Perception of bronchodilation assessed by Visual Analogue Scale in children with asthma

array:23 ["pii" => "S0301054612002121" "issn" => "03010546" "doi" => "10.1016/j.aller.2012.06.002" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "416" "copyright" => "SEICAP" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2013;41:359-63" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 857 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 595 "PDF" => 257 ] ] "itemSiguiente" => array:18 [ "pii" => "S0301054612002856" "issn" => "03010546" "doi" => "10.1016/j.aller.2012.08.007" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "454" "copyright" => "SEICAP" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2013;41:364-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1325 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 928 "PDF" => 388 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Cord IgE and ECP levels of Malay neonates" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "364" "paginaFinal" => "368" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1260 "Ancho" => 1570 "Tamanyo" => 60728 ] ] "descripcion" => array:1 [ "en" => "Scatter plot of cord blood ECP vs. IgE level in Malay neonates. There was no significance on Spearman's correlation coefficient (p=0.513; r=-0.101)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Aravind Yadav, Rakesh Naidu" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Aravind" "apellidos" => "Yadav" ] 1 => array:2 [ "nombre" => "Rakesh" "apellidos" => "Naidu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612002856?idApp=UINPBA00004N" "url" => "/03010546/0000004100000006/v1_201312010029/S0301054612002856/v1_201312010029/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S030105461300253X" "issn" => "03010546" "doi" => "10.1016/j.aller.2013.11.001" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "563" "copyright" => "SEICAP" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Allergol Immunopathol (Madr). 2013;41:357-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 995 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 561 "PDF" => 425 ] ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "Could a Visual Analogue Scale be useful, in real life, to manage children with asthma?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "357" "paginaFinal" => "358" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Sanchez-Solis" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Sanchez-Solis" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461300253X?idApp=UINPBA00004N" "url" => "/03010546/0000004100000006/v1_201312010029/S030105461300253X/v1_201312010029/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Perception of bronchodilation assessed by Visual Analogue Scale in children with asthma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "359" "paginaFinal" => "363" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria Angela Tosca, Michela Silvestri, Giovanni Arturo Rossi, Giorgio Ciprandi" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Maria Angela" "apellidos" => "Tosca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Michela" "apellidos" => "Silvestri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Giovanni Arturo" "apellidos" => "Rossi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "Giorgio" "apellidos" => "Ciprandi" "email" => array:1 [ 0 => "gio.cip@libero.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "IRCCS – Azienda Ospedaliera Universitaria San Martino, Genoa, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 929 "Ancho" => 1663 "Tamanyo" => 120825 ] ] "descripcion" => array:1 [ "en" => "VAS score assessed before and after BD testing in children with or without bronchial obstruction (such as FEV1 value <80% of predicted)." ] ] ] "textoCompleto" => "IntroductionAsthma is characterised by two main pathophysiological characteristics: chronic bronchial inflammation and bronchial hyper-responsiveness to a variety of stimuli, both of them inducing airway obstruction and consequently symptom occurrence, mainly breathlessness.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Reversibility of airflow obstruction is the pathognomonic characteristic of asthma: in fact, bronchodilation testing is commonly used to confirm the asthma diagnosis. However, this test is usually performed only in specialised centres and so it is rarely accessible to the majority of asthmatic patients. The possibility of assessing bronchial reversibility using a simple tool such as VAS could be clinically relevant as it might allow healthcare providers to obtain this information in non-specialty healthcare settings. The control of asthma symptoms is actually considered the cornerstone goal in the management strategy and the level of the achieved control serves also to classify asthma severity. However, many children with asthma are not referred for lung function assessment and do not obtain a well-tailored treatment. Therefore, most of them are managed by family paediatricians who usually base the treatment decisions on symptom report and clinical examination.Asthmatic patients vary in their ability to perceive the airway obstruction.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In fact, fairly large discrepancies have been noted between patients’ subjective ratings of the severity of impaired pulmonary functioning and objective measures of lung function.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a> In particular, the paediatric age is characterised by the additional problem of one individual (the child) experiencing the symptom, and another individual (the parent) needing to interpret the symptoms to decide (or at least participate in deciding) on the course of management. However, judgments of symptom severity are only one aspect of symptom perception and management.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Laypeople cognitively organise information concerning physical symptoms according to prototypical conception about specific disease.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Thus, symptoms not behaving to this prototypical representation may be ignored.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> It was reported that asthmatic patients may ignore early symptoms of exacerbation and easily confuse asthma symptoms with medication side effects.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Beyond perceiving symptoms, patients and parents evaluate and interpret them in a larger context of illness meaning.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Much of the research on symptom perception focused on relating the accuracy of the patients’ subjective symptom perception to the physiological response objectively measured by spirometry. However, in addition to the physical symptom parameters, several factors may exert a role in symptom perception, including: (i) past experience with asthma attacks and the criterion level for action that the patient and family has established; (ii) other background noise from which the symptom has to be discriminated, such as competing symptoms from medication side effects, anxiety, or inter-current illness; and (iii) other evaluative, cultural, and affective components.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Furthermore, it has been proposed that symptom perception and evaluation by children (and parents) has to be considered a multidimensional construct consisting of: (i) accuracy of the assessment of the physical parameter of the symptom (e.g. how tight am I?); (ii) discrimination about what constitutes a symptom related to asthma; (iii) evaluation of the level of symptom intensity at which an intervention is necessary; and (iv) negotiation between child and parent.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>The breathlessness perception may be measured by the Visual Analogue Scale (VAS). The validity of VAS was previously evidenced in the measurement of the sensation of breathlessness in adults and children in both experimental and clinical studies.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> VAS has also been used to investigate breathlessness perception in children as young as five years<a class="elsevierStyleCrossRefs" href="#bib0055">11–13</a>: it has been reported that VAS was sensitive in measuring differences between the means for good, usual, and bad breathing days. VAS was also considered useful in assessing symptom severity when compared with lung function testing.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> On the other hand, physical findings may be inadequate for assessing bronchial obstruction and remarkable airway obstruction may be present despite a normal clinical examination.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Therefore, lung function assessment remains the best way to detect airflow obstruction.The assessment of response to bronchodilation testing by VAS has been investigated by very few studies.<a class="elsevierStyleCrossRefs" href="#bib0075">15–17</a> It was demonstrated that VAS was a tool to obtain reliable information on breathlessness.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> It was hypothesised that the patient's breath perception, determined by their VAS score, could correlate with the degree of bronchial obstruction, as measured by the forced expiratory volume in 1sec (FEV1). Therefore, this study aimed at investigating whether VAS assessment of breathlessness perception could be useful in initially evaluating the response to bronchodilation testing in children with asthma, particularly in non-specialty settings.Materials and methodsStudy populationThis cross-sectional study included a total of 150 children [96 males and 54 females, mean age 11.05 years] with asthma, who had been consecutively referred as outpatients to the Allergy Center of the G. Gaslini Institute for thorough asthma evaluation. The Institutional Ethical Committee of the G. Gaslini Institute approved the protocol. Signed informed parental consent and the child's assent (if the child was ≥12 years old) were obtained.Data collectionInformation on demographics, asthma symptoms, and lung function, was collected at the time of the survey. Information on current asthma-related symptoms (breathlessness, chest tightness, wheezing, recurrent dry cough or exercise-related symptoms) was collected. The diagnosis of asthma was performed according to the Global Initiative for Asthma (GINA) guidelines (<a href="http://www.ginasthma.com/">www.ginasthma.com</a>).Inclusion criteria were: (i) having asthma clinical diagnosis performed by the family paediatrician, and (ii) being aged between 6 and 18 years old (the minimum age of 6 years was chosen to ensure that children were able to perform reproducible lung function tests). Exclusion criteria were: (i) use of medium-high doses of inhaled corticosteroids (such as >200mcg of beclomethasone/daily or equivalent) or any systemic corticosteroids; (ii) current use of long acting β2 agonists; (iii) recent upper and/or lower respiratory infections; and (iv) insufficient knowledge of Italian language.Sample size calculations were performed based on the primary outcome of the inter-group (patients with or without bronchial obstruction) difference in the change in VAS (post–pre). Power was set at 0.80 and alpha at 0.05. A sample size of 43 participants in the group of patients with bronchial obstruction and 86 in the group of patients without bronchial obstruction was required to detect a clinically meaningful change in VAS. Therefore, 50 children with overt bronchial obstruction (such as with FEV1 <80% of predicted) were compared with 100 well-matched asthmatic children without bronchial obstruction (such as with FEV1 ≥80% of predicted). Therefore, the study sample consisted of 150 subjects: 50 with bronchial obstruction and 100 without bronchial obstruction.Visual Analogue Scale (VAS)The VAS consisted of one ruler asking for perception of breathlessness.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Patients indicated their actual perception of breathlessness by marking a VAS. In this study, the VAS was a 10-cm vertical line on which 0 implied breathlessness, while 10 corresponded to no breathlessness. No interval marker was visible on the line. Patients were instructed to place a mark on the line indicating their ease of breathing at that moment. It was explained that 0 represented breathlessness and 10 no problem breathing. Thus, the lower the numerical score marked by the patient, the greater their perceived breathlessness. With a movable marker, the child could mark any point on the 10-cm segment which best described his/her perception.VAS was recorded immediately before and after bronchodilation testingMeasurement of lung functionForced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and forced expiratory flows at 25–75% of vital capacity (FEF25–75%), and the FEV1/FVC ratio were measured by spirometry (Med Graphics, Pulmonary Function System 1070 series 2, Med Graphics Corp., St. Paul, MN, USA), according to the guidelines provided by the American Thoracic Society and the European Respiratory Society.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> All the children were able to obtain at least three technically acceptable breathing manoeuvres with the spirometer. Three forced expiratory manoeuvres were obtained, and the best values were retained. The results were compared with reference values obtained from a well-defined population, identified by the American Thoracic Society and the European Respiratory Society, of healthy subjects comparable for gender, height, and weight and then expressed as a percentage.