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which may respond differently to therapy&#46; To evaluate impairment&#44; international guidelines commonly suggest using standardized tools to evaluate the patients&#8217; perception of their asthma control and its effect on daily function&#46; Hence&#44; investigators have developed several assessment tools&#59; commonly used ones include&#58; the Asthma Control Questionnaire &#40;ACQ&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the Asthma Control Test &#40;ACT&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> ACT Spanish Version&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the Asthma Therapy Assessment Questionnaire &#40;ATAQ&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the Asthma Control Score System &#40;ACSS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and the Asthma Symptom Utility Index&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Initially&#44; these assessment tools were developed for use in adults&#46; Use in children requires modifications and currently validated pediatric versions exist for ACQ&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> ATAQ&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> CAN &#40;Control de Asma en Ni&#241;os&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and ACT&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The CAN is a 4-min&#44; self-administered questionnaire evaluating asthma symptoms occurring during the last 4 weeks&#46; This tool is validated in Spanish and has 2 versions&#58; &#40;1&#41; children age 9&#8211;14 years&#44; self-administered and &#40;2&#41; children age 2&#8211;8&#44; administered by parents&#47;tutors&#46; A pediatric version of ACT&#44; the Childhood Asthma Control Test &#40;c&#8211;ACT&#41;&#44; was developed to assess asthma control in children between ages 4 and 11&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The c-ACT is validated and is one of the most commonly used questionnaires worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The c-ACT has been validated in various languages in several countries<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;15</span></a>&#59; however&#59; it has not yet been validated in Spanish in Spain&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Over 500 million people worldwide speak Spanish making a validated tool essential&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Moreover&#44; according to ISAAC &#40;International Study of Asthma and Allergies in Childhood&#41; report&#44; 2 out of 4 countries with the highest prevalence of asthma in children &#40;Costa Rica&#44; 37&#46;6&#37;&#59; Panama&#44; 22&#46;7&#37;&#41; around the world are Latin-American countries where Spanish is the native language&#46; Another Spanish speaking country&#44; Chile&#44; also has a high prevalence of asthma &#40;17&#46;9&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We sought to validate the Spanish childhood-ACT &#40;Sc-ACT&#41; in a Spanish speaking population in Spain in order to provide physicians with a tool to more accurately assess childhood asthma control&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This prospective&#44; multicenter&#44; assessment-tool validation study was performed in Spain with asthmatic children ages 4&#8211;11&#46; Approximately 40 pediatricians enrolled 10 children each&#58; 5 children between the ages of 4 and 8 and 5 children between the ages of 9 and 11&#46; Each group enrolled 3 children with mild&#44; persistent asthma&#59; 1 child with moderate&#44; persistent asthma&#59; and 1 child with severe&#44; persistent asthma&#46; All children had GINA &#40;Global Initiative for Asthma&#41;-classified asthma&#44; with persistent asthma in the last 6 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;18</span></a> Patients and parents&#47;tutors were required to understand the questionnaire and be available to return at 2 and 16 weeks after admission and keep the same tutor during the entire study&#46; Exclusion criteria included&#58; other chronic respiratory illness &#40;e&#46;g&#46;&#44; cystic fibrosis&#44; bronchopulmonary dysplasia&#44; primary ciliary dyskinesia&#41;&#59; cardiorespiratory malformations&#59; acute pneumonia or lower respiratory illness&#59; toxic abuse&#59; mental illness or incapacity &#40;patient or parent&#47;tutor&#41;&#59; participation in other clinical trials at the same time of the study or planning to do so in the next 4 months&#59; or inability to read&#44; write&#44; or understand Spanish&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The c-ACT is a 2-part&#44; 7-item questionnaire using a Likert scale that addresses asthma control within the previous 4 weeks&#46; Part 1 is a self-assessment using 4 questions about the child&#39;s perception of asthma control&#44; limitation of activities&#44; coughing&#44; and awakening at night&#46; Part 2 is completed by the parent&#47;tutor describing daytime complaints&#44; daytime wheezing&#44; and awakenings at night&#46; The sum of all scores yields the c-ACT score ranging from 0 &#40;poorest asthma control&#41; to 27 &#40;optimal asthma control&#41;&#46; A cutoff point of &#8804;19 indicates uncontrolled asthma&#46; The Spanish translation and linguistic validation of the c-ACT were a forward&#8211;backward translation&#44; a method developed by Mapi Research Institute&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Visit 1 captured demographic information&#44; asthma characteristics&#44; exacerbations&#44; and medication use&#46; Forced spirometry was performed according to ATS&#47;ERS &#40;American Thoracic Society&#47;European Thoracic Society&#41; recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Percentage of normality values used the equations proposed by Zapletal&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the assessment schedule and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents a timeline of data collection&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> presents the Sc-ACT questionnaire&#44; which was completed on all visits&#46; At