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in Italy&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and just 1&#46;4&#37; in China&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This low prevalence could give rise to different interpretations&#46; First&#44; the strict lockdown imposed by public health authorities could explain that these patients&#44; who are supposedly more vulnerable to SARS-CoV-2 infection&#44; had closely followed social distancing protocols&#44; thus decreasing the risk of contact&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Second&#44; there could be a protective effect that is not well established in the physiopathology of chronic respiratory disease&#44; with a different immune response that could prevent infection in these patients or condition milder symptoms&#46; One piece of data in favor of this protection against infection can be concluded from the study by Mehta et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> which analyzes factors associated with a positive result on a SARS-CoV-2 diagnostic test in a sample of 184&#44;772 people&#46; 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another study on inhaled corticosteroids that included just 3 patients&#44; conducted in Japan and without a control group&#44; observed a lower requirement for ventilatory support&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> On this matter&#44; a systematic review was recently published on the possible protective effect of inhaled corticosteroids&#59; it was unable to establish either a beneficial or detrimental effect of this treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Similarly&#44; in an Italian study on a cohort of patients with COVID-19&#44; patients with SARS-CoV-2 infection were compared to the general population&#46; No influence on progress related to either short- or long-term inhaled corticosteroids or beta-adrenergic agonists was noted&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Tiotropium bromide is one of the main treatments for COPD and is usually used in approximately 30&#37; of patients treated in primary care&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Recent studies have demonstrated how tiotropium reduces neutrophils and macrophages as well as IL-6 and gamma interferon levels in the airways of rats exposed to tobacco smoke and infected with the A&#47;PR&#47;8&#47;34 &#40;H1N1&#41; influenza virus&#46; The effect was greater than what was observed with fluticasone and roflumilast&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This potential anti-inflammatory effect with cytokine inhibition in animal models could explain a greater protective effect of tiotropium versus other inhaled therapies in SARS-CoV-2 infection&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We have analyzed the prevalence of COPD in patients treated for COVID-19 in our center&#44; specifically evaluating their baseline treatment with inhalers as a potential protective factor against SARS-CoV-2 infection&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A retrospective&#44; observational study was carried out in the Matar&#243; Hospital which identified patients hospitalized with a clinical and&#47;or microbiological diagnosis of SARS-CoV-2 from March 10 to April 22&#44; 2020&#46; A diagnosis of COPD was established when the physician had recorded it on the medical record or when a compatible spirometry was available&#46; Treatments with inhaled corticosteroids and anticholinergics were also recorded&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">During the study period&#44; 487 patients were identified&#46; Of them&#44; 78 &#40;16&#37;&#41; had a clinical diagnosis and 409 &#40;84&#37;&#41; had a microbiological diagnosis of SARS-CoV-2 infection&#46; Of the patients identified&#44; 62&#46;2&#37; were men&#46; The mean age was 64&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;1 years and the overall mortality rate was 20&#46;5&#37;&#46; Of all patients&#44; 25 had a diagnosis of COPD &#40;5&#46;1&#37;&#41;&#44; 17 of which &#40;68&#37;&#41; had spirometric confirmation&#46; Within the group of patients with COPD&#44; the mean age was 72&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1 years and they had a greater mortality rate of 44&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We compared the baseline treatment of patients with COPD in our COVID-19 cohort with other published series of patients with hospital admission due to COPD exacerbation related to other respiratory pathogens or those in stable clinical condition&#46; We did not note any differences in the use of inhaled corticosteroids between both groups&#46; However&#44; the use of tiotropium was significantly lower in patients with COPD who had been hospitalized for COVID-19 in relation to other cohorts of patients with stable COPD and without SARS-CoV-2 infection and controlled in primary care &#40;12&#37; vs&#46; 29&#46;5&#37; and 31&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> &#46;03&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The analysis of our cohort of patients with SARS-CoV-2 confirms a low prevalence of patients with COPD &#40;5&#46;1&#37;&#41;&#46; These patients were older &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> &#46;02&#41;&#44; had greater mortality &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> &#46;03&#41;&#44; and there was a low percentage of patients treated with tiotropium &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> &#46;034&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Given the discordance in the available information&#44; large studies are needed that evaluate the presence of COPD and baseline treatments as possible protective factors against SARS-CoV-2 infection&#44; with special attention paid to treatment with tiotropium&#44; which appeared to have a protective effect in our study&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Likewise&#44; it seems necessary to evaluate different prognostic factors that allow for confirming whether presence of COPD is associated with a worse disease prognosis or if there are other confounding factors that explain this higher mortality&#44; such as age or the establishment of therapeutic limitations related to the comorbidity itself or the healthcare resources available in the context of a pandemic&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Boixeda R&#44; Campins L&#44; Juanola J&#44; Force L&#46; &#191;Es la enfermedad pulmonar obstructiva cr&#243;nica un factor protector en la infecci&#243;n por SARS-CoV-2&#63; La importancia del tratamiento broncodilatador&#46; Rev Clin Esp&#46; 2020&#59;220&#58;526&#8211;529&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">In Appendix A the remaining members of the COCOHMAT &#40;COhort COvid of the Hospital de MATar&#243;&#41; group are listed&#46;</p>"