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Bronchodilation testThe bronchodilation testing was performed according to international guidelines and using a salbutamol metered dose of 400mcg. Reversibility was considered if an increase of at least 12% of FEV1 from baseline was achieved, according to international guidelines.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Statistical analysisThe distribution of each variable was checked using the Shapiro–Wilk W test. Descriptive statistics were performed and reported in terms of means with standard deviation (SD) (i.e. age) or medians with inter-quartile ranges (i.e. VAS, pulmonary function parameters). For comparisons between two groups, Mann–Whitney U test was used for non-normally distributed quantitative data. For comparisons among more than two groups, non-normally distributed quantitative data were analysed using Kruskall–Wallis test followed by Bonferroni's correction. The relationship between FEV1 (% pred.) and VAS was assessed by means of the Spearman's rank correlation coefficient. All tests were two-tailed and p values less than 0.05 have been considered as statistically significant. “Statistica release 8” (StatSoft Corp., Tulsa, OK, U.S.A.).ResultsPatientsThe demographic, clinical, and functional characteristics of the patients recruited are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There was a mild preponderance of male gender (64%), but without significance. Forty-one children showed reversibility after BD testing.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>VAS assessmentIn the whole sample, the median VAS value was 6.35 at baseline and 7.7 after BD testing. Patients were firstly subdivided in two groups: those with and those without bronchial obstruction. Patients with bronchial obstruction had median VAS value of 4.7 (4–5.85) at baseline and 6.9 (5.95–7.55) after BD (p<0.001) as illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Children without bronchial obstruction had median VAS value of 7.4 (5.6–8.75) at baseline and 8.4 (6.6–9.4) after BD testing (p<0.01) as showed in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The intergroup analysis showed that the baseline VAS values were significantly different between the two sub-groups (p<0.01).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Further, children were subdivided into other sub-groups on the basis of the response to BD testing: those with or without bronchial obstruction reversibility (41 and 109 children, respectively) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Patients with bronchial obstruction reversibility had median VAS value of 5 (4–6.75) at baseline and 7 (6.1–8.15) after BD (p<0.001). Children without bronchial obstruction reversibility had median VAS value of 7 (5.3–8.65) at baseline and 8 (6.3–9.3) after BD (p<0.001) as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The intergroup analysis showed that the baseline VAS values were significantly different between the two sub-groups (p<0.01).Analysing the Δ VAS (i.e. the difference in VAS score obtained after BD testing and before BD testing) there was a significant difference (p<0.0001) between children with bronchial reversibility and without it, as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Analysing the patients we found moderate positive correlations between VAS and FEV1 (r=0.491; p<0.0001). However, there was no significant relationship between VAS and age of children.DiscussionThe perception of breathlessness has been investigated by several studies in children,<a class="elsevierStyleCrossRefs" href="#bib0105">21–27</a> but most of them were conducted in “experimental” settings, such as in patients with symptoms experimentally induced by bronchoconstrictor stimuli (such as methacholine, histamine, or exercise) also considering an ethnical aspect.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Only one study was conducted in a real-life condition, such as considering the asthma symptoms perception assessed by VAS during a regular consultation in an outpatient clinic, where children with asthma were referred for the asthma diagnosis confirmation.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> On the other hand, very few studies investigated the response to BD testing using VAS score.<a class="elsevierStyleCrossRefs" href="#bib0075">15,17</a> The first study was mainly addressed to assessing the perception of airway obstruction induced by methacholine challenge and BD testing was performed after experimental obstruction.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> The second study was performed on adult patients with allergic rhinitis.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> Therefore, the present study was designed to confirm the possibility of using VAS for assessing perception of breathlessness in response to BD testing in children with asthma.The present findings demonstrate that VAS assessment of breathlessness significantly decreased after BD in all patients. To better evaluate the usefulness of the VAS score, we enrolled two sub-groups of asthmatic children, such as patients with overt bronchial obstruction (FEV1 <80% of predicted) and children with normal lung function. The median VAS values were only significantly different at baseline: this finding underlines the ability of VAS assessment to discriminate the presence of bronchial obstruction. Children with or without bronchial obstruction perceived a statistically significant improvement of breathlessness VAS score after BD. Nevertheless, children with bronchial obstruction reported a higher VAS increase after BD: >2 units; whereas children without bronchial obstruction demonstrated a lower increase, i.e. about 1 unit. Therefore, VAS assessment of BD testing might discriminate subjects with overt bronchial obstruction if the VAS breathlessness measurement increases at least 2 units after BD.Secondly, we investigated the VAS response to BD, considering bronchial reversibility. Also in this case, children with reversibility perceived a greater improvement of VAS breathlessness after BD. In fact, considering the Δ VAS values, children with reversibility reported a median increase of 2 units, whereas children without reversibility reported an increase <1 unit. Therefore, the simple assessment of the BD testing by VAS could allow to obtain raw information on bronchial reversibility, suggesting an asthma diagnosis both at home and at the paediatrician office. So it could suggest sending the child to specialised centres for deeper assessment. In addition, the moderate relationship between lung function and VAS could strengthen the applicability and utility of this instrument in settings where there is no spirometry equipment. In fact, many primary care practices do not have spirometry equipment or staff trained in the proper use and interpretation of results. As the VAS could be a reliable indicator of the child's perception of breathlessness, it could potentially be a valuable clinical assessment tool in these practices.On the other hand, this study has a main limitation: as being conducted in a real-life setting, it did not include a large number of children with bronchial airflow obstruction. Therefore, further studies addressing this issue should be conducted.In conclusion, the present study demonstrates that VAS might be considered an initial tool to assess the BD response in children with asthma, mainly with overt bronchial obstruction.Ethical disclosuresProtection of human subjects and animals in researchThe authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.Patients’ data protectionConfidentiality of dataThe authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.Right to privacy and informed consentThe authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.Conflict of interestThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres296089" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec279763" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data collection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Visual Analogue Scale (VAS)" ] 3 => array:3 [ "identificador" => "sec0030" "titulo" => "VAS was recorded immediately before and after bronchodilation testing" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Measurement of lung function" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Bronchodilation test" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] ] ] 4 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "VAS assessment" ] ] ] 5 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0070" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Protection of human subjects and animals in research" ] 1 => array:3 [ "identificador" => "sec0080" "titulo" => "Patients’ data protection" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Confidentiality of data" ] ] ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0095" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack69193" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-05-24" "fechaAceptado" => "2012-06-26" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec279763" "palabras" => array:6 [ 0 => "Asthma" 1 => "Breathlessness" 2 => "VAS" 3 => "Bronchodilation" 4 => "Reversibility" 5 => "Children" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundVisual Analogue Scale (VAS) has been proposed as a useful tool for assessing the perception of asthma symptoms, a cornerstone in disease management. While airway flow limitation and its reversibility are thought to be a useful marker of disease severity, there are very few studies that evaluated the response to bronchodilation (BD) testing perception by VAS. To investigate whether VAS assessment of breathlessness perception could provide a useful tool to assess the response to BD testing in asthmatic children. MethodsThis cross-sectional study included a total of 150 children (96 males, mean age 11.05 years) with asthma, 50 had bronchial obstruction (i.e. FEV1 <80% of predicted). Perception of breathlessness was assessed by VAS; lung function was measured by spirometry. BD testing was performed in all children. ResultsIn children with bronchial obstruction, VAS at baseline was 4.7 and significantly increased to 6.9 (p<0.001) after BD. In children without bronchial obstruction, VAS at baseline was 7.4, but further significantly increased to 8.4 after BD testing (p<0.01). There was a significant difference in Δ VAS between children with bronchial reversibility and children without it (p<0.0001). ConclusionsThe present study demonstrates that VAS might be considered an initial tool to assess the BD response in children with asthma, mainly with overt bronchial obstruction." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 929 "Ancho" => 1663 "Tamanyo" => 120825 ] ] "descripcion" => array:1 [ "en" => "VAS score assessed before and after BD testing in children with or without bronchial obstruction (such as FEV1 value <80% of predicted)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1272 "Ancho" => 1549 "Tamanyo" => 85094 ] ] "descripcion" => array:1 [ "en" => "Δ VAS score in children with or without bronchial reversibility." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "All data are presented as median with lower and upper quartiles in parenthesis unless otherwise specified." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male gender [No. (%)] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96 (64.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) [mean (standard deviation of the mean)] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.05 (2.12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adolescence (>12 years old) [No. (%)] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (36.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS at baseline (score) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.35 (4.90–8.10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS after β2-inhalation (score) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.70 (6.30–9.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV1 (% pred.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.00 (77.00–104.50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FVC (% pred.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.00 (78.00–100.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV1/FVC (% pred.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104.00 (95.00–112.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEF25–75 (% pred.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.00 (63.50–112.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431784.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and clinical characteristics in the whole population." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients with a positive β2 inhalation test (No. 41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients with a negative β2 inhalation test (No. 109) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS at baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.00 (4.00–6.