Visits 1 and 3 the validated Spanish version of the Pediatric Asthma Quality of life Questionnaire &#40;PAQLQ&#41;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;23</span></a> and the Spanish version of the Pediatric Asthma Caregiver&#39;s Quality of life Questionnaire &#40;PACQLQ&#41;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> were administered&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the hospital&#39;s Ethics and Research Committee at Hospital del Ni&#241;o Jesus &#40;Madrid&#44; Spain&#41;&#59; written informed consent and permission were obtained from parents&#47;tutors&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Socio-demographic and clinical characteristics were evaluated by using a mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41; or median with interquartile range &#40;IQR&#41; for continuous variables and <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41; for categorical variables&#46; The validation of Sc-ACT was performed by evaluation of psychometric properties using&#58; feasibility&#44; validity&#44; reliability&#44; and sensitivity to changes&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Feasibility was evaluated by using descriptive analysis of the proportion of children who did not answer each question&#44; the proportion of children who did not answer any question&#44; and the mean time required to complete the questionnaire&#46; Answer omission was evaluated from the proportion of patients who answered all questions&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Validity was evaluated transversally by analyzing the relationship between the questionnaire score with the clinical variables &#40;FEV<span class="elsevierStyleInf">1</span>&#44; asthma symptoms&#44; and exacerbations&#41;&#59; with the scores from the PAQLQ and PACQLQ tools&#59; and with asthma control perception by the pediatricians&#44; by the children &#40;9&#8211;11 years of age&#41;&#44; and by their tutors using either a Pearson correlation or an ANOVA&#44; when appropriate&#46; To evaluate longitudinal validity&#44; we analyzed the relationship between the changes observed in the questionnaire score for the clinical variables during the follow-up period&#44; and the changes in asthma control observed by the pediatrician&#46; These changes were analyzed either with an ANOVA &#40;qualitative variables&#41; or a Pearson correlation &#40;quantitative variables&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Reliability was evaluated by using the internal consistency of the variables within the same score using the Cronbach <span class="elsevierStyleItalic">&#945;</span> coefficient &#40;CC<span class="elsevierStyleItalic">&#945;</span>&#41;&#59; we expected a CC<span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#46; The reliability of test&#8211;retest was evaluated by using the questionnaire between Visit 1 and 2 between those children &#40;9&#8211;11 years of age&#41; or their tutors &#40;for children 4&#8211;8 years of age&#41; who declared no change in asthma control at Visit 2&#46; For the reliability of test&#8211;retest&#44; we used interclass correlation coefficient &#40;ICC&#41;&#44; considered acceptable if ICC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;70&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Sensitivity to change was considered the difference observed between the Sc-ACT questionnaire administrated at Visits 1 and 3&#44; and was analyzed by using Student&#39;s <span class="elsevierStyleItalic">t</span>-test calculating the additional effect size &#40;defined as the difference in mean score between Visits 1 and 3 divided by the SD of the score at Visit 1&#44; according to the change observed in asthma control at Visit 3&#41;&#46; We calculated the minimum clinically important difference &#40;MCID&#41; based on the mean change observed in the questionnaire scores of those children who&#44; for the question of change in asthma control&#44; chose <span class="elsevierStyleItalic">very good</span>&#44; <span class="elsevierStyleItalic">somewhat good</span>&#44; or <span class="elsevierStyleItalic">not too poor</span>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The cutoff analysis for the Sc-ACT questionnaire was calculated using different variables&#46; We defined three clinical groups &#40;clinical criteria of asthma control&#44; &#37; of predicted FEV<span class="elsevierStyleInf">1</span>&#44; and clinical change in treatment&#41; and compared each of them with the global score of the questionnaire&#46; An ANOVA or Kruskal&#8211;Wallis test&#44; when appropriate&#44; was used for comparing the scores among groups&#46; The receiver operating characteristics &#40;ROC&#41; curves were used to determine how the different cutoffs affected the sensitivity and specificity of the ACT questionnaire to measure asthma control&#46; The measurement criteria were the dichotomic classification of patients as either having controlled or uncontrolled asthma&#44; by clinical criteria&#46; We classified asthma status as controlled if the pediatrician responded with <span class="elsevierStyleItalic">very good</span>&#44; <span class="elsevierStyleItalic">somewhat good</span>&#44; or <span class="elsevierStyleItalic">not too poor</span>&#59; and as uncontrolled if the pediatrician responded with <span class="elsevierStyleItalic">neither good nor poor</span>&#44; <span class="elsevierStyleItalic">fairly poor</span>&#44; <span class="elsevierStyleItalic">somewhat poor</span>&#44; or <span class="elsevierStyleItalic">very poor</span>&#46; The cutoff selection included the following factors&#58; &#40;1&#41; balance between sensitivity and specificity&#59; &#40;2&#41; greater sensitivity in the identification of patient with uncontrolled asthma&#59; &#40;3&#41; greater area under the curve &#40;ROC&#41; and percentage of patients correctly classified&#59; and &#40;4&#41; clinical validation&#46; The cutoff selected was confirmed by the results obtained as a function of the three clinical groups&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A logistic regression