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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis multivariable de los factores asociados con un asma bien controlada&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las categor&#237;as de referencia aparecen entre par&#233;ntesis&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se presentan las odds ratio y sus correspondientes intervalos de confianza del 95&#37;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Las gu&#237;as de pr&#225;ctica cl&#237;nica &#40;GPC&#41; ofrecen la posibilidad de reducir la inadecuada variabilidad de la pr&#225;ctica cl&#237;nica&#44; mejorar la incorporaci&#243;n de la evidencia cient&#237;fica a la pr&#225;ctica cl&#237;nica y mejorar la calidad y la seguridad de la atenci&#243;n sanitaria<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El seguimiento de las gu&#237;as sobre asma se ha asociado con un mejor control de los s&#237;ntomas de la enfermedad y una reducci&#243;n de los gastos en medicamentos<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#46; Por el contrario&#44; un escaso seguimiento se ha asociado con un aumento del n&#250;mero de exacerbaciones y hospitalizaciones<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#46; La mayor&#237;a de los estudios revela que un escaso seguimiento de las GPC sobre el asma es un problema com&#250;n y universal que afecta a la mayor&#237;a de los pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4-11</span></a>&#46; El incumplimiento es m&#225;s frecuente en atenci&#243;n primaria que en atenci&#243;n especializada<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#44;10&#44;12</span></a>&#44; aumenta con la edad del paciente<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#44;11&#44;13</span></a> y es m&#225;s com&#250;n en pacientes que presentan un asma entre moderado y grave<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;14</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Una de las medidas eficaces para mejorar el seguimiento de las GPC sobre asma es proporcionar a los profesionales sanitarios datos de rendimiento relacionados con la calidad de la atenci&#243;n sanitaria mediante retroinformaci&#243;n y auditor&#237;as<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46; El seguimiento de la GPC sobre asma puede haber mejorado con el tiempo<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a>&#46; Se ha evaluado previamente el seguimiento de las recomendaciones de la versi&#243;n anterior de la GPC espa&#241;ola para el manejo del asma &#40;GEMA 2003&#41;&#44; comunic&#225;ndose que un tercio de los m&#233;dicos eran malos cumplidores<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; Sin embargo&#44; a&#250;n no se ha evaluado el grado de seguimiento de las versiones 2009 y 2015 de la GEMA &#40;GEMA 2009 y GEMA 2015&#41;&#46; Este estudio observacional ambispectivo pretend&#237;a evaluar el seguimiento de las recomendaciones indicadas en dichas versiones de la GEMA<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18</span></a> y su repercusi&#243;n en el grado de control de los pacientes asm&#225;ticos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudio observacional tuvo una fase retrospectiva&#44; para evaluar el grado de seguimiento previo de las recomendaciones de la GEMA 2009&#44; y una fase prospectiva donde se evalu&#243; el seguimiento de las recomendaciones de la GEMA 2015 y su repercusi&#243;n en el control del asma&#46; El estudio recibi&#243; la aprobaci&#243;n del Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica de las Islas Baleares &#40;Palma de Mallorca&#44; Espa&#241;a&#41; y se obtuvo el consentimiento informado por escrito de cada paciente antes de su inclusi&#243;n en el estudio&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criterios de selecci&#243;n</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se reclut&#243; una muestra de conveniencia de m&#233;dicos de atenci&#243;n primaria &#40;MAP&#41; de toda Espa&#241;a&#46; Estos m&#233;dicos incluyeron de forma consecutiva a pacientes mayores de 18 a&#241;os con asma que estaban recibiendo terapia de mantenimiento para el asma durante al menos 3 meses&#44; que requer&#237;an evaluaciones de seguimiento cada 3-6 meses y que firmaron el consentimiento informado por escrito&#46; Se excluy&#243; del estudio a los pacientes que&#44; seg&#250;n criterio m&#233;dico&#44; no estaban capacitados para participar en el estudio&#44; hab&#237;an recibido tratamiento con productos biol&#243;gicos o inmunoterapia&#44; hab&#237;an sufrido una exacerbaci&#243;n en el mes anterior a la inclusi&#243;n en el estudio&#44; ten&#237;an comorbilidades que pod&#237;an confundir el diagn&#243;stico de asma &#40;p&#46; ej&#46;&#44; enfermedad pulmonar obstructiva cr&#243;nica&#44; fibrosis pulmonar&#44; etc&#46;&#41; o ten&#237;an una cardiopat&#237;a no controlada&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evaluaciones y resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">En la visita inicial se registraron los siguientes datos&#58; intervalo de edad de los m&#233;dicos&#44; los a&#241;os de pr&#225;ctica&#44; la disponibilidad de inhaladores con placebo&#44; la colaboraci&#243;n del personal de enfermer&#237;a en el seguimiento de los pacientes asm&#225;ticos&#44; el n&#250;mero de GPC conocidas&#44; el n&#250;mero de GPC cuyas recomendaciones segu&#237;an&#44; la media de pacientes atendidos en la cl&#237;nica&#44; la media de duraci&#243;n de la visita de un paciente con asma y la media de duraci&#243;n de la visita de un paciente con otras afecciones&#46; En la primera visita&#44; tambi&#233;n se registr&#243; la informaci&#243;n sobre datos sociodemogr&#225;ficos de los pacientes&#44; las condiciones sanitarias de la vivienda y las enfermedades concomitantes&#46; Adem&#225;s&#44; se registr&#243; la informaci&#243;n cl&#237;nica relevante sobre el asma bas&#225;ndose en la &#250;ltima y m&#225;s completa visita de seguimiento del asma del a&#241;o previo&#46; Finalmente&#44; en la primera visita&#44; se proporcion&#243; al m&#233;dico un breve resumen por escrito de las novedades incluidas en la versi&#243;n 2015 de la GEMA y se le pidi&#243; que respondiera a la pregunta de si hab&#237;a le&#237;do dicha informaci&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">En la visita inicial y la visita de seguimiento&#44; que tuvo lugar 3 meses despu&#233;s de la visita inicial&#44; se registr&#243; la siguiente informaci&#243;n&#58; grado de control del asma seg&#250;n el juicio m&#233;dico que se clasific&#243; como&#58; bien controlada&#44; parcialmente controlada o no controlada&#59; presencia de s&#237;ntomas diurnos&#44; limitaciones en las actividades diarias&#44; s&#237;ntomas&#47;despertares nocturnos&#44; necesidad de medicaci&#243;n de rescate&#44; uso de cuestionarios validados de s&#237;ntomas&#44; y presencia de exacerbaciones&#59; adem&#225;s&#44; se registr&#243; la intensidad del asma y escal&#243;n de tratamiento&#44; y si el m&#233;dico modific&#243; dicho escal&#243;n de tratamiento&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para definir la variable &#171;seguimiento adecuado de la GPC&#187;&#44; se evalu&#243; el cumplimiento por los m&#233;dicos participantes de una serie de criterios seleccionados por consenso de los