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.00 (5.30–8.65)<a class="elsevierStyleCrossRef" href="#tblfn0015">§§§</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS after β2-inhalation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.00 (6.10–8.15)<a class="elsevierStyleCrossRef" href="#tblfn0005">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.00 (6.30–9.30)<a class="elsevierStyleCrossRef" href="#tblfn0010">¶¶¶</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431785.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "***" "nota" => "p<0.001, as compared to VAS at baseline recorded in patients with a positive β2 inhalation test." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "¶¶¶" "nota" => "p<0.001, as compared to VAS at baseline recorded in patients with a positive β2 inhalation test." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "§§§" "nota" => "p<0.01, as compared to VAS at baseline recorded in patients with a positive β2 inhalation test." ] ] ] "descripcion" => array:1 [ "en" => "VAS at baseline and after β2-inhalation in different subgroups of patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.R. Punnoose" 1 => "A.E. Burke" 2 => "R.M. Golub" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2011.2001" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22274691" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0163445399905868" "estado" => "S300" "issn" => "01634453" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perception of asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.R. Rubinfeld" 1 => "M.C. Pain" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1976" "volumen" => "1" "paginaInicial" => "882" "paginaFinal" => "884" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2564955" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptom perception and evaluation in childhood asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.H. Lorrie" 1 => "A. McMullen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nurs Res" "fecha" => "1999" "volumen" => "48" "paginaInicial" => "2" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10029396" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twice-daily peak expiratory flow rate monitoring for the assessment of childhood asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O.V. Linna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Allergy Proc" "fecha" => "1993" "volumen" => "14" "paginaInicial" => "33" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8462860" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of symptom perception in childhood |asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.K. Fritz" 1 => "R.B. Klein" 2 => "Overholser JC" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dev Behav Pediatr" "fecha" => "1990" "volumen" => "11" "paginaInicial" => "69" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2324291" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and symptom measures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.T. O’Connor" 1 => "S.T. Weiss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm/149.2_Pt_2.S21" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1994" "volumen" => "149" "paginaInicial" => "S21" "paginaFinal" => "S28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8298766" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Illness representations: a prototype approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.D. Bishop" 1 => "S.A. Converse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Health Psychol" "fecha" => "1986" "volumen" => "5" "paginaInicial" => "95" "paginaFinal" => "114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3732230" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Children's illness concepts: old and new paradigms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Yoos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Nurs" "fecha" => "1994" "volumen" => "20" "paginaInicial" => "134" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8159499" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The sensations of pulmonary dyspnea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Janson-Bjerklie" 1 => "V.K. Carrieri" 2 => "M. Hudes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nurs Res" "fecha" => "1986" "volumen" => "35" "paginaInicial" => "154" "paginaFinal" => "159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3635051" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of the Visual Analogue Scale and modified Borg scale for the measurement of dyspnea during exercise" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.C. Wilson" 1 => "P.W. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Sci" "fecha" => "1989" "volumen" => "76" "paginaInicial" => "277" "paginaFinal" => "282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2924519" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measurement of pain in children with self-reporting and behavioural assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.L. Maunuksela" 1 => "K.T. Olkkola" 2 => "R. Korpela" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Pharmacol Ther" "fecha" => "1987" "volumen" => "42" "paginaInicial" => "137" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3608347" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The word-graphic rating scale as a measure of children's and adolescents’ pain intensity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.D. Tesler" 1 => "A.E. Zuckerman" 2 => "R.M. Sly" 3 => "A.K. Saba" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Res Nurs Health" "fecha" => "1991" "volumen" => "14" "paginaInicial" => "361" "paginaFinal" => "371" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1891622" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The sensation of pulmonary dyspnea in school-age children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.K. Carrieri" 1 => "G. Kieckhelfer" 2 => "S. Janson-Bjerklie" 3 => "J. Souza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nurs Res" "fecha" => "1991" "volumen" => "40" "paginaInicial" => "81" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2003078" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of the severity of asthma: patients versus physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.S. Shim" 1 => "M.H. Williams Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "1980" "volumen" => "68" "paginaInicial" => "11" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7350797" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poor perception of airway obstruction in children with asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.R. Baker" 1 => "S.C. Mishoe" 2 => "F.H. Zaitoun" 3 => "C.B. Arant" 4 => "J. Lucas" 5 => "N.T. Rupp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Asthma" "fecha" => "2000" "volumen" => "37" "paginaInicial" => "613" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11059529" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poor perception of dyspnea in children with undiagnosed asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Van Gent" 1 => "L.E.M. van Essen-Zandvliet" 2 => "M.M. Rovers" 3 => "J.L.L. Kimpen" 4 => "G. de Meer" 5 => "C.K. van der Ent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00031407" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "887" "paginaFinal" => "891" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17652315" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of the bronchodilation test by Visual Analogue Scale in the selection of patients with rhinitis for screening spirometry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Ciprandi" 1 => "S. Quaglini" 2 => "V. Giunta" 3 => "I. Cirillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Investig Allergol Clin Immunol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "419" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20945609" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung function and symptom perception in children with asthma and their parents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Horak" 1 => "G. Grassl" 2 => "D. Skladal" 3 => "H. Ulmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.10218" "Revista" => array:6 [ "tituloSerie" => "Pediatr Pulmonol" "fecha" => "2003" "volumen" => "35" "paginaInicial" => "23" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12461735" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ATS/ERS task force standardisation of spirometry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. Miller" 1 => "J. Hankinson" 2 => "V. Brusasco" 3 => "F. Burgos" 4 => "R. Casaburi" 5 => "A. Coates" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.05.00034805" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "319" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16055882" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perception of dyspnea during acetylcholine-induced bronchoconstriction in asthmatic children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Motomura" 1 => "H. Odajima" 2 => "J. Tezuka" 3 => "J. Harada" 4 => "K. Okada" 5 => "S. Nishima" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1081-1206(10)60241-4" "Revista" => array:6 [ "tituloSerie" => "Ann Allergy Asthma Immunol" "fecha" => "2009" "volumen" => "102" "paginaInicial" => "121" "paginaFinal" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19230462" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptom perception in children with asthma: cognitive and psychological factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Koinis-Mitchell" 1 => "E.L. McQuaid" 2 => "R. Seifer" 3 => "S.J. Kopel" 4 => "J.H. Nassau" 5 => "R.B. Klein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1037/a0013169" "Revista" => array:6 [ "tituloSerie" => "Health Psychol" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "226" "paginaFinal" => "237" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19290715" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ethnic differences in perception of lung function: a factor in pediatric asthma disparities?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.K. Fritz" 1 => "E.L. McQuaid" 2 => "S.J. Kopel" 3 => "R. Seifer" 4 => "R.B. Klein" 5 => "D.K. Mitchell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200906-0836OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2010" "volumen" => "182" "paginaInicial" => "12" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20299534" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchial hyperresponsiveness, word descriptors, and ethnicity: women with mild asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.E. Hardie" 1 => "J.K. Brown" 2 => "W.M. Gold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02770903.2011.637839" "Revista" => array:6 [ "tituloSerie" => "J Asthma" "fecha" => "2012" "volumen" => "49" "paginaInicial" => "36" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22176690" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ethnic differences in methacholine responsiveness and word descriptors in African Americans, Hispanic-Mexican Americans Asian-Pacific Islanders, and Whites with mild asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Hardie" 1 => "R. Liu" 2 => "J. Darden" 3 => "W.M. Gold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02770903.2010.481341" "Revista" => array:6 [ "tituloSerie" => "J Asthma" "fecha" => "2010" "volumen" => "47" "paginaInicial" => "388" "paginaFinal" => "396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20528591" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric asthma morbidity: the importance of symptom perception and family response to symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.L. McQuaid" 1 => "D. Koinis Mitchell" 2 => "N. Walders" 3 => "J.H. Nassau" 4 => "S.J. Kopel" 5 => "R.B. Klein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jpepsy/jsj112" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Psychol" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "167" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16717140" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptom perception and functional morbidity across a 1-year follow-up in pediatric asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Feldman" 1 => "E.L. McQuaid" 2 => "R.B. Klein" 3 => "S.J. Kopel" 4 => "J.H. Nassau" 5 => "D.K. Mitchell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.20584" "Revista" => array:6 [ "tituloSerie" => "Pediatr Pulmonol" "fecha" => "2007" "volumen" => "42" "paginaInicial" => "339" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17358038" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Asthma Risk Grid: clinical interpretation of symptom perception" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.B. Klein" 1 => "N. Walders" 2 => "E.L. McQuaid" 3 => "S. Adams" 4 => "D. Yaros" 5 => "G.K. Fritz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Allergy Asthma Proc" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15055553" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack69193" "titulo" => "Acknowledgement" "texto" => "Partially funded by Ricerca Corrente – Italian Ministry of Health." ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004100000006/v1_201312010029/S0301054612002121/v1_201312010029/en/main.assets" "Apartado" => array:4 [ "identificador" => "5554" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004100000006/v1_201312010029/S0301054612002121/v1_201312010029/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612002121?idApp=UINPBA00004N"]

