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L)10 (on)10.1 (g-)-20 (term )]TJ 0.111 Tw 0 -1.2 Td [(f)15 (ollo)5 (w)-10 (-up of p)10 (atients r)10 (ec)10 (ei)20.1 (vin)10 (g l)15 (un)10 (g-)-10 (v)20 (ol)15 (um)10 (e-r)10.1 (eduction s)10 (ur)10 (gery )]TJ 0.075 Tw 0 -1.2 Td [(v)20 (ers)10 (us m)10 (edic)10 (a)10 (l th)10 (era)10 (p)15 (y f)15 (or s)5 (e)20 (v)20 (er)10 (e em)10 (ph)15 (y)10 (s)5 (em)10 (a b)15 (y th)10 (e N)30 (ation)10.1 (a)10 (l )]TJ 0.066 Tw 0 -1.2 Td [(Em)10 (ph)15 (y)10 (s)5 (em)10 (a T)50 (r)10 (e)15 (atm)10 (ent T)50.1 (ri)10 (a)10 (l r)10.1 (es)4.9 (e)15.1 (ar)10 (ch gr)10 (o)10 (up)20 (. )]TJ /T1_2 1 Tf 0.06 Tw [(A)25 (nn Thor)20 (ac S)10 (ur)20 (g)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 51.56 536.121 Tm (2006)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 69.4837 536.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 71.3017 536.121 Tm (82)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 80.2636 536.121 Tm (:)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 82.0815 536.121 Tm (431)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 95.5243 536.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 97.9902 536.121 Tm (443)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 111.433 536.121 Tm (.)Tj 0.06 Tw -6.653 -2.4 Td [(Ram)10 (s)5 (e)15 (y SD)40 (, Berry K)-20 (, E)20 (t)10.1 (zioni R)-20 (, K)10 (a)10 (pl)10 (an RM, S)10 (ulli)20 (v)20 (an SD)40 (, W)75 (ood )]TJ -0.042 Tw 0 -1.2 Td [(DE; N)30 (ation)10.1 (a)10 (l Em)10 (ph)15 (y)10 (s)5 (em)10.1 (a T)50 (r)10 (e)15 (atm)10 (ent T)50 (ri)10 (a)10 (l R)10 (es)5.1 (e)14.9 (ar)10.1 (ch Gr)10 (o)10 (up)20 (. C)30 (ost )]TJ 0 -1.2 Td [(e\034)15 (ecti)20 (v)20 (en)10 (ess )0.5 (of l)15 (un)10.1 (g-)-10 (v)20 (ol)15 (um)10 (e-r)10 (eduction )0.5 (s)10 (ur)10 (gery f)15 (or )0.5 (p)10 (atients )0.5 (with )]TJ 0 Tw 0 -1.2 Td [(s)5 (e)20 (v)20 (er)10 (e em)10 (ph)15 (y)10 (s)5 (em)10 (a. )]TJ /T1_2 1 Tf [(N E)15.1 (ng J Med)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 180.2317 482.121 Tm (2003)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 198.1555 482.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 199.9734 482.121 Tm (348)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 213.4162 482.121 Tm (:)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 215.2342 482.121 Tm (2092)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 233.158 482.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 235.6238 482.121 Tm (2102)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 253.5476 482.121 Tm (.)Tj -22.443 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.5566 471.321 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.5185 471.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.1744 471.321 Tm (1056)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.015 Tc 0.015 Tw 9 0 0 9 154.0981 471.321 Tm [(/)-15 (N)-15 (E)-5 (JMs)-10 (a)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 190.9437 471.321 Tm (030448)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.228 Tw 9 0 0 9 51.56 449.7209 Tm [(Gin)10 (s)5 (b)10 (ur)10 (g ME, Th)10 (om)10 (a)10 (s)15 (h)10 (o)5 (w BM, Y)20 (i)15 (p CK)-20 (, et a)10 (l. L)30 (un)10 (g v)20 (ol)15 (um)10 (e )]TJ 0.39 Tw 0 -1.2 Td [(r)10 (eduction )0.6 (s)10 (ur)10 (gery )0.5 (usin)10.1 (g )0.5 (th)10 (e )0.5 (NE)20.1 (TT )0.5 (s)5 (election )0.6 (criteri)10 (a. )]TJ /T1_2 1 Tf 0 Tw 24.897 0 Td [(A)25 (nn )]TJ -24.897 -1.2 Td [(Thor)20 (ac S)10 (ur)20 (g)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 101.5813 428.121 Tm (2011)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 119.505 428.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 121.323 428.121 Tm (91)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 130.2849 428.121 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 133.2547 428.121 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 137.7357 428.121 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 142.5235 428.121 Tm (1556)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 160.4473 428.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 162.9131 428.121 Tm (1560)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 180.8369 428.121 Tm [( \()10 (di)10 (s)5 (c)10 (ussion )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 227.9873 428.121 Tm (156)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 241.4301 428.121 Tm (\).)Tj -21.097 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.5566 417.321 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.5185 417.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.1744 417.321 Tm (1016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 154.0981 417.321 Tm [(/j.ath)10.1 (ora)10 (cs)10 (ur)30 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 203.6152 417.321 Tm (2011)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 221.5389 417.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 223.1948 417.321 Tm (01)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 232.1567 417.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 233.8126 417.321 Tm (054)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.14 Tw 9 0 0 9 51.56 395.7209 Tm [(Stanif)15.1 (er BP)50 (, Gin)10 (s)5 (b)10 (ur)10 (g ME. L)30 (un)10 (g v)20 (ol)15 (um)10 (e r)10 (eduction s)10 (ur)10 (gery in )]TJ 0.2 Tw 0 -1.2 Td [(th)10 (e )0.5 (post-N)30.1 (ation)10 (a)10 (l )0.5 (Em)10 (ph)15 (y)10 (s)5 (em)10 (a )0.5 (T)50 (r)10 (e)15 (atm)10 (ent )0.5 (T)50 (ri)10 (a)10 (l )0.5 (era. )]TJ /T1_2 1 Tf 0.182 Tw 22.687 0 Td [(J Thor)19.9 (ac )]TJ 0 Tw -22.687 -1.2 Td (Dis. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 67.7686 374.121 Tm (2018)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 85.6924 374.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 87.5104 374.121 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 96.4722 374.121 Tm [(\()5 (S)10 (uppl )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 123.616 374.121 Tm (23)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 132.5779 374.121 Tm (\):S)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 142.2887 374.121 Tm (2744)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.015 Tc 0.015 Tw 9 0 0 9 160.2124 374.121 Tm (-S)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 167.4663 374.121 Tm (2747)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 185.39 374.121 Tm (.)Tj -14.87 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.5566 363.321 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.5184 363.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.1744 363.321 Tm (21037)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 158.5791 363.321 Tm (/jtd.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 174.1757 363.321 Tm (2018)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 192.0994 363.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 193.7553 363.321 Tm (05)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 202.7172 363.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 204.3731 363.321 Tm (135)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.248 Tw 9 0 0 9 51.56 341.7209 Tm [(C)20 (rin)10 (er GJ)40 (, S)10 (ue R)-20 (, W)55 (right S)10 (, et a)10 (l; LIBERA)70 (TE Study Gr)10 (o)10 (up)20 (. )]TJ 0.668 Tw 0 -1.2 Td [(A Multic)10.1 (enter Ran)10 (domi)10.1 (z)10 (ed C)30 (ontr)10 (olled T)50 (ri)10 (a)10 (l of Zeph)15 (yr )]TJ 0.061 Tw 0 -1.2 Td [(En)10 (dobr)10 (on)10 (chi)10.1 (a)10 (l V)70 (a)10 (l)5 (v)20 (e T)50 (r)10 (e)15 (atm)10 (ent in h)10 (eter)10 (ogen)10 (eo)10 (us Em)10 (ph)15 (y)10 (s)5 (em)10 (a )]TJ 0 Tw 0 -1.2 Td [(\(LIBERA)70.1 (TE\). )]TJ /T1_2 1 Tf -0.032 Tw 5.634 0 Td [(A)25 (m J Resp)5 (ir C)20 (rit C)30 (ar)20 (e Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 205.9275 309.321 Tm (2018)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 223.8512 309.321 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 225.6692 309.321 Tm (198)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 239.112 309.321 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 242.0819 309.321 Tm (9)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 246.5628 309.321 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 251.3506 309.321 Tm (1151)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 269.2744 309.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 271.7403 309.321 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 289.6641 309.321 Tm (.)Tj -26.456 -1.2 Td ( )Tj 0.037 Tw 0 -1.2 Td [(C)20 (rin)10 (er GJ)40.1 (, C)30 (or)10 (do)20 (v)20 (a F)70 (, Stern)10 (ber)10 (g AL, M)10 (artin)10 (e)10 (z F)70 (J)40.1 (. Th)10 (e N)29.9 (ation)10.1 (a)10 (l )]TJ 0.176 Tw 0 -1.2 Td [(Em)10 (ph)15 (y)10 (s)5 (em)10 (a T)50 (r)10 (e)15 (atm)10.1 (ent T)50 (ri)10 (a)10 (l \(NE)20 (TT\): P)25 (art I: L)10 (ess)5 (on)10 (s le)15 (arn)10 (ed )]TJ 0.064 Tw 0 -1.2 Td [(a)10 (bo)10 (ut em)10 (ph)15 (y)10 (s)5 (em)10 (a. )]TJ /T1_2 1 Tf 0.059 Tw [(A)25 (m )0.5 (J )0.6 (Resp)5 (ir )0.6 (C)20 (rit )0.5 (C)30 (ar)20 (e )0.6 (Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 234.4691 266.121 Tm (201)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 247.9119 266.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 249.7298 266.121 Tm (184)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 263.1726 266.121 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 266.1425 266.121 Tm (7)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 270.6234 266.121 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 275.4113 266.121 Tm (763)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 288.8541 266.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 51.56 255.321 Tm (770)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 65.0028 255.321 Tm [(. doi: https:/)120 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 142.7253 255.321 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 151.6871 255.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 153.343 255.321 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 171.2668 255.321 Tm [(/)40 (rcc)-10 (m)-10 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 195.2517 255.321 Tm (201103)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 222.1374 255.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 224.6032 255.321 Tm (0454)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 242.527 255.321 Tm (CI)Tj -0.002 Tw -21.219 -2.4 Td [(H)20 (og)10 (g JC, Chu F)70 (, U)15 (tok)10 (a)10.1 (p)10 (ar)10 (ch S)10 (, et a)10 (l. Th)10 (e n)9.9 (atur)10.1 (e of sm)10 (a)10 (ll-airw)15.1 (a)25 (y )]TJ 0.022 Tw 0 -1.2 Td [(obstruction in chr)10 (onic obstructi)20.1 (v)20 (e p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. )]TJ /T1_2 1 Tf 0.02 Tw [(N E)15 (ngl J )]TJ 0 Tw 0 -1.2 Td (Med)Tj /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 72.3766 212.121 Tm (2004)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 90.3003 212.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 92.1183 212.121 Tm (350)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 105.5611 212.121 Tm (:)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 107.379 212.121 Tm (2645)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 125.3028 212.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 127.7687 212.121 Tm (2653.)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 51.5599 201.321 Tm [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.5566 201.321 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.5184 201.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.1743 201.321 Tm (1056)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 154.0981 201.321 Tm [(/)-10 (N)-10 (EJ)5.1 (M)10 (oa)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 191.6996 201.321 Tm (032158)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.15 Tw 9 0 0 9 51.5599 179.7209 Tm [(H)20 (og)10 (g JC, Chu F)25 (S)9.9 (, T)70 (an W)30 (C, et a)10 (l. S)10 (urvi)20 (v)20 (a)10 (l after l)15 (un)10 (g v)20 (ol)15 (um)10 (e )]TJ 0.197 Tw 0 -1.2 Td [(r)10 (eduction in chr)10 (onic obstructi)20.1 (v)19.9 (e p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e: in)10 (sights )]TJ 0.33 Tw 0 -1.2 Td [(fr)10 (om sm)10 (a)10 (ll airw)15 (a)25 (y p)10 (ath)10 (olog)5 (y)50 (. )]TJ /T1_2 1 Tf 0.301 Tw [(A)25 (m J Resp)5 (ir C)20 (rit C)30 (ar)20 (e Med.)]TJ /T1_1 1 Tf 0 Tw ( )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 51.56 147.321 Tm (2007)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 69.4837 147.321 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 71.3017 147.321 Tm (176)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 84.7445 147.321 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 87.7144 147.321 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 92.1953 147.321 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 96.9831 147.321 Tm (454)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 110.4259 147.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 112.8918 147.321 Tm (459)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 126.3346 147.321 Tm (.)Tj -8.308 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.5566 136.5209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.5184 136.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.1744 136.5209 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 154.0981 136.5209 Tm [(/)40 (rcc)-10 (m)-10 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 178.0831 136.5209 Tm (200612)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 204.9687 136.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 207.4346 136.5209 Tm (1772)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 225.3583 136.5209 Tm (OC)Tj 0.015 Tw -19.311 -2.4 Td [(DeM)20 (eo DL, )0.5 (H)20 (ers)15 (h CP)50 (, H)20 (o\034m)10 (an )0.5 (E)10 (A)-20 (, et a)10 (l. )0.5 (Gen)10 (etic determin)10 (ants )]TJ 0.561 Tw 0 -1.2 Td [(of em)10 (ph)15.1 (y)10 (s)5 (em)10 (a di)10 (stri)10 (b)10 (ution in th)10.1 (e N)30 (ation)10 (a)10.1 (l Em)10 (ph)15 (y)10 (s)5 (em)10 (a )]TJ 0.026 Tw 0 -1.2 Td [(T)50 (r)10 (e)15 (atm)10 (ent T)50 (ri)10 (a)10 (l. )]TJ /T1_2 1 Tf 0.024 Tw [(A)25 (m J Resp)5 (ir C)20 (rit C)30.1 (ar)20 (e Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 221.5461 93.321 Tm (2007)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 239.4699 93.321 Tm (; )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 243.5929 93.321 Tm (176)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 257.0357 93.321 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 260.0056 93.321 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 264.4865 93.321 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 269.2744 93.321 Tm (42)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 278.2362 93.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 280.7021 93.321 Tm (48)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 289.664 93.321 Tm (. )Tj -26.456 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.5565 82.5209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.5184 82.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.1743 82.5209 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 154.0981 82.5209 Tm [(/)40 (rcc)-10 (m)-10 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 178.083 82.5209 Tm (200612)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 204.9687 82.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 207.4345 82.5209 Tm (1797)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 225.3583 82.5209 Tm (OC)Tj ET /CS0 CS 0 0.72 0.9 0 SCN 4 M /GS0 gs q 1 0 0 1 36.22 188.8497 cm 0 0 m 255.6 0 l S Q BT /GS1 gs /TT0 1 Tf 7.5 0 0 7.5 37.1198 179.2635 Tm (54.)Tj ET /GS0 gs q 1 0 0 1 36.22 297.8097 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.1198 288.2235 Tm (52.)Tj ET /GS0 gs q 1 0 0 1 36.66 243.1289 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.5598 233.5428 Tm (53.)Tj ET /GS0 gs q 1 0 0 1 36.22 124.8496 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.1198 115.2635 Tm (55.)Tj ET /GS0 gs q 1 0 0 1 36.22 589.98 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.1198 580.3939 Tm (47.)Tj ET /GS0 gs q 1 0 0 1 36.22 718.9399 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.1198 709.3539 Tm (45.)Tj ET /GS0 gs q 1 0 0 1 36.66 654.2593 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.5598 644.6731 Tm (46.)Tj ET /GS0 gs q 1 0 0 1 36.22 524.98 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.1198 515.3939 Tm (48.)Tj ET /GS0 gs q 1 0 0 1 36 459.54 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 36.8998 449.9539 Tm (49.)Tj ET /GS0 gs q 1 0 0 1 36.66 406.0348 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.5598 396.4487 Tm (50.)Tj ET /GS0 gs q 1 0 0 1 36.22 352.2497 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 37.1198 342.6635 Tm (51.)Tj /T1_1 1 Tf 0.285 Tw 9 0 0 9 336.24 708.921 Tm [(H)20 (ers)15 (h CP)50 (, DeM)20 (eo DL, R)10 (eill)5 (y J)20 (J)40.1 (, Sil)5 (v)20 (erm)10 (an EK)-20 (. X)40 (en)10 (obiotic )]TJ 0.04 Tw 0 -1.2 Td [(m)10 (eta)10 (boli)10.1 (zin)10 (g en)20 (z)10 (ym)10 (e gen)10 (e pol)5 (ym)10 (orphi)10 (sm)10 (s pr)10 (edict r)10 (es)10 (pon)10.1 (s)5 (e to )]TJ 0 Tw 0 -1.2 Td [(l)15 (un)10 (g v)20 (ol)15 (um)10 (e r)10 (eduction s)10.1 (ur)10 (gery)50 (. )]TJ /T1_2 1 Tf [(Resp)5.1 (ir Res)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 499.174 687.321 Tm (2007)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 517.0978 687.321 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 518.9158 687.321 Tm (8)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 523.3967 687.321 Tm (:)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 525.2147 687.321 Tm (59)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 534.1766 687.321 Tm (.)Tj -21.993 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 676.5209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1987 676.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8546 676.5209 Tm (1186)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.7783 676.5209 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.7833 676.5209 Tm (1465)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 460.707 676.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 463.1729 676.5209 Tm (9921)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 481.0966 676.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 483.5625 676.5209 Tm (8)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 488.0435 676.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 490.5093 676.5209 Tm (59)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.037 Tw 9 0 0 9 336.2402 654.921 Tm [(C)20 (rin)10 (er GJ)40.1 (, C)30 (or)10 (do)20 (v)20 (a F)70 (, Stern)10 (ber)10 (g AL, M)10 (artin)10 (e)10 (z F)70 (J)40.1 (. Th)10 (e N)29.9 (ation)10.1 (a)10 (l )]TJ 0.155 Tw 0 -1.2 Td [(Em)10 (ph)15 (y)10 (s)5 (em)10 (a T)49.9 (r)10 (e)15 (atm)10.1 (ent T)50 (ri)10 (a)10 (l \(NE)20 (TT\) P)25 (art II: L)10 (ess)5 (on)10 (s le)15 (arn)10 (ed )]TJ 0.172 Tw 0 -1.2 Td [(a)10 (bo)10 (ut l)15 (un)10 (g v)19.9 (ol)15 (um)10.1 (e r)10 (eduction s)10 (ur)10 (gery)50 (. )]TJ /T1_2 1 Tf 0.157 Tw [(A)25 (m J Resp)5 (ir C)20 (rit C)30.1 (ar)20 (e )]TJ 0 Tw 0 -1.2 Td (Med)Tj /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 357.0568 622.5209 Tm (2011)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 374.9805 622.5209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 376.7985 622.5209 Tm (184)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 390.2413 622.5209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 393.2112 622.5209 Tm (8)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 397.6921 622.5209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 402.48 622.5209 Tm (881)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 415.9228 622.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 418.3887 622.5209 Tm (893)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 431.8315 622.5209 Tm (.)Tj -10.621 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 611.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1987 611.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8546 611.7209 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7783 611.7209 Tm [(/)40 (rcc)-10 (m)-10 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 462.7633 611.7209 Tm (201103)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 489.6489 611.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 492.1148 611.7209 Tm (0455)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 510.0385 611.7209 Tm (CI)Tj -0.064 Tw -19.311 -2.4 Td [(G \222)35 (or)10 (eck)10 (a D)40 (, Gorz)10.1 (el)10 (a)10 (k K)-20 (, S)10 (li)15 (wi\033)10 (s)15 (ki P)50 (, T)75 (obi)10 (a)10 (s)10 (z M, Zieli\033)10.1 (s)15 (ki J)40 (. E\034)15 (ect )]TJ -0.045 Tw 0 -1.2 Td [(of lon)10 (g-)-20 (term o)10 (xy)20 (gen th)10 (era)10 (p)15 (y on s)10 (urvi)20 (v)20 (a)10 (l in p)10 (atients with chr)10 (onic )]TJ 0.392 Tw 0 -1.2 Td [(obstructi)20.1 (v)19.9 (e )0.6 (p)10 (ulm)10 (on)10 (ary )0.6 (di)10 (s)5 (e)15 (a)10 (s)5 (e )0.5 (with )0.6 (m)10 (oderate )0.6 (h)15 (y)10 (po)10 (x)10 (a)10 (emi)10.1 (a. )]TJ /T1_2 1 Tf 0 Tw 0 -1.2 Td [(Thor)20 (ax)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 367.6318 557.7209 Tm (1997)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 385.5556 557.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 387.3735 557.7209 Tm (52)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 396.3354 557.7209 Tm ( \()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 401.3752 557.7209 Tm (8)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 405.8562 557.7209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.644 557.7209 Tm (674)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 424.0869 557.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 426.5527 557.7209 Tm (679)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 439.9955 557.7209 Tm (.)Tj -11.528 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 546.921 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1987 546.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8546 546.921 Tm (1136)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.7783 546.921 Tm [(/th)10 (x.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 456.571 546.921 Tm (52)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 465.5328 546.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 467.1888 546.921 Tm (8)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 471.6697 546.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 473.3256 546.921 Tm (674)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.043 Tw 9 0 0 9 336.2402 525.3209 Tm [(Ch)10 (a)10 (o)10 (uat A)-20 (, W)75 (eit)10 (z)10 (en)10.1 (bl)15 (um E, K)20 (ess)15 (ler R)-20 (, et a)10 (l. A ran)10 (domi)10.1 (z)10 (ed tri)10 (a)10 (l )]TJ 0.075 Tw 0 -1.2 Td [(of n)10 (octurn)10 (a)10 (l o)10.1 (xy)20 (gen th)10 (era)10 (p)15.1 (y in chr)10 (onic obstructi)20.1 (v)20 (e p)10 (ulm)10 (on)10.1 (ary )]TJ 0 Tw 0 -1.2 Td [(di)10 (s)5 (e)15 (a)10 (s)5 (e p)10 (atients. )]TJ /T1_2 1 Tf [(E)30 (ur Resp)5.1 (ir J)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 449.9982 503.7209 Tm (1999)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 467.922 503.