autores&#44; al no disponerse de un criterio validado de seguimiento adecuado de GPC en la literatura consultada&#58; deb&#237;a declarar que cumpl&#237;a con la GPC y el grado de control del asma&#44; seg&#250;n criterio m&#233;dico &#40;v&#233;ase arriba&#41; deb&#237;a coincidir con el grado de control del asma seg&#250;n los criterios modificados del Global Initiative for Asthma &#40;GINA&#41; en&#44; al menos&#44; el 80&#37; de los pacientes&#46; Para evaluar la repercusi&#243;n que ten&#237;a cumplir con la GPC en el grado de control de los s&#237;ntomas&#44; el control del asma se evalu&#243; en la visita inicial y en las visitas de seguimiento seg&#250;n los criterios modificados de GINA&#46; Se consider&#243; que el m&#233;dico segu&#237;a las recomendaciones de la GEMA en un paciente determinado si la evaluaci&#243;n del control de asma por parte del m&#233;dico coincid&#237;a con los criterios modificados de GINA para el control del asma y el m&#233;dico hab&#237;a le&#237;do el resumen de las actualizaciones incluidas en la versi&#243;n 2015 de la GEMA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se presentan con la media y la desviaci&#243;n est&#225;ndar&#44; y las variables cualitativas se presentan con frecuencias absolutas y relativas&#46; No se imputaron los datos perdidos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para analizar los factores asociados con el control del asma seg&#250;n lo evaluado por el m&#233;dico&#44; se llev&#243; a cabo un an&#225;lisis bivariado comparando a pacientes con una enfermedad bien controlada con aquellos con una enfermedad parcialmente controlada o mal controlada&#46; Los factores independientes incluidos en la comparaci&#243;n fueron&#58; edad&#44; sexo&#44; consumo de tabaco&#44; nivel educativo&#44; condiciones sanitarias de la vivienda&#44; otras caracter&#237;sticas dom&#233;sticas como vivir en un bloque de pisos&#44; en el campo o en una casa unifamiliar&#44; antig&#252;edad de la casa&#44; humedad en la casa y vivir cerca del mar&#44; presencia de comorbilidades&#44; seguimiento de las recomendaciones de la GEMA 2015 por parte del m&#233;dico&#44; duraci&#243;n de asma&#44; haber realizado espirometr&#237;a y prueba de reversibilidad&#44; haber le&#237;do la informaci&#243;n sobre las novedades incluidas en la versi&#243;n 2015 de la GEMA&#44; haber recibido educaci&#243;n sanitaria sobre el asma en la visita inicial&#44; la presencia de exacerbaciones&#44; el grado de control del asma al inicio del estudio y la gravedad del asma&#46; Despu&#233;s&#44; se realiz&#243; un an&#225;lisis multivariante utilizando el control del asma seg&#250;n criterio m&#233;dico como la variable dependiente y como variables independientes aquellas que fueran significativas a un nivel <span class="elsevierStyleItalic">p</span> &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;100 en el an&#225;lisis bivariado&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para las comparaciones bivariadas&#44; se usaron las pruebas param&#233;tricas para las variables continuas y las pruebas no param&#233;tricas para las variables ordinales&#44; categ&#243;ricas o no param&#233;tricas&#46; Todas las pruebas fueron bilaterales y se consideraron significativas si <span class="elsevierStyleItalic">p</span> &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Distribuci&#243;n de los pacientes y caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas</span><p id="par0060" class="elsevierStylePara elsevierViewall">El estudio se llev&#243; a cabo entre septiembre del 2015 y abril del 2016 y en &#233;l participaron 314 MAP que reclutaron a 2&#46;864 pacientes&#46; Se excluy&#243; del an&#225;lisis a 40<span class="elsevierStyleHsp" style=""></span>pacientes &#40;1&#44;4&#37;&#41;&#44; fundamentalmente porque ten&#237;an datos incompletos en la visita retrospectiva &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41; o en la visita inicial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las caracter&#237;sticas de los m&#233;dicos participantes&#46; M&#225;s del 95&#37; de los m&#233;dicos conoc&#237;an y segu&#237;an las recomendaciones de la GEMA&#46; Aunque el 75&#37; de los m&#233;dicos respondieron que conoc&#237;an las recomendaciones de la GINA&#44; menos de la mitad de ellos segu&#237;an estas recomendaciones&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La media de edad de los pacientes era de 50 a&#241;os&#44; con un ligero predominio de mujeres y personas que nunca hab&#237;an fumado&#44; y las condiciones sanitarias de sus viviendas eran adecuadas u &#243;ptimas en la mayor&#237;a de los casos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Las comorbilidades m&#225;s comunes eran rinitis al&#233;rgica &#40;51&#37;&#41;&#44; enfermedad por reflujo gastroesof&#225;gico &#40;27&#37;&#41; y depresi&#243;n&#47;ansiedad &#40;25&#37;&#41;&#46; La duraci&#243;n del asma era superior a 10 a&#241;os en el 57&#37; de los pacientes y la media de visitas a la consulta m&#233;dica en el a&#241;o anterior fue de 3&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">S&#237;ntomas&#44; intensidad y escal&#243;n terap&#233;utico del asma</span><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se muestra el grado de control del asma&#44; seg&#250;n juicio m&#233;dico&#44; y la valoraci&#243;n de cada s&#237;ntoma individual&#44; seg&#250;n lo comunicado por los pacientes en las visitas retrospectiva&#44; inicial y de seguimiento&#46; La intensidad del asma y los escalones terap&#233;uticos se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46; En la visita retrospectiva&#44; el asma de los pacientes estaba bien controlada en el 47&#37; de los 2&#46;862 participantes seg&#250;n la opini&#243;n de los investigadores&#46; Sin embargo&#44; el 52&#37; necesitaba medicaci&#243;n de rescate&#44; el 46&#37; presentaba s&#237;ntomas diurnos y el 38&#37; hab&#237;a experimentado exacerbaciones&#46; El 49&#37; de los pacientes se encontraban en escal&#243;n 1 o 2 de tratamiento y 30&#37; de los pacientes necesitaban subir o bajar un escal&#243;n de su medicaci&#243;n&#46; Los resultados en relaci&#243;n con el grado de control del asma y la sintomatolog&#237;a en la visita inicial coincidieron con los de la visita retrospectiva &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; pero el n&#250;mero de pacientes en el escal&#243;n 1 o 2 se redujo al 43 y el 33&#37; de los pacientes que requirieron una modificaci&#243;n del escal&#243;n de tratamiento&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Seguimiento de las recomendaciones de la GEMA y su repercusi&#243;n en el control del asma</span><p id="par0080" class="elsevierStylePara elsevierViewall">En global&#44; utilizando datos retrospectivos&#44; 81 de los 314 m&#233;dicos &#40;25&#44;8&#37; &#91;IC del 95&#37;&#44; 21&#44;3 a 30&#44;9&#93;&#41; comunicaron seguir las recomendaciones de la GEMA 2009&#46; Si usamos los datos obtenidos en la visita inicial&#44; 88 de los 314 m&#233;dicos &#40;28&#44;0&#37; &#91;IC del 95&#37;&#44; 23&#44;4 a 33&#44;2&#93;&#41; segu&#237;an las recomendaciones de la GEMA 2015&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En cuanto a los pacientes&#44; de los 2&#46;744 pacientes evaluables para este criterio de valoraci&#243;n al inicio del estudio&#44; 1&#46;912 pacientes recibieron tratamiento de un m&#233;dico que segu&#237;a las recomendaciones de la GEMA 2015&#46; Se observ&#243; un aumento ligeramente mayor en el control del asma entre los pacientes que recibieron tratamiento seg&#250;n la GEMA 2015 en la visita de seguimiento en comparaci&#243;n con aquellos cuyo tratamiento no se realiz&#243; acorde con esta gu&#237;a&#46; El aumento absoluto en la proporci&#243;n de pacientes con una enfermedad bien controlada entre la visita inicial y la de seguimiento fue del 22&#37; en el grupo tratado por m&#233;dicos que segu&#237;an las recomendaciones &#40;del 52 al 74&#37;&#41; y del 18&#37; &#40;del 39 al 57&#37;&#41; en el grupo tratado por m&#233;dicos que no las segu&#237;an&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En los an&#225;lisis bivariables&#44; los factores significativamente asociados con el control del asma en la visita de seguimiento fueron una menor edad del paciente&#44; ser no fumador&#44; mayor nivel educativo&#44; mejores condiciones sanitarias de la vivienda&#44; vivir en el campo&#44; no tener humedad en la casa&#44; vivir cerca del mar&#44; ausencia de comorbilidades&#44; menor duraci&#243;n del asma&#44; ausencia de exacerbaciones&#44; tener asma controlada en la visita inicial&#44; menor gravedad del asma&#44; si el m&#233;dico sigue recomendaciones de la GEMA 2015 a la hora de tratar al paciente&#46; El an&#225;lisis multivariable mostr&#243; que el tener un asma mal controlada al inicio del estudio &#40;OR 0&#44;19&#44; IC del 95&#37;&#44; 0&#44;13 a 0&#44;28&#41; y un asma persistente grave al inicio del estudio &#40;OR 0&#44;20&#44; IC del 95&#37;&#44; 0&#44;12 a 0&#44;34&#41; se asociaban de manera negativa con un buen control del asma al final del seguimiento &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Por el contrario&#44; el seguimiento de las recomendaciones de la GEMA 2015 por parte del m&#233;dico a la hora de tratar al paciente se asoci&#243; con una mayor probabilidad de tener un asma bien controlada al final del periodo de seguimiento &#40;OR 1&#44;70&#44; IC del 95&#37;&#58; 1&#44;40 a 2&#44;06&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Nuestro estudio muestra que&#44; en Espa&#241;a&#44; el seguimiento de las GEMA por parte de los MAP es bajo y que seguirlas se asocia con un mejor control del asma&#46; Una actuaci&#243;n m&#237;nima como proporcionar un breve resumen por escrito de las novedades incluidas en la versi&#243;n 2015 de las GEMA se asoci&#243; con un leve aumento en el seguimiento de esta gu&#237;a&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; el cumplimiento global con la versi&#243;n m&#225;s actualizada de la GEMA 2015 fue del 28&#37;&#46; Este dato es consistente con los resultados de un estudio anterior realizado en Espa&#241;a en el que participaron 1&#46;066 profesionales sanitarios y en el que se evalu&#243; el grado de conocimiento y seguimiento de una versi&#243;n previa&#44; la GEMA 2003<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; En ese estudio&#44; se consider&#243; que 251 &#40;32&#37;&#41; profesionales sanitarios no solo segu&#237;an&#44; sino que eran buenos cumplidores de la GEMA 2003<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; Sin embargo&#44; cuando se evalu&#243; a los MAP&#44; solo 52 &#40;13&#37;&#41; de los 401 eran cumplidores&#46; Aunque es dif&#237;cil comparar ambos estudios debido a la definici&#243;n de seguimiento de las gu&#237;as&#44; este dato indica que ha aumentado en los &#250;ltimos 10 a&#241;os entre los MAP&#46; Esta mejor&#237;a podr&#237;a estar relacionada con un aumento del conocimiento de las GPC por parte del m&#233;dico&#46; Mientras que en el a&#241;o 2005 solo el 48 y el 55&#37; de los MAP conoc&#237;an las gu&#237;as GINA y GEMA&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#44; las cifras obtenidas en nuestro estudio aumentaron al 75 y el 99&#37;&#44; respectivamente&#46; De hecho&#44; en el primer estudio&#44; el 55&#37; de los MAP consideraban que eran buenos seguidores de la GEMA 2003<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> y&#44; en nuestro estudio&#44; el 95&#37; de ellos se consideraban cumplidores&#46; En otros estudios realizados en Espa&#241;a que se centraron en situaciones cl&#237;nicas espec&#237;ficas&#44; tales como el tratamiento del asma durante el embarazo o el tratamiento de las exacerbaciones agudas&#44; tambi&#233;n se demostr&#243; un seguimiento inadecuado de las gu&#237;as de asma<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; En Estados Unidos<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#44;11&#44;21&#44;22</span></a>&#44; Taiw&#225;n<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#44; Suecia<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;6&#44;23</span></a> y Tasmania-Australia<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> tambi&#233;n se ha comunicado un seguimiento inadecuado de las gu&#237;as de asma&#46; Sin embargo&#44; la mayor&#237;a de estas gu&#237;as valoraban el seguimiento en funci&#243;n de cuestiones espec&#237;ficas&#44; como la evaluaci&#243;n del control del asma mediante pruebas de espirometr&#237;a&#44; y los medicamentos prescritos para el asma&#46; Por lo tanto&#44; no es posible poner nuestros resultados en perspectiva con otros estudios a un nivel cuantitativo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Entre los factores analizados en nuestro estudio&#44; el seguimiento de las recomendaciones de la GEMA constituy&#243; el factor m&#225;s importante asociado a un aumento de la posibilidad de tener asma bien controlada &#40;OR 1&#44;7&#41;&#46; Aunque existe escasa informaci&#243;n sobre este tema&#44; un estudio retrospectivo llevado a cabo en Jap&#243;n en 50 pacientes demostr&#243; que el cumplimiento de las gu&#237;as de asma se asoci&#243; con una remisi&#243;n de los s&#237;ntomas asociados<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#46; Un estudio que se llev&#243; a cabo usando los datos administrativos de Medicaid de Kentucky &#40;Estados Unidos&#41; demostr&#243; que un escaso seguimiento de las gu&#237;as de asma estuvo asociado con un aumento del riesgo de hospitalizaci&#243;n relacionada con el asma &#40;OR 1&#44;5&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#46; Por el contrario&#44; otros factores&#44; como la mayor gravedad del asma y presentar un asma mal controlada al inicio del estudio&#44; afectaron negativamente al grado de control de los pacientes al final del periodo de seguimiento&#46; Estos resultados son coherentes con estudios previos que han demostrado que la gravedad del asma<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">24-26</span></a> y el grado de control inicial del asma<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">27&#44;28</span></a> estaban asociados con el futuro grado de control del asma&#46; Aunque la asociaci&#243;n es m&#225;s d&#233;bil&#44; encontramos que la presencia de comorbilidades se asociaba a unas posibilidades menores de control del asma&#44; un factor que tambi&#233;n se hab&#237;a identificado previamente en la literatura<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias limitaciones&#46; En primer lugar&#44; no hay ninguna definici&#243;n previamente estandarizada de falta de seguimiento de las GPC de asma&#46; No obstante&#44; los investigadores han intentado establecer una definici&#243;n objetiva de seguimiento de las gu&#237;as basado en par&#225;metros objetivos identificados en el estudio m&#225;s all&#225; de la declaraci&#243;n de los propios profesionales&#46; Como se mencion&#243; anteriormente&#44; este hecho hace muy dif&#237;cil comparar nuestros resultados con los de otros estudios&#46; En segundo lugar&#44; la fase prospectiva del estudio podr&#237;a verse afectada por un efecto Hawthorne&#44; con una sobrestimaci&#243;n del control del asma&#46; Finalmente&#44; el m&#233;dico diagnostic&#243; asma sin que hubiera confirmaci&#243;n por otros medios&#44; sin embargo&#44; todos los pacientes estaban recibiendo tratamientos farmacol&#243;gicos para el asma y&#44; por lo tanto&#44; es poco probable que exista una proporci&#243;n importante de diagn&#243;stico inadecuado&#46; Las principales fortalezas del estudio fueron el tama&#241;o de la muestra y el hecho de que nuestra muestra puede considerarse representativa de la pr&#225;ctica cl&#237;nica real&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Existe una evidencia moderada de que las herramientas que apoyan la decisi&#243;n&#44; tales como la retroinformaci&#243;n y auditor&#237;as&#44; y el apoyo de farmacia cl&#237;nica&#44; podr&#237;an modificar el seguimiento de las gu&#237;as de asma por parte de los profesionales sanitarios<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46; La familiaridad con las recomendaciones y un mayor nivel de formaci&#243;n han sido predictores de cumplimiento de las GPC en algunos estudios<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a>&#46; Otros estudios han identificado obst&#225;culos externos para el seguimiento de estas gu&#237;as&#44; como la falta de tiempo&#44; equipo o personal de apoyo<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a>&#59; sin embargo&#44; la evidencia que apoya la utilidad de centrarse en cuestiones organizativas para mejorar el seguimiento de las gu&#237;as de asma parece poco relevante<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">La falta de seguimiento de las GPC de asma &#40;GEMA&#41; es un problema com&#250;n entre los profesionales sanitarios que tratan esta enfermedad y este estudio confirma los resultados de estudios previos que muestran que este problema es m&#225;s frecuente entre los MAP<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">10&#44;12&#44;22</span></a>&#46; En general&#44; se necesitan actuaciones que puedan mejorar el seguimiento de las recomendaciones de las gu&#237;as de asma entre los MAP&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudio ha sido financiado por Mundipharma Pharmaceuticals S&#46;L&#46; &#40;Madrid&#44; Spain&#41;&#46; Dicho patrocinador ha participado junto a los autores en el dise&#241;o&#44; la redacci&#243;n del art&#237;culo y la decisi&#243;n de enviar el art&#237;culo para su publicaci&#243;n&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">MR ha recibido honorarios como ponente y asesor&#237;a de AZ&#44; BI&#44; Chiesi&#44; GSK&#44; Menarini&#44; Mundipharma&#44; Novartis&#44; Pfizer&#44; Rovi y Teva&#44; y subvenciones de investigaci&#243;n a su instituci&#243;n de GSK&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">JM ha recibido honorarios como ponente de Astra-Zeneca&#44; Boehringer Ingelheim GSK&#44; Menarini&#44; Novartis&#44; y honorarios como asesor de Astra-Zeneca&#44; GSK&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">TF es empleado a tiempo completo de Mundipharma Pharmaceuticals S&#46;L&#46;</p></span></span>"
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        5 => array:3 [
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              "titulo" => "Distribuci&#243;n de los pacientes y caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas"
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              "titulo" => "S&#237;ntomas&#44; intensidad y escal&#243;n terap&#233;utico del asma"
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              "titulo" => "Seguimiento de las recomendaciones de la GEMA y su repercusi&#243;n en el control del asma"
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          "titulo" => "Discusi&#243;n"
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    "fechaRecibido" => "2019-07-29"
    "fechaAceptado" => "2019-11-02"
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            1 => "GEMA"
            2 => "Gu&#237;as de pr&#225;ctica cl&#237;nica"
            3 => "Seguimiento"
            4 => "Control del asma"
            5 => "Atenci&#243;n primaria"
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            1 => "GEMA"
            2 => "Clinical practice guidelines"
            3 => "Compliance"
            4 => "Asthma control"
            5 => "Primary care"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar el grado de seguimiento de las recomendaciones de las versiones de la <span class="elsevierStyleItalic">Gu&#237;a espa&#241;ola para el manejo del asma</span> &#40;GEMA 2009 y 2015&#41; y su repercusi&#243;n en el control de la enfermedad&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016&#44; en el que participaron 314 m&#233;dicos de atenci&#243;n primaria y 2&#46;864 pacientes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Utilizando datos retrospectivos&#44; 81 de los 314 m&#233;dicos &#40;25&#44;8&#37; &#91;IC del 95&#37;&#44; 21&#44;3 a 30&#44;9&#93;&#41; comunicaron seguir las recomendaciones de la GEMA 2009&#46; Al inicio del estudio&#44; 88 de los 314 m&#233;dicos &#40;28&#44;0&#37; &#91;IC del 95&#37;&#44; 23&#44;4 a 33&#44;2&#93;&#41; segu&#237;an las recomendaciones de la GEMA 2015&#46; El tener un asma mal controlada &#40;OR 0&#44;19&#44; IC del 95&#37;&#44; 0&#44;13 a 0&#44;28&#41; y presentar un asma persistente grave al inicio del estudio &#40;OR 0&#44;20&#44; IC del 95&#37;&#44; 0&#44;12 a 0&#44;34&#41; se asociaron negativamente con tener un asma bien controlada al final del seguimiento&#46; Por el contrario&#44; el seguimiento de las recomendaciones de la GEMA 2015 se asoci&#243; de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento &#40;OR 1&#44;70&#44; IC del 95&#37;&#44; 1&#44;40 a 2&#44;06&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El escaso seguimiento de las gu&#237;as cl&#237;nicas para el manejo del asma constituye un problema com&#250;n entre los m&#233;dicos de atenci&#243;n primaria&#46; Un seguimiento de estas gu&#237;as se asocia con un control mejor del asma&#46; Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los m&#233;dicos de atenci&#243;n primaria de las gu&#237;as para el manejo del asma&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma &#40;<span class="elsevierStyleItalic">Gu&#237;a Espa&#241;ola para el Manejo del Asma</span> &#91;GEMA&#93;&#41; and the effect of this compliance on controlling the disease&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Using retrospective data&#44; we found that 81 of the 314 physicians &#40;25&#46;8&#37;&#59; 95&#37; CI 21&#46;3&#8211;30&#46;9&#41; stated that they complied with the GEMA2009 recommendations&#46; At the start of the study&#44; 88 of the 314 physicians &#40;28&#46;0&#37;&#59; 95&#37; CI 23&#46;4&#8211;33&#46;2&#41; complied with the GEMA2015 recommendations&#46; Poorly controlled asthma &#40;OR&#44; 0&#46;19&#59; 95&#37; CI 0&#46;13&#8211;0&#46;28&#41; and persistent severe asthma at the start of the study &#40;OR&#44; 0&#46;20&#59; 95&#37; CI 0&#46;12&#8211;0&#46;34&#41; were negatively associated with having well-controlled asthma by the end of the follow-up&#46; In contrast&#44; compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up &#40;OR&#44; 1&#46;70&#59; 95&#37; CI 1&#46;40&#8211;2&#46;06&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians&#46; Compliance with these guidelines is associated with better asthma control&#46; Actions need to be taken to improve primary care physician compliance with the asthma management guidelines&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">El resto de los componentes del grupo GAP-asma est&#225;n relacionados en el <a class="elsevierStyleCrossRef" href="#sec0070">anexo 1</a>&#46;</p>"
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            "apendice" => "<p id="par0150" class="elsevierStylePara elsevierViewall">Participantes en el estudio&#58; Abedianzadeh Timar&#44; Mohsen &#40;Castelldefels&#41;&#59; Acha Dom&#237;nguez&#44; Jes&#250;s &#40;Teruel&#41;&#59; Aguaviva Bascu&#241;ana&#44; Jesus &#40;Huesca&#41;&#59; Aguilar Mart&#237;n&#44; Ignacio &#40;El Ejido&#41;&#59; Ales Conejo&#44; Francisco Ignacio &#40;Sevilla&#41;&#59; Alfaro Gonz&#225;lez&#44; Juan Vicente &#40;Murcia&#41;&#59; Alfonso Landa&#44; Patricia &#40;Sang&#252;esa&#41;&#59; Alt&#233;s Boronat&#44; Andr&#233;s &#40;Barcelona&#41;&#59; &#193;lvarez Arriero&#44; Jes&#250;s Joaqu&#237;n &#40;Talavera de la Reina&#41;&#59; &#193;lvarez Rojo&#44; Juan &#193;ngel &#40;Gondomar&#41;&#59; Allut Vidal German &#40;Noia&#41;&#59; Amaro Cend&#243;n&#44; Jes&#250;s &#40;Cangas&#41;&#59; Amiano Arregui&#44; Mar&#237;a Teresa &#40;Vitoria-Gasteiz&#41;&#59; Angulo Vallejo&#44; Esther &#40;Haro&#41;&#59; Anton &#193;lvarez&#44; Juan Jos&#233; &#40;Barcelona&#41;&#59; Anton Ortega&#44; Javier &#40;Portugalete&#41;&#59; Arconada Perez&#44; Ana &#40;&#193;vila&#41;&#59; Ardiaca Burgu&#233;s&#44; Lidia &#40;Rivas&#41;&#59; Armario V&#225;zquez&#44; Juan Manuel &#40;Arcos&#41;&#59; Arroyo Cubeiro&#44; Amador &#40;Sevilla&#41;&#59; Aso Mendialdea&#44; Koldo &#40;Donostia&#41;&#59; Attardo&#44; Francesca &#40;&#193;vila&#41;&#59; &#193;vila de Tom&#225;s&#44; Jos&#233; Francisco &#40;Legan&#233;s&#41;&#59; Avinent Arnal&#44; M&#46; Jes&#250;s &#40;Sagunto&#41;&#59; Aznar Aguilar&#44; Francisco &#40;Matar&#243;&#41;&#59; Aznar Tejero&#44; Pilar &#40;Zaragoza&#41;&#59; Baena Montilla&#44; Emilio &#40;Valencia&#41;&#59; Baeza L&#243;pez&#44; Jos&#233; Mar&#237;a &#40;X&#224;tiva&#41;&#59; Bar&#243;n Carrillo&#44; Juan Jos&#233; &#40;Roquetas de Mar&#41;&#59; Bartolom&#233; Resano&#44; Rafael &#40;Pamplona&#41;&#59; Beco&#241;a de la Torre&#44; Francisco &#40;Carballedo&#41;&#59; Benavent Mart&#237;n&#44; Isabel &#40;Sant Andreu de la Barca&#41;&#59; Bened&#237; S&#225;nchez&#44; Mar&#237;a Teresa &#40;Marratx&#237;&#41;&#59; Berrocal del Br&#237;o&#44; Jos&#233; &#40;Albacete&#41;&#59; Blanco Delgado&#44; Antonio &#40;Salamanca&#41;&#59; Bleda Cano&#44; Jes&#250;s &#40;Alicante&#41;&#59; Boladeras Sabater&#44; Josep &#40;Port de Pollen&#231;a&#41;&#59; Bol&#237;var Mantilla&#44; Zenaida &#40;Palencia&#41;&#59; Brito Brito&#44; Elisenda &#40;Los Realejos&#41;&#59; Burgos Parra&#44; M&#46; Rosario &#40;Valladolid&#41;&#59; Buxad&#233; Mart&#237;&#44; Isaac &#40;Matar&#243;&#41;&#59; Caballero Garcia&#44; Juan Carlos &#40;Bilbao&#41;&#59; Caba&#241;as Enr&#237;quez&#44; Luis Fernando &#40;Talavera de la Reina&#41;&#59; Calvi&#241;o Cerqueiro&#44; Marcelino &#40;A Coru&#241;a&#41;&#59; Calvo Fern&#225;ndez&#44; Juan &#40;Cerdedo&#41;&#59; Calle Velles&#44; Felipe &#40;Santa Comba&#41;&#59; Camaro Zafra&#44; Beatriz &#40;Valencia&#41;&#59; Campomar Quetlas&#44; Jaume &#40;Porreras&#41;&#59; Capit&#225;n Jurado&#44; M&#243;nica &#40;M&#243;stoles&#41;&#59; C&#225;rdenas Joyanes&#44; Dolores &#40;Madrid&#41;&#59; Carles Bueso&#44; Gonzalo &#40;Valencia&#41;&#59; Carvajal Puente&#44; Cristina &#40;Alcorc&#243;n&#41;&#59; Casado Rodriguez&#44; Cristina &#40;Alcal&#225; de Henares&#41;&#59; Casanova Garc&#237;a&#44; Carlos &#40;Madrid&#41;&#59; Castell&#224; Cahiz&#44; Santiago &#40;Barcelona&#41;&#59; Castell&#224; Cuesta&#44; Cristina &#40;Lloret de Mar&#41;&#59; Castellano Mart&#237;nez&#44; Manuel Antonio &#40;Ja&#233;n&#41;&#59; Catal&#225;n F&#233;lez&#44; Rafael &#40;Alca&#241;iz&#41;&#59; Cavada Garc&#237;a&#44; Miguel &#193;ngel &#40;Madrid&#41;&#59; Cavada Velasco&#44; Antonio &#40;Puertollano&#41;&#59; Cidra Gordillo&#44; Jose Luis &#40;Villafranca de los Barros&#41;&#59; Clemente Garcia&#44; Julia &#40;Valencia&#41;&#59; Collada Jim&#233;nez&#44; Jos&#233; Luis &#40;Alcorc&#243;n&#41;&#59; Cornejo Figueroa&#44; Andr&#233;s &#40;Puertollano&#41;&#59; Cornejo Rodr&#237;guez&#44; Roberto &#40;Los Realejos&#41;&#59; Cuevas Morales&#44; Julio &#40;Azuqueca de Henares&#41;&#59; Curado-Molin&#237; &#193;lvarez&#44; Mar&#237;a Jes&#250;s &#40;Madrid&#41;&#59; Davi&#241;a Romero&#44; Susana &#40;Chapela&#47;Redondela&#41;&#59; de Arriba Mu&#241;oz&#44; Leonor &#40;Cobisa&#41;&#59; de la Flor Ben&#237;tez&#44; Manuel &#40;El Viso de Alcor&#41;&#59; de la Poza Abad&#44; Mariam &#40;Sant Cugat del Valles&#41;&#59; de los Bueis Martinez&#44; Gustavo &#40;Amorebieta&#41;&#59; de Miguel M&#225;rquez&#44; Mar&#237;a P&#237;a &#40;Madrid&#41;&#59; de Pablo Mart&#237;n&#44; Jes&#250;s &#40;Navata&#41;&#59; Delgado Mora&#44; Manuel &#40;Santo Tom&#233;&#41;&#59; D&#237;az Mateo&#44; Joaqu&#237;n &#40;Utrera&#41;&#59; D&#237;az Saborido&#44; Almudena &#40;Valverde del Camino&#41;&#59; D&#237;ez-Caballero Murua&#44; Mar&#237;a &#40;Terrassa&#41;&#59; Doganis Peppas&#44; Constantino &#40;Palma de Mallorca&#41;&#59; Dom&#237;nguez Alonso&#44; Gonzalo &#40;Sanl&#250;car de Barrameda&#41;&#59; Dom&#237;nguez &#193;vila&#44; Juli&#225;n &#40;Plasencia&#41;&#59; Dom&#237;nguez Gonz&#225;lez&#44; Mar&#237;a Nieves &#40;A Coru&#241;a&#41;&#59; Dom&#237;nguez Hern&#225;ndez&#44; Mar&#237;a Isabel &#40;Madrid&#41;&#59; Dosantos Hern&#225;ndez&#44; Javier Oscar &#40;Tudela&#41;&#59; Due&#241;as Buey&#44; Aurelio &#40;Burgos&#41;&#59; Eiris Cambre&#44; M&#46; Jes&#250;s &#40;Santiago de Compostela&#41;&#59; El Wafa Vaca&#44; Yussef Abu &#40;El Puerto de Santamar&#237;a&#41;&#59; Ense&#241;at Sanchez&#44; Antonio Alberto &#40;Palma de Mallorca&#41;&#59; Esquerra Tu&#241;&#237;&#44; Eulalia &#40;Barcelona&#41;&#59; Esteve Ribelles&#44; Jos&#233; Mar&#237;a &#40;Pu&#231;ol&#41;&#59; Estevez Barrondo&#44; Jos&#233; Antonio &#40;Bilbao&#41;&#59; Estraviz Vidal&#44; M&#46; Dolores &#40;Portugalete&#41;&#59; Fajardo Salguero&#44; Rosa Mar&#237;a &#40;Baza&#41;&#59; Felipe Olivero&#44; Jos&#233; Francisco &#40;El Rosario&#41;&#59; Fern&#225;ndez Buj&#237;a&#44; Mar&#237;a Luisa &#40;A Coru&#241;a&#41;&#59; Fern&#225;ndez Cano&#44; Patricia &#40;Talavera de la Reina&#41;&#59; Fern&#225;ndez Ca&#241;averas&#44; M&#46; Isabel &#40;Ciudad Real&#41;&#59; Fern&#225;ndez Fern&#225;ndez&#44; Carmen &#40;Palma de Mallorca&#41;&#59; Fern&#225;ndez Garc&#237;a&#44; Jos&#233; Manuel &#40;Santiago de Compostela&#41;&#59; Fern&#225;ndez G&#243;mez&#44; Patricia &#40;Madrid&#41;&#59; Fern&#225;ndez Gonz&#225;lez&#44; Jos&#233; Mar&#237;a &#40;C&#225;diz&#41;&#59; Fern&#225;ndez Guti&#233;rrez Denia&#44; Irene &#40;Jerez de la Frontera&#41;&#59; Fern&#225;ndez Huelga&#44; M&#46; Esther &#40;Oviedo&#41;&#59; Fern&#225;ndez Martin&#44; Yolanda &#40;Madrid&#41;&#59; Fern&#225;ndez Navarro&#44; Francisco &#40;Madrid&#41;&#59; Fern&#225;ndez Revuelta&#44; Araceli &#40;Zaragoza&#41;&#59; Fern&#225;ndez Toro&#44; Jos&#233; Mar&#237;a &#40;C&#225;ceres&#41;&#59; Fern&#225;ndez-Pacheco Corchado&#44; Luis Mar&#237;a &#40;Madrid&#41;&#59; Ferr&#225;ndiz Miquel&#44; Joaqu&#237;n &#40;Alcoy&#41;&#59; Ferrari Piquero&#44; Carmen &#40;Madrid&#41;&#59; Ferrer Garc&#237;a-Borr&#225;s&#44; Jos&#233; Mar&#237;a &#40;Madrid&#41;&#59; Gago Fernandez&#44; Carlos &#40;Valladolid&#41;&#59; Gago G&#243;mez&#44; Fernando &#40;Algorta&#41;&#59; Galera de Ulierte&#44; Luz Inmaculada &#40;Aguadulce&#41;&#59; Gallegos Ju&#225;rez&#44; Ingrid &#40;Elx&#41;&#59; Garceran Azor&#237;n-G&#243;mez&#44; Jos&#233; Enrique &#40;Ibiza&#41;&#59; Garc&#233;s Romero&#44; Carmen &#40;Zaragoza&#41;&#59; Garc&#237;a Alonso&#44; Francisco Javier &#40;Abrera&#41;&#59; Garc&#237;a Cabana&#44; Andres A&#46; &#40;Lestedo Boqueixon&#41;&#59; Garc&#237;a Cano&#44; Josefa &#40;Alicante&#41;&#59; Garc&#237;a Ceballos&#44; Victoria Gema &#40;Fuenlabrada&#41;&#59; Garc&#237;a de Francisco&#44; Sara &#40;Madrid&#41;&#59; Garc&#237;a Fuentes&#44; Francisco &#40;Algeciras&#41;&#59; Garc&#237;a V&#225;zquez&#44; Yolanda &#40;Castelldefels&#41;&#59; Garc&#237;a Collado&#44; Sergio &#40;Valladolid&#41;&#59; Garc&#237;a-Giralda Ruiz&#44; Luis &#40;Murcia&#41;&#59; Garc&#237;a-Serrano Jim&#233;nez&#44; Beatriz &#40;Madrid&#41;&#59; Garrido P&#233;rez&#44; Montse &#40;Terrassa&#41;&#59; Garro Mendiolagaray&#44; Jon Kepa &#40;Eibar&#41;&#59; Gea Villar&#44; Jorge &#40;Corbera Llobregat&#41;&#59; Genover Llimona&#44; Teresa &#40;Barcelona&#41;&#59; Gil Moreno&#44; Felipe &#40;And&#250;jar&#41;&#59; Gil Pastor&#44; Javier Juli&#225;n &#40;&#193;vila&#41;&#59; Gispert Servitje&#44; Adri&#224; &#40;Gav&#225;&#41;&#59; Godoy Garc&#237;a&#44; Isidro Domingo &#40;Santa Cruz de Tenerife&#41;&#59; G&#243;mez Mart&#237;nez&#44; Gabriel &#40;Abar&#225;n&#41;&#59; G&#243;mez Sanmiguel&#44; Francisco Javier &#40;O Grove&#41;&#59; G&#243;mez Yelo&#44; Jose &#40;Abar&#225;n&#41;&#59; Gonzales Flores&#44; Pedro Alejandro &#40;Sabadell&#41;&#59; Gonz&#225;lez Hern&#225;ndez&#44; Luis &#40;Santa Cruz de Tenerife&#41;&#59; Gonz&#225;lvez Rey&#44; Jaime &#40;Vigo&#41;&#59; Gorgues Comas&#44; Roberto &#40;Valencia&#41;&#59; Guillen Anton&#44; Mar&#237;a Victoria &#40;Jaca&#41;&#59; Guti&#233;rrez Almarza&#44; Miguel &#193;ngel &#40;&#193;vila&#41;&#59; Guti&#233;rrez Esteban&#44; Jose Luis &#40;Hondarribia&#41;&#59; Guz&#243;n Centeno&#44; Marta &#40;Madrid&#41;&#59; Hermoso Sabio&#44; Antonio &#40;Granada&#41;&#59; Hern&#225;ndez Castellanos&#44; Manuel &#40;Ciudad Real&#41;&#59; Hern&#225;ndez P&#233;rez&#44; Ana &#40;Valencia&#41;&#59; Herranz Alfaro&#44; Alfredo &#40;Zaragoza&#41;&#59; Hinojosa D&#237;az&#44; Jos&#233; Francisco &#40;Badajoz&#41;&#59; Iglesias Fern&#225;ndez&#44; Jos&#233; &#40;Pontevedra&#41;&#59; Intxausti Erdoiza&#44; I&#241;aki &#40;Abadi&#241;o&#41;&#59; Izarra P&#225;ramo&#44; Miriam &#40;Burgos&#41;&#59; Jim&#233;nez Marcen&#44; Ana Isabel &#40;Zaragoza&#41;&#59; Jimeno Bernad&#44; Rosa Mar&#237;a &#40;Valencia&#41;&#59; Jover Andreu&#44; Mar&#237;a Jos&#233; &#40;Valencia&#41;&#59; Juan Alcaraz&#44; Francisco Emilio &#40;Los Alc&#225;zares&#41;&#59; Labrador Arranz&#44; Esther &#40;Madrid&#41;&#59; Laencina L&#243;pez&#44; Salvador &#40;Santa Cruz de Tenerife&#41;&#59; Lapuente Troncoso&#44; Elena &#40;Vitoria-Gasteiz&#41;&#59; Latorre C&#225;sedas&#44; Montserrat &#40;Lugo&#41;&#59; Leal Hern&#225;ndez&#44; Mariano &#40;Murcia&#41;&#59; Ledesma Santiago&#44; Lourdes &#40;Zamora&#41;&#59; Lillo Bravo&#44; Francisco Javier &#40;Badajoz&#41;&#59; Lizarribar Sans&#44; Marta &#40;Hondarribia&#41;&#59; Lobato Mart&#237;nez&#44; Roc&#237;o &#40;Jerez de la Frontera&#41;&#59; L&#243;pez Alonso&#44; Emilia Bego&#241;a &#40;Vitoria-Gasteiz&#41;&#59; L&#243;pez Cruz&#44; Urbano &#40;Madrid&#41;&#59; L&#243;pez Chamon&#44; Silvia &#40;Madrid&#41;&#59; L&#243;pez de Vi&#241;aspre Muguerza&#44; Ana Isabel &#40;Vitoria-Gasteiz&#41;&#59; L&#243;pez Herranz&#44; Ana Bel&#233;n &#40;Madrid&#41;&#59; L&#243;pez Marina&#44; V&#237;ctor &#40;Martorell&#41;&#59; L&#243;pez Ortiz&#44; Francisco &#40;Alcal&#225; de Henares&#41;&#59; L&#243;pez Silva&#44; M&#46;&#170; Carmen &#40;Lugo&#41;&#59; Lucas Boronat&#44; Jos&#233; Mar&#237;a &#40;Valencia&#41;&#59; Lugo Ramos&#44; H&#233;ctor Leonardo &#40;El Puerto de Santamar&#237;a&#41;&#59; Lutz Garcia&#44; Erika &#40;Madrid&#41;&#59; Llosa Ventura&#44; Juan Luis &#40;Burriana&#41;&#59; Mac&#237;as Corbacho&#44; Antonio &#40;Badajoz&#41;&#59; Magem Niubo&#44; Juan &#40;Sabadell&#41;&#59; Mancilla las Heras&#44; Diego &#40;Barcelona&#41;&#59; Maneu Juan&#44; Alfonso &#40;Onda&#41;&#59; Manzano Jim&#233;nez&#44; Jos&#233; &#40;Villares de la Reina&#41;&#59; Ma&#241;es Vicente&#44; Pascual &#40;Valencia&#41;&#59; Maranges Comella&#44; Mar&#237;a Isabel &#40;Barcelona&#41;&#59; Marco Segarra&#44; Emilio &#40;Fornells de la Selva&#41;&#59; Mar&#237;a Tablado&#44; Miguel &#193;ngel &#40;Perales de Taju&#241;a&#41;&#59; Marlasca Garcia&#44; Juan Carlos &#40;Bilbao&#41;&#59; Mart&#237; Canales&#44; Juan Carlos &#40;V&#233;lez de Benaudalla&#41;&#59; Mart&#237;n Clos&#44; Jos&#233; &#40;Gand&#237;a&#41;&#59; Mart&#237;n de la Vega&#44; Sa&#250;l &#40;Alcal&#225; de Henares&#41;&#59; Mart&#237;n Ruiz Lavela&#44; Francisco &#40;La &#209;ora&#41;&#59; Martinez Aparicio&#44; M&#46; Desamparada &#40;Valencia&#41;&#59; Mart&#237;nez de Carnero Calzada&#44; Rafael &#40;Valdepe&#241;as&#41;&#59; Martinez Gonz&#225;lez&#44; Agust&#237;n &#40;Barakaldo&#41;&#59; Mart&#237;nez Jim&#233;nez&#44; Juan Manuel &#40;Sevilla&#41;&#59; Mart&#237;nez Laguna&#44; Daniel &#40;Barcelona&#41;&#59; Mart&#237;nez Mayora&#44; Mar&#237;a Teresa &#40;Burgos&#41;&#59; Martinez Merodio&#44; Pilar &#40;Madrid&#41;&#59; Mart&#237;nez Novoa&#44; Luis &#40;Pontevedra&#41;&#59; Mart&#237;nez Ortega&#44; Mireia &#40;Terrassa&#41;&#59; Mart&#237;nez Rojas&#44; Francisco &#40;Cieza&#41;&#59; Mart&#237;nez Rossello&#44; Antonio &#40;Binissalem&#41;&#59; Meijome S&#225;nchez&#44; Mar&#237;a del Carmen &#40;Santiago de Compostela&#41;&#59; M&#233;ndez-Cabeza Vel&#225;zquez&#44; Jes&#250;s &#40;Fuenlabrada&#41;&#59; M&#233;ndez Maiques&#44; Jose Mar&#237;a &#40;Valencia&#41;&#59; Misericordia Garcia&#44; Santiago &#40;Villanueva del Pardillo&#41;&#59; Molina Cabildo&#44; Jos&#233; &#40;Ciudad Real&#41;&#59; Molina Mart&#237;nez&#44; Luis Javier &#40;Badajoz&#41;&#59; Monge Garc&#237;a&#44; Jos&#233; Manuel &#40;El Puerto de Santamar&#237;a&#41;&#59; Montes Belloso&#44; Mar&#237;a Ester &#40;Madrid&#41;&#59; Moreno Molina&#44; Susana &#40;Badajoz&#41;&#59; Motos D&#237;az&#44; Patrocinio &#40;Cieza&#41;&#59; Mourelo Cereijo&#44; Marta &#40;Barcelona&#41;&#59; Moy&#225; Amengual&#44; Ana &#40;Palma de Mallorca&#41;&#59; Mu&#241;oz Ruiz&#44; Pedro Jos&#233; &#40;Baza&#41;&#59; Narv&#225;ez Mart&#237;n&#44; Jos&#233; Mar&#237;a &#40;Adeje&#41;&#59; Navarro Luna&#44; Juan Luis &#40;Huelva&#41;&#59; Navarro Tarin&#44; Fernando &#40;Valencia&#41;&#59; Nicolau Grego&#44; Jorge &#40;Barcelona&#41;&#59; Ni&#241;o Azcarate&#44; Cristina &#40;Santa Cruz de Tenerife&#41;&#59; Nova Alvarez&#44; Jos&#233; &#40;Tavernes Blanques&#41;&#59; N&#250;&#241;ez Cord&#243;n&#44; Juan Carlos &#40;Jerez de la Frontera&#41;&#59; Olagorta de Prado&#44; Asunci&#243;n &#40;Santurce&#41;&#59; Oros Espinosa&#44; Vicente &#40;Sant Andreu de la Barca&#41;&#59; Ortega Pinilla&#44; M&#46; Concepci&#243;n &#40;Majadahonda&#41;&#59; Ortega Ruiz&#44; Mar&#237;a Paz &#40;Alicante&#41;&#59; Osca Pellicer&#44; David &#40;Algemesi&#41;&#59; Otamendi Murillo&#44; Ana &#40;Pamplona&#41;&#59; Otero Mata&#44; Manuel &#40;Noia&#41;&#59; Ouzzine Mar&#237;n&#44; Myriam &#40;Torrej&#243;n de Ardoz&#41;&#59; Paja Fano&#44; Eduardo &#40;Estella&#41;&#59; Palacio Gonzalez&#44; Domingo &#40;Gij&#243;n&#41;&#59; Palau O&#241;ate&#44; Rosario &#40;Castell&#243;n&#41;&#59; Pazos Garrido&#44; N&#233;stor &#40;Pontevedra&#41;&#59; Pecharroman Fuente&#44; Virginia &#40;Burgos&#41;&#59; Pe&#241;a Rosa&#44; Jose Manuel &#40;Valencia&#41;&#59; Peral Cabot&#44; Francisco Javier &#40;Arenys de Mar&#41;&#59; P&#233;rez Barreto&#44; Iv&#225;n Yamir &#40;Alicante&#41;&#59; P&#233;rez Caballero&#44; Isabel &#40;Sevilla&#41;&#59; P&#233;rez Fern&#225;ndez&#44; Maria del Carmen &#40;&#193;vila&#41;&#59; P&#233;rez Fern&#225;ndez&#44; Antonio Luis &#40;El Puerto de Santamar&#237;a&#41;&#59; P&#233;rez Guti&#233;rrez&#44; Esteban &#40;Legan&#233;s&#41;&#59; P&#233;rez Rios&#44; Manuel &#40;Granada&#41;&#59; Petit S&#225;nchez&#44; Jos&#233; Manuel &#40;Sant Andreu de la Barca&#41;&#59; Pi&#241;ero Acin&#44; Maria Jos&#233; &#40;Madrid&#41;&#59; Pozuelos Estrada&#44; Jer&#243;nimo &#40;Badajoz&#41;&#59; Prieto Cid&#44; Manuel &#40;Tarragona&#41;&#59; Prieto Guti&#233;rrez&#44; Joaqu&#237;n &#40;Avil&#233;s&#41;&#59; Raga Casasus&#44; Jos&#233; Vicente &#40;Valencia&#41;&#59; Ram&#237;rez Espinosa&#44; Manuel Francisco &#40;Alicante&#41;&#59; Rebollo Hernamperez&#44; Eduardo &#40;Palma de Mallorca&#41;&#59; Rey Ra&#241;al&#44; Alejandra &#40;A Coru&#241;a&#41;&#59; Ribelles Villalba&#44; Ricardo Sagunto&#59; Rodas Peral&#44; Jos&#233; Antonio &#40;Carmona&#41;&#59; Rodil Martinez&#44; Aurora &#40;Elche&#41;&#59; Rodr&#237;guez Valencia&#44; Jos&#233; Manuel &#40;Valladolid&#41;&#59; Rodr&#237;guez Calca&#241;o&#44; Enrique &#40;Sant Mateu&#41;&#59; Rodr&#237;guez Fernandez&#44; Concepci&#243;n &#40;Lugo&#41;&#59; Rodr&#237;guez Galipienzo&#44; Jos&#233; Miguel &#40;Barcelona&#41;&#59; Rodriguez Lois&#44; Miguel &#193;ngel &#40;Lugo&#41;&#59; Rodr&#237;guez Partida&#44; Jos&#233; Antonio &#40;Jerez de la Frontera&#41;&#59; Roel Conde&#44; Jaime &#40;Madrid&#41;&#59; Roman Rodriguez&#44; Miguel &#40;Soller&#41;&#59; Romero Caballero&#44; Gregorio &#40;Albacete&#41;&#59; Romero Hern&#225;ndez&#44; Pedro &#40;C&#225;ceres&#41;&#59; Rosales Garc&#237;a&#44; Luis Miguel &#40;Arcos de la Frontera&#41;&#59; Royo del R&#237;o&#44; Manuel &#40;Miranda de Ebro&#41;&#59; Ruiz Gomes&#44; Mar&#237;a &#40;Madrid&#41;&#59; Ruiz Moruno&#44; Francisco Javier &#40;C&#243;rdoba&#41;&#59; Ruiz Perez&#44; Jaime &#40;Santander&#41;&#59; Salinero Acevedo&#44; Jos&#233; Ram&#243;n &#40;Madrid&#41;&#59; S&#225;nchez Apresa&#44; Manuel &#40;Utrera&#41;&#59; Sanchez Calavera&#44; Mar&#237;a Antonia &#40;Zaragoza&#41;&#59; S&#225;nchez Garcia&#44; Fernando &#40;Salamanca&#41;&#59; S&#225;nchez Guti&#233;rrez&#44; Miguel &#193;ngel &#40;C&#225;ceres&#41;&#59; S&#225;nchez Ib&#225;&#241;ez&#44; Antonio &#40;Zaragoza&#41;&#59; S&#225;nchez L&#243;pez&#44; Eugenio &#40;El Puerto de Santamar&#237;a&#41;&#59; S&#225;nchez Loureiro&#44; Manuel &#40;Santiago de Compostela&#41;&#59; Sanchez Lozano&#44; Ana &#40;Madrid&#41;&#59; S&#225;nchez Romero&#44; Gregorio &#40;M&#225;laga&#41;&#59; S&#225;nchez Ruano&#44; Fernando &#40;Callsoa d&#8217;en Sarri&#224;&#41;&#59; S&#225;nchez Ruiz&#44; Gabriela &#40;Barcelona&#41;&#59; S&#225;nchez Sanchez&#44; Froil&#225;n &#40;X&#225;tiva&#41;&#59; Santiago Ayarza&#44; Asier &#40;Bilbao&#41;&#59; Santos Bermejo&#44; Juan Antonio &#40;Zamora&#41;&#59; Sanz de Miguel&#44; Elena &#40;Madrid&#41;&#59; Sanz Sanz&#44; Marta &#40;Madrid&#41;&#59; Sanz Velasco&#44; Carmelina &#40;Getafe&#41;&#59; Sauco Col&#243;n&#44; Inmaculada &#40;C&#225;diz&#41;&#59; Sedano Garc&#237;a&#44; Jos&#233; Ignacio &#40;Logro&#241;o&#41;&#59; Segovia Castro&#44; Luis &#40;Mar&#237;n&#41;&#59; Senan Sanz&#44; Mar&#237;a Rosa &#40;Barcelona&#41;&#59; Serra Cabot&#44; Pere &#40;Vilassar de Mar&#41;&#59; Serra Gallego&#44; Marta &#40;Barcelona&#41;&#59; Serrano Tom&#225;s&#44; Daniel &#40;M&#243;stoles&#41;&#59; Sesma Aisa&#44; Francisco Tom&#225;s &#40;Barcelona&#41;&#59; Seuba Garc&#233;s&#44; Jordi &#40;Barcelona&#41;&#59; Soler David&#44; Vicente &#40;Valencia&#41;&#59; Soria Mesa&#44; Jose Antonio &#40;Blanes&#41;&#59; Sosa &#193;lvarez&#44; C&#233;sar &#40;Santa Cruz de Tenerife&#41;&#59; Su&#225;rez P&#233;rez&#44; Mar&#237;a &#40;Huelva&#41;&#59; Tafalla Mart&#237;n&#44; Antonio &#40;Torreviaja&#41;&#59; Tamayo Ferriol&#44; Thaimi &#40;Torrevieja&#41;&#59; Tamayo Mar&#237;n&#44; Jos&#233; Luis &#40;Massanassa&#41;&#59; Thalamas Atienza&#44; Juan Aitor &#40;Ir&#250;n&#41;&#59; Toledo Mu&#241;oz&#44; Ana Mar&#237;a &#40;Eliana&#41;&#59; Tom&#225;s-Rodo Massaneda&#44; Lluis Miquel &#40;Santa Coloma de Farners&#41;&#59; Torres de Castro&#44; Milko &#40;Madrid&#41;&#59; Torres Mart&#237;nez&#44; Francisco Javier &#40;Madrid&#41;&#59; Tovar &#193;lvarez&#44; Enrique &#40;Valencia&#41;&#59; Ugarte Go&#241;i&#44; Ainhoa &#40;Donostia&#41;&#59; Valle Gonz&#225;lez&#44; Irene &#40;Vigo&#41;&#59; Vasco Mahillo&#44; Sonia &#40;Benidorm&#41;&#59; V&#225;zquez Seijas Enrique Jos&#233; &#40;Lugo&#41;&#59; Vericat Roure&#44; Antonio &#40;Barcelona&#41;&#59; Villalba Parrado&#44; Arelis &#40;Santa Cruz de Tenerife&#41;&#59; Villanueva Rebollo&#44; Jose Mar&#237;a &#40;C&#225;ceres&#41;&#59; Villar Valga&#241;on&#44; Ricardo &#40;Miranda de Ebro&#41;&#59; Villena Masegosa&#44; Vicente &#40;Vall D&#769;Uix&#243;&#41;&#59; Vi&#241;als Gigena&#44; Montserrat &#40;Ibiza&#41;&#59; Vi&#241;as Cabrera&#44; Lydia &#40;Barcelona&#41;&#59; Zarco Pinte&#241;o&#44; David &#40;Jerez de la Frontera&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "identificador" => "sec0070"
          ]
        ]
      ]
    ]
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        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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            "Alto" => 1857
            "Ancho" => 2099
            "Tamanyo" => 128618
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis multivariable de los factores asociados con un asma bien controlada&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las categor&#237;as de referencia aparecen entre par&#233;ntesis&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se presentan las odds ratio y sus correspondientes intervalos de confianza del 95&#37;&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; GPC&#58; gu&#237;a de buenas pr&#225;cticas cl&#237;nicas&#59; GEMA&#58; <span class="elsevierStyleItalic">Gu&#237;a espa&#241;ola para el manejo del asma&#59;</span> GINA&#58; Global Initiative for Asthma&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;stica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo &#40;mujer&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;864&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de masa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;6 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Consumo de tabaco&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nunca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;481 &#40;51&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exfumador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">920 &#40;32&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumador activo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">461 &#40;16&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Viviendo solo&#47;a&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;862&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">399 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Condiciones sanitarias de la vivienda&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;862&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#211;ptimas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;228 &#40;42&#44;9&#41;&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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adecuadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;281 &#40;44&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Precarias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" 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  " align="left" valign="\n
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                  \t\t\t\t">180 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Notoriamente inadecuadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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">20 &#40;0&#44;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>Informaci&#243;n no disponible&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">153 &#40;5&#44;3&#41;&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"><span class="elsevierStyleItalic">Comorbilidades&#44; n &#40;&#37;&#41;</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">2&#46;862&nbsp;\t\t\t\t\t\t\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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rinitis al&#233;rgica&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="" 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">1&#46;446 &#40;50&#44;5&#41;&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="elsevierStyleHsp" style=""></span>Reflujo gastroesof&#225;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\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">780 &#40;27&#44;3&#41;&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="elsevierStyleHsp" style=""></span>Depresi&#243;n&#47;ansiedad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\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">711 &#40;24&#44;8&#41;&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="elsevierStyleHsp" style=""></span>Rinosinusitis&#47;p&#243;lipos nasales&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="" 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">482 &#40;16&#44;8&#41;&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="elsevierStyleHsp" style=""></span>Apnea obstructiva del sue&#241;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&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">191 &#40;6&#44;7&#41;&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="elsevierStyleHsp" style=""></span>Disfunci&#243;n de las cuerdas vocales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&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">152 &#40;5&#44;3&#41;&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="elsevierStyleHsp" style=""></span>Hipertiroidismo&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="" 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">69 &#40;2&#44;4&#41;&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="elsevierStyleHsp" style=""></span>Neumon&#237;a eosinof&#237;lica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&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">25 &#40;0&#44;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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aspergilosis al&#233;rgica broncopulmonar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;0&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad de Churg-Strauss&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;0&#44;2&#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">2&#46;864&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>&#8804; 5 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 5 a&#241;os a &#8804;10 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">853 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 10 a&#241;os a &#8804;20 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;060 &#40;37&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 20 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Espirometr&#237;a con prueba de reversibilidad&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;864&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;870 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hospitalizaciones en el a&#241;o anterior&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;426 &#40;84&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#250;mero&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;426&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">2&#44;9 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grado de control del asma &#40;comunicado por el m&#233;dico&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bien controlada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parcialmente controlada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;202 &#40;42&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;217 &#40;42&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">750 &#40;26&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mal controlada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">254 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;ntomas de asma &#40;comunicados por el paciente&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">1&#46;257 &#40;43&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">747 &#40;20&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ntomas&#47;despertares nocturnos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necesidad de medicaci&#243;n de rescate &#40;s&#237;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exacerbaciones&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">1&#46;093 &#40;38&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">869 &#40;30&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">481 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">511 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">420 &#40;14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Escal&#243;n 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">890 &#40;31&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">811 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Escal&#243;n 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">972 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">412 &#40;14&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Escal&#243;n 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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