Statistics

Original article

Maria Angela Toscaa, Michela Silvestria, Giovanni Arturo Rossia, Giorgio Ciprandib,

Corresponding author

gio.cip@libero.it

Corresponding author.

a Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy

b IRCCS – Azienda Ospedaliera Universitaria San Martino, Genoa, Italy

Read

2244

Times
was read the article

654

Total PDF

1590

Total HTML

Share statistics

 array:23 [
  "pii" => "S0301054612002121"
  "issn" => "03010546"
  "doi" => "10.1016/j.aller.2012.06.002"
  "estado" => "S300"
  "fechaPublicacion" => "2013-11-01"
  "aid" => "416"
  "copyright" => "SEICAP"
  "copyrightAnyo" => "2012"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Allergol  Immunopathol &#40;Madr&#41;. 2013;41:359-63"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 857
    "formatos" => array:3 [
      "EPUB" => 5
      "HTML" => 595
      "PDF" => 257
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0301054612002856"
    "issn" => "03010546"
    "doi" => "10.1016/j.aller.2012.08.007"
    "estado" => "S300"
    "fechaPublicacion" => "2013-11-01"
    "aid" => "454"
    "copyright" => "SEICAP"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Allergol  Immunopathol &#40;Madr&#41;. 2013;41:364-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1325
      "formatos" => array:3 [
        "EPUB" => 9
        "HTML" => 928
        "PDF" => 388
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Cord IgE and ECP levels of Malay neonates"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "364"
          "paginaFinal" => "368"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1260
              "Ancho" => 1570
              "Tamanyo" => 60728
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Scatter plot of cord blood ECP vs&#46; IgE level in Malay neonates&#46; There was no significance on Spearman&#39;s correlation coefficient &#40;p&#61;0&#46;513&#59; r&#61;-0&#46;101&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Aravind Yadav, Rakesh Naidu"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Aravind"
              "apellidos" => "Yadav"
            ]
            1 => array:2 [
              "nombre" => "Rakesh"
              "apellidos" => "Naidu"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612002856?idApp=UINPBA00004N"
    "url" => "/03010546/0000004100000006/v1_201312010029/S0301054612002856/v1_201312010029/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S030105461300253X"
    "issn" => "03010546"
    "doi" => "10.1016/j.aller.2013.11.001"
    "estado" => "S300"
    "fechaPublicacion" => "2013-11-01"
    "aid" => "563"
    "copyright" => "SEICAP"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "cita" => "Allergol  Immunopathol &#40;Madr&#41;. 2013;41:357-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 995
      "formatos" => array:3 [
        "EPUB" => 9
        "HTML" => 561
        "PDF" => 425
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Could a Visual Analogue Scale be useful&#44; in real life&#44; to manage children with asthma&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "357"
          "paginaFinal" => "358"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Sanchez-Solis"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Sanchez-Solis"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461300253X?idApp=UINPBA00004N"
    "url" => "/03010546/0000004100000006/v1_201312010029/S030105461300253X/v1_201312010029/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Perception of bronchodilation assessed by Visual Analogue Scale in children with asthma"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "359"
        "paginaFinal" => "363"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Maria Angela Tosca, Michela Silvestri, Giovanni Arturo Rossi, Giorgio Ciprandi"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Maria Angela"
            "apellidos" => "Tosca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Michela"
            "apellidos" => "Silvestri"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Giovanni Arturo"
            "apellidos" => "Rossi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Giorgio"
            "apellidos" => "Ciprandi"
            "email" => array:1 [
              0 => "gio&#46;cip&#64;libero&#46;it"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Pediatric Pulmonology and Allergy Unit&#44; Istituto Giannina Gaslini&#44; Genoa&#44; Italy"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "IRCCS &#8211; Azienda Ospedaliera Universitaria San Martino&#44; Genoa&#44; Italy"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 929
            "Ancho" => 1663
            "Tamanyo" => 120825
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">VAS score assessed before and after BD testing in children with or without bronchial obstruction &#40;such as FEV<span class="elsevierStyleInf">1</span> value &#60;80&#37; of predicted&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma is characterised by two main pathophysiological characteristics&#58; chronic bronchial inflammation and bronchial hyper-responsiveness to a variety of stimuli&#44; both of them inducing airway obstruction and consequently symptom occurrence&#44; mainly breathlessness&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Reversibility of airflow obstruction is the pathognomonic characteristic of asthma&#58; in fact&#44; bronchodilation testing is commonly used to confirm the asthma diagnosis&#46; However&#44; this test is usually performed only in specialised centres and so it is rarely accessible to the majority of asthmatic patients&#46; The possibility of assessing bronchial reversibility using a simple tool such as VAS could be clinically relevant as it might allow healthcare providers to obtain this information in non-specialty healthcare settings&#46; The control of asthma symptoms is actually considered the cornerstone goal in the management strategy and the level of the achieved control serves also to classify asthma severity&#46; However&#44; many children with asthma are not referred for lung function assessment and do not obtain a well-tailored treatment&#46; Therefore&#44; most of them are managed by family paediatricians who usually base the treatment decisions on symptom report and clinical examination&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Asthmatic patients vary in their ability to perceive the airway obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In fact&#44; fairly large discrepancies have been noted between patients&#8217; subjective ratings of the severity of impaired pulmonary functioning and objective measures of lung function&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> In particular&#44; the paediatric age is characterised by the additional problem of one individual &#40;the child&#41; experiencing the symptom&#44; and another individual &#40;the parent&#41; needing to interpret the symptoms to decide &#40;or at least participate in deciding&#41; on the course of management&#46; However&#44; judgments of symptom severity are only one aspect of symptom perception and management&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Laypeople cognitively organise information concerning physical symptoms according to prototypical conception about specific disease&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Thus&#44; symptoms not behaving to this prototypical representation may be ignored&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It was reported that asthmatic patients may ignore early symptoms of exacerbation and easily confuse asthma symptoms with medication side effects&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Beyond perceiving symptoms&#44; patients and parents evaluate and interpret them in a larger context of illness meaning&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Much of the research on symptom perception focused on relating the accuracy of the patients&#8217; subjective symptom perception to the physiological response objectively measured by spirometry&#46; However&#44; in addition to the physical symptom parameters&#44; several factors may exert a role in symptom perception&#44; including&#58; &#40;i&#41; past experience with asthma attacks and the criterion level for action that the patient and family has established&#59; &#40;ii&#41; other background noise from which the symptom has to be discriminated&#44; such as competing symptoms from medication side effects&#44; anxiety&#44; or inter-current illness&#59; and &#40;iii&#41; other evaluative&#44; cultural&#44; and affective components&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Furthermore&#44; it has been proposed that symptom perception and evaluation by children &#40;and parents&#41; has to be considered a multidimensional construct consisting of&#58; &#40;i&#41; accuracy of the assessment of the physical parameter of the symptom &#40;e&#46;g&#46; how tight am I&#63;&#41;&#59; &#40;ii&#41; discrimination about what constitutes a symptom related to asthma&#59; &#40;iii&#41; evaluation of the level of symptom intensity at which an intervention is necessary&#59; and &#40;iv&#41; negotiation between child and parent&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The breathlessness perception may be measured by the Visual Analogue Scale &#40;VAS&#41;&#46; The validity of VAS was previously evidenced in the measurement of the sensation of breathlessness in adults and children in both experimental and clinical studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> VAS has also been used to investigate breathlessness perception in children as young as five years<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a>&#58; it has been reported that VAS was sensitive in measuring differences between the means for good&#44; usual&#44; and bad breathing days&#46; VAS was also considered useful in assessing symptom severity when compared with lung function testing&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; physical findings may be inadequate for assessing bronchial obstruction and remarkable airway obstruction may be present despite a normal clinical examination&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Therefore&#44; lung function assessment remains the best way to detect airflow obstruction&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The assessment of response to bronchodilation testing by VAS has been investigated by very few studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a> It was demonstrated that VAS was a tool to obtain reliable information on breathlessness&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> It was hypothesised that the patient&#39;s breath perception&#44; determined by their VAS score&#44; could correlate with the degree of bronchial obstruction&#44; as measured by the forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>sec &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#46; Therefore&#44; this study aimed at investigating whether VAS assessment of breathlessness perception could be useful in initially evaluating the response to bronchodilation testing in children with asthma&#44; particularly in non-specialty settings&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">This cross-sectional study included a total of 150 children &#91;96 males and 54 females&#44; mean age 11&#46;05 years&#93; with asthma&#44; who had been consecutively referred as outpatients to the Allergy Center of the G&#46; Gaslini Institute for thorough asthma evaluation&#46; The Institutional Ethical Committee of the G&#46; Gaslini Institute approved the protocol&#46; Signed informed parental consent and the child&#39;s assent &#40;if the child was &#8805;12 years old&#41; were obtained&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Data collection</span><p id="par0035" class="elsevierStylePara elsevierViewall">Information on demographics&#44; asthma symptoms&#44; and lung function&#44; was collected at the time of the survey&#46; Information on current asthma-related symptoms &#40;breathlessness&#44; chest tightness&#44; wheezing&#44; recurrent dry cough or exercise-related symptoms&#41; was collected&#46; The diagnosis of asthma was performed according to the Global Initiative for Asthma &#40;GINA&#41; guidelines &#40;<a href="http://www.ginasthma.com/">www&#46;ginasthma&#46;com</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Inclusion criteria were&#58; &#40;i&#41; having asthma clinical diagnosis performed by the family paediatrician&#44; and &#40;ii&#41; being aged between 6 and 18 years old &#40;the minimum age of 6 years was chosen to ensure that children were able to perform reproducible lung function tests&#41;&#46; Exclusion criteria were&#58; &#40;i&#41; use of medium-high doses of inhaled corticosteroids &#40;such as &#62;200<span class="elsevierStyleHsp" style=""></span>mcg of