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Cayo García-Polo,
Bernardino Alcázar-Navarrete,
Luis Alberto Ruiz-Iturriaga,
Alberto Herrejón,
José Antonio Ros-Lucas,
Patricia García-Sidro,
Gema Tirado-Conde, José Luis López-Campos,
Carlos Martínez-Rivera,
Joaquin Costán-Galicia,
Sagrario Mayoralas-Alises,
Javier De Miguel-Díez,
Marc Miravitlles
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) places a huge economic burden on healthcare systems, especially patients with frequent exacerbations and co-morbidities.
To identify factors associated with high utilisation of healthcare resources in a population of patients with COPD.
We conducted an observational, cross-sectional, multicentre study with the aim of identifying the factors associated with high resource utilisation among patients with COPD. Sociodemographic and anthropometric characteristics of the study population, as well as data on health-related quality of life, respiratory symptoms, presence of anxiety and depression, physical activity and lung function were collected. We examined the relationship between these variables and high utilisation of healthcare resources, by performing a multivariate analysis based on a logistic regression model.
115 patients (64 were high users of healthcare resources, and 51 control patients) from 13 hospitals were selected. Patients presenting high resource utilisation had worse FEV(1), worse basal SpO(2), less distance walked in the 6-minute walk test, and increased dyspnoea. They also had a worse BODE index, worse scores in all dimensions of the EURO-QOL 5D and the LCADL scale, and displayed a higher prevalence of depression. Multivariate analysis yielded a statistically significant association between SpO(2), LCADL scores, serum fibrinogen values and total leukocyte count, and high healthcare resource utilisation.
COPD patients who incur higher healthcare resource utilisation show reduced physical activity, increased respiratory failure and increased systemic inflammation.
Respiratory medicine 10/2012; 106(12):1734-42. · 2.33 Impact Factor
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ABSTRACT: INTRODUCTION: This present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort. PATIENTS AND METHODS: CHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD.
Archivos de Bronconeumología 07/2012; · 2.17 Impact Factor
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Bernardino Alcázar,
Cayo García-Polo,
Alberto Herrejón,
Luis Alberto Ruiz,
Javier de Miguel,
José Antonio Ros,
Patricia García-Sidro,
Gema Tirado Conde, José Luis López-Campos,
Carlos Martínez,
Joaquin Costán,
Marc Bonnin,
Sagrario Mayoralas,
Marc Miravitlles
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ABSTRACT: Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) that require hospital admission have a major impact on the progression of disease and generate high health costs.
A multi-center, cross-sectional, observational, study was conducted with the aim to identify factors associated with hospital admission in patients with COPD. We obtained data of socio-demographic and anthropometric characteristics, quality of life, respiratory symptoms, anxiety and depression, physical activity and pulmonary function tests. We analyzed their association with hospital admission with a multivariate analysis using a logistic regression model.
We analyzed 127 patients, 50 (39%) of whom had been hospitalized. 93.7% were men, mean age 67 years (SD=9) and a FEV1 of 41.9% (SD=15.3). In the first model obtained, the baseline SpO(2), the BODE index and emergency room (ER) visits were associated with hospital admission and the area under the ROC curve (AUC) was 0.809. In a second model we included only variables readily available (without the 6 minutes walking test) and only the SpO(2) and previous visits to the ER were significant with an AUC ROC 0.783.
hospital admission for exacerbation of COPD is associated with poor SpO(2), higher BODE index score and a greater number of visits to the ER. In case you do not have the 6 minutes walking test, the other two variables offer a similar discriminative ability.
Archivos de Bronconeumología 12/2011; 48(3):70-6. · 2.17 Impact Factor
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ABSTRACT: We sought to investigate whether the serum concentrations of several inflammatory biomarkers are related to the cyclooxygenase-2 (COX2) -765G>C polymorphism in chronic obstructive pulmonary disease (COPD) and a control group of non-COPD smokers. Serum inflammatory markers (CRP, SAA, CXCL8, and sICAM-1) were measured by ELISA in 144 patients with COPD and in 55 control subjects. Genomic DNA was extracted from peripheral blood leukocytes, and the COX2 -765G>C (rs20417) polymorphism was genotyped. After adjustment for age and active smoking, CRP and SAA concentrations were associated with the COX2 polymorphism in controls (p=0.041 and 0.014, respectively) but not in COPD patients. The CXCL8 and sICAM-1 concentrations were not associated with the COX2 polymorphism for either cases or controls. The results of the present study indicate that there is a relationship between the COX2 -765G>C polymorphism and the concentrations of CRP and SAA in non-COPD smokers and that this relationship does not exist in COPD patients.