multivariate analysis was performed to evaluate the association of potential factors implied in the asthma control&#46; Since asthma control could be estimated by 3 models &#40;by tutors&#44; by clinical approach&#44; or by Sc-ACT&#41;&#44; we performed one multivariate analysis for each model where the dependent variable was asthma control&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The data analysis was performed using the statistical package SAS v&#46; 9&#46;1&#46;3&#46; A <span class="elsevierStyleItalic">p</span>-value of &#60;0&#46;05 was considered significant&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A sample size of 420 children was required to evaluate the psychometric properties of the questionnaire and to evaluate the sensitivity of a change in the questionnaire from Visit 1 to Visit 3 with a SD of 0&#46;15&#44; a significance level of 0&#46;05&#44; a statistical power of 0&#46;80 assuming that 15&#37; of the patients would be lost to follow-up&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Baseline demographic and clinical data</span><p id="par0090" class="elsevierStylePara elsevierViewall">We recruited 394 children&#59; 382 were evaluated&#46; The baseline demographic and clinical characteristics of the children are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The mean age was 7&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4 years old &#40;57&#37; male&#41;&#59; 187 &#40;49&#37;&#41; had mild persistent asthma&#44; 149 &#40;39&#37;&#41; had moderate persistent asthma&#44; and 46 &#40;12&#37;&#41; has severe persistent asthma&#46; The overall mean time since asthma diagnosis was 4&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9 years&#46; Almost half of the children &#40;84&#44; 48&#37;&#41; were taking inhaled corticoids&#44; these children were mainly receiving budesonide alone &#40;118&#44; 64&#37;&#41;&#46; Other medications included long-acting &#223;<span class="elsevierStyleInf">2</span>-agonists &#40;27&#44; 7&#37;&#41; or a combination of both drugs &#40;113&#44; 30&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Feasibility</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 380 &#40;99&#46;7&#37;&#41; children and their caregivers completed all the items of the Sc-ACT in a mean time of 5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4<span class="elsevierStyleHsp" style=""></span>min&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Validity</span><p id="par0100" class="elsevierStylePara elsevierViewall">The analysis of the concurrent validity showed that the Sc-ACT score was correlated with the perception of asthma control by the physician&#44; the patient&#44; and the caregiver &#40;&#8722;0&#46;52&#44; &#8722;0&#46;53&#44; and &#8722;0&#46;51&#44; respectively&#41;&#44; and correlated with the PAQLQ and PACQLQ scores &#40;0&#46;56 and 0&#46;55&#44; respectively&#41;&#46; The correlation results between the Sc-ACT score and the PAQLQ score were similar for the subgroups of children 6&#8211;8 years of age &#40;0&#46;46&#41; and 9&#8211;11 years of age &#40;0&#46;61&#41;&#46; The asthma classification and the number of exacerbations were the only clinical variables well correlated with Sc-ACT score &#40;0&#46;49 and &#8722;0&#46;42&#44; respectively&#41;&#46; As for the longitudinal validity&#44; only the change in asthma classification showed an acceptable positive correlation &#40;0&#46;41&#41; with the change in Sc-ACT score over time&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Reliability</span><p id="par0105" class="elsevierStylePara elsevierViewall">The internal consistency of the questionnaire was good &#40;CC<span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81&#41;&#46; The test&#8211;retest reliability showed high ICC estimates &#40;ICC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;85 in all the items&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Sensitivity to change</span><p id="par0110" class="elsevierStylePara elsevierViewall">The effect size for the Sc-ACT scores was moderate &#40;0&#46;55&#41;&#44; and the mean change in Sc-ACT score between baseline and Visit 3 was 3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;7 points &#40;18&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3 and 21&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6&#44; respectively&#41;&#46; The MCID was 3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4 points &#40;4 points&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Selection of the cutoff points</span><p id="par0115" class="elsevierStylePara elsevierViewall">The selection of a cutoff point was based on a balance between sensitivity and specificity&#44; highest sensitivity for identifying uncontrolled patients&#44; highest AUC and proportion of patients who were classified properly&#44; and clinical validity&#46; Patients were classified as controlled or uncontrolled according to the clinician&#39;s criteria&#44; so patients whose specialist rated their asthma control as <span class="elsevierStyleItalic">very good</span>&#44; <span class="elsevierStyleItalic">somewhat good</span>&#44; or <span class="elsevierStyleItalic">not too poor</span> had their asthma controlled &#40;52&#46;1&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>199&#44; at baseline&#41;&#44; and patients in the remaining categories of asthma control &#40;<span class="elsevierStyleItalic">fairly poor</span>&#44; <span class="elsevierStyleItalic">somewhat poor</span>&#44; and <span class="elsevierStyleItalic">very poor</span>&#41; had their asthma uncontrolled &#40;41&#46;6&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>159 at baseline&#41;&#46; The AUC was 0&#46;598&#46; The cutoff point scores of 20&#46;5&#8211;22&#46;5 had the best balance between sensitivity &#40;ranging from 73&#37; to 57&#46;3&#37;&#41; and specificity &#40;ranging from 47&#46;1&#37; to 60&#46;9&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Regarding the clinical validity&#44; mean Sc-ACT scores were significantly different &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; among the seven categories created for defining the specialist&#39;s perception of asthma control &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; The highest mean score was reported for children with very good control &#40;23&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6&#41; and the lowest mean for children with very bad asthma control &#40;17&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&#41;&#46; Differences in mean Sc-ACT scores were also significant between the specialist-assessed change in therapy &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; with the highest scores &#40;22&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&#41; in children with no changes in therapy&#44; and the lowest scores &#40;20&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;9&#41; in children with dose reductions&#46; Finally&#44; mean Sc-ACT scores were also significantly different &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; depending on the FEV<span class="elsevierStyleInf">1</span>&#44; so children with less than 75&#37; of the FEV<span class="elsevierStyleInf">1</span> reference value had the lowest Sc-ACT scores &#40;20&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&#41;&#44; and children with more than 125&#37; of the FEV<span class="elsevierStyleInf">1</span> reference value had the highest Sc-ACT mean scores &#40;22&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Additional analysis showed that children with severe persistent asthma had the lowest mean Sc-ACT scores &#40;14&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&#41;&#44; whereas those with mild persistent asthma had the highest mean scores &#40;19&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&#41;&#46; Accordingly&#44; the more intense and frequent the symptoms the higher the Sc-ACT scores that were obtained &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">This study validates the Sc-ACT by demonstrating its feasibility&#44; validity&#44; reliability&#44; and sensitivity to change when assessing asthma control in Spanish-speaking children in Spain ages 4&#8211;11&#46; Use of the Sc-ACT is highly feasible&#59; 99&#46;7&#37; of children completed all items in the Sc-ACT taking an average time of 5&#46;3<span class="elsevierStyleHsp" style=""></span>min&#46; The Sc-ACT was a reliable&#44; valid&#44; and sensitive tool to measure asthma control in children using a simple patient&#47;caregiver perspective questionnaire&#44; without needing pulmonary function testing&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The Sc-ACT is reliable having a CC<span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81 and retest reliability &#8805;0&#46;85&#46; Additionally&#44; we calculated for first time the MCID of Sc-ACT &#40;4 points&#41;&#46; To date&#44; no MCID for c-ACT has been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Since there is no gold standard for measuring asthma control in children&#44; the construct validity of the Sc-ACT was assessed by demonstrating appropriate correlations with other measures of asthma control&#44; such as clinical variables and questionnaires&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;27</span></a> We expected to find a low or moderate &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#41; correlation between the Sc-ACT and PAQLQ&#47;PACQLQ&#44; indicating that the later measures quality-of-life more than asthma control&#46; A coefficient ranging from 0&#46;4 to 0&#46;7 is considered a measure of good correlation&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> However&#44; we expected that the variables that measured similar concepts to those on PAQLQ&#47;PACQLQ would have a high correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The results of this analysis showed that the Sc-ACT scores not only correlated well with the clinical perception of asthma control &#40;by patient&#44; caregiver&#44; and physician&#58; &#8722;0&#46;53&#44; &#8722;0&#46;51&#44; and &#8722;0&#46;52&#44; respectively&#41;&#44; but also with some clinical variables&#44; such as asthma classification of severity &#40;0&#46;49&#41; and number of exacerbations &#40;&#8722;0&#46;42&#41;&#44; as well as with the asthma-related quality of life &#40;0&#46;56 and 0&#46;55 for PAQLQ and PACQLQ scores&#44; respectively&#41;&#46; Additional analyses demonstrated that mean Sc-ACT scores were also related to the intensity of asthma symptoms&#46; As expected&#44; these analyses showed that higher Sc-ACT scores correlated to the worst classification of asthma&#44; higher number of exacerbations&#44; more intense asthma symptoms&#44; and a worse perception of asthma control&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The Sc-ACT tool also showed good performance in discriminating between groups of patients differing in the pediatrician&#39;s rating of asthma control&#44; the need for change in a patient&#39;s therapy&#44; and the percentage of predicted FEV<span class="elsevierStyleInf">1</span>&#46; Additionally&#44; the Sc-ACT tool had good reliability and responsiveness&#44; since the tool was internally consistent from one test administration to the next and had a moderate effect size between visits&#46; The reliability of test&#8211;retest in the present study was &#62;0&#46;85 for all of the Sc-ACT items&#46; In contrast&#44; Sekerel et al&#46; reported a test&#8211;retest reliability of 0&#46;71 in the Turkish version of c-ACT <a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#59; Chen et al&#46; reported a test&#8211;retest reliability of 0&#46;537 in the Chinese version of c-ACT&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> In addition to the above mentioned properties&#44; the Sc-ACT questionnaire was completed by most participants &#40;99&#46;7&#37;&#41; in a short amount of time&#46; Therefore it is a feasible and valuable complementary source of information in clinical practice&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Overall&#44; the Sc-ACT questionnaire showed similar properties to the original English version &#40;c-ACT&#41; <a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> and to the adult version &#40;ACT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Previous studies that validated a Spanish ACT in Uruguayan adults showed a CC<span class="elsevierStyleItalic">&#945;</span> 0&#46;79&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> A study in Mexican children living in California reported a CC<span class="elsevierStyleItalic">&#945;</span> 0&#46;76 for children 6&#8211;11 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> A Chinese version of c-ACT performed in children 4&#8211;11 years of age showed a CC<span class="elsevierStyleItalic">&#945;</span> 0&#46;759&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> A Turkish version of c-ACT showed a good CC<span class="elsevierStyleItalic">&#945;</span> for c-ACT item responses &#40;0&#46;82&#44; 0&#46;83&#44; 0&#46;82&#44; 0&#46;82 and 0&#46;80 for first c-ACT to the fifth c-ACT&#41; with a cutoff point of 21 as the highest ROC curve &#40;80&#46;3&#37;&#41;&#59; even sensitivities and specificities of the cutoff points of 18&#8211;21 were comparable&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Nonetheless&#44; our results suggest a higher cutoff point than was originally proposed &#40;above 19&#41; by Liu et al&#46; among children in the US&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In fact&#44; in our study the mean Sc-ACT scores obtained across the categories defined for the specialist assessed child&#39;s therapy&#44; and the specialist assessment of asthma control&#44; as well as the balance between the sensitivity and specificity of the scale&#44; suggested that a cutoff point of 21would be adequate&#46; That is in accordance with a recent study performed in children of Mexican descent in California suggesting a c-ACT cutoff point of 22 for children 6&#8211;11 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> In a recent retrospective analysis&#44; Liu et al&#46; reported a second cutoff point of 12 or less on the c-ACT for children with the lowest level of asthma control&#46; Hence&#44; their group has now established a 3-level asthma control classification&#58; score 20 or greater<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>well controlled&#59; score of 13&#8211;19<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>not well controlled&#59; and score of 12 or less<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>very poorly controlled&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> We are looking at our population for a cutoff for those with poorly controlled asthma&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The clinical manifestations of asthma vary in frequency and intensity and require a standardized approach to assessment via validated tools&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> However&#44; in addition to having a tool that is easy to use and provides valid results&#44; a minimal level of change in score consistent with real benefit is needed&#46; The MCID is the smallest change in a score on a questionnaire that is clinically meaningful and would lead a clinician to consider a change in treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> A search of the medical literature finds no previously reported MCID for the c-ACT&#46; We report a MCID of 3&#46;8 points for the Sc-ACT&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The number of patients able to be recruited was lower than expected&#44; limiting study results&#46; This validation occurred in Spanish-speaking children in Spain&#59; therefore&#44; it may or may not be appropriate for other Spanish-speaking countries due to cultural nuances of Spanish spoken in different countries&#46; Hence&#44; a validation process in each potential country of use needs to be completed&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In conclusion&#44; the Spanish version of the pediatric ACT is a reliable&#44; valid&#44; and sensitive instrument to assess asthma control in patients 4&#8211;11 years of age in Spanish-speaking asthmatic children living in Spain&#44; both in a research or clinical setting&#46; A cutoff point of 21 &#40;with a MCID of 4&#41; is adequate&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Author contributions</span><p id="par0175" class="elsevierStylePara elsevierViewall">EGPY&#44; JRVA&#44; and JGG contributed to conception and design of the study&#46; EGPY&#44; JRVA&#44; JGG&#44; and FJHB were involved in analysis and interpretation of data&#46; EGPY and JACR drafted the article&#46; All authors revised the article critically for important intellectual content and approved this version of the manuscript&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">EGPY has consulting arrangements with Abbott and Merck Sharp &#38; Dohme&#59; has received grant support from Abbott&#44; GlaxoSmithKline&#44; and Merck Sharp &#38; Dohme&#59; and is on the speaker bureau for Abbott&#46; JACR has participated as a lecturer and speaker in scientific meetings and courses under the sponsorship of AstraZeneca&#44; GlaxoSmithKline&#44; Merck Sharp &#38; Dohme&#44; Novartis&#44; and Sanofi&#46; JRVA has participated as a lecturer and speaker in scientific meetings and courses under the sponsorship of AstraZeneca&#44; GlaxoSmithKline&#44; Merck Sharp &#38; Dohme&#44; and Novartis&#46; JGG declares to have no conflict of interest&#46; FJHB is a full-time employee of GlaxoSmithKline&#46;</p></span></span>"
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              "titulo" => "Baseline demographic and clinical data"
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    "fechaRecibido" => "2014-09-30"
    "fechaAceptado" => "2014-10-23"
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            0 => "Childhood Asthma Control Test &#40;c-ACT&#41;"
            1 => "Spanish validation"
            2 => "Asthma"
            3 => "Children"
            4 => "Caregivers"