beclomethasone&#47;daily or equivalent&#41; or any systemic corticosteroids&#59; &#40;ii&#41; current use of long acting &#946;2 agonists&#59; &#40;iii&#41; recent upper and&#47;or lower respiratory infections&#59; and &#40;iv&#41; insufficient knowledge of Italian language&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Sample size calculations were performed based on the primary outcome of the inter-group &#40;patients with or without bronchial obstruction&#41; difference in the change in VAS &#40;post&#8211;pre&#41;&#46; Power was set at 0&#46;80 and alpha at 0&#46;05&#46; A sample size of 43 participants in the group of patients with bronchial obstruction and 86 in the group of patients without bronchial obstruction was required to detect a clinically meaningful change in VAS&#46; Therefore&#44; 50 children with overt bronchial obstruction &#40;such as with FEV<span class="elsevierStyleInf">1</span> &#60;80&#37; of predicted&#41; were compared with 100 well-matched asthmatic children without bronchial obstruction &#40;such as with FEV<span class="elsevierStyleInf">1</span> &#8805;80&#37; of predicted&#41;&#46; Therefore&#44; the study sample consisted of 150 subjects&#58; 50 with bronchial obstruction and 100 without bronchial obstruction&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Visual Analogue Scale &#40;VAS&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">The VAS consisted of one ruler asking for perception of breathlessness&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Patients indicated their actual perception of breathlessness by marking a VAS&#46; In this study&#44; the VAS was a 10-cm vertical line on which 0 implied breathlessness&#44; while 10 corresponded to no breathlessness&#46; No interval marker was visible on the line&#46; Patients were instructed to place a mark on the line indicating their ease of breathing at that moment&#46; It was explained that 0 represented breathlessness and 10 no problem breathing&#46; Thus&#44; the lower the numerical score marked by the patient&#44; the greater their perceived breathlessness&#46; With a movable marker&#44; the child could mark any point on the 10-cm segment which best described his&#47;her perception&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">VAS was recorded immediately before and after bronchodilation testing</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Measurement of lung function</span><p id="par0055" class="elsevierStylePara elsevierViewall">Forced vital capacity &#40;FVC&#41;&#44; forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s &#40;FEV<span class="elsevierStyleInf">1</span>&#41; and forced expiratory flows at 25&#8211;75&#37; of vital capacity &#40;FEF<span class="elsevierStyleInf">25&#8211;75&#37;</span>&#41;&#44; and the FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio were measured by spirometry &#40;Med Graphics&#44; Pulmonary Function System 1070 series 2&#44; Med Graphics Corp&#46;&#44; St&#46; Paul&#44; MN&#44; USA&#41;&#44; according to the guidelines provided by the <span class="elsevierStyleItalic">American Thoracic Society</span> and the <span class="elsevierStyleItalic">European Respiratory Society</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> All the children were able to obtain at least three technically acceptable breathing manoeuvres with the spirometer&#46; Three forced expiratory manoeuvres were obtained&#44; and the best values were retained&#46; The results were compared with reference values obtained from a well-defined population&#44; identified by the <span class="elsevierStyleItalic">American Thoracic Society</span> and the <span class="elsevierStyleItalic">European Respiratory Society</span>&#44; of healthy subjects comparable for gender&#44; height&#44; and weight and then expressed as a percentage&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Bronchodilation test</span><p id="par0060" class="elsevierStylePara elsevierViewall">The bronchodilation testing was performed according to international guidelines and using a salbutamol metered dose of 400<span class="elsevierStyleHsp" style=""></span>mcg&#46; Reversibility was considered if an increase of at least 12&#37; of FEV<span class="elsevierStyleInf">1</span> from baseline was achieved&#44; according to international guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The distribution of each variable was checked using the Shapiro&#8211;Wilk <span class="elsevierStyleItalic">W</span> test&#46; Descriptive statistics were performed and reported in terms of means with standard deviation &#40;SD&#41; &#40;i&#46;e&#46; age&#41; or medians with inter-quartile ranges &#40;i&#46;e&#46; VAS&#44; pulmonary function parameters&#41;&#46; For comparisons between two groups&#44; Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for non-normally distributed quantitative data&#46; For comparisons among more than two groups&#44; non-normally distributed quantitative data were analysed using Kruskall&#8211;Wallis test followed by Bonferroni&#39;s correction&#46; The relationship between FEV<span class="elsevierStyleInf">1</span> &#40;&#37; pred&#46;&#41; and VAS was assessed by means of the Spearman&#39;s rank correlation coefficient&#46; All tests were two-tailed and <span class="elsevierStyleItalic">p</span> values less than 0&#46;05 have been considered as statistically significant&#46; &#8220;Statistica release 8&#8221; &#40;StatSoft Corp&#46;&#44; Tulsa&#44; OK&#44; U&#46;S&#46;A&#46;&#41;&#46;</p></span></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients</span><p id="par0070" class="elsevierStylePara elsevierViewall">The demographic&#44; clinical&#44; and functional characteristics of the patients recruited are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There was a mild preponderance of male gender &#40;64&#37;&#41;&#44; but without significance&#46; Forty-one children showed reversibility after BD testing&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">VAS assessment</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the whole sample&#44; the median VAS value was 6&#46;35 at baseline and 7&#46;7 after BD testing&#46; Patients were firstly subdivided in two groups&#58; those with and those without bronchial obstruction&#46; Patients with bronchial obstruction had median VAS value of 4&#46;7 &#40;4&#8211;5&#46;85&#41; at baseline and 6&#46;9 &#40;5&#46;95&#8211;7&#46;55&#41; after BD &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; as illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Children without bronchial obstruction had median VAS value of 7&#46;4 &#40;5&#46;6&#8211;8&#46;75&#41; at baseline and 8&#46;4 &#40;6&#46;6&#8211;9&#46;4&#41; after BD testing &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; as showed in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The intergroup analysis showed that the baseline VAS values were significantly different between the two sub-groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Further&#44; children were subdivided into other sub-groups on the basis of the response to BD testing&#58; those with or without bronchial obstruction reversibility &#40;41 and 109 children&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Patients with bronchial obstruction reversibility had median VAS value of 5 &#40;4&#8211;6&#46;75&#41; at baseline and 7 &#40;6&#46;1&#8211;8&#46;15&#41; after BD &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Children without bronchial obstruction reversibility had median VAS value of 7 &#40;5&#46;3&#8211;8&#46;65&#41; at baseline and 8 &#40;6&#46;3&#8211;9&#46;3&#41; after BD &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The intergroup analysis showed that the baseline VAS values were significantly different between the two sub-groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Analysing the &#916; VAS &#40;i&#46;e&#46; the difference in VAS score obtained after BD testing and before BD testing&#41; there was a significant difference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; between children with bronchial reversibility and without it&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Analysing the patients we found moderate positive correlations between VAS and FEV<span class="elsevierStyleInf">1</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;491&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; However&#44; there was no significant relationship between VAS and age of children&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The perception of breathlessness has been investigated by several studies in children&#44;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;27</span></a> but most of them were conducted in &#8220;experimental&#8221; settings&#44; such as in patients with symptoms experimentally induced by bronchoconstrictor stimuli &#40;such as methacholine&#44; histamine&#44; or exercise&#41; also considering an ethnical aspect&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Only one study was conducted in a real-life condition&#44; such as considering the asthma symptoms perception assessed by VAS during a regular consultation in an outpatient clinic&#44; where children with asthma were referred for the asthma diagnosis confirmation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> On the other hand&#44; very few studies investigated the response to BD testing using VAS score&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;17</span></a> The first study was mainly addressed to assessing the perception of airway obstruction induced by methacholine challenge and BD testing was performed after experimental obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The second study was performed on adult patients with allergic rhinitis&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Therefore&#44; the present study was designed to confirm the possibility of using VAS for assessing perception of breathlessness in response to BD testing in children with asthma&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The present findings demonstrate that VAS assessment of breathlessness significantly decreased after BD in all patients&#46; To better evaluate the usefulness of the VAS score&#44; we enrolled two sub-groups of asthmatic children&#44; such as patients with overt bronchial obstruction &#40;FEV<span class="elsevierStyleInf">1</span> &#60;80&#37; of predicted&#41; and children with normal lung function&#46; The median VAS values were only significantly different at baseline&#58; this finding underlines the ability of VAS assessment to discriminate the presence of bronchial obstruction&#46; Children with or without bronchial obstruction perceived a statistically significant improvement of breathlessness VAS score after BD&#46; Nevertheless&#44; children with bronchial obstruction reported a higher VAS increase after BD&#58; &#62;2 units&#59; whereas children without bronchial obstruction demonstrated a lower increase&#44; i&#46;e&#46; about 1 unit&#46; Therefore&#44; VAS assessment of BD testing might discriminate subjects with overt bronchial obstruction if the VAS breathlessness measurement increases at least 2 units after BD&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Secondly&#44; we investigated the VAS response to BD&#44; considering bronchial reversibility&#46; Also in this case&#44; children with reversibility perceived a greater improvement of VAS breathlessness after BD&#46; In fact&#44; considering the &#916; VAS values&#44; children with reversibility reported a median increase of 2 units&#44; whereas children without reversibility reported an increase &#60;1 unit&#46; Therefore&#44; the simple assessment of the BD testing by VAS could allow to obtain raw information on bronchial reversibility&#44; suggesting an asthma diagnosis both at home and at the paediatrician office&#46; So it could suggest sending the child to specialised centres for deeper assessment&#46; In addition&#44; the moderate relationship between lung function and VAS could strengthen the applicability and utility of this instrument in settings where there is no spirometry equipment&#46; In fact&#44; many primary care practices do not have spirometry equipment or staff trained in the proper use and interpretation of results&#46; As the VAS could be a reliable indicator of the child&#39;s perception of breathlessness&#44; it could potentially be a valuable clinical assessment tool in these practices&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">On the other hand&#44; this study has a main limitation&#58; as being conducted in a real-life setting&#44; it did not include a large number of children with bronchial airflow obstruction&#46; Therefore&#44; further studies addressing this issue should be conducted&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion&#44; the present study demonstrates that VAS might be considered an initial tool to assess the BD response in children with asthma&#44; mainly with overt bronchial obstruction&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human subjects and animals in research</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients&#8217; data protection</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patients and&#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:2 [