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 469.74 503.7209 Tm (14)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 478.7018 503.7209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 481.6717 503.7209 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 486.1526 503.7209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 490.9405 503.7209 Tm (1002)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 508.8643 503.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 511.3301 503.7209 Tm (1008)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 529.2538 503.7209 Tm (.)Tj -21.446 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 492.921 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1987 492.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8546 492.921 Tm (1183)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.7783 492.921 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.7833 492.921 Tm (09031936)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 478.6308 492.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 480.2867 492.921 Tm (99)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 489.2485 492.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 490.9045 492.921 Tm (14510029)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.24 Tw 9 0 0 9 336.2401 471.321 Tm [(O\222Donn)10 (ell DE, D\222)50 (Arsign)15.1 (y C, W)75 (ebb K)30 (A)-20 (. E\034)15 (ects of h)15 (y)10 (per)10 (o)10 (xi)10 (a )]TJ 0.134 Tw 0 -1.2 Td [(on v)20 (entil)10 (atory limitation durin)10 (g e)10 (x)10 (er)10 (ci)10 (s)5 (e in a)10.1 (dv)20 (an)10 (c)10 (ed chr)10 (onic )]TJ 0.25 Tw 0 -1.2 Td [(obstructi)20.1 (v)19.9 (e p)10 (ulm)10 (on)10 (ary di)10.1 (s)5 (e)15 (a)10 (s)5 (e)10 (. )]TJ /T1_2 1 Tf 0.228 Tw [(A)25 (m J Resp)5.1 (ir C)20 (rit C)30.1 (ar)20 (e Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.2401 438.921 Tm (2001)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 354.1638 438.921 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 355.9818 438.921 Tm (163)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 369.4246 438.921 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 372.3945 438.921 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 376.8755 438.921 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 381.6633 438.921 Tm (892)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 395.1061 438.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 397.572 438.921 Tm (898)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 411.0148 438.921 Tm (.)Tj -8.308 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 428.121 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1986 428.121 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 428.121 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7783 428.121 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 468.856 428.121 Tm (163)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 482.2988 428.121 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 483.9547 428.121 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 488.4356 428.121 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 490.0915 428.121 Tm (2007026)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.023 Tw 9 0 0 9 336.2401 406.521 Tm [(Emtn)10 (er M, P)20 (ors)10 (z)10 (a)10 (s)10 (z J)40 (, B)10 (urn)10 (s M, S)10 (omfa)25.1 (y A)-19.9 (, C)30 (a)10 (s)5 (a)10 (b)10 (uri R)-20 (. Ben)10 (e\037ts )]TJ 0.095 Tw 0 -1.2 Td [(of s)10 (upplem)10.1 (enta)10 (l o)10 (xy)20 (gen in e)10 (x)10 (er)10 (ci)10 (s)5 (e trainin)10.1 (g in n)9.9 (on)10.1 (h)15 (y)10 (po)10 (x)10 (emic )]TJ 0.177 Tw 0 -1.2 Td [(chr)10 (onic obstructi)20.1 (v)20 (e p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e p)10 (atients. )]TJ /T1_2 1 Tf 0.162 Tw [(A)25 (m J Resp)5 (ir )]TJ 0 Tw 0 -1.2 Td [(C)20 (rit C)30 (ar)20 (e Med.)]TJ /T1_1 1 Tf ( )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 393.8661 374.121 Tm (2003)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 411.7899 374.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 413.6078 374.121 Tm (168)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 427.0507 374.121 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 430.0206 374.121 Tm (9)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 434.5015 374.121 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 439.2893 374.121 Tm (1034)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 457.2131 374.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 459.679 374.121 Tm (1042)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 477.6027 374.121 Tm (.)Tj -15.707 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 363.321 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1986 363.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 363.321 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7783 363.321 Tm [(/)40 (rcc)-10 (m)-10 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 462.7632 363.321 Tm (200212)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 489.6489 363.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 492.1147 363.321 Tm (1525)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 510.0385 363.321 Tm (OC)Tj 0.48 Tw -19.311 -2.4 Td [(Rin)10 (gb)10 (a)10 (ek T)50 (, M)10 (artin)10.1 (e)10 (z G, Lan)10 (ge P)50 (. Th)10 (e lon)10 (g-)-19.9 (term e\034)15 (ect )]TJ 0.402 Tw 0 -1.2 Td [(of am)10 (b)10 (ul)10 (atory o)10 (xy)20 (gen in n)10 (orm)10 (o)10 (x)10 (a)10 (emic C)20 (OPD p)10 (atients: a )]TJ 0 Tw 0 -1.2 Td [(ran)10 (domi)10.1 (s)4.9 (ed study)50.1 (. )]TJ /T1_2 1 Tf [(C)20 (hr)20 (on Resp)5 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 474.9194 320.121 Tm (2013)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 492.8432 320.121 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 494.6611 320.121 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 503.623 320.121 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 506.5929 320.121 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 511.0739 320.121 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 515.8617 320.121 Tm (77)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 524.8235 320.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 527.2894 320.121 Tm (84)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 536.2513 320.121 Tm (.)Tj -22.223 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 309.321 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1986 309.321 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 309.321 Tm (1177)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.7783 309.321 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.7832 309.321 Tm (1479972312473135)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.192 Tw 9 0 0 9 336.2401 287.7209 Tm [(Drumm)10 (on)10 (d MB)10 (, Bl)10 (a)10 (ckf)15 (or)10 (d AL, Ben)10 (ditt JO)39.9 (, et a)10 (l. 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L)10 (on)10 (g-)-20 (term o)10 (xy)19.9 (gen tr)10 (e)15 (atm)10 (ent in chr)10 (onic )]TJ 0.317 Tw 0 -1.2 Td [(obstructi)20.1 (v)19.9 (e p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e: r)10 (ec)10 (omm)10 (en)10 (d)10 (ation)10 (s f)15 (or futur)10 (e )]TJ 0.184 Tw 0 -1.2 Td [(r)10 (es)5 (e)15 (ar)10 (ch: )0.6 (an )0.5 (NHLBI )0.5 (w)5 (ork)10 (s)15 (h)10.1 (op )0.5 (r)10 (eport. )]TJ /T1_2 1 Tf 0.168 Tw 16.778 0 Td [(A)25 (m )0.5 (J )0.5 (Resp)5.1 (ir )0.5 (C)20 (rit )0.5 (C)30 (ar)20 (e )]TJ 0 Tw -16.778 -1.2 Td (Med)Tj /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 357.0567 190.5209 Tm (2006)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 374.9805 190.5209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 376.7985 190.5209 Tm (174)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 390.2413 190.5209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 393.2112 190.5209 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 397.6921 190.5209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 402.4799 190.5209 Tm (373)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 415.9227 190.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 418.3886 190.5209 Tm (378)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 431.8314 190.5209 Tm (.)Tj -10.621 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2368 179.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1986 179.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 179.7209 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7783 179.7209 Tm [(/)40 (rcc)-10 (m)-10 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 462.7632 179.7209 Tm (200507)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 489.6489 179.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 492.1147 179.7209 Tm (1161)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.03 Tc 0.03 Tw 9 0 0 9 510.0385 179.7209 Tm (WS)Tj 0 Tc 0.293 Tw -19.311 -2.4 Td [(Y)50 (us)5 (en RD)40 (, C)20 (rin)10 (er GJ)40 (, Stern)10 (ber)10.1 (g AL, et a)10 (l; L)40 (O)20 (TT R)10 (es)5 (e)15 (ar)10 (ch )]TJ 0.153 Tw 0 -1.2 Td [(Gr)10 (o)10 (up *; Th)10 (e L)10 (on)10 (g-)60 (T)75 (erm Oxy)20 (gen T)50 (r)10 (e)15 (atm)10.1 (ent T)50 (ri)10 (a)10 (l f)15 (or chr)10 (onic )]TJ 0.173 Tw 0 -1.2 Td [(obstructi)20.1 (v)19.9 (e p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e: ration)10 (a)10 (le)10 (, design, an)10 (d less)5 (on)10 (s )]TJ 0 Tw 0 -1.2 Td [(le)15 (arn)10 (ed. )]TJ /T1_2 1 Tf [(A)25.1 (nn A)25 (m Thor)20 (ac S)10 (oc)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 446.9386 125.7209 Tm (2018)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 464.8624 125.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 466.6804 125.7209 Tm (15)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 475.6422 125.7209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 478.6121 125.7209 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 483.093 125.7209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 487.8809 125.7209 Tm (89)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 496.8428 125.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 499.3087 125.7209 Tm (101)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 512.7515 125.7209 Tm (.)Tj -19.612 -1.2 Td ( )Tj ET /GS0 gs q 1 0 0 1 319.9601 167.8497 cm 0 0 m 255.6 0 l S Q BT /GS1 gs /TT0 1 Tf 7.5 0 0 7.5 320.8598 158.2635 Tm (65.)Tj ET /GS0 gs q 1 0 0 1 319.9601 296.8097 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 320.8598 287.2235 Tm (63.)Tj ET /GS0 gs q 1 0 0 1 320.4 233.1289 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 321.2998 223.5428 Tm (64.)Tj ET /GS0 gs q 1 0 0 1 319.9601 599.98 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 320.8598 590.3939 Tm (58.)Tj ET /GS0 gs q 1 0 0 1 319.9601 717.9399 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 320.8598 708.3539 Tm (56.)Tj ET /GS0 gs q 1 0 0 1 320.4 665.2593 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 321.2998 655.6731 Tm (57.)Tj ET /GS0 gs q 1 0 0 1 319.9601 535.98 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 320.8598 526.3939 Tm (59.)Tj ET /GS0 gs q 1 0 0 1 319.74 481.54 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 320.6398 471.9539 Tm (60.)Tj ET /GS0 gs q 1 0 0 1 320.4 416.0348 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 321.2998 406.4487 Tm (61.)Tj ET /GS0 gs q 1 0 0 1 319.9601 351.2497 cm 0 0 m 255.6 0 l S Q BT /GS1 gs 7.5 0 0 7.5 320.8598 341.6635 Tm (62.)Tj ET endstream endobj 36 0 obj <>stream q /GS0 gs 0 TL/Fm0 Do Q BT /CS0 cs 0 0 0 0 scn /GS0 gs /T1_0 1 Tf 0.052 Tc -0.052 Tw 12 0 0 12 13.8882 772 Tm (368)Tj ET q 0 Tc 0 Tw 0 g 0 TL/Fm1 Do Q BT 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc -0.004 Tw 9 0 0 9 52.56 708.361 Tm [(B)10 (urr)10 (o)5 (w)10 (s B)10 (, Knud)10 (s)5 (on R)-20 (J)40 (, C)30 (amilli AE, L)20 (y)10 (le SK)-20 (, L)10 (ebo)5 (wit)10 (z MD)40 (. 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Ri)10 (s)15 (k fa)10 (ctors )]TJ -0.011 Tw 0 -1.2 Td [(a)10 (ss)5 (oci)10 (ated with lon)10 (gitudin)10.1 (a)10 (l ch)10 (an)10 (ge in p)10 (ulm)10 (on)10 (ary fun)10 (ction. )]TJ /T1_2 1 Tf -0.025 Tc 0.025 Tw [(Am)-25 ( )]TJ 0 Tc 0 Tw 0 -1.2 Td [(Rev Resp)5.1 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 110.4378 621.9609 Tm (1984)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 128.3615 621.9609 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 130.1795 621.9609 Tm (129)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 143.6223 621.9609 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 146.5922 621.9609 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 151.0731 621.9609 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 155.861 621.9609 Tm (660)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 169.3038 621.9609 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 171.7697 621.9609 Tm (667)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 185.2125 621.9609 Tm (.)Tj -14.739 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 126.5567 611.1609 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.5185 611.1609 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.1744 611.1609 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 155.0982 611.1609 Tm [(/)90 (arr)10 (d.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 175.5189 611.1609 Tm (1984)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 193.4426 611.1609 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 195.0986 611.1609 Tm (129)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 208.5414 611.1609 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 210.1973 611.1609 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 214.6782 611.1609 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 216.3341 611.1609 Tm (660)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.398 Tw 9 0 0 9 52.56 589.561 Tm [(Durkin D)30.1 (A)-20 (, K)-10 (jel)10 (s)5 (ber)10 (g M)20 (O)40 (, B)10 (ui)10 (st A)20 (S)10 (, C)30 (onn)10 (ett JE, Ow)5 (en)9.9 (s )]TJ 0.174 Tw 0 -1.2 Td [(GR)-20 (. R)10 (ecruitm)10 (ent of p)10 (artici)15 (p)10 (ants in th)10 (e L)30 (un)10 (g H)20 (e)15 (a)10 (lth Study)50 (, I: )]TJ 0.137 Tw 0 -1.2 Td [(Des)5 (cri)15 (ption )0.5 (of )0.5 (m)10 (eth)10 (od)10 (s. )]TJ /T1_2 1 Tf 0.125 Tw 10.708 0 Td [(C)30 (ontr)20 (ol C)20 (lin T)50 (rials)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 225.9299 567.9611 Tm (1993)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 243.8537 567.9611 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 245.6717 567.9611 Tm (14)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 254.6335 567.9611 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 257.6034 567.9611 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.137 Tw 9 0 0 9 262.0844 567.9611 Tm [( S)10 (uppl\): )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 52.56 557.161 Tm (20)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 61.5219 557.161 Tm (S-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 68.9107 557.161 Tm (37)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 77.8726 557.161 Tm [(S)10 (. doi: https:/)120 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 160.4281 557.161 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 169.39 557.161 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 171.0459 557.161 Tm (1016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 188.9697 557.161 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 192.9746 557.161 Tm (0197)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 210.8984 557.161 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 213.3642 557.161 Tm (2456)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 231.288 557.161 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 234.2579 557.161 Tm (93)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 243.2197 557.161 Tm (\))Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 246.1896 557.161 Tm (90022)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 268.5943 557.161 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 271.0602 557.161 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.163 Tw 9 0 0 9 52.56 535.561 Tm [(C)30 (onn)10 (ett JE, K)20 (us)5 (ek J)15 (W)90 (, Baile)15 (y W)30 (C, O\222H)20 (ara P)50 (, W)55.1 (u M. Design )]TJ 0.134 Tw 0 -1.2 Td [(of th)10 (e L)30 (un)10 (g H)20 (e)15 (a)10 (lth Study: a ran)10 (domi)10 (z)10 (ed clinic)10 (a)10 (l tri)10 (a)10 (l of e)15 (arl)5 (y )]TJ 0 Tw 0 -1.2 Td [(interv)20 (ention f)15 (or chr)10 (onic obstructi)20.1 (v)20 (e p)10 (ulm)10 (on)10.1 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. )]TJ /T1_2 1 Tf [(C)30 (ontr)20 (ol )]TJ 0 -1.2 Td [(C)20 (lin T)50 (rials)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 96.0294 503.161 Tm (1993)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 113.9532 503.161 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 115.7712 503.161 Tm (14)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 124.733 503.161 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 127.7029 503.161 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 132.1839 503.161 Tm [( S)10 (uppl\):)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 161.1905 503.161 Tm (3)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 165.6714 503.161 Tm (S-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 173.0603 503.161 Tm (19)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 182.0222 503.161 Tm (S.)Tj 0 Tc 0 Tw -14.385 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 126.5566 492.361 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.5185 492.361 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.1744 492.361 Tm (1016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 155.0982 492.361 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 159.1031 492.361 Tm (0197)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 177.0268 492.361 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 179.4927 492.361 Tm (2456)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 197.4164 492.361 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 200.3863 492.361 Tm (93)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 209.3482 492.361 Tm (\))Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 212.3181 492.361 Tm (90021)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 234.7228 492.361 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 237.1887 492.361 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.282 Tw 9 0 0 9 52.56 470.761 Tm [(Enright PL, J)30 (ohn)10 (s)5 (on LR)-20 (, C)30 (onn)10.1 (ett JE, V)70 (oelk)10 (er H, B)10 (ui)10 (st A)20 (S)10 (. )]TJ 0.133 Tw 0 -1.2 Td [(S)10 (pir)10 (om)10 (etry in th)10 (e L)30 (un)10 (g H)20 (e)15 (a)10 (lth Study)50 (. )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 0 Tw 8 0 0 8 202.7229 459.961 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.133 Tw 9 0 0 9 207.2038 459.961 Tm [(. M)20 (eth)10 (od)10 (s an)10 (d qua)10 (lit)15 (y )]TJ 0 Tw -17.183 -1.2 Td [(c)10 (ontr)10 (ol. )]TJ /T1_2 1 Tf [(A)25 (m Rev Resp)5.1 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 156.094 449.161 Tm (1991)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 174.0178 449.161 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 175.8358 449.161 Tm (143)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 189.2786 449.161 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 192.2484 449.161 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 196.7294 449.161 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 201.5172 449.161 Tm (1215)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 219.441 449.161 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 221.9069 449.161 Tm (1223)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 239.8306 449.161 Tm (.)Tj -20.808 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 126.5566 438.361 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.5185 438.361 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.1744 438.361 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 155.0982 438.361 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 187.5249 438.361 Tm (143)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 200.9677 438.361 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 202.6236 438.361 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 207.1045 438.361 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 208.7604 438.361 Tm (1215)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.34 Tw 9 0 0 9 52.56 416.761 Tm [(Anth)10 (oni)10.1 (s)5 (en NR)-19.9 (, C)30 (onn)10.1 (ett JE, K)-30 (ile)15 (y JP)50 (, et a)10 (l f)15 (or th)10 (e L)30 (un)10 (g )]TJ 0.07 Tw 0 -1.2 Td [(H)20 (e)15 (a)10 (lth Study R)10 (es)5 (e)15 (ar)10 (ch Gr)10 (o)10 (up)20 (. E\034)15 (ects of sm)10 (okin)10.1 (g interv)20 (ention )]TJ 0.212 Tw 0 -1.2 Td [(an)10 (d th)10 (e us)5 (e of an in)10 (h)10 (a)10 (led antich)10.1 (olin)10 (er)10 (gic br)10 (on)10 (ch)10 (odil)10 (ator on )]TJ 0.187 Tw 0 -1.2 Td [(th)10 (e rate of declin)10 (e of FE)10 (V)]TJ /TT0 1 Tf 0 Tw 6.996 0 0 6.996 157.2568 383.365 Tm (1)Tj /T1_1 1 Tf 0.187 Tw 9 0 0 9 161.5951 384.361 Tm [(. Th)10 (e L)30 (un)10 (g H)20 (e)15 (a)10 (lth Study)50 (. )]TJ /T1_2 1 Tf -0.01 Tc 0.01 Tw [(J)15 (AMA)]TJ /T1_1 1 Tf 0 Tc 0 Tw 14.341 0 Td (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 52.56 373.561 Tm (1994)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 70.4838 373.561 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 72.3017 373.561 Tm (272)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 85.7445 373.561 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 88.7144 373.561 Tm (19)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 97.6763 373.561 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 102.4641 373.561 Tm (1497)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 120.3879 373.561 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 122.8538 373.561 Tm (1505)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 140.7775 373.561 Tm (.)Tj -9.802 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 126.5566 362.761 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.5185 362.761 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.1744 362.761 Tm (1001)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 155.0982 362.761 Tm [(/jam)10 (a.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 179.0376 362.761 Tm (1994)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 196.9614 362.761 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 198.6173 362.761 Tm (03520190043033)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc -0.018 Tw 9 0 0 9 52.56 341.161 Tm [(O\222H)20 (ara P)50 (, Grill J)40 (, Rig)10 (don M)10 (A)-20 (, C)30 (onn)10 (ett JE, La)10 (uger GA)-20 (, J)30 (ohn)10 (ston )]TJ -0.023 Tw 0 -1.2 Td [(J)20 (J)40 (. )0.5 (Design )0.5 (an)10 (d )0.5 (r)10 (es)10 (ults )0.5 (of )0.5 (th)10 (e )0.5 (initi)10 (a)10 (l )0.5 (interv)20 (ention )0.5 (pr)10 (ogram )0.5 (f)15 (or )0.5 (th)10 (e )]TJ 0.171 Tw 0 -1.2 Td [(L)30 (un)10 (g H)20 (e)15 (a)10 (lth Study)50 (. Th)10 (e L)30 (un)10 (g H)20 (e)15 (a)10 (lth Study R)10 (es)5 (e)15 (ar)10 (ch Gr)10 (o)10 (up)20 (. )]TJ /T1_2 1 Tf 0 Tw 0 -1.2 Td [(Pr)20 (ev Med)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 91.7363 308.761 Tm (1993)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 109.66 308.761 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 111.478 308.761 Tm (22)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 120.4399 308.761 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 123.4098 308.761 Tm (3)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 127.8907 308.761 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 132.6785 308.761 Tm (304)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 146.1214 308.761 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 148.5872 308.761 Tm (315)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 162.0301 308.761 Tm (.)Tj -12.163 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 126.5566 297.961 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.5185 297.961 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.1744 297.961 Tm (1006)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 155.0982 297.961 Tm [(/)50 (pm)10 (ed.