Respiratory Physiology & Neurobiology 11/2011; 180(1):119-25. · 2.24 Impact Factor
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ABSTRACT: Eduardo Márquez-Martín1, Pilar Cejudo Ramos1, José Luis López-Campos1, María del Pilar Serrano Gotarredona2, Silvia Navarro Herrero2, Rodrigo Tallón Aguilar1, Emilia Barrot Cortes1, Francisco Ortega Ruiz11Medical-Surgical Unit of Respiratory Diseases, University Hospital Virgen del Rocío, Seville, Spain; 2Radiodiagnostic Unit, University Hospital Virgen del Rocío, Seville, SpainBackground: More accurate phenotyping of COPD is of great interest since it may have prognostic and therapeutic consequences. We attempted to explore the possible relationship between the extent of emphysema, as assessed by high-resolution computed tomography (HRCT), and COPD severity. We also included some study variables involving exercise tolerance evaluation and peripheral muscle strength (PMS) measurement.Methods: Sixty-four patients with COPD (mean age 64 ± 7 years) were enrolled in a prospective observational cross-sectional study. All patients underwent clinical and functional evaluations: assessment of dyspnea, body mass index (BMI), health status assessment, spirometry testing, and arterial blood gas analysis. The extent of emphysema was graded using HRCT. Functional capacity was evaluated by a cardiopulmonary maximal exercise testing (CPET), the shuttle walking test, and by estimation of PMS.Results: Half of the study patients had an emphysematous phenotype. There was a significant correlation between the score derived from analysis of HRCT images and BMI and respiratory functional parameters, as well as VO2 max (maximal oxygen uptake) and chest pull 1RM (1 rep max). Compared with subjects with a nonemphysematous phenotype, those with an emphysematous phenotype showed a lower BMI, a reduced PMS, and displayed a lower power at CPET. Significant differences in lung function tests were found for diffusing capacity and hyperinflation. No significant differences in quality of life were observed between the two study groups.Conclusions: Compared with subjects with a nonemphysematous phenotype, subjects with an emphysematous phenotype has a different profile in terms of BMI, lung function, PMS, and exercise capacity.Keywords: chronic obstructive pulmonary disease, exercise tolerance, emphysema, phenotypes, lung function
International Journal of COPD. 01/2011;
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ABSTRACT: We analysed the effectiveness of a high intensity behavioural-cognitive intervention compared to minimal intervention started during a hospital stay, to see if the combination of nicotine replacement therapy (NRT) can increase the quitting rate at 12 months of follow up.
A total of 2560 active smokers were studied during their hospital stay. Of these, 717 smokers refused to enter the study and after a minimal intervention they were asked if we could telephone them after one year to ask if they still smoked. The remaining 1843 smokers who received high intensity cognitive therapy were randomised to receive or not receive NRT. The follow up after discharge was carried out by outpatient visits or with telephone sessions.
At one year of follow up, 7% of those who declined to enter the study had stopped smoking compared to 27% of those who entered the study (p<0.001). There were significant differences between the group that only had behavioural therapy (21% stopped) compared to the group that also had NRT (33% stopped; p=0.002). In this latter group there were significant differences (p=0.03) between those who had follow up in clinics (39% stopped) compared to those who were followed up telephone sessions (30%). In the multivariate analysis, the predictors of quitting at 12 months were: to have used NRT (OR 12.2; 95% CI, 5.2-32; p=0.002) and a higher score in the Richmond Test (OR 10.1; 95% CI, 3.9-24.2; p=0.01).
A cognitive type intervention started on smokers when admitted to hospital increases quitting rates at 12 months, compared to a minimal intervention, and these rates increase even more significantly if NRT is added.
Archivos de Bronconeumología 01/2011; 47(1):3-9. · 2.17 Impact Factor
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ABSTRACT: More accurate phenotyping of COPD is of great interest since it may have prognostic and therapeutic consequences. We attempted to explore the possible relationship between the extent of emphysema, as assessed by high-resolution computed tomography (HRCT), and COPD severity. We also included some study variables involving exercise tolerance evaluation and peripheral muscle strength (PMS) measurement.
Sixty-four patients with COPD (mean age 64 ± 7 years) were enrolled in a prospective observational cross-sectional study. All patients underwent clinical and functional evaluations: assessment of dyspnea, body mass index (BMI), health status assessment, spirometry testing, and arterial blood gas analysis. The extent of emphysema was graded using HRCT. Functional capacity was evaluated by a cardiopulmonary maximal exercise testing (CPET), the shuttle walking test, and by estimation of PMS.
Half of the study patients had an emphysematous phenotype. There was a significant correlation between the score derived from analysis of HRCT images and BMI and respiratory functional parameters, as well as VO(2) max (maximal oxygen uptake) and chest pull 1RM (1 rep max). Compared with subjects with a non-emphysematous phenotype, those with an emphysematous phenotype showed a lower BMI, a reduced PMS, and displayed a lower power at CPET. Significant differences in lung function tests were found for diffusing capacity and hyperinflation. No significant differences in quality of life were observed between the two study groups.
Compared with subjects with a non-emphysematous phenotype, subjects with an emphysematous phenotype has a different profile in terms of BMI, lung function, PMS, and exercise capacity.
International Journal of COPD 01/2011; 6:105-12.
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José Luis López-Campos
Archivos de Bronconeumología 12/2010; 46(12):617-20. · 2.17 Impact Factor
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Francisco Pozo-Rodríguez,
Carlos José Alvarez,
Ady Castro-Acosta,
Carlos Melero Moreno,
Alberto Capelastegui,
Cristobal Esteban,
Carmen Hernández Carcereny, José Luis López-Campos,
José Luís Izquierdo Alonso,
Antonio López Quílez,
Alvar Agustí
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ABSTRACT: There is little information regarding the clinical management of hospital inpatients diagnosed with exacerbation of Chronic Obstructive Pulmonary Disease (COPD). AUDIPOC is a clinical audit dealing with the clinical management of COPD in Spain.
To examine the adequacy and validity of the instruments used to measure the variables proposed by AUDIPOC Spain (Preliminary Study) and to verify the viability of AUDIPOC in a complex environment with hospitals of different sizes, resources, and organizational layout (Pilot Study).
The Preliminary Study took place in 4 hospitals and studied 213 cases. The Pilot Study took place in 30 hospitals of 6 Autonomous Communities (i.e. Regions) and studied 1203 cases.
The results of both studies contributed to the improvement of the design, methods and organization of the AUDIPOC work. Some of the improvements include better training of those responsible at a hospital level, a new classification of hospitals, the incorporation of new variables and the creation of a Bureau for the Coordination and Management of the Project.
The AUDIPOC study is viable. It aims to recruit 10000 patients across 142 hospitals from all the Regions of Spain.
Archivos de Bronconeumología 07/2010; 46(7):349-57. · 2.17 Impact Factor
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José Luis López-Campos
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ABSTRACT: Assessment of patients with COPD has changed in the last few years by adding subjective patient evaluations to traditional measurements based on pulmonary function. One of the most recently studied variables is symptom variability during the day and, specifically, patients' perceptions of these symptoms in the first few hours of the day. To evaluate this feature, two new symptom questionnaires, the Capacity of Daily Living in the Morning (CDLM) questionnaire and the Global Chest Symptoms Questionnaire (GCSQ), have recently been developed. Recent studies have begun to provide data on the effect of the available treatments on these morning symptoms, yielding information on the rapidity of action of budesonide/formoterol with a significant and nearly clinically relevant effect on morning activities. Confirmation of these results could lead to future strategies designed to earlier symptomatic improvement, which could lead to greater treatment adherence.
Archivos de Bronconeumología 01/2010; 46 Suppl 8:20-4. · 2.17 Impact Factor
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ABSTRACT: Training in pulmonology at overseas centers may require a considerable effort, and although such an experience could even imply a financial burden for the trainee, the benefits far outweigh the material costs. The desire for personal and scientific growth should encourage young pulmonologists and medical residents to rotate outside Spain and become acquainted with other health care systems, customs, dynamics, and resources in order to obtain quality training and added value that will further enrich our specialty. Any pulmonologist wishing to undergo specialized training at an overseas institution will necessarily consider questions such as the relevance of the stay and its objectives, timing, availability of centers, eligibility, and funding agencies. Based on one resident's personal experience, we attempt to answer several of these questions.
Archivos de Bronconeumología 07/2009; 46(1):35-9. · 2.17 Impact Factor
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ABSTRACT: An association between pulmonary embolism (PE) and a subsequent diagnosis of cancer has been repeatedly reported. Although screening and early detection might play a pivotal part in reducing mortality from cancer, there are currently no definite data to suggest that cancer screening may improve survival rates in patients with PE. We hereby present the results of a screening program and a two-year follow-up survey for detecting occult cancer in this patient population.
A total of 107 patients with PE were consecutively enrolled. All subjects underwent an initial screening program followed by a two-year follow-up survey. We calculated the sensitivity of our screening program, and identified risk factors associated with occult cancer by means of logistic regression.
The initial screening program yielded positive results in five patients (4.7%), and four additional cases were identified during the 2-year follow-up. The overall sensitivity of our screening program in idiopathic PE was 55.5%. In the entire study cohort, the number necessary for screening was 12.1 (6.1 in idiopathic PE, and 58 in secondary PE). Logistic regression analysis revealed that a shock index >/=1 (odds ratio: 5.467; p=0.007) and idiopathic PE (odds ratio: 12.82; p=0.03) were independent risk factors for occult cancer in our PE patients.
A simple and noninvasive screening program yields an acceptable sensitivity for detecting occult cancer in idiopathic PE patients. These results highlight the importance of screening for occult cancer in patients diagnosed with PE, especially in idiopathic forms.
Thrombosis Research 06/2009; 125(1):29-33. · 2.44 Impact Factor
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ABSTRACT: There have been significant advances in the knowledge in the thoracic and extrathoracic aspects of chronic obstructive pulmonary disease (COPD) in the past few years. COPD is associated with numerous comorbidities, the prevalences of which have recently been evaluated. Dyspnea has been shown to be associated with neuropsychiatric disturbances, such as anxiety. Muscular dysfunction has been associated with inflammation and oxidative stress, in which respiratory muscle satellite cells play an important role in repair. Respiratory rehabilitation and physiotherapy must form an important part of individualised patient treatment analogous to the pharmacological treatment. As regards acute exacerbations, infection is the cause of 75% of them, sputum characteristics and the suspicion of Pseudomonad being key factors in the antibiotic treatment. Questions, such as markers which can detect the origin of the infection, prognostic factors, or the role of short stay pneumology units, are of particular importance. The variability in COPD treatments and the lack of suitable international clinical guidelines, continue to be subjects of debate. To the poor use of the treatment schemes in the guidelines, can be added the irregular uses of inhaled medication, the insufficient use of medical advice or the low intervention in cigarette smoking in all age groups.
Archivos de Bronconeumología 01/2009; 45 Suppl 1:30-4. · 2.17 Impact Factor
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José Luis López-Campos
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ABSTRACT: The effect of chronic obstructive pulmonary disease (COPD) on patients and their perception of wellbeing goes beyond functional respiratory alterations. Fatigue, mood and sleep alterations constitute a complex of interrelated symptoms affecting perception of health status. Fatigue is a highly important symptom due to its frequency, clinical repercussions and association with other manifestations. Functional alterations during sleep are of various degrees of severity and are most important in sleep apnea-hypopnea syndrome. Mood alterations are important because of their frequency, clinical repercussion and prognostic implications. In the last few years, several measurement instruments have been developed to quantify these manifestations, such as the Living with COPD scale (LCOPD), the COPD and Asthma Fatigue Scale (CAFS) and the COPD and Asthma Sleep Impact Scale (CASIS).The present article reviews the clinical relevance of these manifestations and the measurement instruments available for their evaluation.