          "identificador" => "xres296089"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Background"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec279763"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Data collection"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Visual Analogue Scale &#40;VAS&#41;"
            ]
            3 => array:3 [
              "identificador" => "sec0030"
              "titulo" => "VAS was recorded immediately before and after bronchodilation testing"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Measurement of lung function"
                ]
                1 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "Bronchodilation test"
                ]
                2 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Statistical analysis"
                ]
              ]
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Patients"
            ]
            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "VAS assessment"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Discussion"
        ]
        6 => array:3 [
          "identificador" => "sec0070"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Protection of human subjects and animals in research"
            ]
            1 => array:3 [
              "identificador" => "sec0080"
              "titulo" => "Patients&#8217; data protection"
              "secciones" => array:1 [
                0 => array:2 [
                  "identificador" => "sec0085"
                  "titulo" => "Confidentiality of data"
                ]
              ]
            ]
            2 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflict of interest"
        ]
        8 => array:2 [
          "identificador" => "xack69193"
          "titulo" => "Acknowledgement"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-05-24"
    "fechaAceptado" => "2012-06-26"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec279763"
          "palabras" => array:6 [
            0 => "Asthma"
            1 => "Breathlessness"
            2 => "VAS"
            3 => "Bronchodilation"
            4 => "Reversibility"
            5 => "Children"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Visual Analogue Scale &#40;VAS&#41; has been proposed as a useful tool for assessing the perception of asthma symptoms&#44; a cornerstone in disease management&#46; While airway flow limitation and its reversibility are thought to be a useful marker of disease severity&#44; there are very few studies that evaluated the response to bronchodilation &#40;BD&#41; testing perception by VAS&#46; To investigate whether VAS assessment of breathlessness perception could provide a useful tool to assess the response to BD testing in asthmatic children&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study included a total of 150 children &#40;96 males&#44; mean age 11&#46;05 years&#41; with asthma&#44; 50 had bronchial obstruction &#40;i&#46;e&#46; FEV<span class="elsevierStyleInf">1</span> &#60;80&#37; of predicted&#41;&#46; Perception of breathlessness was assessed by VAS&#59; lung function was measured by spirometry&#46; BD testing was performed in all children&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In children with bronchial obstruction&#44; VAS at baseline was 4&#46;7 and significantly increased to 6&#46;9 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; after BD&#46; In children without bronchial obstruction&#44; VAS at baseline was 7&#46;4&#44; but further significantly increased to 8&#46;4 after BD testing &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; There was a significant difference in &#916; VAS between children with bronchial reversibility and children without it &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The present study demonstrates that VAS might be considered an initial tool to assess the BD response in children with asthma&#44; mainly with overt bronchial obstruction&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 929
            "Ancho" => 1663
            "Tamanyo" => 120825
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">VAS score assessed before and after BD testing in children with or without bronchial obstruction &#40;such as FEV<span class="elsevierStyleInf">1</span> value &#60;80&#37; of predicted&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1272
            "Ancho" => 1549
            "Tamanyo" => 85094
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#916; VAS score in children with or without bronchial reversibility&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">All data are presented as median with lower and upper quartiles in parenthesis unless otherwise specified&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male gender &#91;No&#46; &#40;&#37;&#41;&#93;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;64&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41; &#91;mean &#40;standard deviation of the mean&#41;&#93;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;05 &#40;2&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adolescence &#40;&#62;12 years old&#41; &#91;No&#46; &#40;&#37;&#41;&#93;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;36&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VAS at baseline &#40;score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;35 &#40;4&#46;90&#8211;8&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VAS after &#946;2-inhalation &#40;score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;70 &#40;6&#46;30&#8211;9&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEV<span class="elsevierStyleInf">1</span> &#40;&#37; pred&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;00 &#40;77&#46;00&#8211;104&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FVC &#40;&#37; pred&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;00 &#40;78&#46;00&#8211;100&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#37; pred&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104&#46;00 &#40;95&#46;00&#8211;112&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEF<span class="elsevierStyleInf">25&#8211;75</span> &#40;&#37; pred&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;00 &#40;63&#46;50&#8211;112&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab431784.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics in the whole population&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with a positive &#946;<span class="elsevierStyleInf">2</span> inhalation test &#40;No&#46; 41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with a negative &#946;<span class="elsevierStyleInf">2</span> inhalation test &#40;No&#46; 109&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VAS at baseline&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;00 &#40;4&#46;00&#8211;6&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;00 &#40;5&#46;30&#8211;8&#46;65&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#167;&#167;&#167;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VAS after &#946;<span class="elsevierStyleInf">2</span>-inhalation&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;00 &#40;6&#46;10&#8211;8&#46;15&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;00 &#40;6&#46;30&#8211;9&#46;30&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#182;&#182;&#182;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab431785.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; as compared to VAS at baseline recorded in patients with a positive &#946;2 inhalation test&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "&#182;&#182;&#182;"
              "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; as compared to VAS at baseline recorded in patients with a positive &#946;2 inhalation test&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#167;&#167;&#167;"
              "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; as compared to VAS at baseline recorded in patients with a positive &#946;2 inhalation test&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">VAS at baseline and after &#946;2-inhalation in different subgroups of patients&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;R&#46; Punnoose"
                            1 => "A&#46;E&#46; Burke"
                            2 => "R&#46;M&#46; Golub"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2011.2001"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "307"
                        "paginaInicial" => "421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22274691"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0163445399905868"
                          "estado" => "S300"
                          "issn" => "01634453"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perception of asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;R&#46; Rubinfeld"
                            1 => "M&#46;C&#46; Pain"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1976"
                        "volumen" => "1"
                        "paginaInicial" => "882"
                        "paginaFinal" => "884"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2564955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptom perception and evaluation in childhood asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y&#46;H&#46; Lorrie"
                            1 => "A&#46; McMullen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurs Res"
                        "fecha" => "1999"
                        "volumen" => "48"
                        "paginaInicial" => "2"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10029396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Twice-daily peak expiratory flow rate monitoring for the assessment of childhood asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "O&#46;V&#46; Linna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy Proc"
                        "fecha" => "1993"
                        "volumen" => "14"
                        "paginaInicial" => "33"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8462860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of symptom perception in childhood &#124;asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;K&#46; Fritz"
                            1 => "R&#46;B&#46; Klein"
                            2 => "Overholser JC"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dev Behav Pediatr"
                        "fecha" => "1990"
                        "volumen" => "11"
                        "paginaInicial" => "69"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2324291"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and symptom measures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;T&#46; O&#8217;Connor"
                            1 => "S&#46;T&#46; Weiss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/149.2_Pt_2.S21"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1994"
                        "volumen" => "149"
                        "paginaInicial" => "S21"
                        "paginaFinal" => "S28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8298766"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Illness representations&#58; a prototype approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;D&#46; Bishop"
                            1 => "S&#46;A&#46; Converse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Health Psychol"
                        "fecha" => "1986"
                        "volumen" => "5"
                        "paginaInicial" => "95"
                        "paginaFinal" => "114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3732230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Children&#39;s illness concepts&#58; old and new paradigms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Yoos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nurs"
                        "fecha" => "1994"
                        "volumen" => "20"
                        "paginaInicial" => "134"
                        "paginaFinal" => "145"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8159499"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The sensations of pulmonary dyspnea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Janson-Bjerklie"
                            1 => "V&#46;K&#46; Carrieri"
                            2 => "M&#46; Hudes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurs Res"