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            0 => "Cuestionario ACT"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Childhood Asthma Control Test &#40;c-ACT&#41; is a validated tool for determining pediatric asthma control&#46; However&#44; it is not validated in Spanish in Spain&#46; We evaluated the psychometric properties of the Spanish version of the Childhood Asthma Control Test &#40;Sc-ACT&#41; for assessing asthma control in children ages 4&#8211;11&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This national&#44; multicentre&#44; prospective study was conducted in Spain with asthmatic children and their caregivers&#46; Patients were assessed at 3 visits &#40;baseline&#44; 2 weeks&#44; and 4 months&#41;&#46; Clinical variables included&#58; symptoms&#44; exacerbations&#44; FEV<span class="elsevierStyleInf">1</span>&#44; asthma classification&#44; PAQLQ and PACQLQ questionnaire scores&#44; and asthma control as perceived by physicians&#44; patients and caregivers&#46; The Sc-ACT feasibility&#44; validity&#44; reliability&#44; and sensitivity to change were assessed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 394 children were included&#59; mean &#40;SD&#41; time to complete the Sc-ACT was 5&#46;3 &#40;4&#46;4&#41; min&#46; Sc-ACT score was correlated with asthma control as perceived by physician &#40;&#8722;0&#46;52&#41;&#44; patient &#40;&#8722;0&#46;53&#41;&#44; and caregiver &#40;&#8722;0&#46;51&#41; and with the PAQLQ &#40;0&#46;56&#41; and PACQLQ &#40;0&#46;55&#41; scores&#46; Sc-ACT was found to be significantly related to intensity and frequency of asthma symptoms&#46; Cronbach alpha coefficient &#40;CC&#945;&#41; was 0&#46;81 and intraclass correlation coefficient &#40;ICC&#41; was &#8805;0&#46;85 for all of the items&#46; The global effect size of Sc-ACT was 0&#46;55&#46; The cutoff point scores of 21 or higher indicated a good asthma control and their MCID was 4 points&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Spanish version of the c-ACT was found to be a reliable and valid questionnaire for evaluating asthma control in Spanish-speaking children ages 4&#8211;11 in Spain&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El cuestionario ACT pedi&#225;trico es una herramienta validada para determinar el grado de control del asma&#46; Sin embargo&#44; no est&#225; valida en espa&#241;ol para Espa&#241;a&#44; motivo de evaluar las propiedades psicom&#233;tricas de la versi&#243;n en espa&#241;ol del cuestionario ACT pedi&#225;trico&#44; dirigido a conocer el grado de control del asma en ni&#241;os de 4 a 11 a&#241;os de edad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio nacional&#44; prospectivo&#44; multic&#233;ntrico&#44; desarrollado en Espa&#241;a en ni&#241;os asm&#225;ticos y en sus padres&#46; Los pacientes fueron evaluados en 3 visitas &#40;basal&#44; a las 2 semanas y a los 4 meses&#41;&#46; Variables cl&#237;nicas relacionadas&#58; s&#237;ntomas&#44; exacerbaciones&#44; FEV<span class="elsevierStyleInf">1</span>&#44; clasificaci&#243;n del asma&#44; escalas de los cuestionarios PAQLQ y PACQLQ y control del asma percibido por el paciente&#44; sus padres y por su m&#233;dico&#46; Se evaluaron la factibilidad&#44; validez&#44; fiabilidad y sensibilidad del cuestionario ACT&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cohorte constituida por 394 ni&#241;os&#46; La duraci&#243;n media y la DS para completar el cuestionario fue 5&#44;3 &#40;4&#44;4&#41; minutos&#46; La puntuaci&#243;n se correlacion&#243; con el grado de control del asma percibido por su m&#233;dico &#40;-0&#44;52&#41;&#44; por el ni&#241;o &#40;-0&#44;53&#41; y por sus padres &#40;-0&#44;51&#41;&#44; y con las puntuaciones de los cuestionarios PAQLQ &#40;0&#44;56&#41; y PACQLQ &#40;0&#44;55&#41;&#46; Se ha observado una estrecha asociaci&#243;n de la puntuaci&#243;n del cuestionario con la intensidad y la frecuencia de los s&#237;ntomas relacionados con asma&#46; Para todos los items&#44; coeficiente alfa-Cronbach 0&#44;81 y coeficiente de correlaci&#243;n intraclase &#8805;0&#44;85&#46; El punto de corte de 21 o m&#225;s indican un muy buen control del asma y su MCID fue de 4 puntos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La versi&#243;n en espa&#241;ol del cuestionario ACP pedi&#225;trico es fidedigno y v&#225;lido para evaluar en control del asma en Espa&#241;a&#44; en ni&#241;os de 4 a 11 a&#241;os de edad&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; P&#233;rez-Yarza EG&#44; Castro-Rodriguez JA&#44; Villa Asensi JR&#44; Garde Garde J&#44; Hidalgo Bermejo FJ&#44; en representaci&#243;n del Grupo VESCASI&#46; Validaci&#243;n de la versi&#243;n en espa&#241;ol de la prueba de control del asma infantil &#40;sc-act&#41; para su uso en espa&#241;a&#46; Anales de Pediatr&#237;a&#46; 2015&#59;83&#58;94&#8211;103&#46;</p>"
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            "apendice" => "<p id="par0195" class="elsevierStylePara elsevierViewall">Alc&#225;ntara M &#40;Ja&#233;n&#41;&#44; Aloy G &#40;Barcelona&#41;&#44; Antelo C &#40;Madrid&#41;&#44; Asensio O &#40;Barcelona&#41;&#44; Bandr&#233;s F &#40;Pontevedra&#41;&#44; Bartolom&#233; M &#40;Burgos&#41;&#44; Cabanes L &#40;Madrid&#41;&#44; Canseco A &#40;Barcelona&#41;&#44; Carrasco M &#40;Huelva&#41;&#44; Casanovas JM &#40;Barcelona&#41;&#44; Cortell I &#40;Valencia&#41;&#44; Corcuera P &#40;San Sebasti&#225;n&#41;&#44; Corzo JL &#40;M&#225;laga&#41;&#44; Cubero M &#40;Ja&#233;n&#41;&#44; Martin A &#40;Sevilla&#41;&#44; De Mir I &#40;Barcelona&#41;&#44; Echavarri F &#40;Madrid&#41;&#44; Edo A &#40;Castell&#243;n&#41;&#44; Escribano A &#40;Valencia&#41;&#44; Ferr&#233;s J &#40;Barcelona&#41;&#44; Garc&#237;a-Hern&#225;ndez G &#40;Madrid&#41;&#44; Gartner S &#40;Barcelona&#41;&#44; Gir&#243;n F &#40;Granada&#41;&#44; Herrera L &#40;Barcelona&#41;&#44; Korta-Murua J &#40;San Sebasti&#225;n&#41;&#44; Larco JI &#40;Madrid&#41;&#44; L&#243;pez-Silvarey A &#40;La Coru&#241;a&#41;&#44; Lozano D &#40;Ciudad Real&#41;&#44; Marco N &#40;Alicante&#41;&#44; Mart&#237;n-Mateos A &#40;Barcelona&#41;&#44; Mart&#237;nez-Ca&#241;avate AM &#40;Granada&#41;&#44; Moya M &#40;Ciudad Real&#41;&#44; Navarro M &#40;Sevilla&#41;&#44; Oliva C &#40;Tenerife&#41;&#44; P&#233;rez-Fr&#237;as J &#40;M&#225;laga&#41;&#44; Plaza AM &#40;Barcelona&#41;&#44; Rueda S &#40;Madrid&#41;&#44; Salcedo A &#40;Madrid&#41;&#44; S&#225;nchez T &#40;Barcelona&#41;&#44; Sard&#243;n O &#40;San Sebasti&#225;n&#41;&#44; Toral T &#40;Alicante&#41;&#44; Torres J &#40;C&#243;rdoba&#41;&#44; Valverde-Molina J &#40;Los Arcos&#44; Murcia&#41;&#44; V&#225;zquez C &#40;Baracaldo&#41;&#44; Vela C &#40;Toledo&#41;&#44; Velasco R &#40;Toledo&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 1 &#40;Baseline&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 2 &#40;2 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 3 &#40;16 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Criteria for entrance into the study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Demographic questionnaire of the patients and their tutors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Date of asthma diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Classification of asthma severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lung function &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma exacerbations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Co-morbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sc-ACT questionnaire&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PAQLQ and PACQLQ questionnaires&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma control perception according to patient &#40;9&#8211;11 years old&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma control perception according to tutor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Changes in asthma control perception according to patient &#40;9&#8211;11 years old&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Changes in asthma control perception according to tutor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma control perception according to pediatrician&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Changes in asthma control perception according to pediatrician&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Reasons for withdrawal from the study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8730;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>forced expiratory volume in the first second&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>382&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mild persistent&#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>187&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Moderate persistent&#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>149&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Severe persistent&#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;9 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;7 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gender &#40;male&#41;&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">219 &#40;57&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;58&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;56&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;54&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">&#40;L&#41;&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Presence of symptoms</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coughing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">272 &#40;71&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122 &#40;65&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;73&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;87&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wheezing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">163 &#40;42&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;35&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71 &#40;48&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;56&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Shortness of breath&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">172 &#40;45&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;33&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;53&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;65&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exacerbations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">172 &#40;45&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;41&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;46&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;64&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab869357.png"
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            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">In the last 2 weeks before study start&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline demographic and clinical characteristics by asthma severity&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ICC&#58; intraclass correlation coefficient&#46; <span class="elsevierStyleItalic">n</span>&#58; number of patients&#47;tutors Sc-ACT test&#8211;retest reliability was calculated with patients&#47;tutors who reported no variations in asthma control in Visit 2 &#40;no changes in symptoms&#44; exacerbations&#44; treatment and variations in FEV<span class="elsevierStyleInf">1</span> &#60;9&#37;&#41;&#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"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Question number of Sc-ACT questionnaire &#40;Items&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;ICC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Item 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;0&#46;942&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Item 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;0&#46;885&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Item 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;0&#46;849&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Item 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;0&#46;879&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Item 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;0&#46;896&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Item 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;0&#46;962&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Item 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;0&#46;951&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab869359.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Results of the test&#8211;retest reliability of Sc-ACT questionnaire measured between Visits 1 and 2&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>forced expiratory volume in the first second&#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"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Category&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean Sc-ACT score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">&#37; <span class="elsevierStyleItalic">predicted FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="table-entry  " align="left" valign="top">&#60;75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">75&#37;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">90&#37;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>110&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">110&#37;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>125&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#8805;125&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Physician&#39;s assessment of asthma control</span></td><td class="td" title="table-entry  " align="left" valign="top">Very good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Somewhat good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Not too poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Neither good nor poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fairly poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Somewhat poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Very poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Physician&#39;s assessed change in child&#39;s therapy</span></td><td class="td" title="table-entry  " align="left" valign="top">Increase dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">No change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Decrease dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Asthma severity</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Mild persistent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Moderate persistent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Severe persistent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Symptom intensity</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coughing</td><td class="td" title="table-entry  " align="left" valign="top">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Shortness of breath</td><td class="td" title="table-entry  " align="left" valign="top">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Symptom frequency</span><span class="elsevierStyleSup">&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coughing</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#8805;1&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Daily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wheezing</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#8805;1&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Daily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Shortness of breath</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#8805;1&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Daily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Comparison of Sc-ACT scores across clinical categories at Visit 3&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Global strategy for the diagnosis and management of asthma in children 5 years and&#44; younger"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "Global Initiative for Asthma &#40;GINA&#41;"
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                    0 => array:2 [
                      "titulo" => "Development and validation of a questionnaire to measure asthma control"
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                        0 => array:2 [
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                            0 => "E&#46;F&#46; Juniper"
                            1 => "P&#46;M&#46; O&#8217;Byrne"
                            2 => "G&#46;H&#46; Guyatt"
                            3 => "P&#46;J&#46; Ferrie"
                            4 => "D&#46;R&#46; King"
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                    0 => array:1 [
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                        "tituloSerie" => "Eur Respir J"
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                        "volumen" => "14"
                        "paginaInicial" => "902"
                        "paginaFinal" => "907"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10573240"
                            "web" => "Medline"
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                      "titulo" => "Development of the asthma control test&#58; a survey for assessing asthma control"
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                            4 => "J&#46;T&#46; Li"
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                    0 => array:2 [
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                      "titulo" => "Validation of the Spanish version of the Asthma Control Test &#40;ACT&#41;"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0185" class="elsevierStylePara elsevierViewall">The study was sponsored by <span class="elsevierStyleGrantSponsor" id="gs0005">GlaxoSmithKline S&#46;A</span>&#46;</p> <p id="par0190" class="elsevierStylePara elsevierViewall">The authors would like to acknowledge the role of Nicol&#225;s Cobos&#44; M&#46;D&#46;&#44; as a member of VESCASI study Steering Committee&#46; Moreover&#44; the authors wish to thank all the investigators who participated in the study&#46; Their names and affiliations are listed in the Appendix&#46; Barbara Rinehart&#44; MS of PRA Health Sciences &#40;RPS&#41; assisted in manuscript preparation&#46;</p>"
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