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            "apendice" => "<p id="par0080" class="elsevierStylePara elsevierViewall">ABS Cirera-Molins &#40;Joaquim Oyon&#44; Mariona Ferrer&#44; Antonia Llinares&#44; Astrid Arkesteijn&#44; Amaia Erraiz&#44; Tatiana Rejon&#44; Evora Igual&#44; Mireia Carmona&#44; Axel Mu&#241;oz&#44; Patricia Prado&#44; Andrea Ventura&#41;&#44; Cardiology Department &#40;Berta Ferreiro&#41;&#44; Endocrinology Department &#40;Elena Guanyabens&#41;&#44; Pharmacy Department &#40;Laia P&#233;rez&#44; Azhara Sanchez&#44; Javier Delgado&#44; Marc Bitlloch&#41;&#44; Geriatrics Department &#40;Nicol&#225;s Mor&#243;n&#44; Franz Sancho&#44; Adrian Oller&#44; Cristina Borrellas&#41;&#44; Hematology Department &#40;Esther Plensa&#41;&#44; Internal Medicine Department &#40;Raquel Ar&#224;nega&#44; Carlos Lopera&#44; Laia Arbon&#233;s&#44; Javier Fern&#225;ndez&#44; Ainhoa Rex&#44; Marta Parra&#44; Aleix Serrallonga&#44; Mar&#237;a Fernanda Solano&#44; Mar&#237;a Larrousse&#44; Montserrat Mauri&#44; Concepci&#243; Falg&#224;&#44; Sandra Bacca&#44; Paula Fern&#225;ndez&#44; Laura Pacho&#44; Miquel Martin&#41;&#44; Pulmonology Department &#40;Alejandro Robles&#44; Xavier Vil&#224;&#44; Laura Ovejero&#44; Pilar Ortega&#41;&#44; Oncology Department &#40;Susana Mart&#237;nez&#44; Irene Ortiz&#41;&#44; Pediatrics Department &#40;Anna Vidal&#44; Pamela Calder&#243;n&#44; Julio Baena&#44; Ingrid Badia&#41;&#44; Rehabilitation Department &#40;Adri&#225;n Ruiz&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Members of the COCOHMAT &#40;COhorte COvid del Hospital de MATar&#243;&#41; Group"
            "identificador" => "sec0005"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The data are shown in absolute values &#40;percentage&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">AC&#58; anticholinergics&#59; IC&#58; inhaled corticosteroids&#59; COPD&#58; chronic obstructive pulmonary disease&#59; LTAC&#58; long-term anticholinergics&#46;</p>"
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LTAC&nbsp;\t\t\t\t\t\t\n
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                  \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">Tiotropium&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Severe SARS-CoV-2 infection</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\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
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                  \t\t\t\t">Boixeda et al&#46; &#40;Matar&#243; Hospital&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;64&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">17 &#40;68&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;44&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;12&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\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">Severe COPD exacerbation</span>&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&nbsp;\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="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\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
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                  \t\t\t\t">Casas-Mendez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">465&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">293 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">363 &#40;77&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">158 &#40;33&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\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">Stable COPD</span>&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&nbsp;\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
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                  \t\t\t\t">Morros et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3837&nbsp;\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="left" valign="\n
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                  \t\t\t\t">2224 &#40;57&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1763 &#40;45&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1134 &#40;29&#46;5&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\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">De Oliveira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">180&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">167 &#40;92&#46;8&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\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="left" valign="\n
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Vol. 220. Issue 8.
Pages 526-529 (November 2020)
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Vol. 220. Issue 8.
Pages 526-529 (November 2020)
Correspondence
Is chronic obstructive pulmonary disease a protective factor in SARS-CoV-2 infection? The importance of bronchodilator treatment
¿Es la enfermedad pulmonar obstructiva crónica un factor protector en la infección por SARS-CoV-2? La importancia del tratamiento broncodilatador
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R. Boixedaa,b,c,
Corresponding author
, L. Campinsd, J. Juanolab,e,f, L. Forcea,f, on behalf of the COCOHMAT group 1
a Servicio de Medicina Interna, Hospital de Mataró, Consorci Sanitari del Maresme (CSDM), Mataró, Barcelona, Spain
b Grup d’Estudi al Maresme de la Pneumònia Adquirida en la Comunitat i la MPOC (GEMP@C), Mataró, Barcelona, Spain
c Universidad de Barcelona, CIBERES Barcelona, Barcelona, Spain
d Servicio de Farmacia, Hospital de Mataró, CSDM, Mataró, Barcelona, Spain
e Servicio de Neumología, Hospital de Mataró, CSDM, Mataró, Barcelona, Spain
f Escola de Ciències de la Salut, Tecnocampus, Universitat Pompeu Fabra, Barcelona, Spain
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Table 1. Treatment with inhaled corticosteroids and anticholinergics in patients with COPD in series of patients hospitalized due to SARS-CoV-2, severe exacerbation of COPD, and patients in the stable phase (primary care).

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