                        "fecha" => "1986"
                        "volumen" => "35"
                        "paginaInicial" => "154"
                        "paginaFinal" => "159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3635051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of the Visual Analogue Scale and modified Borg scale for the measurement of dyspnea during exercise"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;C&#46; Wilson"
                            1 => "P&#46;W&#46; Jones"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Sci"
                        "fecha" => "1989"
                        "volumen" => "76"
                        "paginaInicial" => "277"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2924519"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measurement of pain in children with self-reporting and behavioural assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;L&#46; Maunuksela"
                            1 => "K&#46;T&#46; Olkkola"
                            2 => "R&#46; Korpela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Pharmacol Ther"
                        "fecha" => "1987"
                        "volumen" => "42"
                        "paginaInicial" => "137"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3608347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The word-graphic rating scale as a measure of children&#39;s and adolescents&#8217; pain intensity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;D&#46; Tesler"
                            1 => "A&#46;E&#46; Zuckerman"
                            2 => "R&#46;M&#46; Sly"
                            3 => "A&#46;K&#46; Saba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Res Nurs Health"
                        "fecha" => "1991"
                        "volumen" => "14"
                        "paginaInicial" => "361"
                        "paginaFinal" => "371"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1891622"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The sensation of pulmonary dyspnea in school-age children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;K&#46; Carrieri"
                            1 => "G&#46; Kieckhelfer"
                            2 => "S&#46; Janson-Bjerklie"
                            3 => "J&#46; Souza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurs Res"
                        "fecha" => "1991"
                        "volumen" => "40"
                        "paginaInicial" => "81"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2003078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of the severity of asthma&#58; patients versus physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;S&#46; Shim"
                            1 => "M&#46;H&#46; Williams Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1980"
                        "volumen" => "68"
                        "paginaInicial" => "11"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7350797"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poor perception of airway obstruction in children with asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;R&#46; Baker"
                            1 => "S&#46;C&#46; Mishoe"
                            2 => "F&#46;H&#46; Zaitoun"
                            3 => "C&#46;B&#46; Arant"
                            4 => "J&#46; Lucas"
                            5 => "N&#46;T&#46; Rupp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Asthma"
                        "fecha" => "2000"
                        "volumen" => "37"
                        "paginaInicial" => "613"
                        "paginaFinal" => "624"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11059529"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poor perception of dyspnea in children with undiagnosed asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Van Gent"
                            1 => "L&#46;E&#46;M&#46; van Essen-Zandvliet"
                            2 => "M&#46;M&#46; Rovers"
                            3 => "J&#46;L&#46;L&#46; Kimpen"
                            4 => "G&#46; de Meer"
                            5 => "C&#46;K&#46; van der Ent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00031407"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "887"
                        "paginaFinal" => "891"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17652315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of the bronchodilation test by Visual Analogue Scale in the selection of patients with rhinitis for screening spirometry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Ciprandi"
                            1 => "S&#46; Quaglini"
                            2 => "V&#46; Giunta"
                            3 => "I&#46; Cirillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Investig Allergol Clin Immunol"
                        "fecha" => "2010"
                        "volumen" => "20"
                        "paginaInicial" => "419"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20945609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung function and symptom perception in children with asthma and their parents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Horak"
                            1 => "G&#46; Grassl"
                            2 => "D&#46; Skladal"
                            3 => "H&#46; Ulmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.10218"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2003"
                        "volumen" => "35"
                        "paginaInicial" => "23"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12461735"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ATS&#47;ERS task force standardisation of spirometry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Miller"
                            1 => "J&#46; Hankinson"
                            2 => "V&#46; Brusasco"
                            3 => "F&#46; Burgos"
                            4 => "R&#46; Casaburi"
                            5 => "A&#46; Coates"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00034805"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "319"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16055882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perception of dyspnea during acetylcholine-induced bronchoconstriction in asthmatic children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Motomura"
                            1 => "H&#46; Odajima"
                            2 => "J&#46; Tezuka"
                            3 => "J&#46; Harada"
                            4 => "K&#46; Okada"
                            5 => "S&#46; Nishima"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1081-1206(10)60241-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Allergy Asthma Immunol"
                        "fecha" => "2009"
                        "volumen" => "102"
                        "paginaInicial" => "121"
                        "paginaFinal" => "124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19230462"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptom perception in children with asthma&#58; cognitive and psychological factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Koinis-Mitchell"
                            1 => "E&#46;L&#46; McQuaid"
                            2 => "R&#46; Seifer"
                            3 => "S&#46;J&#46; Kopel"
                            4 => "J&#46;H&#46; Nassau"
                            5 => "R&#46;B&#46; Klein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1037/a0013169"
                      "Revista" => array:6 [
                        "tituloSerie" => "Health Psychol"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "226"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19290715"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ethnic differences in perception of lung function&#58; a factor in pediatric asthma disparities&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;K&#46; Fritz"
                            1 => "E&#46;L&#46; McQuaid"
                            2 => "S&#46;J&#46; Kopel"
                            3 => "R&#46; Seifer"
                            4 => "R&#46;B&#46; Klein"
                            5 => "D&#46;K&#46; Mitchell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200906-0836OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "182"
                        "paginaInicial" => "12"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20299534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchial hyperresponsiveness&#44; word descriptors&#44; and ethnicity&#58; women with mild asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;E&#46; Hardie"
                            1 => "J&#46;K&#46; Brown"
                            2 => "W&#46;M&#46; Gold"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/02770903.2011.637839"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Asthma"
                        "fecha" => "2012"
                        "volumen" => "49"
                        "paginaInicial" => "36"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22176690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ethnic differences in methacholine responsiveness and word descriptors in African Americans&#44; Hispanic-Mexican Americans Asian-Pacific Islanders&#44; and Whites with mild asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Hardie"
                            1 => "R&#46; Liu"
                            2 => "J&#46; Darden"
                            3 => "W&#46;M&#46; Gold"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/02770903.2010.481341"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Asthma"
                        "fecha" => "2010"
                        "volumen" => "47"
                        "paginaInicial" => "388"
                        "paginaFinal" => "396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20528591"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric asthma morbidity&#58; the importance of symptom perception and family response to symptoms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;L&#46; McQuaid"
                            1 => "D&#46; Koinis Mitchell"
                            2 => "N&#46; Walders"
                            3 => "J&#46;H&#46; Nassau"
                            4 => "S&#46;J&#46; Kopel"
                            5 => "R&#46;B&#46; Klein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jpepsy/jsj112"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Psychol"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "167"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16717140"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptom perception and functional morbidity across a 1-year follow-up in pediatric asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Feldman"
                            1 => "E&#46;L&#46; McQuaid"
                            2 => "R&#46;B&#46; Klein"
                            3 => "S&#46;J&#46; Kopel"
                            4 => "J&#46;H&#46; Nassau"
                            5 => "D&#46;K&#46; Mitchell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.20584"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2007"
                        "volumen" => "42"
                        "paginaInicial" => "339"
                        "paginaFinal" => "347"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17358038"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Asthma Risk Grid&#58; clinical interpretation of symptom perception"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;B&#46; Klein"
                            1 => "N&#46; Walders"
                            2 => "E&#46;L&#46; McQuaid"
                            3 => "S&#46; Adams"
                            4 => "D&#46; Yaros"
                            5 => "G&#46;K&#46; Fritz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy Asthma Proc"
                        "fecha" => "2004"
                        "volumen" => "25"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15055553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:3 [
        "identificador" => "xack69193"
        "titulo" => "Acknowledgement"
        "texto" => "<p id="par0145" class="elsevierStylePara elsevierViewall">Partially funded by Ricerca Corrente &#8211; Italian Ministry of Health&#46;</p>"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03010546/0000004100000006/v1_201312010029/S0301054612002121/v1_201312010029/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5554"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004100000006/v1_201312010029/S0301054612002121/v1_201312010029/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612002121?idApp=UINPBA00004N"
]

Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2012.06.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	0	4
2024 October	49	9	58
2024 September	33	4	37
2024 August	28	3	31
2024 July	38	5	43
2024 June	11	4	15
2024 May	17	2	19
2024 April	19	19	38
2024 March	44	4	48
2024 February	38	6	44
2024 January	41	7	48
2023 December	35	3	38
2023 November	42	4	46
2023 October	38	8	46
2023 September	25	7	32
2023 August	15	5	20
2023 July	25	19	44
2023 June	17	5	22
2023 May	15	5	20
2023 April	26	5	31
2023 March	31	3	34
2023 February	18	23	41
2023 January	18	12	30
2022 December	17	4	21
2022 November	29	4	33
2022 October	14	14	28
2022 September	14	4	18
2022 August	19	9	28
2022 July	10	8	18
2022 June	18	8	26
2022 May	14	6	20
2022 April	23	3	26
2022 March	18	9	27
2022 February	17	10	27
2022 January	21	3	24
2021 December	16	9	25
2021 November	14	7	21
2021 October	15	8	23
2021 September	13	12	25
2021 August	7	7	14
2021 July	16	11	27
2021 June	13	10	23
2021 May	16	6	22
2021 April	10	35	45
2021 March	13	17	30
2021 February	11	17	28
2021 January	9	4	13
2020 November	0	2	2
2020 September	0	1	1
2020 August	1	0	1
2020 July	0	2	2
2020 June	0	1	1
2020 May	0	1	1
2020 April	0	2	2
2020 March	0	1	1
2019 December	0	2	2
2019 November	0	3	3
2019 September	0	4	4
2019 July	0	4	4
2019 June	0	3	3
2018 February	8	2	10
2018 January	10	3	13
2017 December	2	2	4
2017 November	6	2	8
2017 October	9	1	10
2017 September	5	7	12
2017 August	15	2	17
2017 July	14	1	15
2017 June	10	16	26
2017 May	25	12	37
2017 April	19	7	26
2017 March	10	12	22
2017 February	17	2	19
2017 January	8	4	12
2016 December	9	3	12
2016 November	26	2	28
2016 October	21	5	26
2016 September	7	4	11
2016 August	16	5	21
2016 July	7	1	8
2016 June	15	2	17
2016 May	9	17	26
2016 April	7	6	13
2016 March	12	6	18
2016 February	10	12	22
2016 January	10	8	18
2015 December	13	9	22
2015 November	11	2	13
2015 October	15	6	21
2015 September	16	5	21
2015 August	5	1	6
2015 July	5	3	8
2015 June	2	0	2
2015 May	4	1	5
2015 April	11	4	15
2015 March	4	5	9
2015 February	8	2	10
2015 January	16	3	19
2014 December	36	13	49
2014 November	8	3	11
2014 May	0	1	1
2014 March	39	11	50
2014 February	37	5	42
2014 January	31	14	45
2013 December	27	9	36

Show all

Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

Indexed in:

Follow us:

Statistics

Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter