Campos Rocío" "apellidos" => "Magdalena" ] 126 => array:2 [ "nombre" => "Gandolfo Cano María del" "apellidos" => "Mar" ] 127 => array:2 [ "nombre" => "García Rodríguez" "apellidos" => "Leticia" ] 128 => array:2 [ "nombre" => "García Romero de Tejada Jose" "apellidos" => "Andrés" ] 129 => array:2 [ "nombre" => "González Mancebo" "apellidos" => "Eloina" ] 130 => array:2 [ "nombre" => "González Seco" "apellidos" => "Emma" ] 131 => array:2 [ "nombre" => "González Torralba" "apellidos" => "Fernando" ] 132 => array:2 [ "nombre" => "Henríquez Santana" "apellidos" => "Aythamy" ] 133 => array:2 [ "nombre" => "Herráez Herrera Pilar de" "apellidos" => "Lys" ] 134 => array:2 [ "nombre" => "Herrero Mosquete María" "apellidos" => "Ruth" ] 135 => array:2 [ "nombre" => "Landete Rodríguez" "apellidos" => "Pedro" ] 136 => array:2 [ "nombre" => "López-Muñiz Ballesteros" "apellidos" => "Belén" ] 137 => array:2 [ "nombre" => "Mohedano Vicente" "apellidos" => "Ester" ] 138 => array:2 [ "nombre" => "Morales Chacón" "apellidos" => "Beatriz" ] 139 => array:2 [ "nombre" => "Moreno Fernández" "apellidos" => "Antonio" ] 140 => array:2 [ "nombre" => "Muñoz García" "apellidos" => "Esther" ] 141 => array:2 [ "nombre" => "Ojeda Castillejo" "apellidos" => "Elena" ] 142 => array:2 [ "nombre" => "Pedraza Serrano" "apellidos" => "Fernando" ] 143 => array:2 [ "nombre" => "Peña Acevedo Acevedo" "apellidos" => "Yesenia" ] 144 => array:2 [ "nombre" => "Pérez Rojo" "apellidos" => "Raquel" ] 145 => array:2 [ "nombre" => "Quílez Ruiz-Rico" "apellidos" => "Natividad" ] 146 => array:2 [ "nombre" => "Ramos Pinedo" "apellidos" => "Ángela" ] 147 => array:2 [ "nombre" => "Rodríguez Jiménez" "apellidos" => "Beatriz" ] 148 => array:2 [ "nombre" => "Rodríguez Rodríguez" "apellidos" => "Mercedes" ] 149 => array:2 [ "nombre" => "Rosado Ingelmo" "apellidos" => "Ana" ] 150 => array:2 [ "nombre" => "Ruiz Peña" "apellidos" => "Antonio" ] 151 => array:2 [ "nombre" => "Sánchez González María" "apellidos" => "José" ] 152 => array:2 [ "nombre" => "Trujillo Trujillo María" "apellidos" => "Jesús" ] 153 => array:2 [ "nombre" => "Vázquez Fuertes" "apellidos" => "Laura" ] 154 => array:2 [ "nombre" => "Vila Albelda" "apellidos" => "Concepción" ] 155 => array:2 [ "nombre" => "Yago Meniz" "apellidos" => "Alexandra" ] 156 => array:2 [ "nombre" => "Aguilar Perez Grovas Ricardo" "apellidos" => "Ismael" ] 157 => array:2 [ "nombre" => "Alcázar Ramírez Alcázar Ramírez" "apellidos" => "José" ] 158 => array:2 [ "nombre" => "Barceló Muñoz José" "apellidos" => "Manuel" ] 159 => array:2 [ "nombre" => "Bentabol Manzanares" "apellidos" => "Miguel" ] 160 => array:2 [ "nombre" => "De Luiz Martínez" "apellidos" => "Gustavo" ] 161 => array:2 [ "nombre" => "García Núñez" "apellidos" => "Ignacio" ] 162 => array:2 [ "nombre" => "Linde de Luna" "apellidos" => "Francisco" ] 163 => array:2 [ "nombre" => "Miranda Paez" "apellidos" => "Alfonso" ] 164 => array:2 [ "nombre" => "Ortega Sáenz de Tejada" "apellidos" => "Ezequiel" ] 165 => array:2 [ "nombre" => "Padilla Galo" "apellidos" => "Alicia" ] 166 => array:2 [ "nombre" => "Pérez Estrada Cornejo" "apellidos" => "Manuel" ] 167 => array:2 [ "nombre" => "Soria Esojo" "apellidos" => "Carmen" ] 168 => array:2 [ "nombre" => "Abellán Alemán Ángel" "apellidos" => "Francisco" ] 169 => array:2 [ "nombre" => 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Only those variables with statistical significance are shown in the graph. The reference categories appear between parentheses. <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>363 patients. m, months. *Factor studied as continuous variable.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">The treatment objectives for asthma are daily control of the disease's symptoms and the prevention of future risks, exacerbations and mortality.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> The drugs typically employed as maintenance therapy are inhaled glucocorticoids (IGC) and long-acting beta agonists (LABA). The main strategy for persistent asthma consists of the IGC/LABA combination due to its demonstrated greater efficacy than monotherapy with IGC. The national and international directives for managing asthma (such as the Global Initiative for Asthma [GINA]<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> and the Spanish guidelines for managing asthma [GEMA]<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a>) recommend that, once proper control has been achieved and maintained for 3–6 months, a reduction in therapy (step-down) should be started with caution, with the objective of maintaining the control with the minimum effective dosage, minimizing the adverse effects and costs of treatment.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Various studies have published differing results regarding the suitability of and the necessary time for reducing the dosage and maintaining subsequent asthma control.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are several recommended strategies for the step-down, all of them based on low levels of evidence. Most guidelines recommend considering an IGC dosage reduction every 3 months, reducing the dosage by 25–50% in each visit. The guidelines indicate, however, that the step-down decision should be individualized and should consider several factors such as the course of the disease, the daily symptoms, the number of exacerbations, the previous step-down attempts and the patient's preferences. Systematic reviews of controlled clinical trials have shown that the risk of exacerbations doubles in the 6 months after completely discontinuing IGC therapy and is therefore not a recommended practice. However, the risk of exacerbations by reducing the IGC dosage by 50% is similar to that of patients whose dosage is not reduced.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4–6</span></a> Studies have also observed that step-down failure is lower in patients with combined IGC/LABA therapy compared with those who took IGC in monotherapy, although the number of exacerbations identified in these clinical trials was small.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7–9</span></a> Meta-analyses have concluded that reducing the IGC dosage while maintaining the LABA dosage is safer than discontinuing the LABA and maintaining the IGC dosage stable.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The step-down results from observational studies conducted in standard clinical practice have not always been satisfactory, and there is very little published evidence on the criteria that physicians follow to reduce maintenance therapy. It is therefore advisable to collect information on the criteria that determine the reduction in therapy in standard practice for patients with persistent asthma, as well as the factors related to the success or failure of this therapeutic change.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11–15</span></a> This advice is relevant because managing asthma requires a permanent assessment of the disease and changes in therapy depending on its control.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Objectives</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study's primary objective was to determine the predictors of success/failure after treatment step-down for patients with moderate-severe persistent asthma treated with an IGC/LABA combination in standard clinical practice.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The secondary objective was to determine the assessment criteria followed by physicians for conducting the step-down.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">A multicenter study of a retrospective cohort was conducted by 226 researchers in various locations throughout Spain. Forty-four percent of the researchers were allergists, and 56% were pulmonologists. The study was approved by the clinical research ethics committee (CREC) of University Hospital Dr. Peset, which was the reference CREC, as well as by each of the participating hospitals’ CREC. All included participants signed and dated the informed consent.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Participation consisted of a single face-to-face visit during which information was collected on the patient's current asthma control and clinical follow-up of the progress from the step-down to determine the success or failure of the step-down.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study population</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study was conducted in 2017 and consecutively included patients 18 years of age and older with a confirmed diagnosis of asthma before 2016 according to the GINA/GEMA guidelines.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The inclusion criterion was having moderate-severe asthma undergoing treatment with fixed combinations of IGC/LABA in which at least 1 treatment step-down was performed in 2016.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The reasons that lead physicians to reduce the therapeutic step could be related to the absence of diurnal or nocturnal symptoms, improvements in pulmonary function and exhaled fraction of nitric oxide, absence of exacerbations, reduced eosinophilia and negative bronchodilator test, among others. In some patients, the step-down was indicated due to a combination of some or all of the previous factors; however, the physician was also asked to identify all factors that could have been, in their judgment, the essential element.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study excluded patients who had difficulty understanding the study or difficulty answering questions regarding the study, as well as patients who did not sign the study's informed consent document.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The study objective was defined as a step-down, reducing the dosage/intensity of maintenance therapy (IGC/LABA), prompted by appropriate symptom control, with the objective of administering the lowest dosage that maintains control.</p><p id="par0065" class="elsevierStylePara elsevierViewall">“Duration of controlled symptoms” was defined as the period in which the patient had adequate symptom control.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Control was measured with the ACT questionnaire,<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">16,17</span></a> considering the asthma as controlled when the score on the questionnaire was ≥20.</p><p id="par0075" class="elsevierStylePara elsevierViewall">We considered asthma exacerbations when the patient had to take systemic corticosteroids.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">The quantitative variables are listed with measures of centralization and dispersion (mean, median, standard deviation, first quartile, third quartile and range). The qualitative variables are listed as absolute and relative frequencies.</p><p id="par0085" class="elsevierStylePara elsevierViewall">When an inferential analysis was required, we employed parametric tests for the continuous variables and nonparametric tests for the ordinal, categorical and nonparametric variables. The hypothesis tests performed in all cases were bilateral, with a significance level of 0.05. For the variables that did not fit the normal distribution (or parametric), we employed the Mann–Whitney U test (for unpaired data) and the Wilcoxon test (for paired data). To analyze the contingency tables and compare the proportions and/or distributions of frequencies, we employed the chi-squared test or Fisher's exact test, as appropriate.</p><p id="par0090" class="elsevierStylePara elsevierViewall">We also performed a logistic regression analysis to determine the predictors of success/failure of the change in medication in the patients’ subsequent outcome. We calculated a dichotomous variable in which we considered success if the patient has not experienced any increase in treatment since the step-down, has presented an ACT score ≥20 in the inclusion visit and has not had exacerbations. We considered failure if the opposite situation was true: exacerbations, loss of clinical control measured by the ACT and/or the need to increase the therapeutic step since the step-down.</p><p id="par0095" class="elsevierStylePara elsevierViewall">We employed SPSS v18.0 for the data analysis</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">The study included a total of 374 patients, with a mean age of 52 years (standard deviation, 16 years); 53% of the patients were diagnosed with asthma when they were younger than 40 years. The population's clinical characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. At least 35% of the population presented 2 associated comorbidities (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), the most common of which were rhinitis (67%), nasal polyposis (19%), depression/anxiety (13%), gastroesophageal reflux disease (13%) and obstructive sleep apnea syndrome (9%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In terms of maintenance therapy at the time of the visit, 374 patients were taking IGC/LABA (100%), 54 were taking antileukotrienes (14%), 49 were taking LAMA (13%), and 16 were taking biological drugs (4%). A total of 299 (80%) patients had moderate persistent asthma, and 75 (20%) had severe persistent asthma.</p><p id="par0110" class="elsevierStylePara elsevierViewall">No patient had their IGC/LABA therapy discontinued after the step-down, only the dosage of IGCs combined with LABA was reduced (all patients remained at least at step 3 of GEMA after the step-down, i.e., with lower dosages of IGC/LABA).</p><p id="par0115" class="elsevierStylePara elsevierViewall">The main reasons that led physicians to conduct the step-down (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) were improvements in diurnal symptoms 122 (33%) and reduced limitation of daily activities 92 (25%); only 35 (9%) performed the step-down due to FEV<span class="elsevierStyleInf">1</span> improvement, and 30 (8%) did so due to the absence of exacerbations in the previous year.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The step-down failed for 156 patients (41.70%), while 218 patients (58.30%) did not lose asthma control in the subsequent revisions. When the step-down was performed for the patients who had more than 6 months of asthma control, success was achieved for 67% of the patients. Sixty-one percent of the failures in the step-down were due to asthma exacerbation.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the bivariate analysis, the factors related to failure defined as when the patient required an increase in dosage after the step-down or lost clinical control with an ACT score <20 and/or presented some exacerbation (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) were the following: greater patient age (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.006), presence of 2 or more comorbidities (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.016), greater severity level (severe persistent vs. moderate persistent) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), greater age at diagnosis (>40 years) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.045), the higher the therapeutic step before (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.003) and after the change (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), the shorter the time of improvement/control prior to the change (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.019), lower FEV<span class="elsevierStyleInf">1</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001) and a poorer ACT score before the step-down (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001). In contrast, the following factors were not related to step-down failure: patient sex (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.122), history of tobacco use (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.380), BMI (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.212), allergic asthma or not (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.999), time from the initial confirmed diagnosis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.834), exacerbations in the previous year (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.634), positive bronchodilator test (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.999), eosinophilia (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.734), fraction of exhaled nitric oxide (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.260) and type of IGC/LABA combination prescribed (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.093).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The logistic regression analysis was performed using success/failure as the dependent variable, while the independent variables were those that were considered clinically relevant: patient's age, severity level (severe or moderate asthma), exacerbations in the past year, reduced pulmonary function, ACT score, duration of asthma control before the step-down and the therapeutic step at which the patient remains after the step-down. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the odds ratio and 95% confidence interval of the best model obtained, which indicates that there are higher chances of step-down failure in the most elderly patients (OR, 0.983; 95% CI 0.969–0.997), those with severe versus moderate asthma (OR, 0.537; 95% CI 0.292–0.985) and greater probability of success if the patient has gone more than 6 months with the disease controlled (OR, 2.253; 95% CI 1.235–4.112).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">This multicenter study analyzed the factors that determine the loss of control when reducing the therapeutic steps in treating moderate-severe asthma in standard clinical practice. According to our results, 41.70% of the patients lost control of the disease upon reducing the IGC dosage in the IGC/LABA combination. The factors related to failure were greater patient age, the presence of comorbidities, an increased level of severity, a lower FEV<span class="elsevierStyleInf">1</span> and a poorer ACT score. In the multivariate analysis, the predictors of failure were patient's age, asthma severity and a disease control time of shorter than 6 months.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Many patients with asthma are believed to be overtreated in standard clinical practice given that, when the disease has been controlled, physicians fear that the patient will worsen and tend to not lower the therapeutic steps and instead maintain the same IGC/LABA combination in the long-term or for highly extended periods. It would therefore be highly useful to be able to identify those patients for whom treatment can be decreased while ensuring the maintenance of disease control. The fact that the 226 researchers in this study found only 374 eligible patients (i.e., many of the specialists only performed step-downs for 1–2 patients/year) shows that physicians in standard practice tend not to reduce the therapeutic steps of patients with moderate-severe asthma.</p><p id="par0145" class="elsevierStylePara elsevierViewall">A US populational study published in 2016 in which 4235 patients with asthma were interviewed by telephone established that there was an indication for reducing the medication if the patients had not presented asthma exacerbations (or hospitalizations, emergency department visits or systemic corticosteroid regimens) and not required more than 3 canisters of rescue inhaler in the past year.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Some 29.90% of the patients met the criteria for decreasing the medication and were those who were analyzed, although not all of them underwent the step-down. The result was that 89.40% of the patients (95% CI 86.40–92.40) for whom the treatment was reduced maintained their asthma control, compared with 83.5% (95% CI 79.90–87) of the patients who also met the criteria for medication reduction but maintained the same treatment. On average, the monthly asthma-related cost savings was $34.02 (95% CI 5.42–61.24) for those who decreased the medication, compared with those who maintained the same level of treatment. The authors’ conclusion was that reducing the maintenance medication for patients with well-controlled asthma results in similar outcomes but at a reduced financial cost. The problem is determining the risk factors for losing control during the medication reduction.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Unlike the previous study, our study observed a failure of the step-down in almost 42% of the patients who underwent this treatment strategy. These results could have been conditioned by the study sample, which only included patients with moderate-severe asthma and none with mild asthma.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Numerous studies have shown that therapeutic noncompliance rates with control medication are high, because patients abandon the medication or lower the dosage, which happens at all levels of asthma severity.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> However, when physicians indicate these therapeutic decreases, which is what we analyzed in this study, there is also a non-negligible rate of loss of control. Both situations can contribute to the high percentage of patients with asthma who do not gain control over the disease. Further studies are therefore needed to delve into the reasons for this clinical situation.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Within the limitations of a retrospective study in conditions of standard clinical practice, this study enabled us to identify factors associated with step-down failure in patients with asthma treated with the IGC/LABA combination, factors that are fascinating from the clinical point of view. Advanced patient age, comorbidities, poorer pulmonary function and previous severity, shorter time under control before the step-down and lower ACT scores are factors to consider when indicating a step-down, given that they can affect its success or failure. Curiously, eosinophilia, a positive bronchodilator test, high exhaled fraction of nitric oxide levels and previous exacerbations did not affect the probability of step-down failure. The finding that the chances of failure are higher in more elderly and severely ill patients is consistent with previous studies, as is the fact that psychiatric comorbidity and poor therapeutic compliance are determinants of step-down failure,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> although these factors were not analyzed in this study.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Spanish researchers recently published a simple score aimed at predicting the future risk of losing asthma control when performing the step-down adjusted to the recommendations of the clinical practice guidelines.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> The study was prospective and therefore required the same criteria from all researchers for performing the step-down (good control by the patient during the last 3 months, with an ACT score >19 and no exacerbations). The patients were checked at 3 months to determine whether they maintained the control. Some 46.80% of the patients had lost asthma control. The independent factors associated with loss of control were bronchial obstruction documented in the medical history (FEV<span class="elsevierStyleInf">1</span>/FVC <70%), FEV<span class="elsevierStyleInf">1</span> <80%, having 1 or more severe exacerbations in the previous year and an ACT score <25. A score with these variables achieved a predictive value for step-down failure of 0.76 (95% CI 0.643–0.882, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) when validated in 114 patients. These results might supplement ours.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The analysis conducted in the present study showed a greater probability of failure when performing a step-down when the patient has controlled their asthma for less than 6 months, has severe asthma, is elderly, presents 2 or more associated comorbidities, has impaired pulmonary function (FEV<span class="elsevierStyleInf">1</span> <80%) and has less control at the time of the change. We considered this approach highly relevant, Given that in this study we observed that physicians used basically clinical criteria for establishing the step-down, mainly the lack of diurnal symptoms and limitations in daily activities. Including the aspects we found in this study as determinants of step-down failure could increase the success rate, especially if we consider spirometric variables and a longer time for disease control.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">The present study was funded by Mundipharma Pharmaceuticals, S. L., Madrid, Spain.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">E. Martinez Moragón has participated in consultancies and has received honoraria for conferences of Astra Zeneca, GlaxoSmithKline, Novartis, Chiesi, ALK, Sanofi, Mundipharma and Boehringer-Ingelheim. J. Delgado has participated in consultancies and has received honoraria for conferences of Novartis, Mundipharma, TEVA, AstraZeneca, ALK and Chiesi. S. Mogrovejo declares that they have no conflicts of interest. T. Fernández-Sanchez works for the medical department of Mundipharma.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1309619" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1209189" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1309618" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1209188" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study design" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Study population" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack451182" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-13" "fechaAceptado" => "2019-05-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1209189" "palabras" => array:3 [ 0 => "Asthma" 1 => "Control" 2 => "Step-down" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1209188" "palabras" => array:3 [ 0 => "Asma" 1 => "Control" 2 => "Step-down" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although the clinical practice guidelines recommend continuous adjustment of asthma treatment and reducing the maintenance drugs when achieving control (step-down), there are few studies of standard clinical practice aimed at collecting information on the factors that determine step-down failure.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the factors that determine step-down failure in standard clinical practice of patients with moderate-severe asthma controlled by a combination of inhaled glucocorticoids and long-acting beta agonists.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A multicentre retrospective study included 374 patients with moderate-severe asthma controlled with inhaled glucocorticoids and long-acting beta agonists for whom the physician indicated a step-down in 2016.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The step-down failed in 41.7% of the patients. The following factors were related to failure: greater patient age (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.006), presence of at least 2 comorbidities (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.016), greater severity level (severe persistent vs. moderate persistent) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), greater age at diagnosis (>40 years) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.045), the higher the therapeutic step before (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.003) and after the change (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), the shorter the time of improvement/control prior to the change (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.019), lower FEV<span class="elsevierStyleInf">1</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001) and a poorer Asthma Control Test score or Asthma Control Questionnaire score before the step-down (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001). The logistic regression analysis showed a higher probability of step-down failure in the more elderly patients (OR, 0.983; 95% CI 0.969–0.997) and those with severe asthma compared to those with moderate asthma (OR, 0.537; 95% CI 0.292–0.985), as well as an increased probability of success if the patients had the disease controlled for more than 6 months (OR, 2.253; 95% CI 1.235–4.112).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In standard clinical practice conditions, step-down fails in a high percentage of patients, and the suggestion is to indicate step-down when the patient has had more than 6 months of disease control.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Aunque las guías de práctica clínica recomiendan un ajuste continuado del tratamiento del asma, reduciendo la medicación de mantenimiento cuando se alcanza el control (step-down), existen pocos estudios de práctica clínica habitual orientados a recabar información de los factores que condicionan su fracaso.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar los factores que condicionan en la práctica clínica habitual el fracaso del step-down en los pacientes asmáticos moderados-graves controlados con una combinación de glucocorticoides inhalados/agonistas beta-2 adrenérgicos de acción larga.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio multicéntrico retrospectivo sobre 374 pacientes con asma moderada-grave controlada con glucocorticoides inhalados/agonistas beta-2 adrenérgicos de acción larga en quienes el facultativo indicó en 2016 un step-down.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El step-down fracasó en el 41,7%. Los factores relacionados con el fracaso fueron: la mayor edad del paciente (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,006), la presencia de 2 o más comorbilidades (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,016), el mayor nivel de gravedad (persistente grave vs. persistente moderada) (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), la mayor edad al diagnóstico (><span class="elsevierStyleHsp" style=""></span>40 años) (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,045), cuanto más alto es el escalón terapéutico previo (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,003) y posterior al cambio (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), cuanto menor sea el tiempo de mejoría/control previo al cambio (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,019), el FEV<span class="elsevierStyleInf">1</span> más bajo (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001) y un peor Asthma Control Test o Asthma Control Questionnaire antes del step-down (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). El análisis de regresión logística mostró que existe una mayor probabilidad (odds ratio [IC 95%] de fracaso del step-down en los pacientes más añosos: OR 0,983 [0,969-0,997], con asma grave vs. moderada: OR 0,537 [0,292-0,985] y mayor probabilidad de éxito si llevan más de 6 meses con la enfermedad controlada: OR 2,253 [1,235-4,112]).</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En condiciones de práctica clínica habitual el step-down fracasa en un porcentaje alto de pacientes y se recomienda indicarlo cuando el paciente lleve más de 6 meses controlado.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">The other members of the STEP group are listed in the Appendix.</p>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Martínez-Moragón E, Delgado J, Mogrovejo S, Fernández-Sánchez T, en nombre del grupo de investigación STEP. Factores que condicionan la pérdida de control al reducir escalones terapéuticos en el tratamiento del asma moderada-grave en la práctica clínica habitual: estudio español multicéntrico. Rev Clin Esp. 2020;220:86–93.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0190" class="elsevierStylePara elsevierViewall">The authors would like to thank the following participating researchers for their collaboration (ordered alphabetically): Albacete:</p> <p id="par0195" class="elsevierStylePara elsevierViewall">Jiménez López, Jesús; Moscardó Orenes, Miguel Ángel; Prieto Montaño, Patricia; Torrecillas Toro, Miguel. Alicante: Cueva Oliver, Begoña; Ferrer Torres, Ángel; González Delgado, Purificación; Jiménez Rodríguez, Teodorikez Wilfox; Vila Auli, Brian. Almería: Zapata Yebenes, Juan José. Álava: Audicana Berasategui, María Teresa; Frias Jiménez, Marta; Hurtado De Mendoza Ruibio, Nieves; Velasco Azagra, Marta. Asturias: Álvarez Fernández, Jose Antonio. Ávila: Acero Sainz, Sara; Blanco González, Rosa Mª. Badajoz: Gómez Nieves, María Estela. Barcelona: Aisa Carpio, Diego; Angrill Sellés, Núria; Berastegui García, Cristina; Crespo Lessmann, Astrid; De La Rosa Carrillo, David; Juanola Pla, Jordi; López Giraldo, Alejandra; Luengo Sánchez, Olga; Martínez Rivera, Carlos; Martínez Olondris, Pilar; Muñoz Gall, Xavier; Pinto Nogués, Ester; Planas Coimerma, Francisco; Portillo Carroz, Karina; Riba Blanch, Antoni; Rivera Ortún, Mª Luisa; Sánchez Berenguer, Dan; Serra Batlles, Joan; Serra Mitjà, Pere; Sogo Sagardía, Ana; Soto Retes, Lorena; Valldeperas Combas, Joan; Vila Giralte, Xavier. Vizcaya: Ansotegui Zubeldia, Ignacio; Antepara Ercoreca, Ignacio; Herrerías Peña, Miguel; Iriberri Pascual, María Milagros; Jaca Michelena, Carmen; Lahuerta Castro, Adolfo; Laita Legarreta, Amaia; Losada Llorente, Paula; Prieto Prieto, Joaquina; Zorrilla Lorenzo, Vanessa. Burgos: Alonso Gil, Lidia; García Muñoz, Juan Pablo; Marcos Durantez, Marisa; Peña Miguel, Teresa. Cáceres: Ahmida, Tahar; Alvarado Izquierdo, María Isabel. Cádiz: Alwakil Olbah, Michael; Arnedillo Muñoz, Aurelio; García Núñez, Ignacio; Gutiérrez Fernández, Diego; Letran Camacho, Antonio. Cantabria: Fernández Pellon, Luis; Morchon Miguel, Eva Maria; Ortiz Portal, Félix. Castellón: Raducan, Isabela; Royo Prats, Juan Antonio; Salvador Segarra, María Dolores; Tatay Soler, Frederic. Ceuta: Levy Naon, Alberto. Ciudad Real: Galindo Bonilla, Pedro; Gil Muñoz, Francisco Luis; Mata Calderón, Patricia. Córdoba: Entrenas Costa, Luis Manuel. La Coruña: Blanco Aparicio, Marina; García Pazos, Jose Manuel; García Paz, Vanessa; González Barcala, Francisco-Javier; Iriarte Sotes, Pilar; Marcos Rodríguez, Pedro Jorge; Molina Nieto, Fernando; Nuñez Orjales, Ramón; Sevillano Martín, Carracedo; Suárez Antelo, Juan; Tábara Rodríguez, Julia. Gerona: Aparicio Español, Santiago; Sabadell Nieto, Carlos; Sabater Talaverano, Gladis. Granada: Escribano Rodríguez, Mª Mar; Florido López, José Fernando; Lara Jiménez, María Ángeles; Rojas Vílchez, María José. Guipúzcua: Chic Palacín, Susana; Dorronsoro Quintana, Silvia; Navarro Echeverria, Jose Antonio. Huelva: Figueroa De La Guardia, Eduardo; Hinojosa Jara, Belén; Moreno García, Victoria; Valverde Vazquez, Lucía. Huesca: Cegoñino De Sus, Joaquín; Compaired Villa, Jose Santonio. Jaén: Almagro López, Juan Alfonso; Arcalá Campillo, Eduardo; Cruz Molina, Jose María; Soto Venegas, Antonia Dolores. León: Benito Martínez, Patricia; Blanco Reinosa, Begoña; Fernández Parra, Beatriz; Fernández García, Domingo; Serrano Gutiérrez, Virginia; Velez Ruiz De Lobera, Adolfo. Lérida: Lara Alcon, Silvia. Lugo: Carballada González, Francisco; González Fernández, Teresa; Martín Lázaro, Joaquín; Mengual Macenlle, Noemí. Madrid: Alonso Viteri, Soledad; Antolín Amerigo, Darío; Bobolea, Irina; Cano Aguirre, M Del Puerto; Cardenas Contreras, Remedios; Carrillo Arias, Fernando; Cimarra Álvarez, Mercedes; De Higes Martínez, Eva Belén;Díaz Campos, Rocío Magdalena; Gandolfo Cano, María Del Mar; García Rodríguez, Leticia; García Romero De Tejada, Jose Andrés; González Mancebo, Eloina; González Seco, Emma; González Torralba, Fernando; Henríquez Santana, Aythamy; Herráez Herrera, Pilar De Lys; Herrero Mosquete, María Ruth; Landete Rodríguez, Pedro; López-Muñiz Ballesteros, Belén; Mohedano Vicente, Ester; Morales Chacón, Beatriz; Moreno Fernández, Antonio; Muñoz García, Esther; Ojeda Castillejo, Elena; Pedraza Serrano, Fernando; Peña Acevedo Acevedo, Yesenia; Pérez Rojo, Raquel; Quílez Ruiz-Rico, Natividad; Ramos Pinedo, Ángela; Rodríguez Jiménez, Beatriz; Rodríguez Rodríguez, Mercedes; Rosado Ingelmo, Ana; Ruiz Peña, Antonio; Sánchez González, María José; Trujillo Trujillo, María Jesús; Vázquez Fuertes, Laura; Vila Albelda, Concepción; Yago Meniz, Alexandra. Málaga: Aguilar Perez Grovas, Ricardo Ismael; Alcázar Ramírez Alcázar Ramírez, José; Barceló Muñoz, José Manuel; Bentabol Manzanares, Miguel; De Luiz Martínez, Gustavo; García Núñez, Ignacio; Linde De Luna, Francisco; Miranda Paez, Alfonso; Ortega Sáenz De Tejada, Ezequiel; Padilla Galo, Alicia; Pérez Estrada Cornejo, Manuel; Soria Esojo, Carmen. Murcia: Abellán Alemán, Ángel Francisco; Alcalde Rumayor, María Consuelo; Andújar Espinosa, Rubén; Bernabeu Mora, Roberto. Navarra: Campano Lancharro, Francisco Javier; Gutiérrez Urra, Tamara; Herrero Martín, Sonia; Resano Lizaldre, Alfredo. Orense: Dacal Quintas, Raquel; García Álvarez-Eire, Marimar; Gómez Márquez, Hugo; González López, Armando. <span class="elsevierStyleItalic">Las Palmas</span>: Cumplido Bonny, Jose Ángel. <span class="elsevierStyleItalic">Pontevedra</span>: Arenas Villarroel, Luis Javier; Barros Casas, David; Blanco Cid, Nagore; Cobas Paz, Ana; Corbacho Abelaira, María Dolores; Iglesias Río, Fernando; Pallarés Sanmartín, Abel. <span class="elsevierStyleItalic">Salamanca</span>: Igea Aznar, Juan Manuel; Lázaro Sastre, Milagros; Rodríguez Hernández, Marina Carmen. <span class="elsevierStyleItalic">Santa Cruz De Tenerife</span>: Cornejo Rodríguez, Roberto; Hernández Méndez, Ana Isabel; Izaguirre Flores, Hemily Katerine.</p>" "etiqueta" => "Appendix A" "identificador" => "sec0055" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1259 "Ancho" => 2057 "Tamanyo" => 128993 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Logistic regression analysis with the dependent variable being the success/failure and the statistically significant independent variables considered clinically relevant.</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Odds ratio with 95% confidence interval of the best model. Only those variables with statistical significance are shown in the graph. The reference categories appear between parentheses. <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>363 patients. m, months. *Factor studied as continuous variable.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: ACT, Asthma Control Test; BMI, body mass index; FeNO, exhaled fraction of nitric oxide; FEV<span class="elsevierStyleInf">1</span>, forced expiratory volume in 1 second; <span class="elsevierStyleItalic">n</span>, number of patients with available datum; ppb: parts per billion; SD, standard deviation.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The values have been calculated based on patients with available data.</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"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inclusion visit data \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean age, years (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.2 (16.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean age at diagnosis, years (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.5 (18.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Women, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">246 (65.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean BMI, kg/m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">(SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.4 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean time since confirmed diagnosis, years (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.9 (12.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Patients with at least 2 concomitant diseases, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">133 (35.56) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Allergic asthma, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">223 (59.35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean FeNO, ppb (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.6 (27.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Tobacco use, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nonsmoker (never or ex-smoker) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">352 (94.11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (5.88) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">%</span><span class="elsevierStyleItalic">over theoretical, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (8.28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>60<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 (32.62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">221 (59.09) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Eosinophils (cells/μL), n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 (57.90) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (42.10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Asthma severity, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">299 (79.94) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (20.05) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ACT</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean total score, <span class="elsevierStyleItalic">n</span> (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.9 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><20, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">102 (27.27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>20, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">272 (72.72) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2244425.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Study population characteristics.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rhinitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">251 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rhinosinusitis/polyposis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Depression/anxiety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastroesophageal reflux \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obstructive sleep apnea syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thyroid disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vocal cord dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sclerotherapy of esophageal varicose veins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eosinophilic pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2244424.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Diseases concomitant with asthma in the 374 patients.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: ACT, asthma control test; FeNO, exhaled fraction of nitric oxide; IGC, inhaled glucocorticoid; LABA, long-acting beta agonists.</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"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reason \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diurnal symptoms<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>times/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No limitation for daily activities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved ACT score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved lung function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No nocturnal symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rescue medication<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>times/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absence of exacerbations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative bronchodilator test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Secondary effects from IGC and LABA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal FeNO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">374 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2244422.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Physician's main motivation for performing the step-down.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: ACT, Asthma Control Test; BMI, body mass index; FeNO, exhaled fraction of nitric oxide; IGC, inhaled glucocorticoid; LABA, long-acting beta agonists.</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">We considered success if the patient did not experience an additional dose increase after the change, exacerbations or adverse reactions and presented an ACT score ≥20 in the inclusion visit. We calculated the <span class="elsevierStyleItalic">p</span>-value based on the number of patients available for each factor; the data were not available for all patients.</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"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Risk factor when changing \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Two or more comorbidities</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Greater severity (moderate, severe)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">>40 years at diagnosis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.045 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Higher therapeutic step before change (from 3 to 6 of GEMA)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Higher therapeutic step after change (from 3 to 6 of GEMA)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Shorter improvement/control time before change (≤3</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m, >3</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">≤6</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m, >6</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">≤12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Lower FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">% (<60, 60–79, ≥80)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Presenting no</span><span class="elsevierStyleItalic">symptoms</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Presence of adverse reaction before change</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Poorly controlled asthma according to ACT</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Factors unrelated to failure (not statistical significance)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.122 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tobacco use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.380 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.212 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Allergic asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Time since diagnosis (≤ or >10 years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.834 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exacerbations in the past year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.634 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FeNO<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.260 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IGC/LABA Combination after change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.093 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positive or negative result on the bronchodilator test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eosinophilia (≤ or >300<span class="elsevierStyleHsp" style=""></span>cells/μL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.734 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2244423.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Factor studied as continuous variable.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Presenting no symptoms meant meeting all of the following parameters: diurnal symptoms (≥2<span class="elsevierStyleHsp" style=""></span>times/week), no nocturnal symptoms, no limitation of activities or need for rescue medication (≥2<span class="elsevierStyleHsp" style=""></span>times/week).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Factors related to step-down failure.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Initiative for Asthma: Global strategy for asthma management and prevention. 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Cebollero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaip.2018.10.017" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol Pract" "fecha" => "2019" "volumen" => "7" "paginaInicial" => "1214" "paginaFinal" => "1221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30368006" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack451182" "titulo" => "Acknowledgements" "texto" => "<p id="par0185" class="elsevierStylePara elsevierViewall">The statistical analysis was performed by Elena Casas of Dynamic, Madrid, Spain.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000002/v1_202002180732/S2254887419302577/v1_202002180732/en/main.assets" "Apartado" => array:4 [ "identificador" => "1901" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000002/v1_202002180732/S2254887419302577/v1_202002180732/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419302577?idApp=WRCEE" ]
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