Archivos de Bronconeumología 01/2009; 45 Suppl 5:2-6. · 2.17 Impact Factor
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ABSTRACT: Bronchial asthma is an important cause of morbidity and mortality worldwide. There is limited availability of updated information on asthma mortality trends. In this context, further investigation of asthma mortality trends is necessary.
We aimed to assess trends in asthma mortality trends in the Autonomous Community of Andalusia (over 7 million inhabitants), Spain, during the period 1975-2005.
Official population estimates and data on asthma deaths were obtained from official authorities. Crude and age-adjusted death rates for different age and gender groups were calculated. Joinpoint regression analysis was used for trend analysis.
Age-adjusted death rates for asthma have fallen 2.9% for females and 7.7% for males from 1975 to 2005. This trend has not been constant but has varied during the study period. After a non-significant increase from 1975 to 1981 (4.5% for females and 3.8% for males), adjusted asthma mortality rates have been declining 3.7% for females and 9.6% for males (both p values < 0.05) since 1981. Age-group analysis revealed that the downturn in asthma mortality rates occurred in all age groups above 45 years for males and 35 years for females.
During the last decades, significant variation in asthma mortality was found in Andalusia. This variation has not been constant during the study period. Currently, the decreasing trend initiated in 1981 continues.
Journal of Asthma 09/2008; 45(7):611-4. · 1.52 Impact Factor
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ABSTRACT: To describe the characteristics observed in patients diagnosed of hepatopulmonary syndrome (HPS) waiting for orthotopic liver transplantation and those who underwent liver trasplantation.
An observational prospective descriptive study was carried out of patients waiting for liver transplantation in whom data of liver illness and lung function tests were analyzed.
107 patients of 53.69 years average age were studied (7.7 standard deviation). 24 of them (22.4%) had criteria of HPS. Ortodeoxia was present in the 34% of cases. The lung function tests were normal. In the comparative study between patients with HPS and no HPS, differences in diffusion were found (7.1 vs. 8.6 mmol/min/kPa; p = 0.04), as well as in the shunt (8% vs. 5.3%; p = 0.05) and the forced expiratory volume in one second (2,390 vs. 2,743 ml; p = 0.03). Seven patients were transplanted with correction of oxygenation and vascular dilatations in all of them.
HPS is a frequent illness in patients waiting for orthotopic liver transplantation. The main alteration in the blood oxygenation seems owe to shunt, and the diffusion tests is the analysis that could best differentiate patients with HPS. Orthotopic liver transplantation corrects the syndrome in all cases.
Medicina Clínica 03/2008; 130(3):98-102. · 1.38 Impact Factor
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ABSTRACT: A cross-sectional prospective design was used to compare the effectiveness of the shuttle walking test (SWT) and the maximal cycle ergometry test (CET) to assess the functional capacity of patients with chronic hypercapnic respiratory failure due to severe kyphoscoliosis. Twenty-four patients completed both the SWT and CET. Heart rate, blood pressure, leg fatigue, chest pain and dyspnea (Borg's scale) were measured immediately after each test. Correlation coefficients and Bland-Altman analysis were used to compare the two methods. Borg's dyspnea, leg and chest pain after exercise were not significantly different between tests. Only heart rate (SWT 130[20.7] versus CET 116[28.75]; p = 0.048) and diastolic blood pressure (SWT: 85.5[13.75] versus CET 95[17.5]; p = 0.021) were slightly but significantly different between the two protocols. There was a good positive correlation between the distance walked in SWT and maximal oxygen consumption (r = 0.675; p < 0.001). SWT and CET testing elicited similar clinical and hemodynamic responses. SWT is a feasible measure of functional capacity in this patient group.
Respiratory Physiology & Neurobiology 03/2008; 160(3):334-40. · 2.24 Impact Factor
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ABSTRACT: To describe trends in lung cancer mortality in Spain between 1980 and 2005.
Data on deaths from lung cancer during the study period were obtained from the Spanish National Institute of Statistics. Global and truncated (35 to 64 years) age-specific and gender-specific mortality rates were calculated and expressed as rates per 100,000 person-years. Trends were analyzed using joinpoint regression models.
In 2005 in Spain, 16 647 men and 2471 women died from lung cancer, accounting for 26.6% and 6.6%, respectively, of all cancer deaths. In men, truncated mortality rates initially increased in the 1980-1992 period (3.1% per year; P<.05) but began to decrease in the 1992-2005 period (-0.8% per year, P<.05). Starting in the 1990s, age-specific mortality rates showed a statistically significant decrease in patients aged less than 85 years. For women, after an initial stable period, truncated mortality rates increased significantly from 1992 onward by 6.3% per year. The analysis by age groups showed that the rates increased in all age groups, except for patients aged 25 to 34 years and patients aged 75 to 84 years, in whom they remained stable.
While lung cancer mortality began to decrease slightly among Spanish men 15 years ago, it increased significantly among women during the same period.
Archivos de Bronconeumología 02/2008; 44(2):70-4. · 2.17 Impact Factor
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ABSTRACT: Home mechanical ventilation is used with patients with severe, chronic respiratory failure, a condition that has a serious impact on quality of life. The aim of this study was to produce a translation and cultural adaptation of the Severe Respiratory Insufficiency. Questionnaire for the Spanish population, the first health-related quality of life questionnaire specifically designed for patients receiving home mechanical ventilation.
Four bilingual German-Spanish translators were used to translate and back-translate the questionnaire. Meetings were held with the translators following each step of the translation process to produce a single version that could be used in the next step. At the end of the process, the questionnaire was piloted to assess its comprehensibility. A scoring system using a scale of 1 (lowest) to 10 (highest) was used to rate both translation difficulty and the naturalness of the language produced. The equivalence of the original and translated items was also evaluated.
Three Spanish versions of the questionnaire were produced. Task difficulty was rated as quite low: the mean (SD) ratings were 1.4 (0.6) for translation and 2.2 (1.1) for back translation. The naturalness of the translated items was rated as very high, with scores improving with the successive versions (version 1, 8.4; version 2, 8.7; version 3, 9.1; P< .001). Thirty of the questionnaire items (61.2%) were judged to be fully equivalent, 13 (26.5%) to be similar, and 6 (12.2%) to be non-equivalent. The meaning conveyed by 5 of the items was changed or clarified during piloting.
The translation of the questionnaire using the translation-back-translation procedure has produced a version that is both comparable to the original and accessible to the Spanish population. Its validity is currently being tested in a multicenter study.
Archivos de Bronconeumología 12/2006; 42(11):588-93. · 2.17 Impact Factor
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ABSTRACT: This study aims to describe the distribution of interstitial lung diseases (ILD) in the South of Spain.
A prospective multicentre population-based registry was established in nine provinces in the south of Spain with a population of 6,848,243 during a 3-year period (1998-2000). The number of participant physicians was 36 among 29 public hospitals. The number of diagnoses recorded was 66, divided in eight categories and coded according to ICD-9. A consensus document was elaborated for the classification of diseases and their diagnostic criteria. The number of cases declared was analysed each 3 months and communicated to each one of the participants.
There were 744 cases of them registered with an annual incidence of 3.62 cases/ 100,000. 40.1% of diagnoses were biopsy confirmed. Men had a slightly higher incidence (4.18 cases/ 100,000/year) than women (3.07 cases/100,000/year). The most frequent diseases found were: idiopathic interstitial pneumonias (38.58%), ILD associated to systemic diseases (20.97%), and Sarcoidosis (11.69%). According to province distribution, most of the cases were grouped in an area between the provinces of Seville and Cordoba, which comprised more than 50% of cases.
The study of the incidence of ILD depicts an intermediate situation from previous studies on the incidence and distribution of this group of diseases.
European Journal of Epidemiology 02/2004; 19(2):155-61. · 4.71 Impact Factor