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 181.864 297.961 Tm (1993)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 199.7878 297.961 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 201.4437 297.961 Tm (1025)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.134 Tw 9 0 0 9 52.56 276.361 Tm [(S)10 (c)10 (an)10 (lon )0.5 (PD)40 (, )0.5 (C)30 (onn)10 (ett )0.5 (JE, )0.5 (W)65 (a)10 (ller )0.5 (LA)-20 (, )0.5 (et )0.5 (a)10 (l; )0.5 (L)30 (un)10 (g )0.5 (H)20 (e)15 (a)10 (lth )0.5 (Study )]TJ 0.041 Tw 0 -1.2 Td [(R)10 (es)5 (e)15 (ar)10 (ch Gr)9.9 (o)10.1 (up)20 (. S)10 (m)10 (okin)10 (g c)10 (ess)5 (ation an)10 (d l)15 (un)10 (g fun)10 (ction in mild-)]TJ 0.093 Tw 0 -1.2 Td [(to-m)10 (oderate )0.5 (chr)10.1 (onic obstructi)20.1 (v)20 (e )0.5 (p)10 (ulm)10 (on)10 (ary )0.5 (di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. Th)10 (e )0.5 (L)30 (un)10 (g )]TJ 0.037 Tw 0 -1.2 Td [(H)20 (e)15 (a)10 (lth Study)50 (. )]TJ /T1_2 1 Tf 0.034 Tw [(A)25 (m J Resp)5 (ir C)20 (rit C)30 (ar)20 (e Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 213.6141 243.961 Tm (2000)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 231.5379 243.961 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 233.3558 243.961 Tm (161)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 246.7986 243.961 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 249.7685 243.961 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.037 Tw 9 0 0 9 254.2494 243.961 Tm ( Pt )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 0 Tw 8 0 0 8 267.1425 243.961 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 271.6235 243.961 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 276.4113 243.961 Tm (381)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 289.8541 243.961 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 52.56 233.161 Tm (390)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 66.0028 233.161 Tm [(. doi: https:/)120 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 143.7253 233.161 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 152.6872 233.161 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 154.3431 233.161 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 172.2668 233.161 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 202.3445 233.161 Tm (161)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 215.7873 233.161 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 217.4433 233.161 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 221.9242 233.161 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 223.5801 233.161 Tm (9901044)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.016 Tw 9 0 0 9 52.56 211.561 Tm [(T)70 (a)10 (s)15 (hkin DP)50 (, Altos)5 (e MD)40 (, C)30 (onn)10.1 (ett JE, K)10 (ann)10 (er RE, L)10 (ee WW)90 (, W)15.1 (i)10 (s)5 (e )]TJ 0.083 Tw 0 -1.2 Td [(RA)-20 (. M)20 (eth)10 (a)10 (ch)10.1 (olin)10 (e r)10 (e)15 (a)10 (cti)20 (vit)15 (y pr)10 (edicts ch)10.1 (an)10 (ges in l)15 (un)10 (g fun)10 (ction )]TJ 0.036 Tw 0 -1.2 Td [(o)20 (v)20 (er tim)10.1 (e in sm)10.1 (ok)10 (ers with e)15 (arl)5 (y chr)10.1 (onic obstructi)20.1 (v)20 (e p)10 (ulm)10 (on)10 (ary )]TJ 0.097 Tw 0 -1.2 Td [(di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. Th)10 (e L)30.1 (un)10 (g H)20 (e)15 (a)10 (lth Study R)10 (es)5 (e)15 (ar)10 (ch Gr)10 (o)10 (up)20 (. )]TJ /T1_2 1 Tf 0.089 Tw [(A)25 (m J Resp)5 (ir )]TJ 0 Tw 0 -1.2 Td [(C)20 (rit C)30 (ar)20 (e Med)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 110.186 168.361 Tm (1996)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 128.1098 168.361 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 129.9277 168.361 Tm (153)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 143.3705 168.361 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 146.3404 168.361 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 150.8214 168.361 Tm ( Pt )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 163.0431 168.361 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 167.524 168.361 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 172.3119 168.361 Tm (1802)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 190.2356 168.361 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 192.7015 168.361 Tm (1811)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 210.6253 168.361 Tm (.)Tj -17.563 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 126.5566 157.561 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.5185 157.561 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.1744 157.561 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 155.0981 157.561 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 185.1758 157.561 Tm (153)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 198.6186 157.561 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 200.2746 157.561 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 204.7555 157.561 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 206.4114 157.561 Tm (8665038)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc -0.062 Tw 9 0 0 9 52.56 135.961 Tm [(T)70 (a)10 (s)15 (hkin )0.6 (DP)50 (, )0.5 (Altos)5 (e )0.6 (MD)40 (, )0.5 (Bleeck)10 (er )0.5 (ER)-20 (, )0.5 (et )0.5 (a)10 (l. )0.6 (Th)10 (e )0.5 (l)15 (un)10 (g )0.6 (h)10 (e)15 (a)10 (lth )0.5 (study: )]TJ -0.009 Tw 0 -1.2 Td [(airw)15 (a)25 (y r)10 (es)10 (pon)10 (si)20 (v)20 (en)10 (ess to in)10.1 (h)10 (a)10 (led m)10 (eth)10 (a)10 (ch)10 (olin)10.1 (e in sm)10 (ok)10 (ers with )]TJ 0.21 Tw 0 -1.2 Td [(mild to m)10 (oderate air\035o)5 (w limitation. Th)10 (e L)29.9 (un)10.1 (g H)20 (e)15 (a)10 (lth Study )]TJ 0.136 Tw 0 -1.2 Td [(R)10 (es)5 (e)15 (ar)10 (ch Gr)10 (o)10 (up)20 (. )]TJ /T1_2 1 Tf 0.124 Tw [(A)25 (m Rev Resp)5 (ir Dis)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 196.7397 103.561 Tm (1992)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 214.6635 103.561 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 216.4814 103.561 Tm (145)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 229.9242 103.561 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 232.8941 103.561 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.136 Tw 9 0 0 9 237.375 103.561 Tm ( Pt )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 0 Tw 8 0 0 8 252.0438 103.561 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 256.5247 103.561 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 261.3126 103.561 Tm (301)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 274.7554 103.561 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 277.2213 103.561 Tm (310)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 290.6641 103.561 Tm (. )Tj -26.456 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 126.5566 92.761 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.5185 92.761 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.1744 92.761 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 155.0981 92.761 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 187.5248 92.761 Tm (145)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 200.9677 92.761 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 202.6236 92.761 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 207.1045 92.761 Tm (_Pt_)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 224.4563 92.761 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 228.9372 92.761 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 230.5932 92.761 Tm (301)Tj ET /CS0 CS 0 0.72 0.9 0 SCN 4 M q 1 0 0 1 36.72 426.94 cm 0 0 m 255.6 0 l S Q BT 0 0 0 1 scn /GS1 gs 0 Tc 0 Tw 7.5 0 0 7.5 37.6198 417.3539 Tm (28.)Tj /T1_1 1 Tf 0.075 Tw 9 0 0 9 336.38 708.921 Tm [(K)10 (ann)10 (er RE, C)30 (onn)10 (ett JE, Altos)5 (e MD)40 (, et a)10 (l. Gen)10 (der di\034)15 (er)10 (en)10 (c)10 (e in )]TJ 0.105 Tw 0 -1.2 Td [(airw)15 (a)25 (y )0.6 (h)15 (y)10 (perr)10 (es)10 (pon)10 (si)20 (v)20 (en)10 (ess )0.6 (in )0.5 (sm)10 (ok)10 (ers )0.6 (with )0.6 (mild )0.5 (C)20 (OPD)40 (. )0.6 (Th)10 (e )]TJ -0.023 Tw 0 -1.2 Td [(L)30 (un)10 (g H)20 (e)15 (a)10.1 (lth Study)50 (. )]TJ /T1_2 1 Tf -0.021 Tw [(A)25 (m J Resp)5.1 (ir C)20 (rit C)30 (ar)20 (e Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 514.8081 687.321 Tm (1994)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 532.7319 687.321 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 534.5499 687.321 Tm (150)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 547.9927 687.321 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 550.9625 687.321 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 555.4435 687.321 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 560.2313 687.321 Tm (956)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 573.6741 687.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.38 676.5209 Tm (961)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 349.8228 676.5209 Tm [(. doi: https:/)120 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 427.5453 676.5209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 436.5072 676.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 438.1631 676.5209 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 456.0869 676.5209 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 486.1646 676.5209 Tm (150)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 499.6074 676.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 501.2632 676.5209 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 505.7442 676.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 507.4001 676.5209 Tm (7921469)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.238 Tw 9 0 0 9 336.38 654.921 Tm [(W)15 (i)10 (s)5 (e RA)-20 (, K)10 (ann)10 (er RE, Lin)10.1 (dgr)10 (en P)50.1 (, et a)10 (l; L)30 (un)10 (g H)20 (e)15 (a)10 (lth Study )]TJ 0.229 Tw 0 -1.2 Td [(R)10 (es)5 (e)15 (ar)10 (ch Gr)10 (o)10 (up)20 (. Th)10.1 (e e\034)15 (ect of sm)10 (okin)10.1 (g interv)20.1 (ention an)10 (d an )]TJ -0.014 Tw 0 -1.2 Td [(in)10 (h)10 (a)10 (led br)10 (on)10 (ch)10 (odil)10 (ator on airw)15.1 (a)25 (y)10 (s r)10 (e)15 (a)10 (cti)20 (vit)15.1 (y in C)20 (OPD: th)10 (e L)30 (un)10 (g )]TJ 0 Tw 0 -1.2 Td [(H)20 (e)15 (a)10 (lth Study)50 (. )]TJ /T1_2 1 Tf [(C)20 (hest)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 414.751 622.5209 Tm (2003)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 432.6747 622.5209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 434.4927 622.5209 Tm (124)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 447.9355 622.5209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 450.9054 622.5209 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 455.3863 622.5209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 460.1742 622.5209 Tm (449)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 473.6169 622.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 476.0828 622.5209 Tm (458)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 489.5256 622.5209 Tm (.)Tj -17.016 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.3766 611.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.3385 611.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.9944 611.7209 Tm (1378)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.9182 611.7209 Tm [(/)100 (ch)10 (est.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 463.7128 611.7209 Tm (124)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 477.1556 611.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 478.8115 611.7209 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 483.2924 611.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 484.9484 611.7209 Tm (449)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.366 Tw 9 0 0 9 336.38 590.121 Tm [(Ran)10 (d C)15 (S)10 (, W)15 (i)10 (s)5 (e RA)-20 (, N)10 (ides M, et a)10 (l. M)20 (eter)10.1 (ed-dos)5 (e in)10 (h)10.1 (a)10 (ler )]TJ -0.06 Tw 0 -1.2 Td [(a)10 (dh)10 (er)10 (en)10 (c)10 (e in a clinic)10 (a)10 (l tri)10.1 (a)10 (l. )]TJ /T1_2 1 Tf -0.055 Tw [(A)25 (m Rev Resp)5 (ir Dis)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 510.3272 579.3209 Tm (1992)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 528.2509 579.3209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 530.0689 579.3209 Tm (146)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 543.5117 579.3209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 546.4816 579.3209 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 550.9625 579.3209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 555.7504 579.3209 Tm (1559)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 573.6741 579.3209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.38 568.521 Tm (1564)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 354.3037 568.521 Tm [(. doi: https:/)120 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 432.0262 568.521 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 440.9881 568.521 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.644 568.521 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 460.5678 568.521 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 492.9945 568.521 Tm (146)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 506.4373 568.521 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 508.0932 568.521 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 512.5742 568.521 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 514.23 568.521 Tm (1559)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.043 Tw 9 0 0 9 336.38 546.921 Tm [(Anth)10 (oni)10.1 (s)5 (en NR)-19.9 (, S)10 (k)10.1 (e)15 (an)10 (s M)10 (A)-20 (, W)15 (i)10 (s)5 (e RA)-19.9 (, M)10 (anfr)10 (ed)10 (a J)40 (, K)9.9 (ann)10.1 (er RE, )]TJ 0.189 Tw 0 -1.2 Td [(C)30 (onn)10 (ett JE; L)30 (un)10 (g H)19.9 (e)15 (a)10 (lth Study R)10 (es)5 (e)15 (ar)10 (ch Gr)10 (o)10 (up)20 (. Th)10 (e e\034)15 (ects )]TJ 0.163 Tw 0 -1.2 Td [(of a sm)10 (okin)10 (g c)10 (ess)5 (ation interv)20 (ention on )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 494.5149 525.3209 Tm (14)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 503.4768 525.3209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 505.1327 525.3209 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.163 Tw 9 0 0 9 509.6136 525.3209 Tm [(-)-10 (y)20 (e)15 (ar m)10.1 (orta)10 (lit)15 (y: a )]TJ 0 Tw -19.248 -1.2 Td [(ran)10 (domi)10.1 (z)10 (ed clinic)10 (a)10 (l tri)10 (a)10 (l. )]TJ /T1_2 1 Tf [(A)25 (nn Intern Med)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 495.4793 514.521 Tm (2005)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 513.4031 514.521 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 515.2211 514.521 Tm (142)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 528.6638 514.521 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 531.6337 514.521 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 536.1146 514.521 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 540.9025 514.521 Tm (233)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 554.3453 514.521 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 556.8112 514.521 Tm (239)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 570.254 514.521 Tm (. )Tj -25.986 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.3766 503.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.3384 503.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.9944 503.7209 Tm (7326)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.9181 503.7209 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.923 503.7209 Tm (0003)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 460.8468 503.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 463.3127 503.7209 Tm (4819)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 481.2364 503.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 483.7023 503.7209 Tm (142)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 497.1451 503.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 499.611 503.7209 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 504.0919 503.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 506.5578 503.7209 Tm (200502150)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 546.8862 503.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 549.3521 503.7209 Tm (00005)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.072 Tw 9 0 0 9 336.3799 482.121 Tm [(U)15 (S Pr)10 (e)20 (v)20 (enti)20 (v)20 (e S)10 (ervic)10 (es T)70 (a)10 (s)15 (k F)80 (or)10 (c)10 (e \(U)15.1 (SPS)15 (TF\), Si)15 (u AL, Bi)10 (bbin)10 (s-)]TJ 0.457 Tw 0 -1.2 Td [(Domin)10 (go K)-20 (, Gr)10 (ossm)10 (an DC, et a)10.1 (l. S)10 (cr)10 (eenin)10 (g f)15 (or chr)10 (onic )]TJ 0.241 Tw 0 -1.2 Td [(obstructi)20.1 (v)19.9 (e p)9.9 (ulm)10.1 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e: U)15 (S Pr)10 (e)20 (v)20 (enti)20 (v)20 (e S)10 (ervic)10 (es T)70 (a)10 (s)15 (k )]TJ 0.271 Tw 0 -1.2 Td [(F)80 (or)10 (c)10 (e r)10 (ec)10 (omm)10 (en)10 (d)10 (ation statem)10 (ent. )]TJ /T1_2 1 Tf -0.01 Tc 0.01 Tw [(J)15 (AMA)]TJ /T1_1 1 Tf 0 Tc 0 Tw 18.144 0 Td (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 505.8462 449.7209 Tm (2016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 523.77 449.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 525.5879 449.7209 Tm (315)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 539.0307 449.7209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 542.0006 449.7209 Tm (13)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 550.9625 449.7209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 555.7504 449.7209 Tm (1372)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 573.6741 449.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.38 438.921 Tm (1377)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 354.3037 438.921 Tm [(. doi: https:/)120 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 432.0262 438.921 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 440.9881 438.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.644 438.921 Tm (1001)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 460.5678 438.921 Tm [(/jam)10 (a.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 484.5073 438.921 Tm (2016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 502.431 438.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 504.0869 438.921 Tm (2638)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.199 Tw 9 0 0 9 336.38 417.321 Tm [(Brantig)10.1 (an OC, Mueller E, Kr)10 (ess MB)10 (. A s)10 (ur)10 (gic)10 (a)10 (l a)10 (ppr)10 (o)10 (a)10 (ch to )]TJ 0 Tw 0 -1.2 Td [(p)10 (ulm)10 (on)10 (ary em)10 (ph)15.1 (y)10 (s)5 (em)10 (a. )]TJ /T1_2 1 Tf [(A)25 (m Rev Resp)5.1 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 502.2297 406.521 Tm (1959)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 520.1535 406.521 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 521.9714 406.521 Tm (80)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 530.9333 406.521 Tm (:)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 532.7512 406.521 Tm (194)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 546.194 406.521 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 548.6599 406.521 Tm (206)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 562.1028 406.521 Tm (.)Tj -25.08 -1.2 Td ( )Tj 0.453 Tw 0 -1.2 Td [(C)30 (ooper JD)40 (, T)50 (rulock EP)50 (, T)50 (ri)10 (anta\037llo)10 (u AN)30 (, et a)10 (l. Bil)10 (atera)10 (l )]TJ 0.509 Tw 0 -1.2 Td [(pn)10 (e)10 (um)10 (ectom)15.1 (y \(v)20 (ol)15 (um)10 (e r)10 (eduction\) f)15 (or chr)10 (onic obstructi)20 (v)20 (e )]TJ 0.045 Tw 0 -1.2 Td [(p)10 (ulm)10 (on)10 (ary )0.5 (di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. )]TJ /T1_2 1 Tf 0.041 Tw 8.398 0 Td [(J Thor)20 (ac C)30 (ar)20.1 (dio)20 (v)15 (as)10 (c S)9.9 (ur)20.1 (g)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 514.8081 363.321 Tm (1995)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 532.7319 363.321 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 534.5499 363.321 Tm (109)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 547.9927 363.321 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 550.9625 363.321 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 555.4435 363.321 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 560.2313 363.321 Tm (106)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 573.6741 363.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.38 352.521 Tm (116)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 349.8228 352.521 Tm [(. \()10 (di)10 (s)5 (c)10 (ussion )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 398.6292 352.521 Tm (116)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 412.072 352.521 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 414.5379 352.521 Tm (119)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 427.9807 352.521 Tm (\).)Tj -10.178 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.3766 341.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.3385 341.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.9944 341.7209 Tm (1016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.015 Tc 0.015 Tw 9 0 0 9 438.9182 341.7209 Tm (/S)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 447.7111 341.7209 Tm (0022)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 465.6348 341.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 468.1007 341.7209 Tm (5223)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 486.0244 341.7209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 488.9943 341.7209 Tm (95)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 497.9562 341.7209 Tm (\))Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 500.9261 341.7209 Tm (70426)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 523.3308 341.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 525.7967 341.7209 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_2 1 Tf 0.114 Tw 9 0 0 9 336.38 320.121 Tm [(Issues )0.6 (Relating )0.6 (to )0.5 (Medicar)20.1 (e)19.9 (\222s )0.6 (C)30 (o)20 (v)5 (er)20 (ag)10 (e )0.5 (P)20 (olicy: )0.6 (Hearing )0.6 (Bef)20 (or)20 (e )]TJ 0.095 Tw 0 -1.2 Td [(the )0.5 (S)10 (ubco)10.1 (mmittee )0.6 (on )0.5 (Health )0.5 (o)15 (f )0.6 (the )0.5 (Ho)10 (us)10 (e )0.6 (C)30 (o)10 (mmittee )0.6 (on )0.5 (W)65 (ay)10 (s )]TJ 0.041 Tw 0 -1.2 Td (and Means)Tj /T1_1 1 Tf 0 Tw (, )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 383.0418 298.521 Tm (105)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.045 Tw 9 0 0 9 396.4846 298.521 Tm [(th C)30 (on)10 (g)50 (, )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 0 Tw 8 0 0 8 431.1399 298.521 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.045 Tw 9 0 0 9 435.6208 298.521 Tm [(st S)10 (ess \()]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 467.0811 298.521 Tm (1997)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.045 Tw 9 0 0 9 485.0049 298.521 Tm [(\) \(testim)10.1 (on)15 (y of Bruc)10.1 (e C. )]TJ 0 Tw -16.514 -1.2 Td [(Vl)10 (a)10 (deck\). )]TJ 0.192 Tw 0 -2.4 Td [(W)15 (i)10 (s)5 (e RA)-19.9 (, Drumm)10 (on)10 (d MB)10 (. )0.5 (Th)10 (e r)10 (ole )0.5 (of NEE)20 (T in )0.5 (em)10 (ph)15 (y)10 (s)5 (em)10 (a )]TJ 0 Tw 0 -1.2 Td [(r)10 (es)5 (e)15 (ar)10 (ch. )]TJ /T1_2 1 Tf [(Pr)20 (oc A)25.1 (m Thor)20 (ac S)10 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1 36 644.8201 cm 0 0 m 255.6 0 l S Q q 1 0 0 1 35.28 580.22 cm 0 0 m 255.6 0 l S Q q 1 0 0 1 35.28 537.8192 cm 0 0 m 255.6 0 l S Q q 1 0 0 1 35.28 472.5808 cm 0 0 m 255.6 0 l S Q q 1 0 0 1 35.28 418.1004 cm 0 0 m 255.6 0 l S Q q 1 0 0 1 35.56 353.4996 cm 0 0 m 255.6 0 l S Q q 1 0 0 1 35.56 298.0192 cm 0 0 m 255.6 0 l S Q q 1 0 0 1 35.28 244.82 cm 0 0 m 255.6 0 l S Q BT 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.416 Tw 9 0 0 9 51.84 688.8001 Tm [(Th)10 (e Intermittent P)20 (ositi)20.1 (v)20 (e Pr)10 (ess)10 (ur)10 (e Br)10 (e)15 (athin)10 (g T)50 (ri)10 (a)10 (l Gr)10 (o)10 (up)20 (. )]TJ 0.31 Tw 0 -1.2 Td [(Intermittent positi)20 (v)20 (e pr)10 (ess)10 (ur)10 (e br)10 (e)15 (athin)10 (g th)10 (era)10.1 (p)15 (y of chr)10.1 (onic )]TJ 0.003 Tw 0 -1.2 Td [(obstructi)20.1 (v)19.9 (e )0.6 (p)10 (ulm)10 (on)10 (ary )0.5 (di)10.1 (s)4.9 (e)15 (a)10 (s)5.1 (e)9.9 (. )]TJ /T1_2 1 Tf 0.002 Tw 13.272 0 Td [(A)25 (nn Intern Med)]TJ /T1_1 1 Tf 0 Tw (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 232.6567 667.2001 Tm (1983)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 250.5805 667.2001 Tm (; )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 254.4908 667.2001 Tm (99)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 263.4526 667.2001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 266.4225 667.2001 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 270.9034 667.2001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 275.6913 667.2001 Tm (612)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 289.1341 667.2001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 51.84 656.4001 Tm (620)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 65.2828 656.4001 Tm [(. doi: https:/)120 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 143.0053 656.4001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 151.9672 656.4001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 153.6231 656.4001 Tm (7326)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 171.5468 656.4001 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 175.5517 656.4001 Tm (0003)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 193.4755 656.4001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 195.9414 656.4001 Tm (4819)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 213.8651 656.4001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 216.331 656.4001 Tm (99)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 225.2929 656.4001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 227.7588 656.4001 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 232.2397 656.4001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 234.7056 656.4001 Tm (612)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.177 Tw 9 0 0 9 51.84 634.8001 Tm [(T)60 (urn)10 (er J)40 (, W)55 (right E, M)20 (en)10 (dell)10 (a L, Anth)10 (oni)10 (s)5 (en N)30 (. Pr)10 (edictors of )]TJ 0.292 Tw 0 -1.2 Td [(p)10 (atient )0.5 (a)10 (dh)10 (er)10 (en)10 (c)10 (e to lon)10 (g-)-20 (term )0.5 (h)10 (om)10 (e n)10 (eb)10 (uli)10 (z)10 (er th)10 (era)10 (p)15 (y f)15 (or )]TJ 0.126 Tw 0 -1.2 Td [(C)20 (OPD)40 (. Th)10.1 (e IPPB Study Gr)10 (o)10.1 (up)19.9 (. Intermittent P)20 (ositi)20 (v)20 (e Pr)10 (ess)10 (ur)10 (e )]TJ 0 Tw 0 -1.2 Td [(Br)10 (e)15 (athin)10.1 (g)50 (. )]TJ /T1_2 1 Tf [(C)20 (hest)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 117.8269 602.4001 Tm (1995)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 135.7506 602.4001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 137.5686 602.4001 Tm (108)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 151.0114 602.4001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 153.9813 602.4001 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 158.4622 602.4001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 163.25 602.4001 Tm (394)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 176.6928 602.4001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 179.1587 602.4001 Tm (400)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 192.6015 602.4001 Tm (.)Tj -15.64 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.8366 591.6001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.7984 591.6001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.4543 591.6001 Tm (1378)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 154.3781 591.6001 Tm [(/)100 (ch)10 (est.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 179.1727 591.6001 Tm (108)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 192.6155 591.6001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 194.2715 591.6001 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 198.7524 591.6001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 200.4083 591.6001 Tm (394)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.069 Tw 9 0 0 9 51.8399 570.0001 Tm [(Anth)10 (oni)10.1 (s)5 (en NR)-20 (, W)55 (right E)20 (C, H)20 (odgkin JE. Pr)10 (ogn)10.1 (osi)10 (s in chr)10 (onic )]TJ -0.155 Tw 0 -1.2 Td [(obstructi)20.1 (v)19.9 (e p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. )]TJ /T1_2 1 Tf -0.141 Tw [(A)25 (m )0.5 (Rev )0.6 (Resp)5 (ir )0.5 (Dis)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 234.749 559.2001 Tm (1986)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 252.6728 559.2001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 254.4907 559.2001 Tm (133)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 267.9335 559.2001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 270.9034 559.2001 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 275.3843 559.2001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 280.1722 559.2001 Tm (14)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 289.1341 559.2001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 51.84 548.4001 Tm (20)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 60.8018 548.4001 Tm [(. doi: https:/)120.1 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 138.5243 548.4001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 147.4862 548.4001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 149.1421 548.4001 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 167.0659 548.4001 Tm [(/)90 (arr)10 (d.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 187.4865 548.4001 Tm (1986)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 205.4103 548.4001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 207.0662 548.4001 Tm (133)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 220.509 548.4001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 222.1649 548.4001 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 226.6459 548.4001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 228.3018 548.4001 Tm (14)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.292 Tw 9 0 0 9 51.8399 526.8001 Tm [(W)15 (il)10 (s)5 (on DO)40 (, R)10 (ogers RM, W)55 (right E)20 (C, Anth)10.1 (oni)10 (s)5 (en NR)-20 (. Body )]TJ 0.038 Tw 0 -1.2 Td [(w)5 (eight in chr)10 (onic obstructi)20 (v)20 (e p)10 (ulm)10 (on)10 (ary di)10.1 (s)5 (e)15 (a)10 (s)5 (e)10 (. Th)10 (e N)30 (ation)10 (a)10.1 (l )]TJ 0.25 Tw 0 -1.2 Td [(In)10 (stitutes )0.6 (of )0.6 (H)19.9 (e)15 (a)10 (lth )0.6 (Intermittent )0.6 (P)20 (ositi)20.1 (v)20 (e-Pr)10 (ess)10 (ur)10 (e )0.5 (Br)10 (e)15 (athin)10.1 (g )]TJ 0 Tw 0 -1.2 Td [(T)50 (ri)10 (a)10 (l. )]TJ /T1_2 1 Tf [(A)25 (m Rev Resp)5.1 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 146.1403 494.4001 Tm (1989)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 164.064 494.4001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 165.882 494.4001 Tm (139)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 179.3248 494.4001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 182.2946 494.4001 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 186.7756 494.4001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 191.5634 494.4001 Tm (1435)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 209.4872 494.4001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 211.953 494.4001 Tm (1438)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 229.8768 494.4001 Tm (.)Tj -19.782 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.8365 483.6001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.7984 483.6001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.4543 483.6001 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 154.3781 483.6001 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 186.8048 483.6001 Tm (139)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 200.2476 483.6001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 201.9035 483.6001 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 206.3844 483.6001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 208.0403 483.6001 Tm (1435)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.274 Tw 9 0 0 9 51.8399 462.0001 Tm [(C)30 (elli BR)-20 (, C)30 (ote C)20 (G, M)10 (arin J)15 (M, et a)10 (l. Th)10 (e body)-10 (-m)10 (a)10 (ss in)10 (de)10 (x, )]TJ 0.252 Tw 0 -1.2 Td [(air\035o)5 (w obstruction, dy)10 (s)10 (pn)10 (e)15 (a, an)10 (d e)10 (x)10 (er)10 (ci)10 (s)5 (e c)10 (a)10 (p)10 (a)10 (cit)15 (y in)10 (de)10 (x in )]TJ -0.019 Tw 0 -1.2 Td [(chr)10 (onic obstructi)20.1 (v)20 (e p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. )]TJ /T1_2 1 Tf -0.017 Tw [(N E)15 (ngl J Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 256.0335 440.4001 Tm (2004)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 273.9573 440.4001 Tm (; )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 277.6771 440.4001 Tm (350)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 291.5999 440.4001 Tm ( )Tj -26.64 -1.2 Td (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 54.8098 429.6001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 63.7717 429.6001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 68.5595 429.6001 Tm (1005)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 86.4833 429.6001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 88.9491 429.6001 Tm (1012)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 106.8729 429.6001 Tm [(. doi: https:/)120.1 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 184.5954 429.6001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 193.5573 429.6001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 195.2132 429.6001 Tm (1056)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 213.1369 429.6001 Tm [(/)-10 (N)-10 (EJ)5.1 (M)10 (oa)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 250.7385 429.6001 Tm (021322)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.074 Tw 9 0 0 9 51.8399 408.0001 Tm [(Puh)10 (an M)10 (A)-20 (, Gar)10 (ci)10.1 (a)9.9 (-)15.1 (A)20 (ym)10 (erich J)40 (, F)54.9 (r)10 (e)15 (y M, et a)10 (l. Exp)10 (an)10 (sion of th)10 (e )]TJ 0.318 Tw 0 -1.2 Td [(pr)10 (ogn)10 (ostic a)10 (ss)5 (essm)10 (ent of p)9.9 (atients with chr)10 (onic obstructi)20.1 (v)20 (e )]TJ 0.241 Tw 0 -1.2 Td [(p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e: th)10 (e upd)10 (ated BODE in)10.1 (de)10 (x an)10 (d th)10 (e ADO )]TJ 0 Tw 0 -1.2 Td [(in)10 (de)10 (x. )]TJ /T1_2 1 Tf [(L)10 (ancet)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 106.1449 375.6001 Tm (2009)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 124.0687 375.6001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.8866 375.6001 Tm (374)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 139.3294 375.6001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 142.2993 375.6001 Tm (9691)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 160.2231 375.6001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 165.0109 375.6001 Tm (704)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 178.4537 375.6001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 180.9196 375.6001 Tm (711)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 194.3624 375.6001 Tm (.)Tj -15.836 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.8365 364.8001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.7984 364.8001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.4543 364.8001 Tm (1016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.015 Tc 0.015 Tw 9 0 0 9 154.3781 364.8001 Tm (/S)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 163.171 364.8001 Tm (0140)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 181.0947 364.8001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 183.5606 364.8001 Tm (6736)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 201.4844 364.8001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 204.4542 364.8001 Tm (09)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 213.4161 364.8001 Tm (\))Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 216.386 364.8001 Tm (61301)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 238.7907 364.8001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 241.2566 364.8001 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.051 Tw 9 0 0 9 51.8399 343.2001 Tm [(V)70 (estbo J)40 (, E)20 (dw)15 (ar)10 (d)10 (s LD)40 (, S)10 (c)10 (an)10 (lon PD)40.1 (, th)10.1 (e E)20 (CLIPSE In)25 (v)20 (estig)10 (ators. )]TJ 0.08 Tw 0 -1.2 Td [(Ch)10 (an)10 (ges in f)15 (or)10 (c)10 (ed e)10 (xpiratory v)20 (ol)15 (um)10 (e in )]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 0 Tw 8 0 0 8 208.1216 332.4001 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.08 Tw 9 0 0 9 212.6025 332.4001 Tm [( s)5 (ec)10 (on)10 (d o)20 (v)20 (er tim)10 (e in )]TJ 0 Tw -17.863 -1.2 Td [(C)20 (OPD)40 (. )]TJ /T1_2 1 Tf [(N E)15 (ngl J Med)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 135.6197 321.6001 Tm (2011)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 153.5435 321.6001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 155.3615 321.6001 Tm (365)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 168.8043 321.6001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 171.7741 321.6001 Tm (13)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 180.736 321.6001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 185.5238 321.6001 Tm (1184)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 203.4476 321.6001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 205.9135 321.6001 Tm (1192)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 223.8372 321.6001 Tm (.)Tj -19.111 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.8365 310.8001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.7984 310.8001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.4543 310.8001 Tm (1056)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 154.3781 310.8001 Tm [(/)-10 (N)-10 (EJ)5.1 (M)10 (oa)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 191.9796 310.8001 Tm (1105482)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.242 Tw 9 0 0 9 51.8399 289.2001 Tm [(N)30 (a)10 (g)10 (ai A)-20 (, W)75 (est WW)90 (, P)25 (a)10 (ul JL, Thurl)10.1 (beck W)30 (M. Th)10 (e N)30 (ation)10 (a)10 (l )]TJ 0.25 Tw 0 -1.2 Td [(In)10 (stitutes )0.6 (of )0.6 (H)19.9 (e)15 (a)10 (lth )0.6 (Intermittent )0.6 (P)20 (ositi)20.1 (v)20 (e-Pr)10 (ess)10 (ur)10 (e )0.5 (Br)10 (e)15 (athin)10.1 (g )]TJ -0.108 Tw 0 -1.2 Td [(tri)10 (a)10 (l: )0.5 (p)10 (ath)10 (olog)5 (y )0.5 (studies. )0.5 (I. Interr)10 (el)10 (ation)10.1 (s)15 (hi)15 (p )0.5 (betw)5 (een m)10 (orph)10 (ologic )]TJ 0 Tw 0 -1.2 Td [(lesion)10 (s. )]TJ /T1_2 1 Tf [(A)25 (m Rev Resp)5.1 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 155.122 256.8001 Tm (1985)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 173.0457 256.8001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 174.8637 256.8001 Tm (132)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 188.3065 256.8001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 191.2764 256.8001 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 195.7573 256.8001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 200.5452 256.8001 Tm (937)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 213.988 256.8001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 216.4539 256.8001 Tm (945)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 229.8967 256.8001 Tm (. )Tj -19.784 -1.2 Td ( )Tj 0.05 Tw 0 -1.2 Td [(N)30 (a)10 (g)10 (ai A)-20 (, W)75 (est WW)90 (, Thurl)10 (beck W)30 (M. Th)10 (e N)30 (ation)10.1 (a)10 (l In)10 (stitutes of )]TJ -0.012 Tw 0 -1.2 Td [(H)20 (e)15 (a)10 (lth Intermittent P)20 (ositi)20 (v)20 (e-Pr)10.1 (ess)10 (ur)10 (e Br)10 (e)15 (athin)10.1 (g tri)10 (a)10 (l: p)10 (ath)10 (olog)5 (y )]TJ 0.125 Tw 0 -1.2 Td [(studies. II. C)30 (orr)10 (el)10 (ation betw)5 (een m)10 (orph)10 (ologic \037n)10 (din)10.1 (g)15 (s, clinic)10 (a)10 (l )]TJ 0.176 Tw 0 -1.2 Td [(\037n)10 (din)10 (g)15 (s, an)10 (d e)20 (viden)10 (c)10 (e of e)10 (xpiratory air)-15 (-\035o)5 (w obstruction. )]TJ /T1_2 1 Tf -0.025 Tc 0.025 Tw [(Am)-25 ( )]TJ 0 Tc 0 Tw 0 -1.2 Td [(Rev Resp)5.1 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 109.7177 192.0001 Tm (1985)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 127.6414 192.0001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 129.4594 192.0001 Tm (132)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 142.9022 192.0001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 145.8721 192.0001 Tm (5)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 150.353 192.0001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 155.1409 192.0001 Tm (946)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 168.5837 192.0001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 171.0496 192.0001 Tm (953)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 184.4924 192.0001 Tm (.)Tj -14.739 -1.2 Td ( )Tj 0.028 Tw 0 -1.2 Td [(W)75 (est WW)90 (, N)30 (a)10 (g)10 (ai A)-20 (, H)20 (odgkin JE, Thurl)10 (beck W)30 (M. 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Th)10 (e di)10 (a)10 (gn)10 (osi)10 (s of em)10 (ph)15 (y)10 (s)5 (em)10 (a. )]TJ /T1_2 1 Tf -0.025 Tc 0.025 Tw [(Am)-25 ( )]TJ 0 Tc 0 Tw 0 -1.2 Td [(Rev Resp)5.1 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 109.7177 138.0001 Tm (1987)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 127.6414 138.0001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 129.4594 138.0001 Tm (135)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 142.9022 138.0001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 145.8721 138.0001 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 150.353 138.0001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 155.1409 138.0001 Tm (123)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 168.5837 138.0001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 171.0496 138.0001 Tm (129)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 184.4924 138.0001 Tm (.)Tj -14.739 -1.2 Td ( )Tj 0.201 Tw 0 -1.2 Td [(M)10 (ats)10 (u)10 (b)10 (a K)-20 (, Ik)10 (ed)10 (a T)50 (, N)30 (a)10 (g)10 (ai A)-20 (, Thurl)10 (beck W)30 (M. Th)10 (e N)30 (ation)10 (a)10 (l )]TJ 0.25 Tw 0 -1.2 Td [(In)10 (stitutes )0.6 (of )0.6 (H)19.9 (e)15.1 (a)9.9 (lth )0.6 (Intermittent )0.6 (P)20 (ositi)20.1 (v)20 (e-Pr)10 (ess)10 (ur)10 (e )0.5 (Br)10 (e)15 (athin)10.1 (g )]TJ 0.278 Tw 0 -1.2 Td [(T)50 (ri)10 (a)10 (l: p)10 (ath)10 (olog)5.1 (y studies. IV)90 (. Th)10 (e destructi)20.1 (v)20 (e in)10 (de)10 (x. )]TJ /T1_2 1 Tf 0.254 Tw [(A)25 (m Rev )]TJ 0 Tw 0 -1.2 Td [(Resp)5 (ir Dis)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 94.0671 84.0001 Tm (1989)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 111.9909 84.0001 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 113.8088 84.0001 Tm (139)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 127.2516 84.0001 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 130.2215 84.0001 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 134.7025 84.0001 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 139.4903 84.0001 Tm (1439)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 157.414 84.0001 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 159.8799 84.0001 Tm (1445)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 177.8037 84.0001 Tm (.)Tj -13.996 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 125.8366 73.2001 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 134.7984 73.2001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 136.4543 73.2001 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 154.3781 73.2001 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 186.8048 73.2001 Tm (139)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 200.2476 73.2001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 201.9035 73.2001 Tm (6)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 206.3845 73.2001 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 208.0404 73.2001 Tm (1439)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 51.8399 51.6001 Tm ( )Tj /TT0 1 Tf 7.5 0 0 7.5 39.2252 689.5139 Tm (1.)Tj 0 -7.237 Td (2.)Tj -0.096 -8.613 Td (3.)Tj 0 -5.653 Td (4.)Tj 0 -8.698 Td (5.)Tj 0 -7.264 Td (6.)Tj -0.096 -8.613 Td (7.)Tj 0 -7.264 Td (8.)Tj 0.096 -7.227 Td (9.)Tj ET 0 0.1 0.15 0 scn /GS0 gs 36 699.12 255.6 20.88 re f BT 0 0 0 1 scn /GS1 gs /T1_3 1 Tf 14 0 0 14 40.5 704.3099 Tm (References)Tj /T1_1 1 Tf 0.245 Tw 9 0 0 9 336.24 708.921 Tm [(N)30 (a)10 (g)10 (ai A)-20 (, Y)70 (am)10 (a)20 (w)15.1 (a)10 (ki I, T)70 (a)10 (ki)10 (z)10 (a)20 (w)15 (a T)50 (, Thurl)10 (beck W)30 (M. Al)5 (v)20 (eol)10 (ar )]TJ -0.005 Tw 0 -1.2 Td [(atta)10.1 (chm)10 (ents in em)10 (ph)15 (y)10 (s)5 (em)10 (a of hum)10 (an l)15.1 (un)9.9 (g)15.1 (s. )]TJ /T1_2 1 Tf -0.004 Tw [(A)25 (m )0.5 (Rev )0.6 (Resp)5.1 (ir )0.6 (Dis)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.2401 687.321 Tm (1991)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 354.1638 687.321 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 355.9818 687.321 Tm (144)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 369.4246 687.321 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 372.3945 687.321 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 376.8754 687.321 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 381.6632 687.321 Tm (888)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 395.106 687.321 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 397.5719 687.321 Tm (891)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 411.0147 687.321 Tm (.)Tj -8.308 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2367 676.5209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1985 676.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 676.5209 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7782 676.5209 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 471.2049 676.5209 Tm (144)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 484.6477 676.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 486.3036 676.5209 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 490.7845 676.5209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 492.4405 676.5209 Tm (888)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.47 Tw 9 0 0 9 336.2401 654.921 Tm [(N)30 (a)10 (g)10 (ai A)-20 (, Thurl)10.1 (beck W)30 (M, K)20 (onn)10 (o K)-20 (. R)10.1 (es)10 (pon)10 (si)20 (v)20 (en)10 (ess an)10 (d )]TJ 0.613 Tw 0 -1.2 Td [(v)20 (ari)10 (a)10 (bilit)15.1 (y of )0.5 (air\035o)5 (w )0.5 (obstruction )0.5 (in )0.5 (chr)10 (onic )0.5 (obstructi)20.1 (v)19.9 (e )]TJ 0.03 Tw 0 -1.2 Td [(p)10 (ulm)10 (on)10 (ary di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. Clinic)10 (op)10 (ath)10 (ologic c)10 (orr)10 (el)10 (ati)20.1 (v)20 (e studies. )]TJ /T1_2 1 Tf 0.028 Tw [(A)25 (m )0.5 (J )]TJ 0 Tw 0 -1.2 Td [(Resp)5 (ir C)20 (rit C)30.1 (ar)20 (e Med)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 419.7046 622.5209 Tm (1995)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 437.6283 622.5209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 439.4463 622.5209 Tm (151)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 452.8891 622.5209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 455.8589 622.5209 Tm (3)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 460.3399 622.5209 Tm ( Pt )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 472.5616 622.5209 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 477.0426 622.5209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 481.8304 622.5209 Tm (635)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 495.2732 622.5209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 497.7391 622.5209 Tm (639)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 511.1819 622.5209 Tm (.)Tj -19.438 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2367 611.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1985 611.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 611.7209 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7782 611.7209 Tm [(/)80 (aj)-10 (rcc)-10.1 (m)-9.9 (/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 471.2049 611.7209 Tm (151)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 484.6477 611.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 486.3036 611.7209 Tm (3)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 490.7845 611.7209 Tm (_Pt_)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 508.1364 611.7209 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 512.6173 611.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 514.2732 611.7209 Tm (635)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.183 Tw 9 0 0 9 336.24 590.121 Tm [(Bh)10 (att SP)49.9 (, W)64.9 (a)10.1 (s)15 (hk)10 (o GR)-20 (, H)20 (o\034m)10 (an E)10 (A)-20 (, et a)10 (l. Im)10 (a)10 (gin)10.1 (g a)10 (dv)20 (an)10 (c)10 (es )]TJ 0.233 Tw 0 -1.2 Td [(in chr)10 (onic obstructi)20 (v)20 (e p)10 (ulm)10 (on)10 (ary di)9.9 (s)5.1 (e)14.9 (a)10.1 (s)5 (e)10 (. In)10 (sights fr)10 (om th)10 (e )]TJ 0.48 Tw 0 -1.2 Td [(Gen)10 (etic E)20 (pidemiolog)5.1 (y of Chr)10 (onic O)5 (bstructi)20 (v)20 (e Pulm)10 (on)10.1 (ary )]TJ 0.404 Tw 0 -1.2 Td [(Di)10 (s)5 (e)15 (a)10 (s)5 (e \()10 (C)20 (OPDGen)10.1 (e)10 (\) study)50 (. )]TJ /T1_2 1 Tf 0.369 Tw [(A)25 (m )0.5 (J )0.6 (Resp)5 (ir )0.5 (C)20 (rit )0.6 (C)30 (ar)20 (e )0.5 (Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.24 546.921 Tm (2019)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 354.1637 546.921 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 355.9817 546.921 Tm (199)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 369.4245 546.921 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 372.3944 546.921 Tm (3)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 376.8753 546.921 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 381.6632 546.921 Tm (286)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 395.106 546.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 397.5719 546.921 Tm (301)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 411.0147 546.921 Tm (.)Tj -8.308 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2366 536.121 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1985 536.121 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8544 536.121 Tm (1164)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7781 536.121 Tm [(/)40 (rcc)-10 (m)-10 (.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 462.7631 536.121 Tm (201807)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 489.6487 536.121 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 492.1146 536.121 Tm (1351)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 510.0384 536.121 Tm (SO)Tj 0.07 Tw -19.311 -2.4 Td [(H)20 (e\034n)10 (er JE. Th)10 (e story of o)10 (xy)20 (gen. )]TJ /T1_2 1 Tf 0.064 Tw [(Resp)5 (ir C)30 (ar)20 (e)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 513.0122 514.521 Tm (2013)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 530.936 514.521 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 532.754 514.521 Tm (58)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 541.7158 514.521 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 544.6857 514.521 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 549.1666 514.521 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 553.9545 514.521 Tm (18)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 562.9164 514.521 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 565.3823 514.521 Tm (31)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 574.3441 514.521 Tm (. )Tj -26.456 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2367 503.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1985 503.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 503.7209 Tm (4187)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.01 Tc 0.01 Tw 9 0 0 9 438.7782 503.7209 Tm [(/)40 (re)-10 (sp)-10 (ca)-9.9 (re.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 475.876 503.7209 Tm (01831)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.167 Tw 9 0 0 9 336.2401 482.121 Tm [(L)10 (e)20 (vin)10 (e BE, )0.5 (Bigelo)5 (w )0.5 (DB)10 (, H)20 (am)10 (stra )0.5 (RD)40 (, )0.5 (et a)10 (l. )0.5 (Th)10 (e r)10 (ole )0.5 (of lon)10.1 (g-)]TJ 0.527 Tw 0 -1.2 Td [(term c)10 (ontinuo)10.1 (us o)10 (xy)20 (gen a)10 (dmini)10 (stration in p)10 (atients with )]TJ 0.18 Tw 0 -1.2 Td [(chr)10 (onic airw)15.1 (a)25 (y obstruction with h)15.1 (y)10 (po)10 (x)10 (emi)10 (a. )]TJ /T1_2 1 Tf 0.164 Tw [(A)25 (nn Intern Med)]TJ /T1_1 1 Tf 0 Tw (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.2401 449.7209 Tm (1967)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 354.1638 449.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 355.9818 449.7209 Tm (66)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 364.9436 449.7209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 367.9135 449.7209 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 372.3945 449.7209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 377.1823 449.7209 Tm (639)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 390.6251 449.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 393.091 449.7209 Tm (650)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 406.5338 449.7209 Tm (.)Tj -7.81 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2367 438.921 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1985 438.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 438.921 Tm (7326)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.7782 438.921 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.7831 438.921 Tm (0003)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 460.7069 438.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 463.1728 438.921 Tm (4819)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 481.0965 438.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 483.5624 438.921 Tm (66)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 492.5243 438.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 494.9902 438.921 Tm (4)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 499.4711 438.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 501.937 438.921 Tm (639)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.22 Tw 9 0 0 9 336.2401 417.321 Tm [(P)20 (ett)15 (y TL, F)20 (inig)10 (an M)10 (M. Th)10 (e clinic)10 (a)10 (l e)19.9 (v)20 (a)10 (l)15.1 (uation of pr)10 (olon)10 (ged )]TJ 0.271 Tw 0 -1.2 Td [(am)10 (b)10 (ul)10 (atory )0.6 (o)10 (xy)20 (gen )0.5 (th)10 (era)10.1 (p)15 (y )0.5 (in )0.5 (p)10 (atients )0.6 (with )0.6 (chr)10 (onic )0.5 (airw)15.1 (a)25 (y )]TJ 0 Tw 0 -1.2 Td (obstruction. )Tj /T1_2 1 Tf [(A)25 (m J Med)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 426.4364 395.7209 Tm (1968)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 444.3602 395.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 446.1781 395.7209 Tm (45)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 455.14 395.7209 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 458.1099 395.7209 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 462.5908 395.7209 Tm (\):)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 467.3787 395.7209 Tm (242)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 480.8215 395.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 483.2874 395.7209 Tm (252)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 496.7302 395.7209 Tm (.)Tj -17.832 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2367 384.921 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1985 384.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 384.921 Tm (1016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 438.7782 384.921 Tm (/)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 442.7831 384.921 Tm (0002)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 460.7069 384.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 463.1728 384.921 Tm (9343)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 481.0965 384.921 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 484.0664 384.921 Tm (68)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 493.0283 384.921 Tm (\))Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 495.9982 384.921 Tm (90042)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 518.4028 384.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 520.8687 384.921 Tm (9)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.112 Tw 9 0 0 9 336.2401 363.321 Tm [(F)10 (len)10 (le)15 (y DC, Do)10 (ugl)10 (a)10.1 (s N)19.9 (J)40.1 (, Lam)10.1 (b D)40 (. N)15 (octurn)10 (a)10 (l h)15 (y)10 (po)10 (x)10 (emi)10 (a an)10 (d lon)10 (g-)]TJ 0.004 Tw 0 -1.2 Td [(term domicili)10 (ary o)10 (xy)20 (gen in bl)15 (ue an)10 (d blo)10 (ated br)10 (on)10 (chitics. )]TJ /T1_2 1 Tf 0 Tw [(C)20 (hest)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 336.2401 341.7209 Tm (1980)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 354.1638 341.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 355.9818 341.7209 Tm (77)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 364.9436 341.7209 Tm (:)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 366.7616 341.7209 Tm (305)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 380.2044 341.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 382.6703 341.7209 Tm (307)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 396.1131 341.7209 Tm [(. doi: https:/)120.1 (/)100 (doi.or)10.1 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 473.8356 341.7209 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 482.7975 341.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 484.4534 341.7209 Tm (1378)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 502.3771 341.7209 Tm [(/)100 (ch)10 (est.)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 527.1718 341.7209 Tm (77)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 536.1337 341.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 537.7896 341.7209 Tm (2)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 542.2705 341.7209 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 543.9265 341.7209 Tm (305)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0.137 Tw 9 0 0 9 336.2401 320.121 Tm [(R)10 (eport of th)10 (e M)20 (edic)10 (a)10 (l R)10 (es)5 (e)15 (ar)10 (ch C)30 (o)10 (un)10 (cil w)5 (orkin)10 (g p)10 (art)15.1 (y)50 (. L)10 (on)10 (g-)]TJ 0.468 Tw 0 -1.2 Td [(term )0.6 (domicili)10 (ary )0.6 (o)10 (xy)20 (gen )0.5 (th)10 (era)10.1 (p)15 (y )0.5 (in )0.6 (chr)10 (onic )0.5 (h)15 (y)10 (po)10 (xic )0.6 (c)10 (or )]TJ 0.234 Tw 0 -1.2 Td [(p)10 (ulm)10 (on)10 (a)10 (le c)10 (om)10 (plic)10 (atin)10 (g chr)10 (onic br)10 (on)10 (chiti)10 (s an)10 (d em)10 (ph)15 (y)10 (s)5.1 (em)9.9 (a. )]TJ /T1_2 1 Tf 0 Tw 0 -1.2 Td [(L)10 (ancet)]TJ /T1_1 1 Tf (. )Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 365.8133 287.7209 Tm (1981)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 383.7371 287.7209 Tm (;)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf 8 0 0 8 385.5551 287.7209 Tm (1)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 9 0 0 9 390.036 287.7209 Tm (:)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 391.8539 287.7209 Tm (681)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 405.2968 287.7209 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 407.7626 287.7209 Tm (685)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 421.2054 287.7209 Tm (.)Tj -9.441 -1.2 Td [(doi: https:/)120.1 (/)100 (doi.or)10 (g/)]TJ 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 410.2367 276.921 Tm (10)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 419.1985 276.921 Tm (.)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 420.8545 276.921 Tm (1016)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.015 Tc 0.015 Tw 9 0 0 9 438.7782 276.921 Tm (/S)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 447.5711 276.921 Tm (0140)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 465.4949 276.921 Tm (-)Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 467.9608 276.921 Tm (6736)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 485.8845 276.921 Tm (\()Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 488.8544 276.921 Tm (81)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0 Tc 0 Tw 9 0 0 9 497.8163 276.921 Tm (\))Tj 0 0 0 0.9 scn /GS0 gs /TT0 1 Tf -0.06 Tc 0.06 Tw 8 0 0 8 500.7861 276.921 Tm (91970)Tj 0 0 0 1 scn /GS1 gs /T1_1 1 Tf -0.05 Tc 0.05 Tw 9 0 0 9 523.1908 276.921 Tm (-X)Tj 0 Tc -0.003 Tw -20.772 -2.4 Td [(T)10 (imm)10 (s RM, Kh)10.1 (a)10 (ja F)20 (U)40 (, W)15 (illi)10 (am)10 (s G)30 (W)90 (, an)10 (d th)10.1 (e N)15 (octurn)10.1 (a)10 (l Oxy)20 (gen )]TJ 0.497 Tw 0 -1.2 Td [(Th)10 (era)10 (p)15 (y T)50 (ri)10 (a)10 (l Gr)10 (o)10 (up)20 (. 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(. )0.5 ( W)75 (e n)10 (o)10 ( )]TJ 0.214 Tw 0 -1.2 Td [(lon)10 (ger us)5 (e positi)20 (v)20 (e pr)10 (ess)10 (ur)10 (e br)9.9 (e)15 (athin)10 (g m)10 (a)10 (chin)10 (es to)10 ( )]TJ 0.158 Tw 0 -1.2 Td [(deli)20 (v)20 (er br)10 (on)10 (ch)10 (odil)10 (ator a)10 (er)10 (os)5 (ol)10 (s. C)30 (ontinuo)10 (us o)10 (xy)20 (gen)10 ( )]TJ 0.217 Tw 0 -1.2 Td [(s)10 (upplem)10 (entation f)15 (or s)5 (e)19.9 (v)20 (er)10 (el)5 (y h)15 (y)10 (po)10 (x)10 (emic p)10 (atients i)10 (s)10 ( )]TJ 0.008 Tw 0 -1.2 Td [(c)10 (on)10 (sider)10 (ed stan)10 (d)10 (ar)10 (d of c)10 (ar)10 (e)10 (. S)10 (cr)10 (eenin)10 (g a)10 (s)5 (ym)10 (ptom)10 (atic)10 ( )]TJ 0.037 Tw 0 -1.2 Td [(sm)10 (ok)10 (ers f)15 (or air\035o)5 (w obstruction an)10 (d enr)10 (ollin)10 (g th)10 (em in)10 ( )]TJ 0.049 Tw 0 -1.2 Td [(an e\034)15 (ecti)20 (v)19.9 (e sm)10 (okin)10 (g c)10 (ess)5 (ation pr)10 (ogram h)10.1 (a)10 (s potenti)10 (a)10 (l)10 ( )]TJ 0.408 Tw 0 -1.2 Td [(f)15 (or dimini)9.9 (s)15.1 (hin)10 (g th)10 (e di)10 (s)5 (e)15 (a)10 (s)5 (e im)9.9 (p)10 (a)10 (ct an)10 (d r)10 (educin)10 (g)10 ( )]TJ 0.163 Tw 0 -1.2 Td [(C)20 (OPD m)10 (orbidit)15 (y an)10 (d m)10 (orta)10 (lit)15.1 (y lon)10 (g into th)10 (e futur)10 (e)10 (.)10 ( )403 ( )]TJ 0.442 Tw 0 -1.2 Td [(L)30 (un)10 (g v)20 (ol)15 (um)10 (e r)10 (eduction s)10 (ur)10 (gery i)10 (s n)10 (o)5 (w a)25 (v)20 (ail)10 (a)10 (ble)10 ( )]TJ 0.4 Tw 0 -1.2 Td [(to highl)4.9 (y s)5 (elected )0.5 (p)9.9 (atients an)10 (d w)5 (e h)10 (a)25 (v)20 (e a good)10 ( )]TJ 0.165 Tw 0 -1.2 Td [(un)10 (derstan)10 (din)10 (g of p)10 (atients w)5 (h)10 (o will n)10 (ot ben)10 (e\037t fr)10 (om)10 ( )]TJ -0.043 Tw 0 -1.2 Td [(thi)10 (s )0.5 (pr)10 (oc)10 (edur)10 (e)10 (. )0.5 (C)30 (ontinuo)10 (us )0.5 (o)10 (xy)20 (gen )0.5 (in )0.5 (in)10 (di)20 (vidua)10 (l)9.9 (s with)10 ( )]TJ -0.031 Tw 0 -1.2 Td [(m)10 (oderate r)10 (estin)10 (g h)15 (y)10 (po)10 (x)10 (emi)10 (a or am)10 (b)10 (ul)9.9 (atory o)9.9 (xy)20 (gen f)15 (or)10 ( )]TJ -0.045 Tw 0 -1.2 Td [(in)10 (di)20 (vidua)10 (l)10 (s with C)19.9 (OPD w)5 (h)10 (o des)5 (aturate with e)10 (x)10 (er)9.9 (ci)10 (s)5 (e i)10 (s)10 ( )]TJ 0 Tw 0 -1.2 Td [(n)10 (o lon)10 (ger c)10 (on)10 (sider)10 (ed a m)10 (an)10 (d)10 (atory tr)10 (e)15 (atm)10 (ent.)10 ( )-10 ( )]TJ 0.432 Tw 0.818 -1.2 Td [(On)10 (e of th)10 (e m)10 (a)10 (jor a)10.1 (c)9.9 (c)10 (om)10 (pli)10 (s)15 (hm)10 (ents of NHLBI)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 572.001 195.18 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.009 Tw 11 0 0 11 320.4 181.98 Tm [(s)10 (pon)10 (s)5 (or)10 (ed l)10 (an)10 (dm)10 (ark tri)10 (a)10 (l)9.9 (s i)10 (s th)10 (e in\035)15 (uen)10 (c)9.9 (e on stan)10 (d)10 (ar)10 (d)10 ( )]TJ 0.572 Tw 0 -1.2 Td [(pr)10 (oc)10 (edur)10 (es f)15 (or c)9.9 (on)10 (ductin)10 (g C)20 (OPD clinic)10 (a)10 (l tri)10 (a)10 (l)10 (s.)10 ( )812 ( )]TJ 0.369 Tw 0 -1.2 Td [(Clinic)10 (a)10 (l tri)10 (a)10.1 (l m)10 (eth)10 (od)10 (s th)10 (at h)10 (a)25 (v)20 (e been a)10.1 (d)9.9 (a)10 (pted or)10 ( )]TJ 0.103 Tw 0 -1.2 Td [(de)20 (v)20 (eloped b)15 (y NHLBI clinic)10 (a)10 (l tri)10 (a)10 (l)10 (s h)10 (a)25 (v)20 (e been widel)4.9 (y)10 ( )]TJ -0.015 Tw 0 -1.2 Td [(a)10 (c)10 (c)10 (epted in r)10 (es)5 (e)15 (ar)10 (ch f)15 (or C)20 (OPD an)10 (d r)10 (el)10 (ated c)10 (on)10 (dition)9.9 (s.)10 ( )225 ( )]TJ 0 Tw 0 -1.2 Td [(Th)10 (es)5 (e pr)10 (oc)10 (edur)10 (es in)10 (cl)15 (ude:)]TJ 0.32 Tw 0.818 -1.2 Td [(\225 )0.5 (C)19.9 (riteri)10 (a )0.5 (b)15 (y )0.5 (w)5 (hich C)20 (OPD )0.5 (i)10 (s de\037n)10 (ed )0.5 (in clinic)10 (a)10 (l)10 ( )]TJ 0.014 Tw 0 -1.2 Td [(r)10 (es)5 (e)15 (ar)10 (ch, s)10 (peci\037c)10 (a)10 (ll)5 (y th)10 (e us)5 (e of FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 499.8347 88.917 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.014 Tw 11 0 0 11 503.8115 89.58 Tm [(/F)20 (V)30 (C ratio less)10 ( )]TJ -0.01 Tw -15.856 -1.2 Td [(th)10 (an )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 353.4125 76.38 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 359.6136 76.38 Tm (.)Tj /TT0 1 Tf 10 0 0 10 361.7475 76.38 Tm (7)Tj /T1_1 1 Tf 0.01 Tc 11 0 0 11 367.9487 76.38 Tm [( a)10 (s a de\037nition of air\035o)5 (w limitation. \(LHS\))10 ( )]TJ ET 0 0.1 0.15 0 scn /GS0 gs 320.4 434.86 255.6 25.14 re f BT 0 0 0 1 scn /GS1 gs /T1_2 1 Tf 0 Tc 14 0 0 14 324.9 442.18 Tm (Summary )Tj /T1_1 1 Tf 0.01 Tc -0.02 Tw 11 0 0 11 36 710.6401 Tm [(H)20 (g \226 or )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 72.6629 710.6401 Tm (55-60)Tj /T1_1 1 Tf 0.01 Tc -0.02 Tw 11 0 0 11 101.4666 710.6401 Tm [( mm H)20 (g with e)20 (viden)10 (c)10 (e of c)10 (om)10 (plic)10 (ation)10 (s)10 (\))10 ( )]TJ 0.219 Tw -5.952 -1.2 Td [(ar)10 (e n)10 (ot gen)10 (era)10 (ll)5 (y c)10 (on)10 (sider)10 (ed c)10 (an)10 (did)10 (ates f)15 (or o)10 (xy)20 (gen)10 ( )]TJ 0.068 Tw 0 -1.2 Td [(tr)10 (e)15 (atm)10 (ent. T)60 (w)5 (o c)10 (ontr)10 (olled tri)10 (a)10 (l)10 (s h)10 (a)25 (v)20 (e been p)10 (u)10 (bli)10 (s)15 (h)10 (ed)10 ( )]TJ -0.016 Tw 0 -1.2 Td [(th)10 (at h)9.9 (a)25.1 (v)19.9 (e enr)10.1 (olled in)10 (di)20 (vidua)10 (l)9.9 (s with interm)10 (edi)10 (ate le)20 (v)20 (el)10 (s)10 ( )]TJ 0.19 Tw 0 -1.2 Td [(of h)15 (y)10 (po)10 (x)10 (emi)10 (a.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 104.228 662.5021 Tm (58,59)Tj /T1_1 1 Tf 0.01 Tc 0.19 Tw 11 0 0 11 127.084 657.8401 Tm [( N)15 (eith)10 (er study s)15 (h)10 (o)5 (w)5 (ed a s)10 (urvi)19.9 (v)20 (a)10 (l)10 ( )]TJ 0.152 Tw -8.28 -1.2 Td [(ben)10 (e\037t, b)10 (ut th)10 (e tri)10 (a)10 (l)10 (s w)5 (er)10 (e un)10 (derpo)5 (w)5 (er)10 (ed to e)10 (x)10 (cl)15 (ude)10 ( )]TJ 0.128 Tw 0 -1.2 Td [(a m)10 (orta)10 (lit)15 (y r)9.9 (eduction. S)10 (upplem)10 (enta)10 (l o)10 (xy)20 (gen in th)10 (es)5 (e)10 ( )]TJ -0.008 Tw 0 -1.2 Td [(p)10 (atients h)10 (a)25 (v)20 (e n)10 (ot s)15 (h)10 (o)5 (wn c)10 (on)10 (si)10 (stent)15.1 (l)4.9 (y ben)9.9 (e\037ci)9.9 (a)10 (l e\034)15 (ects)10 ( )]TJ 0.136 Tw 0 -1.2 Td [(in term)10 (s of e)10 (x)10 (er)10 (ci)10 (s)5 (e c)10 (a)10 (p)10 (a)10 (cit)15 (y)50 (, s)5 (ym)10 (ptom)10 (s, an)10 (d qua)10 (lit)15 (y)10 ( )]TJ 0.377 Tw 0 -1.2 Td [(of lif)15 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 69.1523 596.5021 Tm (60-62)Tj /T1_1 1 Tf 0.01 Tc 0.377 Tw 11 0 0 11 92.6618 591.8401 Tm [( On)10 (e obs)5 (erv)20 (ation)10 (a)10 (l study s)15 (h)10 (o)5 (w)5 (ed th)10 (at)10 ( )]TJ 0.261 Tw -5.151 -1.2 Td [(o)10 (xy)20 (gen pr)10 (es)5 (cri)15 (ption)10 (s th)10 (at did n)10 (ot c)10 (om)10 (pl)4.9 (y with th)10 (e)10 ( )]TJ 0.021 Tw 0 -1.2 Td [(M)20 (edic)10 (ar)10 (e g)10 (uidelin)10 (es w)15 (a)10 (s a)9.9 (ss)4.9 (oci)10 (ated with an in)10 (cr)10 (e)15 (a)10 (s)5 (ed)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(m)10 (orta)10 (lit)15 (y)50 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 80.9013 556.9021 Tm (63)Tj /T1_1 1 Tf 0.01 Tc 0.172 Tw 11 0 0 11 45 539.04 Tm [(Bec)10 (a)10 (us)5 (e th)10 (e us)5 (e of o)10 (xy)20 (gen in C)20 (OPD p)10 (atients w)15 (a)10 (s)10 ( )]TJ 0.266 Tw -0.818 -1.2 Td [(c)10 (on)10 (sider)10 (ed an im)10 (portant g)10 (a)10 (p in th)10 (e e)20 (viden)10 (c)10 (e b)10 (a)10 (s)5 (e)10 ( )]TJ 0.213 Tw 0 -1.2 Td [(f)15 (or tr)10 (e)15 (atin)10 (g C)20 (OPD)40 (, th)10 (e NIH)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 175.5304 512.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.213 Tw 11 0 0 11 179.5294 512.6401 Tm [(NHLBI, in c)10 (on)10 (jun)10 (ction)10 ( )]TJ 0.241 Tw -13.048 -1.2 Td [(with th)10 (e C)10 (M)15 (S)10 (, c)9.9 (on)25.1 (v)19.9 (en)10 (ed a w)5 (ork)10 (s)15 (h)10 (op to r)10 (e)20 (vie)10 (w th)10 (e)10 ( )]TJ 0.613 Tw 0 -1.2 Td [(c)10 (umul)10 (ati)20 (v)20 (e e)20 (viden)10 (c)10 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 142.1193 490.9021 Tm (64)Tj /T1_1 1 Tf 0.01 Tc 0.613 Tw 11 0 0 11 152.242 486.2401 Tm [( F)79.9 (o)10 (ur clinic)10 (a)10 (l tri)9.9 (a)10.1 (l)9.9 (s w)5 (er)10 (e)10 ( )]TJ 0.152 Tw -10.567 -1.2 Td [(r)10 (ec)10 (omm)10 (en)10 (ded in)10 (cl)15 (udin)10 (g on)10 (e in p)10 (atients with C)20 (OPD)10 ( )]TJ 0.009 Tw 0 -1.2 Td [(an)10 (d m)10 (oderate le)20 (v)20 (el)10 (s of )0.5 (h)15 (y)9.9 (po)9.9 (x)10 (emi)10 (a )0.5 (an)10 (d on)10 (e in p)10 (atients)10 ( )]TJ 0.296 Tw 0 -1.2 Td [(with )0.5 (e)10 (x)10 (er)10 (ci)10 (s)5 (e )0.5 (in)10 (duc)10 (ed )0.5 (h)15 (y)9.9 (po)10 (x)9.9 (emi)10 (a. )0.5 ( )0.5 (Th)10 (e L)10 (on)10.1 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 265.5023 446.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 269.5013 446.6401 Tm [(term)10 ( )]TJ 0.514 Tw -21.227 -1.2 Td [(Oxy)20 (gen T)50 (r)10 (e)15 (atm)10 (ent T)50 (ri)10 (a)10 (l \(L)40 (O)19.9 (TT\) a)10 (ddr)10 (ess)5 (ed both)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(i)10 (ss)10 (ues.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 67.0856 424.9021 Tm (65)Tj /T1_1 1 Tf 0.01 Tc 0.299 Tw 11 0 0 11 77.2084 420.2401 Tm [( Durin)10 (g th)10 (e c)10 (o)10 (urs)5 (e of th)10 (e tri)10 (a)10 (l, th)10 (e study)10 ( )]TJ 0.338 Tw -3.746 -1.2 Td [(design w)15 (a)10 (s m)10 (odi\037ed thr)10 (o)10 (ugh a s)5 (eries of pr)10 (otoc)9.9 (ol)9.9 ( )]TJ 0.256 Tw 0 -1.2 Td [(am)10 (en)10 (dm)10 (ents. Initi)10 (a)10 (ll)5 (y)49.9 (, on)10 (l)5 (y m)10 (oderatel)5 (y h)15 (y)9.9 (po)10 (x)9.9 (emic)9.9 ( )]TJ 0.091 Tw 0 -1.2 Td [(p)10 (atients w)5 (er)10 (e enr)10 (olled, b)10 (ut bec)10 (a)10 (us)5 (e of e)15 (arl)5 (y di\036c)10 (ult)15 (y)10 ( )]TJ 0.543 Tw 0 -1.2 Td [(in enr)10 (ollin)10 (g p)9.9 (atients, th)10 (e in)10 (dic)10 (ation of e)10 (x)10 (er)10 (ci)10 (s)5 (e)10 ( )]TJ 0.519 Tw 0 -1.2 Td [(des)5 (aturation w)15 (a)10 (s a)10 (dded. Th)10 (e prim)10 (ary o)10 (utc)10 (om)10 (e)10 ( )]TJ 0 -1.2 Td [(w)15 (a)10 (s ch)10 (an)10 (ged fr)10 (om m)10 (orta)10 (lit)15 (y to a c)10 (om)10 (posite of)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(h)10 (os)10 (pita)10 (li)10 (z)10 (ation)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 106.4425 327.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.141 Tw 11 0 0 11 110.4415 327.8401 Tm [(fr)10 (ee s)10 (urvi)20 (v)20 (a)10 (l. Bec)10 (a)10 (us)5 (e th)10 (e e)20 (v)20 (ent rate)10 ( )]TJ 0.142 Tw -6.767 -1.2 Td [(f)15 (or th)10.1 (e prim)10 (ary o)10 (utc)10.1 (om)9.9 (e w)15 (a)10 (s antici)15 (p)9.9 (ated to in)10 (cr)9.9 (e)15 (a)10.1 (s)4.9 (e)10 ( )]TJ 0.488 Tw 0 -1.2 Td [(s)10 (u)10 (bstanti)10 (a)10 (ll)5 (y)50 (, th)10 (e s)5 (am)10 (ple si)10 (z)10 (e w)15 (a)10 (s r)10 (educ)10 (ed fr)10 (om)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 288.2401 Tm (3108)Tj /T1_1 1 Tf 0.01 Tc 0.114 Tw 11 0 0 11 60.8047 288.2401 Tm ( to )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 78.0486 288.2401 Tm (1347)Tj /T1_1 1 Tf 0.01 Tc 0.114 Tw 11 0 0 11 102.8533 288.2401 Tm [(. After interim an)10 (a)10 (l)5 (y)10 (s)5 (es s)15 (h)10 (o)5 (w)5 (ed better)10 ( )]TJ 0.312 Tw -6.078 -1.2 Td [(th)10 (an e)10 (xpected a)10 (dh)10 (er)10 (en)10 (c)10 (e to tr)10 (e)15 (atm)9.9 (ent a)10 (ssignm)10 (ent,)10 ( )]TJ 0.221 Tw 0 -1.2 Td [(th)10 (e s)5 (am)10 (ple si)10 (z)10 (e w)15.1 (a)9.9 (s furth)10 (er r)10 (educ)10 (ed to )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 236.4505 261.8401 Tm (737)Tj /T1_1 1 Tf 0.01 Tc 0.221 Tw 11 0 0 11 255.054 261.8401 Tm [(. After)10 ( )]TJ -0.01 Tw -19.914 -1.2 Td [(s)5 (cr)10 (eenin)10 (g )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 87.5698 248.6401 Tm (1759)Tj /T1_1 1 Tf 0.01 Tc 0.227 Tw 11 0 0 11 112.3745 248.6401 Tm [( p)10 (artici)15 (p)10 (ants, a s)5 (am)10 (ple of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 245.7694 248.6401 Tm (738)Tj /T1_1 1 Tf 0.237 Tw 11 0 0 11 264.3729 248.6401 Tm [( w)-5 (e)-10 (re )]TJ 0.01 Tc 0.029 Tw -20.761 -1.2 Td [(ran)10 (domi)10 (z)10 (ed to r)10 (ec)10 (ei)20 (v)20 (e eith)10 (er n)10 (o s)10 (upplem)10 (enta)10 (l o)10 (xy)20 (gen)10 ( )]TJ 0.059 Tw 0 -1.2 Td [(or a tailor)10 (ed o)10 (xy)20 (gen pr)10 (es)5 (cri)15 (ption. F)80 (ort)15 (y)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 226.3517 222.2401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.059 Tw 11 0 0 11 230.3507 222.2401 Tm [(s)5 (e)20 (v)20 (en clinics)10 ( )]TJ -0.01 Tw -17.668 -1.2 Td (in )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 49.8175 209.0401 Tm (37)Tj /T1_1 1 Tf 0.01 Tc 0.154 Tw 11 0 0 11 62.2199 209.0401 Tm [( loc)10 (ation)10 (s enr)10 (olled )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 157.3629 209.0401 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.154 Tw 11 0 0 11 163.5641 209.0401 Tm [( or m)10 (or)10 (e p)10 (atients into th)10 (e)10 ( )]TJ -0.035 Tw -11.597 -1.2 Td [(tri)10 (a)10 (l. Th)10 (e tailor)10 (ed pr)10 (es)5 (cri)15 (ption w)15.1 (a)9.9 (s f)15 (or )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 216.593 195.8401 Tm (24-)Tj /T1_1 1 Tf 0.01 Tc -0.035 Tw 11 0 0 11 232.9944 195.8401 Tm [(h)10 (o)10 (ur o)10 (xy)19.9 (gen)10 ( )]TJ -0.012 Tw -17.909 -1.2 Td [(in th)10 (os)5 (e with r)10 (estin)10 (g m)10 (oderate h)15 (y)10 (po)10 (x)10 (emi)10 (a an)10 (d o)10 (xy)20 (gen)10 ( )]TJ 0.337 Tw 0 -1.2 Td [(durin)10 (g a)10 (cti)20 (vit)15 (y an)10 (d s)14.9 (leep f)15 (or th)10 (os)5 (e with e)10 (x)10 (er)10 (ci)10 (s)5 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 287.601 169.4401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.022 Tw 11 0 0 11 36 156.2401 Tm [(in)10 (duc)10 (ed des)5 (aturation. P)25 (artici)15 (p)10 (ants w)5 (er)10 (e f)15 (ollo)5 (w)5 (ed f)15 (or )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 285.3988 156.2401 Tm (1)Tj /T1_1 1 Tf 11 0 0 11 291.6 156.2401 Tm ( )Tj 0.01 Tc -0.01 Tw -23.236 -1.2 Td (to )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 47.9516 143.0401 Tm (6)Tj /T1_1 1 Tf 0.01 Tc -0.012 Tw 11 0 0 11 54.1527 143.0401 Tm [( )0.5 (y)20 (e)15 (ars with )0.5 (a )0.5 (c)10 (omm)10 (on )0.5 (clos)4.9 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 183.2767 143.0401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.012 Tw 11 0 0 11 187.2757 143.0401 Tm [(o)10 (ut )0.5 (d)10 (ate an)10 (d a )0.5 (m)10 (edi)10 (an)10 ( )]TJ -0.01 Tw -13.752 -1.2 Td [(f)15 (ollo)5 (w)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 64.7646 129.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 11 0 0 11 68.7636 129.8401 Tm (up period of )Tj /TT0 1 Tf 0 Tc 10 0 0 10 129.0977 129.8401 Tm (18)Tj /T1_1 1 Tf 11 0 0 11 141.5 129.8401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 143.6339 129.8401 Tm (4)Tj /T1_1 1 Tf 0.01 Tc 11 0 0 11 149.8351 129.8401 Tm [( m)10 (onth)10 (s.)10 ( )]TJ 0.73 Tw -9.53 -1.2 Td [(R)10 (es)10 (ults of th)10 (e study in)10 (dic)10 (ated th)10 (at o)10 (xy)20 (gen)10 ( )]TJ 0.194 Tw -0.818 -1.2 Td [(pr)10 (es)5 (cri)15 (ption)10 (s )0.5 (did n)10 (ot a\034)15 (ect )0.5 (th)10 (e )0.5 (prim)10 (ary )0.5 (o)10 (utc)10 (om)10 (e of)10 ( )]TJ 0.281 Tw 0 -1.2 Td [(tim)10 (e to )0.5 (h)10 (os)10 (pita)10 (li)10 (z)10 (ation )0.5 (or de)15 (ath.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 198.6351 94.9021 Tm (66)Tj /T1_1 1 Tf 0.01 Tc 0.281 Tw 11 0 0 11 208.7579 90.2401 Tm [( M)20 (or)10 (eo)20 (v)20 (er)30 (, th)10 (er)10 (e)10 ( )]TJ 0.416 Tw -15.705 -1.2 Td [(w)15 (a)10 (s )0.5 (n)10 (o )0.5 (di)10 (s)5 (c)9.9 (ern)10 (a)10 (ble )0.5 (tr)10 (e)15 (atm)10 (ent )0.5 (e\034)15 (ect )0.5 (on )0.5 (eith)10 (er )0.5 (of)10 ( )]TJ 0.443 Tw 25.855 57.6 Td [(th)10 (e )0.5 (c)10 (om)9.9 (pon)10 (ents, or )0.5 (C)20 (OPD)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 459.2581 710.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.443 Tw 11 0 0 11 463.2571 710.6401 Tm [(r)10 (el)10 (ated h)10 (os)10 (pita)10 (li)10 (z)10 (ation,)10 ( )]TJ 0.077 Tw -12.987 -1.2 Td [(qua)10 (lit)15 (y of lif)15 (e or )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 401.3616 697.4401 Tm (6-)Tj /T1_1 1 Tf 0.01 Tc 0.077 Tw 11 0 0 11 411.5618 697.4401 Tm [(minute w)15 (a)10 (lk di)10 (stan)10 (c)10 (e)10 (. Th)10 (er)10 (e w)5 (er)10 (e)10 ( )]TJ 0.246 Tw -8.287 -1.2 Td [(n)10 (o s)10 (u)10 (bgr)10 (o)10 (ups th)10 (at w)5 (er)10 (e dem)10 (on)10 (stra)10 (bl)5 (y ben)10 (e\037ted b)15 (y)10 ( )]TJ 0.216 Tw 0 -1.2 Td [(th)10 (e o)10 (xy)20 (gen tr)9.9 (e)15 (atm)9.9 (ent. Alth)10 (o)10 (ugh th)10 (es)5 (e w)5 (er)10 (e highl)5 (y)10 ( )]TJ 0.48 Tw 0 -1.2 Td [(c)10 (on)10 (si)10 (stent an)10 (d stati)10 (stic)10 (a)10 (ll)5 (y r)10 (ob)10 (ust \037n)10 (din)10 (g)15 (s, th)9.9 (er)10 (e)10 ( )]TJ -0.114 Tw 0 -1.2 Td [(s)15 (h)10 (o)10 (uld be r)10 (ec)9.9 (ognition th)10 (at highl)5 (y s)5 (ym)9.9 (ptom)10 (atic p)10 (atients)9.9 ( )]TJ 0.066 Tw 0 -1.2 Td [(m)10 (a)25 (y h)10 (a)25 (v)20 (e r)10 (efus)5 (ed to be ran)10 (domi)10 (z)10 (ed to th)10 (e n)10 (o o)10 (xy)20 (gen)10 ( )]TJ 0.085 Tw 0 -1.2 Td [(gr)10 (o)10 (up)20 (. )0.5 ( )0.5 (Thus, b)10.1 (a)9.9 (s)5 (ed )0.5 (on )0.5 (thi)10 (s )0.5 (study)50 (, )0.5 (it )0.5 (i)10 (s )0.5 (still )0.5 (a )0.5 (ration)10 (a)10 (l)10 ( )]TJ 0.002 Tw 0 -1.2 Td [(a)10 (ppr)10 (o)10 (a)10 (ch to o\034)15 (er m)10 (oderatel)5 (y h)15 (y)10 (po)10 (x)10 (emic s)4.9 (ym)10 (ptom)9.9 (atic)10 ( )]TJ 0.186 Tw 0 -1.2 Td [(p)10 (atients a tri)10 (a)10 (l of o)10 (xy)20 (gen s)10 (upplem)10 (entation with th)10 (e)10 ( )]TJ 0.091 Tw 0 -1.2 Td [(un)10 (derstan)10 (din)10 (g th)10 (at it will n)10 (ot lik)10 (el)5 (y im)10 (pr)9.9 (o)20 (v)20 (e s)10 (urvi)20 (v)20 (a)10 (l)10 ( )]TJ 0.181 Tw 0 -1.2 Td [(or r)9.9 (educ)10 (e h)10 (os)10 (pita)10 (li)10 (z)10 (ation)10 (s. If th)10 (e in)10 (di)20 (vidua)10 (l p)10 (atient)10 ( )]TJ 0.034 Tw 0 -1.2 Td [(does n)10 (ot h)10 (a)25 (v)20 (e s)5 (ym)10 (ptom)10 (atic im)10 (pr)9.9 (o)20.1 (v)19.9 (em)10 (ent or objecti)20 (v)19.9 (e)10 ( )]TJ 0.263 Tw 0 -1.2 Td [(e)20 (viden)10 (c)10 (e of im)10 (pr)10 (o)20 (v)19.9 (ed e)10 (x)10 (er)10 (ci)9.9 (s)5 (e toleran)10 (c)10 (e)10 (, th)10 (en it i)10 (s)9.9 ( )]TJ -0.05 Tw 0 -1.2 Td [(r)10 (e)15 (a)10 (s)5 (on)10 (a)10 (ble to di)10 (s)5 (c)10 (ontinue th)10 (e o)10 (xy)20 (gen.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 496.7245 530.5021 Tm (67)Tj /T1_1 1 Tf 0.01 Tc -0.05 Tw 11 0 0 11 506.8473 525.8401 Tm [( In thi)10 (s r)10 (eg)10 (ar)10 (d,)10 ( )]TJ 0.404 Tw -16.95 -1.2 Td [(a s)10 (u)10 (bs)5 (et an)9.9 (a)10.1 (l)5 (y)9.9 (si)10.1 (s of L)40 (O)20 (TT p)10 (artici)15.1 (p)9.9 (ants in)10 (dic)10 (ated)10 ( )]TJ 0.082 Tw 0 -1.2 Td [(th)10 (at a positi)20 (v)19.9 (e attitude to)5 (w)15 (ar)10 (d th)10 (e us)5 (e of o)10 (xy)20 (gen w)15 (a)10 (s)10 ( )]TJ 0 Tw 0 -1.2 Td [(a)10 (ss)5 (oci)10 (ated with better a)10 (dh)10 (er)10 (en)10 (c)10 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 8.162 0 0 8.162 477.3018 490.9021 Tm (68)Tj ET endstream endobj 21 0 obj <>stream q /GS0 gs 0 TL/Fm0 Do Q BT /CS0 cs 0 0 0 0 scn /GS0 gs /T1_0 1 Tf 0.01 Tc -0.01 Tw 12 0 0 12 14.1401 772 Tm [(3)-42 (64)]TJ ET q 0 Tc 0 Tw 0 g 0 TL/Fm1 Do Q BT 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.043 Tw 11 0 0 11 320.4 248.7402 Tm [(Alth)10 (o)10 (ugh th)10 (e tr)10 (e)15 (ated pop)10 (ul)10 (ation in th)10 (e MRC tri)10 (a)10 (l an)10 (d)10 ( )]TJ 0.251 Tw 0 -1.2 Td [(NO)20 (TT \()20 (s)4.9 (ee a)10 (bo)20 (v)20 (e)10 (\) w)15 (a)10.1 (s sm)10 (a)10 (ll b)15 (y tod)9.9 (a)25.1 (y)-10 (\222)34.9 (s stan)10 (d)10 (ar)10 (d)10 (s,)10 ( )]TJ 0.343 Tw 0 -1.2 Td [(it pr)9.9 (o)20 (vided str)10 (on)10 (g e)20 (viden)10 (c)10 (e f)15 (or a s)10 (urvi)19.9 (v)20 (a)10 (l ben)10 (e\037t)10 ( )]TJ 0.478 Tw 0 -1.2 Td [(in C)20 (OPD p)10 (atients with s)5 (e)20 (v)20 (er)10 (e r)10 (estin)10 (g r)10 (oom air)10 ( )]TJ 0.244 Tw 0 -1.2 Td [(h)15 (y)10 (po)10 (x)10 (emi)10 (a. Th)10 (er)9.9 (ef)15.1 (or)9.9 (e)10 (, lon)10 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 460.1318 195.9402 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.244 Tw 11 0 0 11 464.1308 195.9402 Tm [(term o)10 (xy)20 (gen h)10 (a)10 (s been)10 ( )]TJ 0.121 Tw -13.066 -1.2 Td [(c)10 (on)10 (sider)10 (ed )0.5 (th)10 (e )0.5 (stan)10 (d)10 (ar)10 (d of )0.5 (c)10 (ar)10 (e )0.5 (f)15 (or )0.5 (s)10 (uch )0.5 (in)10 (di)20 (vidua)10 (l)10 (s.)10 ( )361 ( )]TJ 0.412 Tw 0 -1.2 Td [(It w)15 (a)10 (s un)10 (kn)10 (o)5 (wn w)5 (h)10 (eth)10 (er p)9.9 (atients with less th)10 (an)10 ( )]TJ 0.053 Tw 0 -1.2 Td [(s)5 (e)20 (v)20 (er)10 (e h)14.9 (y)10 (po)10 (x)10 (emi)10 (a or th)10 (os)5 (e with e)10 (x)10 (er)10 (ci)10 (s)5 (e des)5 (aturation)10 ( )]TJ 0.089 Tw 0 -1.2 Td [(might ben)10 (e\037t fr)10 (om tailor)10 (ed o)10 (xy)20 (gen pr)10 (es)5 (cri)15 (ption)10 (s. It)10 ( )]TJ 0.226 Tw 0 -1.2 Td [(h)10 (a)10 (s been c)9.9 (omm)9.9 (on pra)10 (ctic)10 (e to pr)10 (es)5 (cri)10 (be o)10 (xy)20 (gen f)14.9 (or)10 ( )]TJ 0.361 Tw 0 -1.2 Td [(p)10 (atients with e)10 (x)10 (er)10 (ci)10 (s)5 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 430.9645 116.7402 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.361 Tw 11 0 0 11 434.9635 116.7402 Tm [(in)10 (duc)10 (ed des)5 (aturation. Thi)10 (s)10 ( )]TJ -0.02 Tw -10.415 -1.2 Td [(pra)10 (ctic)10 (e h)10 (a)10 (s been s)10 (upported b)15 (y th)10 (e M)20 (edic)10 (ar)10 (e c)9.9 (o)20 (v)20 (era)10 (ge)10 ( )]TJ -0.023 Tw 0 -1.2 Td [(rules. P)25 (atients with m)10 (oderate le)20 (v)20 (el)10 (s of h)15 (y)10 (po)10 (x)10 (emi)10 (a th)10 (at)10 ( )]TJ 0.138 Tw 0 -1.2 Td [(do n)10 (ot m)10 (eet th)10 (e NO)20 (TT criteri)10 (a \(P)25 (aO)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 500.8203 76.4772 Tm (2)Tj /T1_1 1 Tf -0.01 Tc 0.158 Tw 11 0 0 11 504.7971 77.1402 Tm [( a)-9.9 (b)-20 (ove)-20 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 541.0899 77.1402 Tm (55)Tj /T1_1 1 Tf 0.148 Tw 11 0 0 11 553.4922 77.1402 Tm [( m)-10 (m )]TJ ET 0 0.1 0.15 0 scn /GS0 gs 320.4 264.02 255.6 25.14 re f BT 0 0 0 1 scn /GS1 gs /T1_2 1 Tf 0 Tw 14 0 0 14 324.9 271.34 Tm [(Long-)41 (T)82 (erm O)20 (xygen T)82.1 (reatment T)82 (rial)]TJ /T1_1 1 Tf 0.01 Tc 0.001 Tw 11 0 0 11 36 710.6401 Tm [(at p)10 (artic)10.1 (ul)10 (ar )0.5 (ri)10 (s)15 (k f)15 (or s)10 (ur)10 (gic)10 (a)10 (l m)10 (orta)10 (lit)15.1 (y)49.9 (. )0.5 ( Thi)10 (s s)10 (u)10 (bgr)10 (o)10 (up)10 ( )]TJ 0 Tc -0.046 Tw 0 -1.2 Td [(had)-10 ( a)-10 ( )]TJ /TT0 1 Tf 0 Tw 10 0 0 10 63.0049 697.4401 Tm (16%)Tj /T1_1 1 Tf 0.01 Tc -0.056 Tw 11 0 0 11 84.4063 697.4401 Tm [( s)10 (ur)10 (gic)10 (a)10 (l m)9.9 (orta)10 (lit)15 (y with limited s)4.9 (ym)10 (ptom)9.9 (atic)10 ( )]TJ 0.133 Tw -4.401 -1.2 Td [(ben)10 (e\037t in th)10 (os)5 (e w)4.9 (h)10 (o s)10 (urvi)20 (v)20 (ed s)10 (ur)10 (gery)49.9 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 222.1027 688.9021 Tm (44)Tj /T1_1 1 Tf 0.01 Tc 0.133 Tw 11 0 0 11 232.2254 684.2401 Tm [( Thi)10 (s \223high)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 287.601 684.2401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.061 Tw 11 0 0 11 36 671.0402 Tm [(ri)10 (s)15 (k\224 s)10 (u)10 (bgr)10 (o)10 (up w)15 (a)10 (s th)10 (er)10 (ef)15 (or)10 (e e)10 (x)10 (cl)15 (uded fr)10 (om c)10 (ontinuin)10 (g)10 ( )]TJ 0.024 Tw 0 -1.2 Td [(in th)10 (e tri)10 (a)10 (l, an unus)10 (ua)10 (l oc)10 (c)10 (urr)10 (en)10 (c)9.9 (e f)15 (or a s)10 (u)10 (bgr)10 (o)9.9 (up th)10 (at)10.1 ( )]TJ 0 Tw 0 -1.2 Td [(w)15 (a)10 (s n)10 (ot pr)10 (e)]TJ /TT0 1 Tf 0 Tc 10 0 0 10 89.9432 644.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 93.9423 644.6401 Tm [(s)10 (peci\037ed.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 138.3928 649.3021 Tm (45)Tj /T1_1 1 Tf 11 0 0 11 148.5156 644.6401 Tm ( )Tj 0.01 Tc 0.2 Tw -9.411 -1.2 Td [(A)15 (t th)10 (e en)10 (d of th)10 (e tri)10 (a)10 (l, th)10 (e p)10 (artici)15 (p)10 (ants w)5 (h)10 (o w)5 (er)10 (e)10 ( )]TJ 0.378 Tw -0.818 -1.2 Td [(n)10 (ot in th)10 (e high)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 118.3026 618.2401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.378 Tw 11 0 0 11 122.3016 618.2401 Tm [(ri)10 (s)15 (k s)10 (u)10 (bgr)10 (o)10 (up h)10 (a)10 (d an a)10 (c)10 (c)10 (epta)10 (ble)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 605.0402 Tm (2)Tj /T1_1 1 Tf 11 0 0 11 42.2012 605.0402 Tm (.)Tj /TT0 1 Tf 10 0 0 10 44.3351 605.0402 Tm (2%)Tj /T1_1 1 Tf 11 0 0 11 59.5353 605.0402 Tm ( )Tj /TT0 1 Tf 10 0 0 10 66.2761 605.0402 Tm (30-)Tj /T1_1 1 Tf 0.01 Tc 0.373 Tw 11 0 0 11 82.6775 605.0402 Tm [(d)10 (a)25 (y s)10 (ur)10 (gic)10 (a)10 (l m)10 (orta)10 (lit)15 (y)50 (. A)15.1 (t )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 227.1284 605.0402 Tm (90)Tj /T1_1 1 Tf 0.383 Tw 11 0 0 11 239.5307 605.0402 Tm [( da)15 (ys)-10 (,)-10 ( t)-10 (he )]TJ 0.01 Tc 0.255 Tw -18.503 -1.2 Td [(s)10 (ur)10 (gic)10 (a)10 (l gr)10 (o)10 (up h)10 (a)10 (d signi\037c)10 (ant)15 (l)5 (y high)10 (er de)15 (ath rates)10 ( )]TJ -0.01 Tw 0 -1.2 Td (with )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 59.9238 578.6401 Tm (5)Tj /T1_1 1 Tf 11 0 0 11 66.1249 578.6401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 68.2588 578.6401 Tm (2%)Tj /T1_1 1 Tf 0.01 Tc 0.061 Tw 11 0 0 11 83.459 578.6401 Tm [( m)10 (orta)10 (lit)15 (y c)9.9 (om)10 (p)10 (ar)10 (ed to )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 196.4137 578.6401 Tm (1)Tj /T1_1 1 Tf 11 0 0 11 202.6149 578.6401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 204.7488 578.6401 Tm (5%)Tj /T1_1 1 Tf 0.01 Tc 0.061 Tw 11 0 0 11 219.949 578.6401 Tm [( in th)10 (e m)10 (edic)10 (a)10 (l)10 ( )]TJ 0.107 Tw -16.723 -1.2 Td [(gr)10 (o)10 (up)20 (. )0.5 ( A)15 (t )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 88.8825 565.4401 Tm (24)Tj /T1_1 1 Tf 0.015 Tc 0.102 Tw 11 0 0 11 101.2848 565.4401 Tm [( )0.5 (m)15 (o)5 (n)5 (t)5 (h)15 (s)5 (,)5 ( )0.5 (h)15 (o)10 (w)10 (e)25 (v)25 (e)5 (r)35 (,)5 ( )0.5 (th)10 (e )-4.5 (s)10 (ur)10 (gic)9.9 (a)10.1 (l )-4.5 (p)10 (atients)15 ( )]TJ 0.01 Tc 0.28 Tw -5.935 -1.2 Td [(h)5 (a)5 (d)-5 ( )-4.8 (a)-5 ( )-4.8 (s)-5 (i)-5 (g)-4.9 (n)-5 (i)-5 (\037)-5 (c)5 (a)-5 (n)-5 (t)10 (ly)-5 ( )-4.8 (g)-5 (r)5 (e)10 (a)-5 (t)-5 (e)-5 (r)-5 ( pr)10 (ob)10 (a)10 (bilit)15 (y of clinic)9.9 (a)10 (ll)4.9 (y)10 ( )]TJ 0.277 Tw 0 -1.2 Td [(m)10 (e)15 (anin)10 (gful )0.5 (im)10 (pr)10 (o)20 (v)19.9 (em)10 (ents in )0.5 (e)10 (x)10 (er)10 (ci)10 (s)5 (e )0.5 (c)9.9 (a)10.1 (p)9.9 (a)10 (cit)14.9 (y an)10 (d)10 ( )]TJ 0.032 Tw 0 -1.2 Td [(qua)10 (lit)15 (y of lif)15.1 (e)9.9 (. Im)10 (portant)15 (l)5 (y)50 (, s)10 (u)10 (bgr)10 (o)10 (ups w)5 (er)10 (e identi\037ed)10 ( )]TJ 0.002 Tw 0 -1.2 Td [(w)5 (h)10 (o )0.5 (w)5 (er)10 (e )0.6 (m)9.9 (ost )0.5 (lik)10 (el)5 (y )0.5 (to )0.6 (ben)10 (e\037t )0.5 (fr)10 (om )0.5 (s)10 (ur)10 (gery)50 (. )0.5 ( )0.6 (In )0.5 (th)10 (os)5 (e)10 ( )]TJ 0.151 Tw 0 -1.2 Td [(with pr)9.9 (edomin)9.9 (ant)15 (l)5 (y upper lobe em)10 (ph)15 (y)10 (s)5 (em)10 (a an)9.9 (d lo)5 (w)10 ( )]TJ 0 Tc 0.3 Tw 0 -1.2 Td [(exe)-10 (rc)-10 (is)-5 (e)-10 ( capac)-10 (i)-10 (t)5 (y)40 (,)-10 ( )]TJ /TT0 1 Tf 0 Tw 10 0 0 10 126.8996 486.2401 Tm (30%)Tj /T1_1 1 Tf 0.01 Tc 0.29 Tw 11 0 0 11 148.301 486.2401 Tm [( s)15 (h)10 (o)5 (w)5 (ed an im)10 (pr)10 (o)20 (v)20 (em)10 (ent in)10.1 ( )]TJ 0 Tc 0.234 Tw -10.209 -1.2 Td [(exe)-10 (rc)-10 (is)-5 (e)-10 ( )0.5 (capac)-10 (i)-10 (t)5 (y)-9.9 ( )0.5 (a)-10 (nd)-10 ( )]TJ /TT0 1 Tf 0 Tw 10 0 0 10 146.6424 473.0401 Tm (48%)Tj /T1_1 1 Tf 0.01 Tc 0.224 Tw 11 0 0 11 168.0437 473.0401 Tm [( )0.5 (s)15 (h)10 (o)5 (w)5 (ed )0.5 (im)10 (pr)10 (o)20 (v)20 (em)10 (ent )0.5 (in)10 ( )]TJ 0.039 Tw -12.004 -1.2 Td [(qua)10 (lit)15 (y of lif)15 (e c)10 (om)10 (p)10 (ar)10 (ed to )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 164.9079 459.8401 Tm (0%)Tj /T1_1 1 Tf 0.01 Tc 0.039 Tw 11 0 0 11 180.1081 459.8401 Tm [( an)10 (d )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 203.9496 459.8401 Tm (9%)Tj /T1_1 1 Tf 0.01 Tc 0.039 Tw 11 0 0 11 219.1497 459.8401 Tm [( r)10 (es)10 (pecti)20 (v)20 (el)4.9 (y in)10 ( )]TJ -0.071 Tw -16.65 -1.2 Td [(th)10 (e m)10 (edic)10 (a)10 (ll)5 (y tr)10 (e)15 (ated arm.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 156.6707 451.3021 Tm (46)Tj /T1_1 1 Tf 0.01 Tc -0.071 Tw 11 0 0 11 166.7935 446.6401 Tm [( P)25 (artici)15 (p)10 (ants w)5 (er)10 (e f)15 (ollo)5 (w)5 (ed)10 ( )]TJ 0.25 Tw -11.89 -1.2 Td [(f)15 (or s)10 (urvi)20 (v)19.9 (a)10 (l f)15 (or a m)10 (edi)10 (an of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 182.5268 433.4401 Tm (4)Tj /T1_1 1 Tf 11 0 0 11 188.728 433.4401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 190.8618 433.4401 Tm (3)Tj /T1_1 1 Tf 0.01 Tc 0.25 Tw 11 0 0 11 197.063 433.4401 Tm [( y)20 (e)15 (ars, s)15 (h)10 (o)5 (win)9.9 (g an)10 ( )]TJ 0.028 Tw -14.642 -1.2 Td [(o)20 (v)20 (era)10 (ll better s)10 (urvi)20 (v)20 (a)10 (l in th)10 (e s)10 (ur)10 (gic)10 (a)10 (l gr)10 (o)10 (up c)9.9 (om)9.9 (p)10 (ar)9.9 (ed)9.9 ( )]TJ -0.037 Tw 0 -1.2 Td [(to th)10 (e m)10 (edic)10 (a)10 (l gr)10 (o)10 (up des)10 (pite th)10 (e initi)10 (a)10 (ll)5 (y in)10 (cr)10 (e)15 (a)10 (s)5 (ed )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 275.1987 407.0401 Tm (30-)Tj /T1_1 1 Tf 0.01 Tc -0.047 Tw 11 0 0 11 36 393.8401 Tm [(d)10 (a)25 (y s)10 (ur)10 (gic)10 (a)10 (l m)10 (orta)10.1 (lit)15 (y \()]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 143.9053 393.8401 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 150.1064 393.8401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 152.2403 393.8401 Tm (11)Tj /T1_1 1 Tf 0.01 Tc -0.047 Tw 11 0 0 11 164.6427 393.8401 Tm [( de)15 (ath)10 (s/)50 (pers)5 (on)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 234.905 393.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.047 Tw 11 0 0 11 238.9041 393.8401 Tm [(y)20 (e)15 (ar v)20 (ers)10 (us)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 380.6401 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 42.2012 380.6401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 44.3351 380.6401 Tm (13)Tj /T1_1 1 Tf 0.01 Tc 11 0 0 11 56.7374 380.6401 Tm [( de)15 (ath)10 (s/)50 (pers)5 (on)]TJ /TT0 1 Tf 0 Tc 10 0 0 10 127.5216 380.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 131.5206 380.6401 Tm [(y)20 (e)15 (ar)30 (, )]TJ /T1_3 1 Tf 0 Tc 0 Tw 2.231 0 Td (P)Tj /T1_1 1 Tf 0.01 Tc 0.57 0 Td ( = )Tj /TT0 1 Tf 0 Tc 10 0 0 10 172.0552 380.6401 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 178.2563 380.6401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 180.3902 380.6401 Tm (02)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 192.7926 380.6401 Tm (\).)Tj /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 198.6663 385.3021 Tm (47)Tj /T1_1 1 Tf 0.01 Tw 11 0 0 11 208.7891 380.6401 Tm ( )Tj 0.01 Tc 0.107 Tw -14.89 -1.2 Td [(Bec)10 (a)10 (us)5 (e th)10 (e study w)15 (a)10 (s lin)10 (k)10 (ed to M)19.9 (edic)9.9 (ar)9.9 (e fun)10 (din)10 (g)50 (,)10 ( )]TJ 0.134 Tw -0.818 -1.2 Td [(a rigor)10 (o)10 (us c)10 (ost)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 108.8984 354.2401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.134 Tw 11 0 0 11 112.8974 354.2401 Tm [(e\034)15 (ecti)20 (v)20 (en)10 (ess an)10 (a)10 (l)5 (y)9.9 (si)9.9 (s w)15.1 (a)9.9 (s c)10 (on)10 (ducted)10 ( )]TJ 0.1 Tw -6.991 -1.2 Td [(in p)10 (ara)10 (llel with th)10 (e tri)10 (a)10 (l.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 152.8864 345.7021 Tm (48)Tj /T1_1 1 Tf 0.01 Tc 0.1 Tw 11 0 0 11 163.0092 341.0401 Tm [( Thi)10 (s an)10 (a)10 (l)5 (y)10 (si)10 (s s)15 (h)10 (o)5 (w)5 (ed th)10 (at)10 ( )]TJ 0.226 Tw -11.546 -1.2 Td [(th)10 (e c)10 (ost per qua)10 (lit)15 (y)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 134.1381 327.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.226 Tw 11 0 0 11 138.1371 327.8401 Tm [(a)10 (djusted lif)15 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 198.4924 327.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.226 Tw 11 0 0 11 202.4914 327.8401 Tm [(y)20 (e)15 (ar depen)9.9 (ded on)10 ( )]TJ 0.135 Tw -15.136 -1.2 Td [(th)10 (e )0.5 (an)10 (a)10 (l)5 (y)15 (tic tim)9.9 (efram)9.9 (e)10 (. )0.5 ( )0.5 (Bec)10 (a)10 (us)5 (e of )0.5 (th)10 (e )0.5 (am)10 (orti)10 (z)10 (ation)10 ( )]TJ 0.234 Tw 0 -1.2 Td [(of th)10 (e l)10 (ar)10 (ge initi)10 (a)10 (l c)10 (ost of s)10 (ur)10 (gery)50 (, th)10 (e in)10 (cr)10 (em)10 (enta)10 (l)10 ( )]TJ 0.016 Tw 0 -1.2 Td [(c)10 (osts )0.5 (w)5 (er)10 (e )0.5 (pr)10 (ojected )0.5 (to )0.5 (fa)10 (ll )0.5 (o)20 (v)19.9 (er )0.5 (tim)10 (e)10 (. )0.5 ( )0.5 (In )0.5 (th)10 (e )0.5 (\037rst )0.5 (y)20 (e)15 (ar)30 (,)10 ( )]TJ 0.263 Tw 0 -1.2 Td [(th)10 (e tota)10 (l c)10 (osts f)15 (or th)10 (e m)10 (edic)10 (a)10 (l gr)9.9 (o)10 (up w)15 (a)10 (s )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 252.2591 275.0401 Tm ($23)Tj /T1_1 1 Tf 11 0 0 11 270.8626 275.0401 Tm (,)Tj /TT0 1 Tf 10 0 0 10 272.9965 275.0401 Tm (371)Tj /T1_1 1 Tf 11 0 0 11 291.6 275.0401 Tm ( )Tj 0.01 Tc 0.305 Tw -23.236 -1.2 Td [(c)10 (om)10 (p)10 (ar)10 (ed to )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 104.3806 261.8401 Tm ($71)Tj /T1_1 1 Tf 11 0 0 11 122.9841 261.8401 Tm (,)Tj /TT0 1 Tf 10 0 0 10 125.118 261.8401 Tm (515)Tj /T1_1 1 Tf 0.01 Tc 0.305 Tw 11 0 0 11 143.7215 261.8401 Tm [( f)15 (or s)10 (ur)10 (gery)50 (. After th)10 (e initi)10 (a)10 (l)10 ( )]TJ -0.01 Tw -9.793 -1.2 Td (post)Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 56.4596 248.6401 Tm (-)Tj /T1_1 1 Tf 11 0 0 11 60.4586 248.6401 Tm [(su)-10 (rg)-10 (i)-10 (cal)-10 ( )]TJ /TT0 1 Tf 10 0 0 10 102.2305 248.6401 Tm (6-)Tj /T1_1 1 Tf 0.01 Tc 0.133 Tw 11 0 0 11 112.4307 248.6401 Tm [(m)10 (onth )0.5 (period, )0.6 (tota)10 (l )0.5 (h)10 (e)15 (a)10 (lth )0.5 (c)10 (ar)10 (e )0.6 (c)9.9 (osts)10 ( )]TJ -0.003 Tw -6.948 -1.2 Td [(in th)10 (e s)10 (ur)10 (gic)10 (a)10 (l gr)10 (o)10 (up w)5 (er)10 (e lo)5 (w)5 (er up to y)20 (e)15 (ar )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 239.7129 235.4401 Tm (3)Tj /T1_1 1 Tf 0.007 Tw 11 0 0 11 245.9141 235.4401 Tm ( \()Tj /TT0 1 Tf 0 Tw 10 0 0 10 252.2591 235.4401 Tm ($36)Tj /T1_1 1 Tf 11 0 0 11 270.8626 235.4401 Tm (,)Tj /TT0 1 Tf 10 0 0 10 272.9965 235.4401 Tm (199)Tj /T1_1 1 Tf 11 0 0 11 291.6 235.4401 Tm ( )Tj 0.01 Tc -0.01 Tw -23.236 -1.2 Td [(v)20 (ers)10 (us )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 72.7355 222.2401 Tm ($49)Tj /T1_1 1 Tf 11 0 0 11 91.339 222.2401 Tm (,)Tj /TT0 1 Tf 10 0 0 10 93.4729 222.2401 Tm (628)Tj /T1_1 1 Tf 0.01 Tc 0.319 Tw 11 0 0 11 112.0764 222.2401 Tm [(\). Thi)10 (s c)10 (ost)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 176.9512 222.2401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.319 Tw 11 0 0 11 180.9502 222.2401 Tm [(s)5 (a)25 (vin)10 (g w)15 (a)10 (s a)10 (ss)5 (oci)10 (ated)10 ( )]TJ 0.192 Tw -13.177 -1.2 Td [(with f)15 (e)10 (w)5 (er h)10 (os)10 (pita)10 (l )0.5 (d)10 (a)25 (y)9.9 (s )0.5 (in th)10 (e post)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 215.1932 209.0401 Tm (-)Tj /T1_1 1 Tf -0.23 Tw 11 0 0 11 219.1922 209.0401 Tm [(su)-10 (rg)-10 (i)-10 (cal)-10 ( )-431.6 (g)-9.9 (rou)-10 (p)10 (. )]TJ 0.01 Tc 0.015 Tw -16.654 -1.2 Td [(Th)10 (e in)10 (cr)10 (em)10 (enta)10 (l c)10 (ost)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 136.0956 195.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.015 Tw 11 0 0 11 140.0946 195.8401 Tm [(e\034)15 (ecti)20 (v)20 (en)10 (ess ratio f)15 (or L)59.9 (VRS w)15 (a)10 (s)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 182.6401 Tm ($190)Tj /T1_1 1 Tf 11 0 0 11 60.8047 182.6401 Tm (,)Tj /TT0 1 Tf 10 0 0 10 62.9386 182.6401 Tm (000)Tj /T1_1 1 Tf 0.01 Tc -0.028 Tw 11 0 0 11 81.5421 182.6401 Tm [( per qua)10 (lit)15 (y)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 134.5874 182.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.028 Tw 11 0 0 11 138.5865 182.6401 Tm [(a)10 (djusted lif)15 (e y)20 (e)15 (ar)30 (. H)19.9 (o)5 (w)5 (e)20 (v)20 (er)30 (, o)20 (v)20 (er)10 ( )]TJ -0.01 Tw -9.326 -1.2 Td (a )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 45.864 169.4401 Tm (10-)Tj /T1_1 1 Tf 0.01 Tc 0.162 Tw 11 0 0 11 62.2653 169.4401 Tm [(y)20 (e)15 (ar tim)10 (efram)10 (e thi)10 (s w)15 (a)10 (s pr)10 (ojected to fa)10 (ll to an)9.9 ( )]TJ -0.01 Tw -2.388 -1.2 Td [(a)10 (c)10 (c)10 (epta)10 (ble )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 89.5061 156.2401 Tm ($53)Tj /T1_1 1 Tf 11 0 0 11 108.1096 156.2401 Tm (,)Tj /TT0 1 Tf 10 0 0 10 110.2435 156.2401 Tm (000)Tj /T1_1 1 Tf 0.01 Tc 0.032 Tw 11 0 0 11 128.847 156.2401 Tm [( per qua)10 (lit)15 (y)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 183.2242 156.2401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.032 Tw 11 0 0 11 187.2232 156.2401 Tm [(a)10 (djusted lif)15 (e y)19.9 (e)15 (ar)30 (. 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R)10 (el)10 (a)10 (ps)5 (e to sm)10 (okin)10 (g w)15 (a)10 (s)10 ( )]TJ 0.121 Tw 0 -1.2 Td [(a)10 (ss)5 (oci)10 (ated with an in)10 (cr)10 (e)15 (a)10 (s)5 (ed rate of declin)10 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 251.2365 490.9021 Tm (30)Tj /T1_1 1 Tf 0.01 Tc 0.121 Tw 11 0 0 11 261.3592 486.2401 Tm [( Thus,)10 ( )]TJ 0.151 Tw -20.487 -1.2 Td [(th)10 (e LHS pr)10 (o)20 (vided str)10 (on)10 (g e)20 (viden)10 (c)10 (e th)10 (at C)20 (OPD c)10.1 (a)10 (s)4.9 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 287.601 473.0401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.059 Tw 11 0 0 11 36 459.8401 Tm [(\037n)10 (din)10 (g )0.5 (am)10 (on)10 (g )0.5 (cig)10 (ar)10 (ette )0.5 (sm)10 (ok)10 (ers an)10 (d enr)10 (ollm)10 (ent )0.5 (in )0.5 (a)10 ( )]TJ 0.117 Tw 0 -1.2 Td [(sm)10 (okin)10 (g c)10 (ess)5 (ation pr)10 (ogram c)10 (o)10 (uld h)10 (a)25 (v)20 (e a s)10 (u)10 (bstanti)10 (a)10 (l)10 ( )]TJ 0 Tw 0 -1.2 Td [(im)10 (p)10 (a)10 (ct on l)15 (un)10 (g fun)10 (ction o)20 (v)20 (er )]TJ /TT0 1 Tf 0 Tc 10 0 0 10 175.7093 433.4401 Tm (5)Tj /T1_1 1 Tf 0.01 Tc 11 0 0 11 181.9104 433.4401 Tm [( y)20 (e)15 (ars.)10 ( )-10 ( )]TJ 0.35 Tw -12.446 -1.2 Td [(An)10 (oth)10 (er im)10 (portant obs)4.9 (erv)20 (ation w)15 (a)10 (s th)10 (at airw)15 (a)25 (y)10 (s)10 ( )]TJ 0.592 Tw -0.818 -1.2 Td [(r)10 (e)15 (a)10 (cti)20 (vit)15 (y to m)10 (eth)10 (a)10.1 (ch)10.1 (olin)9.9 (e w)15 (a)10 (s c)10 (omm)10 (on am)10 (on)10 (g)10 ( )]TJ 0.276 Tw 0 -1.2 Td [(p)10 (artici)15 (p)10 (ants with mild)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 146.423 393.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 150.4221 393.8401 Tm (to)Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 159.8708 393.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.276 Tw 11 0 0 11 163.8698 393.8401 Tm [(m)10 (oderate C)20 (OPD w)5 (h)10 (o did)9.9 ( )]TJ 0.214 Tw -11.625 -1.2 Td [(n)10 (ot e)10 (xhi)10 (bit a)10 (sthm)10 (a s)5 (ym)10 (ptom)10 (s an)10 (d th)10 (at th)10 (e s)5 (e)20 (v)20 (erit)15 (y)10 ( )]TJ 0.283 Tw 0 -1.2 Td [(of airw)14.9 (a)25 (y)10 (s r)10 (e)15 (a)10 (cti)20 (vit)15 (y pr)10 (edicted s)10 (u)10 (bs)5 (equent rates of)10 ( )]TJ 0 Tc 0 Tw 0 -1.2 Td [(F)-10 (EV)]TJ /TT0 1 Tf 6.413 0 0 6.413 56.7239 353.5771 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.074 Tw 11 0 0 11 60.7007 354.2401 Tm [( declin)9.9 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 100.6616 358.9021 Tm (31,32)Tj /T1_1 1 Tf 0.01 Tc 0.074 Tw 11 0 0 11 123.5175 354.2401 Tm [( Airw)15 (a)25 (y)10 (s r)10 (e)15 (a)10 (cti)20 (vit)15 (y an)10 (d s)10 (u)10 (bs)5 (equent)10 ( )]TJ 0.106 Tw -7.956 -1.2 Td [(declin)10 (e in FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 108.2943 340.3771 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.106 Tw 11 0 0 11 112.2711 341.0401 Tm [( w)15 (a)10 (s m)10 (or)10 (e pr)10 (omin)10 (ent in w)5 (om)10 (en th)10 (an)10 ( )]TJ 0.054 Tw -6.934 -1.2 Td [(m)10 (en s)10 (ug)10 (gestin)10 (g th)10.1 (at th)10 (er)10 (e w)5 (er)10 (e gen)10 (der di\034)14.9 (er)10 (en)10 (c)10 (es in)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(s)10 (us)5 (c)10 (epti)10 (bilit)15 (y to sm)10 (okin)10 (g)50 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 156.8423 319.3021 Tm (33)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 166.9651 314.6401 Tm [( C)30 (ontinuin)10 (g sm)10 (ok)10 (ers with)10 ( )]TJ -0.003 Tw -11.906 -1.2 Td [(th)10 (e )0.5 (gr)10 (e)15 (atest )0.5 (declin)10 (e in )0.5 (FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 164.281 300.7771 Tm (1)Tj /T1_1 1 Tf 0.01 Tc -0.003 Tw 11 0 0 11 168.2578 301.4401 Tm [( )0.5 (h)10 (a)10 (d th)10 (e l)10 (ar)10 (gest )0.5 (in)10 (cr)10 (em)10 (ent)10 ( )]TJ 0.185 Tw -12.023 -1.2 Td [(in airw)15.1 (a)25 (y)9.9 (s r)10 (e)15 (a)10 (cti)20 (vit)15 (y o)20 (v)20 (er )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 164.7364 288.2401 Tm (5)Tj /T1_1 1 Tf 0.01 Tc 0.185 Tw 11 0 0 11 170.9376 288.2401 Tm [( y)20 (e)15 (ars.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 202.6652 292.9021 Tm (34)Tj /T1_1 1 Tf 0.01 Tc 0.185 Tw 11 0 0 11 212.788 288.2401 Tm [( In a s)10.1 (u)9.9 (bs)5 (et of)10 ( )]TJ 0.35 Tw -16.072 -1.2 Td [(p)10 (artici)15 (p)10 (ants w)5 (h)10 (os)5 (e in)10 (h)10 (a)10 (lers w)5 (er)10 (e c)10 (onn)10 (ected to an)10 ( )]TJ 0.183 Tw 0 -1.2 Td [(electr)10 (onic dos)5 (e c)10 (o)10 (untin)10 (g de)20 (vic)10 (e)10 (, it w)15 (a)10 (s v)20 (eri\037ed th)10 (at)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(s)5 (elf)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 52.7089 248.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.307 Tw 11 0 0 11 56.7079 248.6401 Tm [(r)10 (eport v)20 (a)10 (st)15 (l)5 (y o)20 (v)20 (er)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 146.0692 248.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.307 Tw 11 0 0 11 150.0682 248.6401 Tm [(estim)10 (ated th)10 (e a)10 (ctua)10 (l in)10 (h)10 (a)10 (ler)10 ( )]TJ 0.199 Tw -10.37 -1.2 Td [(us)5 (e)10 (. M)20 (or)10 (eo)20 (v)20 (er)30 (, it w)15 (a)10 (s di)10 (s)4.9 (c)10 (o)20 (v)20 (er)10 (ed th)10 (at a s)10 (u)9.9 (bstanti)10 (a)10 (l)10 ( )]TJ 0.045 Tw 0 -1.2 Td [(num)10 (ber of p)10 (artici)15 (p)10 (ants w)5 (er)10 (e \223)14.9 (dum)10 (pin)10 (g\224 th)10 (eir in)10 (h)10 (a)10 (lers)10 ( )]TJ 0.153 Tw 0 -1.2 Td [(b)15 (y r)10 (epetiti)20 (v)20 (e a)10 (ctuation)10 (s just prior to a vi)10 (sit in or)10 (der)10 ( )]TJ 0.196 Tw 0 -1.2 Td [(to a)10 (ppe)15 (ar a)10 (dh)10 (er)10 (ent to th)10 (e clinic)10 (a)10 (l te)15 (am.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 233.1702 200.5021 Tm (35)Tj /T1_1 1 Tf 0.206 Tw 11 0 0 11 243.2929 195.8401 Tm [( T)-10 (h)-10 (is)-10 ( w)5 (as )]TJ 0.01 Tc 0.215 Tw -18.845 -1.2 Td [(th)10 (e \037rst l)10 (ar)10 (ge)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 103.5709 182.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.215 Tw 11 0 0 11 107.5699 182.6401 Tm [(s)5 (c)10 (a)10 (le us)5 (e of electr)10 (onic m)10 (onitorin)10 (g of)10 ( )]TJ 0.121 Tw -6.506 -1.2 Td [(in)10 (h)10 (a)10 (lers w)5 (hich h)10 (a)10 (s bec)10 (om)10 (e c)10 (omm)10 (on)10 (pl)10 (a)10 (c)10 (e in m)10 (odern)10 ( )]TJ 0 Tw 0 -1.2 Td [(br)10 (on)10 (ch)10 (odil)10 (ator tri)10 (a)10 (l)10 (s.)10 ( )-10 ( )]TJ 0.235 Tw 0.818 -1.2 Td [(P)20 (erh)10 (a)10 (ps )0.5 (th)10 (e )0.5 (m)10 (ost )0.5 (im)10 (portant )0.6 (o)10 (utc)9.9 (om)10 (e )0.5 (of )0.5 (th)10 (e )0.5 (LHS)10 ( )]TJ 0.328 Tw -0.818 -1.2 Td [(w)15 (a)10 (s deri)20.1 (v)19.9 (ed fr)10 (om th)10 (e lon)10 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 172.9376 129.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.328 Tw 11 0 0 11 176.9366 129.8401 Tm [(term p)10 (a)9.9 (ssi)20 (v)19.9 (e f)15 (ollo)5 (w)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 275.3911 129.8401 Tm (-)Tj /T1_1 1 Tf 11 0 0 11 279.3901 129.8401 Tm [(u)-10 (p )]TJ 0.01 Tc 0.24 Tw -22.126 -1.2 Td [(of p)10 (artici)15 (p)10 (ants after th)10 (e)15 (y h)10 (a)10 (d c)9.9 (om)9.9 (pleted th)10 (e initi)10 (a)10 (l)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 103.4401 Tm (5)Tj /T1_1 1 Tf 0.01 Tc 0.205 Tw 11 0 0 11 42.2012 103.4401 Tm [( y)20 (e)15 (ars )0.5 (of th)10 (e study)49.9 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 138.9369 108.1021 Tm (36)Tj /T1_1 1 Tf 0.01 Tc 0.205 Tw 11 0 0 11 149.0597 103.4401 Tm [( )0.5 (After an )0.5 (a)25 (v)20 (era)10 (ge f)15 (ollo)5 (w)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 275.3911 103.4401 Tm (-)Tj /T1_1 1 Tf 11 0 0 11 279.3901 103.4401 Tm [(u)-10 (p )]TJ 0.01 Tc -0.01 Tw -22.126 -1.2 Td (of )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 49.9986 90.2401 Tm (14)Tj /T1_1 1 Tf 11 0 0 11 62.401 90.2401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 64.5349 90.2401 Tm (5)Tj /T1_1 1 Tf 0.01 Tc 0.184 Tw 11 0 0 11 70.7361 90.2401 Tm [( y)20 (e)15 (ars, th)10 (os)5 (e in)10 (di)20 (vidua)10 (l)10 (s w)5 (h)10 (o w)5 (er)10 (e origin)10 (a)10 (ll)4.9 (y)10 ( )]TJ 0.709 Tw -3.158 -1.2 Td [(s)5 (cr)10 (een)10 (ed an)10 (d enter)9.9 (ed th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 188.6638 77.0401 Tm (12-)Tj /T1_1 1 Tf 0.01 Tc 0.709 Tw 11 0 0 11 205.0652 77.0401 Tm [(s)5 (ession sm)10 (okin)10 (g)10 ( )]TJ 0.018 Tw 10.485 57.6 Td [(c)10 (ess)5 (ation pr)10 (ogram h)10 (a)10 (d an )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 446.2042 710.6401 Tm (18%)Tj /T1_1 1 Tf 0.01 Tc 0.018 Tw 11 0 0 11 467.6056 710.6401 Tm [( r)10 (eduction in m)10 (orta)10 (lit)15.1 (y)49.9 (.)10 ( )258 ( )]TJ 0.119 Tw -13.382 -1.2 Td [(M)20 (ost of th)10 (e a)10 (djudic)10 (ated c)10 (a)10 (us)5 (es of de)15 (ath w)5 (er)10 (e due to)10 ( )]TJ 0.239 Tw 0 -1.2 Td [(l)15 (un)10 (g c)10 (an)10 (c)10 (er an)10 (d c)10 (ar)10 (dio)20 (v)20 (a)10 (s)5 (c)10 (ul)9.9 (ar di)10 (s)5 (e)15 (a)10 (s)5 (e w)5 (hich w)5 (er)10 (e)9.9 ( )]TJ 0.069 Tw 0 -1.2 Td [(gr)10 (e)15 (ater in th)10 (os)5 (e w)5 (h)10 (o c)9.9 (ontinued to sm)10 (ok)10 (e)10 (. Thi)10 (s lon)10 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 572.001 671.0401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.153 Tw 11 0 0 11 320.4 657.8401 Tm [(term o)10 (utc)10 (om)10 (e fr)10 (om th)10 (e LHS i)9.9 (s str)10 (on)10 (g e)20 (viden)10 (c)10 (e th)9.9 (at)10 ( )]TJ 0.137 Tw 0 -1.2 Td [(s)10 (pir)10 (om)10 (etric s)5 (cr)10 (eenin)10 (g f)15 (or C)20 (OPD p)10 (atients w)5 (h)10 (o ar)10 (e at)10 ( )]TJ -0.052 Tw 0 -1.2 Td [(high ri)10 (s)15 (k f)15 (or sm)10 (okin)9.9 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 420.2132 631.4401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.052 Tw 11 0 0 11 424.2122 631.4401 Tm [(r)10 (el)10 (ated m)10 (orta)10 (lit)15 (y an)10 (d enr)10 (ollm)10 (ent)10 ( )]TJ -0.01 Tw -9.437 -1.2 Td [(in a s)15.1 (h)9.9 (ort)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 364.5793 618.2401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 368.5783 618.2401 Tm [(term structur)10 (ed sm)10 (okin)10 (g c)10 (ess)5 (ation pr)10 (ogram)10 ( )]TJ 0.382 Tw -4.38 -1.2 Td [(c)10 (an h)10 (a)25 (v)20 (e s)10 (u)10 (bstanti)10 (a)10 (l lon)10.1 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 453.2219 605.0401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.382 Tw 11 0 0 11 457.2209 605.0401 Tm [(term m)10 (orta)10 (lit)15 (y ben)10 (e\037ts.)10 ( )622 ( )]TJ 0.303 Tw -12.438 -1.2 Td [(It i)10.1 (s an)10 (om)10 (a)10 (lo)10 (us, th)10 (er)10 (ef)15 (or)9.9 (e th)10 (at th)10 (e U)40 (.S)10 (. Pr)10 (e)19.9 (v)20 (enti)20 (v)20 (e)10 ( )]TJ 0.182 Tw 0 -1.2 Td [(S)10 (ervic)10 (es T)69.9 (a)10.1 (s)14.9 (k F)80 (or)10 (c)10 (e h)10 (a)10 (s ign)10 (or)10 (ed th)10 (e \037n)10 (din)10.1 (g)14.9 (s of th)10 (e)10 ( )]TJ 0.083 Tw 0 -1.2 Td [(LHS tri)10 (a)10 (l in th)10 (eir deci)10 (sion to r)10 (ec)10 (omm)10 (en)10 (d a)10 (g)10 (ain)10 (st th)10 (e)10 ( )]TJ 0.233 Tw 0 -1.2 Td [(us)5 (e of s)10 (pir)9.9 (om)9.9 (etry s)5 (cr)10 (eenin)10 (g in a)10 (s)5 (ym)10 (ptom)10 (atic a)10 (dult)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(sm)10 (ok)10 (ers.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 362.1444 543.702 Tm (37)Tj /T1_1 1 Tf 0.01 Tc 0.3 Tw 11 0 0 11 320.4 472.8203 Tm [(L)30 (un)10 (g v)20 (ol)15 (um)10 (e r)10 (eduction s)10 (ur)10 (gery \(L)60 (VRS\), a s)10 (ur)10 (gic)10 (a)10 (l)10 ( )]TJ 0.158 Tw 0 -1.2 Td [(pr)10 (oc)10 (edur)10 (e to r)10 (em)10 (o)20 (v)20 (e em)10 (ph)15 (y)10 (s)4.9 (em)10 (ato)10 (us r)10 (egion)10 (s of th)10 (e)10 ( )]TJ 0.154 Tw 0 -1.2 Td [(l)15 (un)10 (g w)15 (a)10 (s origin)10 (a)10 (ll)5 (y de)20 (v)19.9 (eloped in th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 504.5212 446.4203 Tm (1950)Tj /T1_1 1 Tf 0.164 Tw 11 0 0 11 529.3259 446.4203 Tm [(s)-10 ( bu)-10 (t)-10 ( w)5 (as )]TJ 0.01 Tc 0.235 Tw -18.993 -1.2 Td [(a)10 (b)10 (an)10 (don)10 (ed bec)10 (a)10 (us)5 (e of high m)10 (orta)10 (lit)15 (y rates.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 536.973 437.8822 Tm (38)Tj /T1_1 1 Tf 0.245 Tw 11 0 0 11 547.0958 433.2202 Tm [( T)-10 (he )]TJ 0.01 Tc 0.02 Tw -20.609 -1.2 Td [(pr)10 (oc)10 (edur)10 (e w)15 (a)10 (s r)10 (e)20 (vi)20 (v)20 (ed in th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 459.5869 420.0203 Tm (1990)Tj /T1_1 1 Tf 0.01 Tc 0.02 Tw 11 0 0 11 484.3916 420.0203 Tm [(s after a c)10 (a)10 (s)5 (e s)5 (eries)9.9 ( )]TJ 0.401 Tw -14.908 -1.2 Td [(s)15 (h)10 (o)5 (w)5 (ed a r)10 (em)10 (ark)10 (a)10 (ble )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 435.9124 406.8203 Tm (82%)Tj /T1_1 1 Tf 0.01 Tc 0.401 Tw 11 0 0 11 457.3138 406.8203 Tm [( im)10 (pr)10 (o)20 (v)20 (em)10 (ent in FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 572.0233 406.1573 Tm (1)Tj /T1_1 1 Tf 11 0 0 11 576.0001 406.8203 Tm ( )Tj 0.01 Tc 0.334 Tw -23.236 -1.2 Td [(an)10 (d n)10 (o s)10 (ur)9.9 (gic)10.1 (a)10 (l m)10 (orta)10 (lit)15 (y or l)9.9 (ate m)10 (orta)10 (lit)15 (y)50 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 541.1191 398.2822 Tm (39)Tj /T1_1 1 Tf 0.344 Tw 11 0 0 11 551.2418 393.6202 Tm [( T)-10 (he )]TJ 0.01 Tc 0.19 Tw -20.986 -1.2 Td [(pr)10 (oc)10 (edur)10 (e w)15 (a)10 (s th)10 (en widel)5 (y a)10 (dopted with m)9.9 (or)9.9 (e th)10 (an)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 320.4001 367.2202 Tm (700)Tj /T1_1 1 Tf 0.01 Tc 0.127 Tw 11 0 0 11 339.0036 367.2202 Tm [( operation)10 (s c)9.9 (on)10 (ducted in a )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 474.1662 367.2202 Tm (4-)Tj /T1_1 1 Tf 0.01 Tc 0.127 Tw 11 0 0 11 484.3664 367.2202 Tm [(m)10 (onth period after)10 ( )]TJ 0.033 Tw -14.906 -1.2 Td [(M)20 (edic)10 (ar)10 (e i)10 (ss)10 (ued a pr)10 (oc)10 (edur)10 (e c)10 (ode f)15 (or r)10 (eim)10 (b)10 (urs)5 (em)10 (ent.)10 ( )273 ( )]TJ -0.026 Tw 0 -1.2 Td [(Th)10 (e o)10 (utc)10 (om)10 (es in th)10 (e c)10 (ommunit)15 (y w)5 (er)9.9 (e poor with a )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 554.5988 340.8203 Tm (26%)Tj /T1_1 1 Tf 11 0 0 11 576.0001 340.8203 Tm ( )Tj 0.01 Tc -0.022 Tw -23.236 -1.2 Td [(m)10 (orta)10 (lit)15 (y an)10 (d high h)10 (os)10 (pita)10 (li)10 (z)10 (ation us)5 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 501.5224 332.2822 Tm (40)Tj /T1_1 1 Tf -0.012 Tw 11 0 0 11 511.6452 327.6202 Tm [( Acco)-9.9 (rd)-10 (i)-10 (ng)-10 (l)-5 (y)40 (, )]TJ 0.01 Tc -0.014 Tw -17.386 -1.2 Td [(th)10 (e H)20 (e)15 (a)9.9 (lth)10 (c)10 (ar)10 (e F)20 (in)10 (an)10 (c)10 (e A)25.1 (dmini)10 (stration p)10 (artn)10.1 (er)10 (ed with)10 ( )]TJ -0.005 Tw 0 -1.2 Td [(th)10 (e NIH)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 359.3446 301.2202 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.005 Tw 11 0 0 11 363.3436 301.2202 Tm [(NHLBI to c)10 (on)10 (duct a ran)10 (domi)10 (z)10 (ed clinic)10 (a)10 (l tri)10 (a)10 (l)10 ( )]TJ 0.253 Tw -3.904 -1.2 Td [(of L)60 (VRS)10 (, th)10 (e N)30 (ation)10 (a)10 (l Em)10 (ph)15.1 (y)9.9 (s)5 (em)10 (a T)50 (r)10 (e)15 (atm)10 (ent T)50 (ri)10 (a)10 (l)10 ( )]TJ -0.022 Tw 0 -1.2 Td [(\(NE)20 (TT\). Th)10 (e tri)10 (a)10 (l w)15 (a)10 (s s)10 (u)10 (bject to c)10 (on)10 (sidera)10 (ble politic)10 (a)10 (l)10 ( )]TJ 0.029 Tw 0 -1.2 Td [(an)10 (d ethic)10 (a)10 (l s)5 (crutin)15 (y b)10 (ut w)15 (a)10 (s l)10 (a)10 (un)10 (ch)10 (ed in )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 515.4356 261.6202 Tm (1997)Tj /T1_1 1 Tf 11 0 0 11 540.2403 261.6202 Tm (.)Tj /TT0 1 Tf 8.162 0 0 8.162 542.3742 266.2822 Tm (41,42)Tj /T1_1 1 Tf 0.039 Tw 11 0 0 11 565.2302 261.6202 Tm ( A )Tj 0.01 Tc 0.13 Tw -22.257 -1.2 Td [(tota)10 (l of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 359.3603 248.4203 Tm (3777)Tj /T1_1 1 Tf 0.01 Tc 0.13 Tw 11 0 0 11 384.1649 248.4203 Tm [( p)10 (atients w)5 (er)10 (e s)5 (cr)10 (een)10 (ed an)10 (d )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 525.0325 248.4203 Tm (1218)Tj /T1_1 1 Tf 0.14 Tw 11 0 0 11 549.8372 248.4203 Tm [( w)-5 (e)-9.9 (re )]TJ 0.01 Tc 0.041 Tw -20.858 -1.2 Td [(ran)10 (doml)5 (y a)10 (ssign)10 (ed to eith)10 (er L)60 (VRS \(n=)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 501.3104 235.2202 Tm (608)Tj /T1_1 1 Tf 0.01 Tc 0.041 Tw 11 0 0 11 519.9139 235.2202 Tm [(\) or optim)10 (a)10 (l)10 ( )]TJ 0.448 Tw -18.138 -1.2 Td [(m)10 (edic)10 (a)10 (l m)10 (an)10 (a)10 (gem)10 (ent \(n=)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 449.2567 222.0203 Tm (610)Tj /T1_1 1 Tf 0.01 Tc 0.448 Tw 11 0 0 11 467.8602 222.0203 Tm [(\). M)9.9 (a)10.1 (jor enr)10 (ollm)10 (ent)10 ( )]TJ 0.036 Tw -13.405 -1.2 Td [(criteri)10 (a in)10 (cl)15 (uded C)20 (T e)20 (viden)10 (c)9.9 (e of bil)10 (atera)10 (l em)10 (ph)15 (y)10 (s)5 (em)10 (a)10 ( )]TJ 0.312 Tw 0 -1.2 Td [(with h)15 (y)10 (perin\035)10 (ation an)10 (d air)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 456.7768 195.6202 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.312 Tw 11 0 0 11 460.7758 195.6202 Tm [(tra)10 (ppin)10 (g)50 (, an)9.9 (d n)10 (o oth)10 (er)10 ( )]TJ 0.639 Tw -12.761 -1.2 Td [(enum)10 (erated c)9.9 (om)10 (orbidities th)10 (at w)5 (o)10 (uld c)10 (on)10 (stitute)10 ( )]TJ 0.265 Tw 0 -1.2 Td [(a c)10 (ontrain)10 (dic)10 (ation to th)10 (e s)10 (ur)10 (gery)50 (. All p)10 (artici)15 (p)10 (ants)9.9 ( )]TJ 0.102 Tw 0 -1.2 Td [(w)5 (er)10 (e r)10 (equir)10 (ed to c)10 (om)10 (plete a stan)10 (d)10 (ar)10 (di)10 (z)10 (ed p)10 (ulm)10 (on)10 (ary)10 ( )]TJ 0.441 Tw 0 -1.2 Td [(r)10 (eh)10 (a)10 (bilitation pr)10 (ogram an)10 (d un)10 (derta)10 (k)10 (e a s)10 (peci\037ed)9.9 ( )]TJ 0 Tw 0 -1.2 Td [(pr)10 (ogram of optim)9.9 (a)10 (l m)10 (edic)10 (a)10 (l m)10 (an)10 (a)10 (gem)10 (ent.)]TJ /TT0 1 Tf 0 Tc 8.162 0 0 8.162 518.9805 134.2822 Tm (43)Tj /T1_1 1 Tf 11 0 0 11 529.1033 129.6202 Tm ( )Tj 0.01 Tc 0.321 Tw -18.155 -1.2 Td [(Bef)15 (or)10 (e th)10 (e tri)10 (a)10 (l w)15 (a)10 (s c)10 (om)10 (pleted, interim an)10 (a)10 (l)5 (y)10 (s)5 (es)9.9 ( )]TJ -0.076 Tw -0.818 -1.2 Td [(in)10 (dic)10 (ated th)10 (at a s)10 (u)10 (bgr)10 (o)10 (up of p)9.9 (atients w)4.9 (h)10 (o h)10 (a)10 (d lo)5 (w FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 572.0233 102.5572 Tm (1)Tj /T1_1 1 Tf 11 0 0 11 576.0001 103.2202 Tm ( )Tj -23.236 -1.2 Td (\()Tj /TT0 1 Tf 10 0 0 10 324.14 90.0203 Tm (<)Tj /T1_1 1 Tf 11 0 0 11 330.1409 90.0203 Tm ( )Tj /TT0 1 Tf 10 0 0 10 333.476 90.0203 Tm (20%)Tj /T1_1 1 Tf 0.01 Tc 0.063 Tw 11 0 0 11 354.8774 90.0203 Tm [( pr)10 (edicted\) an)10 (d eith)10 (er a lo)5 (w di\034usin)10 (g c)10 (a)10 (p)10 (a)10 (cit)15 (y)10 ( )]TJ 0 Tc 0 Tw -3.134 -1.2 Td (\()Tj /TT0 1 Tf 10 0 0 10 324.14 76.8203 Tm (<)Tj /T1_1 1 Tf 11 0 0 11 330.141 76.8203 Tm ( )Tj /TT0 1 Tf 10 0 0 10 333.4913 76.8203 Tm (20%)Tj /T1_1 1 Tf 0.01 Tc 0.065 Tw 11 0 0 11 354.8926 76.8203 Tm [( pr)10 (edicted\) or h)10 (om)10 (ogen)10 (eo)10 (us em)10 (ph)15 (y)10 (s)5 (em)10 (a w)5 (er)10 (e)10 ( )]TJ ET 0 0.1 0.15 0 scn /GS0 gs 320.4 488.1 255.6 25.14 re f BT 0 0 0 1 scn /GS1 gs /T1_2 1 Tf 0 Tc 0 Tw 14 0 0 14 324.9 495.42 Tm [(National Emphysema T)82.1 (reatment T)82.1 (rial)]TJ ET endstream endobj 71 0 obj <>stream q /GS0 gs 0 TL/Fm0 Do Q BT /CS0 cs 0 0 0 0 scn /GS0 gs /T1_0 1 Tf 0.01 Tc -0.01 Tw 12 0 0 12 14.1401 772 Tm [(3)-42 (62)]TJ ET q 0 Tc 0 Tw 0 g 0 TL/Fm1 Do Q BT 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 11 0 0 11 36 710.6401 Tm (to )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 50.4918 710.6401 Tm (55)Tj /T1_1 1 Tf 0.01 Tc 0.219 Tw 11 0 0 11 62.8942 710.6401 Tm [( )0.5 (mm )0.6 (H)19.9 (g )0.6 (or )0.5 (less )0.5 (th)10 (an )0.6 (or )0.5 (equa)10 (l )0.5 (to )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 236.0125 710.6401 Tm (59)Tj /T1_1 1 Tf 0.01 Tc 0.219 Tw 11 0 0 11 248.4149 710.6401 Tm [( )0.5 (mm )0.6 (H)19.9 (g)10 ( )]TJ 0.101 Tw -19.31 -1.2 Td [(with e)20 (viden)10 (c)10 (e of edem)10 (a, pol)4.9 (y)20 (c)10 (y)15 (th)10 (emi)10 (a, or right atri)10 (a)10 (l)10 ( )]TJ -0.039 Tw 0 -1.2 Td [(en)10 (l)10 (ar)10 (gem)10 (ent on an electr)10 (oc)10 (ar)10 (diogram Th)10 (e FE)10.1 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 259.0294 683.5771 Tm (1)Tj /T1_1 1 Tf -0.02 Tc -0.009 Tw 11 0 0 11 263.0062 684.2401 Tm [(/)-30 ( F)-10.1 (VC)-20 ( )]TJ 0.01 Tc -0.094 Tw -20.637 -1.2 Td [(ratio h)10 (a)10 (d to be less th)10 (an )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 145.6208 671.0402 Tm (70%)Tj /T1_1 1 Tf 0.01 Tc -0.094 Tw 11 0 0 11 167.0221 671.0402 Tm [( after a br)10 (on)10 (ch)10 (odil)10 (ator with)10 ( )]TJ 0.036 Tw -11.911 -1.2 Td [(a n)10 (orm)10 (a)10 (l or ele)20 (v)20 (ated tota)10 (l l)14.9 (un)10 (g c)9.9 (a)10.1 (p)9.9 (a)10.1 (cit)15 (y an)10 (d a clinic)10 (a)10 (l)10 ( )]TJ 0.065 Tw 0 -1.2 Td [(di)10 (a)10 (gn)10 (osi)10 (s )0.6 (of )0.5 (C)20 (OPD)40 (. )0.5 ( )0.6 (After )0.5 (s)5 (cr)10 (eenin)10 (g )0.6 (m)10 (or)10 (e )0.5 (th)10 (an )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 266.7953 644.6401 Tm (1000)Tj /T1_1 1 Tf 11 0 0 11 291.6 644.6401 Tm ( )Tj 0.01 Tc -0.01 Tw -23.236 -1.2 Td [(p)10 (atients, )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 79.7173 631.4401 Tm (203)Tj /T1_1 1 Tf 0.01 Tc 0.05 Tw 11 0 0 11 98.3208 631.4401 Tm [( p)10 (artici)15 (p)10 (ants at )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 173.748 631.4401 Tm (6)Tj /T1_1 1 Tf 0.01 Tc 0.05 Tw 11 0 0 11 179.9492 631.4401 Tm [( c)10 (enters w)5 (er)10 (e ran)10 (doml)5 (y)10 ( )]TJ 0.182 Tw -13.086 -1.2 Td [(a)10 (ssign)10 (ed to th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 116.4292 618.2401 Tm (2)Tj /T1_1 1 Tf 0.01 Tc 0.182 Tw 11 0 0 11 122.6303 618.2401 Tm [( tr)10 (e)15 (atm)10 (ent gr)10 (o)10 (ups. P)25 (atients c)10 (o)10 (uld)10 ( )]TJ 0.303 Tw -7.875 -1.2 Td [(us)5 (e eith)10 (er o)10 (xy)20 (gen c)10 (on)10 (c)10 (entrators, liquid o)10 (xy)19.9 (gen, or)10 ( )]TJ 0.022 Tw 0 -1.2 Td [(c)10 (om)10 (pr)10 (ess)5 (ed )0.5 (tan)10 (k)10 (s )0.6 (at )0.5 (a )0.6 (\035o)5 (w )0.5 (rate )0.6 (th)10 (at )0.5 (in)10 (cr)10 (e)15 (a)10 (s)5 (ed )0.5 (arteri)10 (a)10 (l)10 ( )]TJ 0.074 Tw 0 -1.2 Td [(o)10 (xy)20 (gen b)14.9 (y )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 88.9918 578.6401 Tm (6)Tj /T1_1 1 Tf 0.01 Tc 0.074 Tw 11 0 0 11 95.193 578.6401 Tm [( mm H)20 (g or m)10 (or)10 (e an)10 (d m)10 (aintain)10 (ed a P)25 (aO)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 287.6232 577.9771 Tm (2)Tj /T1_1 1 Tf 11 0 0 11 291.6 578.6401 Tm ( )Tj 0.01 Tc -0.01 Tw -23.236 -1.2 Td (of )Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 49.2363 565.4401 Tm (60-80)Tj /T1_1 1 Tf 0.01 Tc 0.114 Tw 11 0 0 11 78.04 565.4401 Tm [( mm H)20 (g)50 (. In)9.9 (cr)10 (e)15 (a)10 (s)5 (es of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 190.2278 565.4401 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.114 Tw 11 0 0 11 196.429 565.4401 Tm [( L/)50 (min o)10 (xy)20 (gen \035o)5 (w)10 ( )]TJ -0.024 Tw -14.584 -1.2 Td [(w)5 (er)10 (e m)10 (a)10.1 (de durin)10 (g s)15 (leep an)10 (d with e)10 (x)10 (er)10 (ci)10 (s)5 (e)10 (. A)25 (dh)10 (er)9.9 (en)10 (c)10 (e)10 ( )]TJ 0.029 Tw 0 -1.2 Td [(to o)10 (xy)20 (gen us)5 (e w)15 (a)10 (s m)10 (e)15 (a)10 (s)10 (ur)10 (ed b)15 (y di)10 (aries an)10 (d electr)10 (onic)10 ( )]TJ -0.016 Tw 0 -1.2 Td [(tim)10 (ers atta)10 (ch)10 (ed to station)10 (ary o)10 (xy)20 (gen deli)20 (v)20 (ery s)5 (y)10 (stem)10 (s.)10 ( )224 ( )]TJ 0.301 Tw 0 -1.2 Td [(Th)10 (e prim)10 (ary o)10 (utc)10 (om)10 (e m)10 (e)15 (a)10 (s)10 (ur)9.9 (e w)15 (a)10 (s m)9.9 (orta)10 (lit)15 (y)50 (, with)10 ( )]TJ 0.513 Tw 0 -1.2 Td [(s)5 (ec)10 (on)10 (d)10 (ary m)10 (e)15 (a)10 (s)10 (ur)10 (es in)10 (cl)15 (udin)10 (g n)10 (e)10 (ur)10 (ops)5 (y)20 (ch)10 (ologic)10 (a)10 (l)10 ( )]TJ 0.169 Tw 0 -1.2 Td [(fun)10 (ction, p)10 (ulm)10 (on)10 (ary artery pr)9.9 (ess)10 (ur)10 (e)10 (, an)10 (d h)10 (em)10 (atocrit)10 ( )]TJ -0.135 Tw 0 -1.2 Td [(r)10 (ec)10 (or)10 (ded. After )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 107.659 473.0401 Tm (24)Tj /T1_1 1 Tf 0.01 Tc -0.135 Tw 11 0 0 11 120.0614 473.0401 Tm [( m)10 (onth)10 (s of f)15 (ollo)5 (w)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 197.3409 473.0401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.135 Tw 11 0 0 11 201.34 473.0401 Tm [(up)20 (, th)10 (e NO)20 (TT study)10 ( )]TJ -0.036 Tw -15.031 -1.2 Td [(s)15 (h)10 (o)5 (w)5 (ed )0.5 (th)10 (at )0.5 (th)10 (e )0.5 (m)9.9 (orta)10 (lit)15 (y )0.5 (rate in )0.5 (th)10 (e )0.5 (n)10 (octurn)10 (a)10 (l )0.5 ( )0.5 (o)10 (xy)20 (gen)10 ( )]TJ 0.043 Tw 0 -1.2 Td [(gr)10 (o)10 (up w)15 (a)10 (s n)10 (e)15 (arl)5 (y twic)10 (e th)10.1 (at of th)10 (e c)10 (ontinuo)10 (us o)10.1 (xy)19.9 (gen)10 ( )]TJ 0.293 Tw 0 -1.2 Td [(gr)10 (o)10 (up )0.5 (\(P)20 (eto )0.5 (odd)10 (s )0.5 (ratio )0.5 (= )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 167.6509 433.4401 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 173.8521 433.4401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 175.986 433.4401 Tm (45)Tj /T1_1 1 Tf 0.01 Tc 0.293 Tw 11 0 0 11 188.3883 433.4401 Tm [( )0.5 ([)10 (c)10 (on\037den)10 (c)10 (e )0.5 (interv)20 (a)10 (l)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 420.2401 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 42.2012 420.2401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 44.3351 420.2401 Tm (25-0)Tj /T1_1 1 Tf 11 0 0 11 66.9376 420.2401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 69.0715 420.2401 Tm (81)Tj /T1_1 1 Tf 0.01 Tc 0.052 Tw 11 0 0 11 81.4738 420.2401 Tm [(]\). A)25 (dh)10 (er)10 (en)10 (c)10 (e to th)10 (e a)10 (ssign)10 (ed tr)10 (e)15 (atm)10 (ent w)15 (a)10 (s)10 ( )]TJ 0.094 Tw -4.134 -1.2 Td [(c)10 (on)10 (sider)10 (ed good with )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 143.637 407.0401 Tm (80%)Tj /T1_1 1 Tf 0.01 Tc 0.094 Tw 11 0 0 11 165.0384 407.0401 Tm [( of th)10 (e c)10 (ontinuo)10 (us o)10 (xy)19.9 (gen)10 ( )]TJ -0.036 Tw -11.731 -1.2 Td [(gr)10 (o)10 (up usin)10 (g it )0.5 (f)15 (or )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 119.6778 393.8401 Tm (14)Tj /T1_1 1 Tf 0.01 Tc -0.036 Tw 11 0 0 11 132.0801 393.8401 Tm [( )0.5 (or m)10 (or)10 (e )0.5 (h)10 (o)10 (urs per )0.5 (d)10 (a)25 (y an)10 (d )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 258.7309 393.8401 Tm (80%)Tj /T1_1 1 Tf -0.026 Tw 11 0 0 11 280.1323 393.8401 Tm [( )0.5 (o)-10 (f )]TJ 0.01 Tc -0.033 Tw -22.194 -1.2 Td [(th)10 (e n)10 (octurn)10 (a)10 (l o)10 (xy)20 (gen gr)10 (o)10 (up usin)10 (g it less th)10 (an )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 250.2568 380.6401 Tm (13)Tj /T1_1 1 Tf -0.023 Tw 11 0 0 11 262.6591 380.6401 Tm [( hou)-10 (r)-10 (s )]TJ 0.01 Tc 0.143 Tw -20.605 -1.2 Td [(per d)10 (a)25 (y)50 (. In s)10 (u)9.9 (bgr)10 (o)10.1 (up an)10 (a)10 (l)5 (y)10 (si)10 (s, h)15 (y)10 (per)10 (c)10 (a)10 (pnic p)10 (atients)10 ( )]TJ 0.034 Tw 0 -1.2 Td [(w)5 (er)10 (e p)10 (artic)10 (ul)10 (arl)5 (y ben)10 (e\037ted b)15 (y c)10 (ontinuo)10 (us o)9.9 (xy)20 (gen: th)10 (e)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 341.0401 Tm (24-)Tj /T1_1 1 Tf 0.01 Tc 0.162 Tw 11 0 0 11 52.4014 341.0401 Tm [(m)10 (onth c)10 (a)10 (s)5 (e fata)10 (lit)15 (y rate w)15.1 (a)9.9 (s )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 195.3525 341.0401 Tm (46%)Tj /T1_1 1 Tf 0.01 Tc 0.162 Tw 11 0 0 11 216.7539 341.0401 Tm [( with n)10 (octurn)10 (a)10 (l)10 ( )]TJ 0.408 Tw -16.432 -1.2 Td [(on)10 (l)5 (y o)10 (xy)20 (gen an)10 (d )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 130.2708 327.8401 Tm (19)Tj /T1_1 1 Tf 11 0 0 11 142.6732 327.8401 Tm (.)Tj /TT0 1 Tf 10 0 0 10 144.8071 327.8401 Tm (6%)Tj /T1_1 1 Tf 0.01 Tc 0.408 Tw 11 0 0 11 160.0072 327.8401 Tm [( with c)10 (ontinuo)10 (us o)10 (xy)20 (gen.)10 ( )648 ( )]TJ 0.237 Tw -11.273 -1.2 Td [(M)20 (e)15 (a)10 (s)10 (ur)10 (em)10 (ent of h)10 (em)10 (odyn)10 (amic p)10 (aram)10 (eters b)15 (y right)10 ( )]TJ -0.05 Tw 0 -1.2 Td [(h)10 (e)15 (art c)10 (ath)10 (eri)10 (z)10 (ation s)15 (h)10 (o)5 (w)5 (ed th)10 (at th)10 (e c)10 (ontinuo)10 (us o)10 (xy)20 (gen)10 ( )]TJ 0.077 Tw 0 -1.2 Td [(gr)10 (o)10 (up h)10 (a)10 (d im)10 (pr)10 (o)20 (v)20 (ed str)10 (ok)10 (e v)20 (ol)15 (um)10 (e in)10 (de)10 (x, p)9.9 (ulm)10 (on)10 (ary)10 ( )]TJ 0.589 Tw 0 -1.2 Td [(v)20 (a)10 (s)5 (c)10 (ul)10 (ar r)9.9 (esi)10 (stan)10 (c)10 (e an)10 (d lo)5 (w)5 (er p)10 (ulm)10 (on)10 (ary artery)10 ( )]TJ 0 Tc 0 Tw 0 -1.2 Td [(p)-10 (re)-10 (s)-10 (su)-10 (re.)]TJ /TT0 1 Tf 8.162 0 0 8.162 78.4157 266.5021 Tm (20)Tj /T1_1 1 Tf 0.01 Tc 0.037 Tw 11 0 0 11 88.5385 261.8401 Tm [( N)15.1 (e)9.9 (ur)10 (ops)5 (y)20 (ch)10 (ologic)10 (a)10 (l fun)10 (ction w)15 (a)10 (s s)15 (light)15 (l)4.9 (y)10 ( )]TJ 0.085 Tw -4.776 -1.2 Td [(im)10 (pr)10 (o)20 (v)20 (ed in p)10 (atients on c)10 (ontinuo)9.9 (us v)20 (ers)10 (us n)10 (octurn)10 (a)10 (l)10 ( )]TJ 0.281 Tw 0 -1.2 Td [(o)10 (xy)20 (gen b)10 (ut thi)10 (s did n)10 (ot tran)10 (s)15 (l)10 (ate into ben)9.9 (e\037ts f)15 (or)10 ( )]TJ 0 Tw 0 -1.2 Td [(qua)10 (lit)15 (y of lif)15 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 8.162 0 0 8.162 100.4588 226.9021 Tm (21)Tj /T1_1 1 Tf 0.01 Tc 0.45 Tw 11 0 0 11 45 209.0401 Tm [(Th)10 (e NO)20 (TT study s)4.9 (et th)10 (e stan)10 (d)9.9 (ar)10 (d criteri)9.9 (a f)15.1 (or)10 ( )]TJ 0.089 Tw -0.818 -1.2 Td [(pr)10 (es)5 (cri)15 (ption of c)10 (ontinuo)10 (us o)10 (xy)20 (gen th)10 (at w)5 (er)10 (e a)10 (dopted)10 ( )]TJ 0.022 Tw 0 -1.2 Td [(b)15 (y p)10 (a)25 (y)20 (ers in)10 (cl)15 (udin)10 (g th)10 (e U)40 (.S)10 (. C)30 (enters f)15 (or M)20 (edic)10 (ar)10 (e an)10 (d)10 ( )]TJ 0.058 Tw 0 -1.2 Td [(M)20 (edic)10 (aid S)10 (ervic)10 (es \()10 (C)10 (M)15 (S\). P)25 (atients w)5 (h)10 (o did n)10 (ot m)10 (eet)10 ( )]TJ -0.116 Tw 0 -1.2 Td [(th)10 (e )0.5 (NO)20 (TT )0.5 (entry criteri)10 (a )0.5 (w)5 (er)10 (e )0.5 (n)10 (ot )0.5 (c)10 (on)10 (sider)10 (ed )0.5 (c)9.9 (an)9.9 (did)9.9 (ates)10 ( )]TJ 0.101 Tw 0 -1.2 Td [(f)15 (or c)10 (ontinuo)10 (us o)10 (xy)20 (gen a)10.1 (lth)10 (o)10 (ugh th)10 (e tri)10 (a)10 (l did n)10 (ot test)10 ( )]TJ 0.083 Tw 0 -1.2 Td [(w)5 (h)10 (eth)10 (er o)10 (xy)20 (gen w)15 (a)10 (s e\034)15 (ecti)20 (v)20 (e in th)10 (es)5 (e in)10 (di)20 (vidua)10 (l)10 (s. It)10 ( )]TJ 0.222 Tw 0 -1.2 Td [(i)10 (s r)10 (em)10 (ark)10 (a)10 (ble th)10 (at o)10 (ur c)10 (urr)10 (ent str)10 (on)10 (g stan)9.9 (d)10 (ar)9.9 (d)10 (s f)15 (or)10 ( )]TJ 0.118 Tw 0 -1.2 Td [(us)5 (e of o)10 (xy)19.9 (gen ar)10 (e deri)20 (v)20 (ed fr)10 (om a sin)10 (gle tri)10 (a)10 (l of on)10 (l)5 (y)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 36 90.2401 Tm (203)Tj /T1_1 1 Tf 0.01 Tc 0.198 Tw 11 0 0 11 54.6035 90.2401 Tm [( people)9.9 (, a)10 (l)10 (beit c)10 (on)10 (si)10 (stent with th)10 (e MRC r)10 (es)10 (ults.)10 ( )438 ( )]TJ 0.051 Tw -1.691 -1.2 Td [(Alth)10 (o)10 (ugh th)10 (e tri)10 (a)10 (l w)15 (a)10 (s sm)10 (a)10 (ll b)15 (y tod)10 (a)25 (y)-10 (\222)35 (s stan)9.9 (d)10 (ar)10 (d)10 (s, th)10 (e)10 ( )]TJ 0.234 Tw 25.855 57.6 Td [(m)10 (etic)10 (ulo)10 (us c)9.9 (ar)9.9 (e ta)10 (k)10 (en b)15 (y th)10 (e in)25 (v)20 (estig)10 (ators an)10 (d th)10 (e)10 ( )]TJ 0.119 Tw 0 -1.2 Td [(in)10 (c)10 (orporation of multi)15 (ple o)10 (utc)10 (om)10 (e m)9.9 (e)15 (a)10 (s)10 (ur)10 (es an)10 (d th)10 (e)10 ( )]TJ 0.162 Tw 0 -1.2 Td [(str)10 (en)10 (gth of th)10 (e \037n)10 (din)10 (g)15 (s h)10 (a)25 (v)20 (e n)10 (ot led to an)15 (y s)5 (erio)10 (us)10 ( )]TJ 0 Tw 0 -1.2 Td [(ch)10 (a)10 (llen)10 (ges to th)10 (e c)10 (on)10 (cl)15 (usion)10 (s of thi)10 (s tri)9.9 (a)10 (l.)10.1 ( )-10 ( )]TJ 0.071 Tw 0.818 -1.2 Td [(S)10 (e)20 (v)20 (era)10 (l question)10 (s w)5 (er)10 (e left un)10 (an)10 (s)5 (w)5 (er)9.9 (ed b)15 (y NO)20 (TT \226)9.9 ( )]TJ -0.07 Tw -0.818 -1.2 Td [(w)5 (h)10 (eth)10 (er p)10 (atients with oth)10 (er l)15 (un)10 (g di)10 (s)5 (e)15 (a)10 (s)5 (es or with less)5 (er)10 ( )]TJ -0.009 Tw 0 -1.2 Td [(degr)10 (ees of h)15 (y)10 (po)10 (x)10 (emi)10 (a w)5 (o)10 (uld a)10 (l)10 (s)5 (o ben)10 (e\037t fr)10 (om o)9.9 (xy)19.9 (gen.)10 ( )231 ( )]TJ 0.019 Tw 0 -1.2 Td [(It w)5 (o)10 (uld ta)10 (k)10 (e m)10 (or)10 (e th)10 (an )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 436.3364 618.2401 Tm (3)Tj /T1_1 1 Tf 0.01 Tc 0.019 Tw 11 0 0 11 442.5376 618.2401 Tm [( dec)10 (a)10 (des bef)15 (or)10.1 (e th)10 (es)5 (e i)10 (ss)10 (ues)10 ( )]TJ 0.24 Tw -11.103 -1.2 Td [(w)5 (er)10 (e p)10 (arti)10 (a)10 (ll)5 (y a)10 (ddr)10 (ess)4.9 (ed in th)10.1 (e f)15.1 (ollo)4.9 (w)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 509.5215 605.0402 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.24 Tw 11 0 0 11 513.5206 605.0402 Tm [(up l)10 (an)10 (dm)10 (ark)10 ( )]TJ 0.04 Tw -17.556 -1.2 Td [(tri)10 (a)10 (l \226 th)10 (e L)10 (on)10 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 392.9348 591.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.04 Tw 11 0 0 11 396.9338 591.8401 Tm [(term Oxy)19.9 (gen T)50 (r)10 (e)15 (atm)10 (ent T)50 (ri)10 (a)10 (l \(L)40.1 (O)19.9 (TT\))10 ( )]TJ 0 Tw -6.958 -1.2 Td [(w)5 (hich i)10 (s des)5 (cri)10 (bed l)10 (ater in thi)10 (s r)10 (e)20 (vie)10 (w)30 (.)]TJ 0.294 Tw 0 -6.049 Td [(Pr)10 (e)20 (vio)10 (us m)10 (a)10 (jor NHLBI)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 434.8378 512.1 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.294 Tw 11 0 0 11 438.8369 512.1 Tm [(s)10 (pon)10 (s)5 (or)10 (ed multi)10 (site clinic)10 (a)10 (l)10 ( )]TJ 1.058 Tw -10.767 -1.2 Td [(tri)10 (a)10 (l)10 (s enr)10 (olled p)9.9 (atients with w)5 (ell)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 518.5087 498.9 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 522.5077 498.9 Tm [(esta)10 (bli)10 (s)15 (h)10 (ed)10 ( )]TJ -0.036 Tw -18.373 -1.2 Td [(s)5 (ym)10 (ptom)10 (atic di)10 (s)5 (e)15 (a)10 (s)5 (e)9.9 (. It w)15.1 (a)10 (s w)5 (ell)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 474.2795 485.7 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.036 Tw 11 0 0 11 478.2785 485.7 Tm [(r)10 (ec)10 (ogni)10 (z)10 (ed, h)10 (o)5 (w)5 (e)19.9 (v)20 (er)30 (,)10 ( )]TJ 0.24 Tw -14.353 -1.2 Td [(th)10 (at m)10 (an)15 (y in)10 (di)20 (vidua)10 (l)10 (s w)5 (h)10 (o h)10 (a)10 (d e)20 (viden)10 (c)10 (e of air\035o)5 (w)10 ( )]TJ 0.156 Tw 0 -1.2 Td [(limitation w)5 (er)10 (e a)10 (s)5 (ym)10 (ptom)10 (atic or h)10 (a)10 (d minim)10 (a)10 (l, often)10 ( )]TJ -0.125 Tw 0 -1.2 Td [(di)10 (smi)10 (ss)5 (ed s)5 (ym)10 (ptom)10 (s of c)10 (o)10 (ugh an)10 (d phlegm. Ph)15 (y)10 (siologic)9.9 ( )]TJ 0.189 Tw 0 -1.2 Td [(studies of e)15 (arl)5 (y in)25 (v)20 (ol)5 (v)19.9 (em)10 (ent of sm)10 (a)10 (ll airw)15 (a)25 (y)10 (s usin)10 (g)10 ( )]TJ 0.101 Tw 0 -1.2 Td [(s)5 (ophi)10 (stic)10 (ated tests s)9.9 (uch a)9.9 (s closin)10 (g v)20 (ol)15 (um)9.9 (e pr)9.9 (o)20 (v)20 (ed of)10 ( )]TJ 0.056 Tw 0 -1.2 Td [(limited v)19.9 (a)10 (l)15.1 (ue in esta)10 (bli)10 (s)15 (hin)10 (g w)5 (hich cig)10 (ar)10 (ette sm)10 (ok)10 (ers)10 ( )]TJ 0.27 Tw 0 -1.2 Td [(w)5 (o)10 (uld de)20 (v)20 (elop C)20 (OPD)40 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 430.2648 397.962 Tm (22)Tj /T1_1 1 Tf 0.01 Tc 0.27 Tw 11 0 0 11 440.3876 393.3 Tm [( A)10 (c)10 (c)10 (or)10 (din)10 (gl)5 (y)50 (, th)10 (er)10 (e w)15 (a)10 (s an)10 ( )]TJ 0.389 Tw -10.908 -1.2 Td [(inter)10 (est in identifyin)10 (g sm)10 (ok)10 (ers w)5 (h)10 (o h)9.9 (a)10.1 (d minim)10 (a)10 (l)10 ( )]TJ 0.414 Tw 0 -1.2 Td [(s)5 (ym)10 (ptom)10 (s an)10 (d testin)10 (g w)5 (h)10 (eth)10 (er e)15 (arl)5 (y interv)20 (ention)10 ( )]TJ 0.059 Tw 0 -1.2 Td [(with br)10 (on)10 (ch)10 (odil)10 (ators an)10 (d sm)10 (okin)10.1 (g interv)20 (ention c)10 (o)10 (uld)10 ( )]TJ 0.009 Tw 0 -1.2 Td [(a)10 (lter th)10 (e tra)10 (jectory of th)10 (e di)10 (s)5 (e)15 (a)10 (s)5 (e)10 (. Th)10 (e th)10 (eory w)15 (a)10 (s th)10 (at)10 ( )]TJ 0.392 Tw 0 -1.2 Td [(r)10 (eduction of airw)15 (a)25 (y)10 (s h)15 (y)10 (perr)10 (e)15 (a)10 (cti)20 (vit)15 (y an)10 (d r)9.9 (epe)15 (ated)10 ( )]TJ 0.315 Tw 0 -1.2 Td [(br)10 (on)10 (ch)10 (oc)10 (on)10 (striction w)5 (o)10 (uld a)10 (lter airw)15 (a)25.1 (y r)10 (em)10 (odelin)10 (g)10 ( )]TJ 0.068 Tw 0 -1.2 Td [(in a m)10 (ann)10 (er an)9.9 (a)10.1 (logo)10 (us to tr)10 (e)15 (atm)10 (ent of a)10 (s)5 (ym)10 (ptom)10 (atic)10 ( )]TJ -0.043 Tw 0 -1.2 Td [(s)5 (y)10 (stemic h)15 (y)10 (perten)10 (sion to pr)10 (e)20 (v)19.9 (ent v)20 (a)10 (s)5 (c)10 (ul)10 (ar r)10 (em)10 (odelin)9.9 (g)50 (.)10 ( )197 ( )]TJ 0.167 Tw 0.818 -1.2 Td [(E)20 (pidemiologic studies fr)10 (om Ba)10 (ltim)10 (or)10 (e an)10 (d T)60 (ucs)5 (on)10 ( )]TJ 0.096 Tw -0.818 -1.2 Td [(dem)10 (on)10 (strated th)10 (at th)10 (e r)10 (eduction in FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 513.9965 260.6371 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.096 Tw 11 0 0 11 517.9733 261.3 Tm [(/F)20 (V)30 (C belo)5 (w)10 ( )]TJ -0.028 Tw -17.961 -1.2 Td [(a thr)10 (es)15 (h)10 (old of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 386.9973 248.1 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 393.1985 248.1 Tm (.)Tj /TT0 1 Tf 10 0 0 10 395.3323 248.1 Tm (7)Tj /T1_1 1 Tf 0.01 Tc -0.028 Tw 11 0 0 11 401.5335 248.1 Tm [( w)15 (a)10 (s a str)10 (on)10 (g pr)10 (edictor of s)10 (u)10 (bs)5 (equent)10 ( )]TJ 0.42 Tw -7.376 -1.2 Td [(declin)10 (e in FE)10.1 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 399.6151 234.237 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.42 Tw 11 0 0 11 403.5919 234.9 Tm [( w)5 (h)10 (er)10 (e)15 (a)10 (s a)10.1 (bs)4.9 (ol)15 (ute FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 524.4111 234.237 Tm (1)Tj /T1_1 1 Tf 0.43 Tw 11 0 0 11 528.3879 234.9 Tm [( w)5 (as)-10 ( no)-10 (t )]TJ 0.01 Tc -0.01 Tw -18.908 -1.2 Td [(pr)10 (edicti)20 (v)20 (e)10 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 369.9217 226.362 Tm (23,24)Tj /T1_1 1 Tf 0.01 Tc 0.429 Tw 11 0 0 11 392.7776 221.7 Tm [( Ov)20 (er a )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 443.949 221.7 Tm (2-)Tj /T1_1 1 Tf 0.01 Tc 0.429 Tw 11 0 0 11 454.1492 221.7 Tm [(y)20 (e)15 (ar period, )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 521.8532 221.7 Tm (10)Tj /T1_1 1 Tf 0.01 Tc 0.429 Tw 11 0 0 11 534.2556 221.7 Tm [( c)10 (enters)10 ( )]TJ 0.239 Tw -19.441 -1.2 Td [(enr)10 (olled a tota)10 (l of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 416.7563 208.5 Tm (5887)Tj /T1_1 1 Tf 0.01 Tc 0.239 Tw 11 0 0 11 441.561 208.5 Tm [( c)10 (urr)10 (ent sm)10 (ok)10 (ers a)10 (ged )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 559.5986 208.5 Tm (35-)Tj -23.92 -1.32 Td (60)Tj /T1_1 1 Tf 0.01 Tc 0.153 Tw 11 0 0 11 332.8023 195.3 Tm [( y)20 (e)15 (ars with an FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 428.0463 194.6371 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.153 Tw 11 0 0 11 432.0231 195.3 Tm [(/F)20 (V)30 (C ratio of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 502.9473 195.3 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 509.1485 195.3 Tm (.)Tj /TT0 1 Tf 10 0 0 10 511.2823 195.3 Tm (7)Tj /T1_1 1 Tf 0.01 Tc 0.153 Tw 11 0 0 11 517.4835 195.3 Tm [( or less an)10.1 (d)9.9 ( )]TJ 0.213 Tw -17.917 -1.2 Td [(a FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 351.5519 181.437 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.213 Tw 11 0 0 11 355.5287 182.1 Tm [( betw)5 (een )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 405.0947 182.1 Tm (55%-90%)Tj /T1_1 1 Tf 0.01 Tc 0.213 Tw 11 0 0 11 451.8965 182.1 Tm [( pr)10 (edicted.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 504.0581 186.762 Tm (25)Tj /T1_1 1 Tf 0.01 Tc 0.213 Tw 11 0 0 11 514.1809 182.1 Tm [( P)25 (artici)15 (p)10 (ants)10 ( )]TJ 0.007 Tw -17.616 -1.2 Td [(w)5 (er)10 (e ran)10 (doml)5 (y a)10 (ssign)10 (ed to )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 450.4414 168.9 Tm (3)Tj /T1_1 1 Tf 0.01 Tc 0.007 Tw 11 0 0 11 456.6426 168.9 Tm [( tr)10 (e)15 (atm)9.9 (ent arm)10 (s: )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 536.6203 168.9 Tm (1)Tj /T1_1 1 Tf 0.017 Tw 11 0 0 11 542.8215 168.9 Tm [(\))-10 ( U)30 (su)-10 (al )]TJ 0.01 Tc -0.011 Tw -20.22 -1.2 Td [(C)30 (ar)10 (e c)10 (on)10 (si)10 (stin)10 (g of a)10 (dvic)10 (e to quit sm)10 (okin)10 (g an)10 (d r)10 (ef)15 (erra)10 (l)10 ( )]TJ 0.29 Tw 0 -1.2 Td [(to c)9.9 (ommunit)14.9 (y r)10 (es)5 (o)10 (ur)9.9 (c)10 (es; )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 448.8018 142.5 Tm (2)Tj /T1_1 1 Tf 0.01 Tc 0.29 Tw 11 0 0 11 455.003 142.5 Tm [(\) S)10 (m)10 (okin)10 (g Interv)19.9 (ention)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 572.001 142.5 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.236 Tw 11 0 0 11 320.4 129.3 Tm [(Pl)10 (a)10 (c)10 (ebo w)5 (hich c)9.9 (on)10 (si)10 (sted of a )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 477.0229 129.3 Tm (12)Tj /T1_1 1 Tf 0.01 Tc 0.236 Tw 11 0 0 11 489.4252 129.3 Tm [( s)5 (ession sm)10 (okin)10 (g)10 ( )]TJ -0.043 Tw -15.366 -1.2 Td [(c)10 (ess)5 (ation pr)9.9 (ogram an)10 (d a )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 437.4625 116.1 Tm (3-)Tj /T1_1 1 Tf 0.01 Tc -0.043 Tw 11 0 0 11 447.6627 116.1 Tm [(tim)10 (es d)10 (ail)5 (y pl)10 (a)10 (c)10 (ebo in)10 (h)10 (a)10 (ler;)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 320.4 102.9 Tm (3)Tj /T1_1 1 Tf 0.01 Tc 0.233 Tw 11 0 0 11 326.6011 102.9 Tm [(\) S)10 (m)10 (okin)10 (g Interv)20 (ention)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 442.3453 102.9 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.233 Tw 11 0 0 11 446.3443 102.9 Tm [(A)10 (cti)20 (v)20 (e \()5 (SIA)10 (\) c)10 (on)10 (si)10 (stin)10 (g of)10 ( )]TJ 0.353 Tw -11.449 -1.2 Td [(th)10 (e sm)10 (okin)10 (g c)10 (ess)5 (ation pr)10 (ogram an)10 (d in)10 (h)10 (a)10.1 (l)9.9 (ation of)9.9 ( )]TJ 0.12 Tw 0 -1.2 Td [(th)10 (e br)10 (on)10 (ch)10 (odil)10 (ator i)14.9 (pratr)10 (opi)15 (um )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 474.3112 76.5 Tm (3)Tj /T1_1 1 Tf 0.01 Tc 0.12 Tw 11 0 0 11 480.5123 76.5 Tm [( tim)10 (es d)10 (ail)5 (y)50 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 539.5021 81.162 Tm (26)Tj /T1_1 1 Tf 0.13 Tw 11 0 0 11 549.6249 76.5 Tm [( T)-10 (he )]TJ ET 0 0.1 0.15 0 scn /GS0 gs 320.4 527.38 255.6 25.14 re f BT 0 0 0 1 scn /GS1 gs /T1_2 1 Tf 0 Tw 14 0 0 14 324.9 534.7 Tm (Lung Health Study )Tj ET endstream endobj 70 0 obj <>stream q /GS0 gs 0 TL/Fm0 Do Q BT /CS0 cs 0 0 0 0 scn /GS0 gs /T1_0 1 Tf 0.052 Tc -0.052 Tw 12 0 0 12 13.8882 772 Tm (361)Tj ET q 0 Tc 0 Tw 0 g 0 TL/Fm1 Do Q BT 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.01 Tc 0.126 Tw 11 0 0 11 320.4 710.6401 Tm [(r)10 (epri)10 (s)5 (ed in th)10 (e c)10 (urr)10 (ent literatur)10 (e usin)10 (g in vi)20 (v)20 (o high)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 572.001 710.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 11 0 0 11 320.4 697.4401 Tm [(r)10 (es)5 (ol)15 (ution c)10 (om)10 (p)10 (uted tom)10 (ogra)10 (ph)15 (y \()10 (C)20 (T\).)]TJ /TT0 1 Tf 0 Tc 8.162 0 0 8.162 505.5936 702.1021 Tm (14)Tj /T1_1 1 Tf 11 0 0 11 515.7164 697.4401 Tm ( )Tj 0.01 Tc 0.37 Tw -16.938 -1.2 Td [(Thi)10 (s study)49.9 (, a c)9.9 (om)10 (p)10 (arati)20 (v)19.9 (e e\036c)10 (a)10 (c)10 (y study)50 (, h)10 (a)10 (d a)10 ( )]TJ -0.02 Tw -0.818 -1.2 Td [(dram)10 (atic im)10 (p)10 (a)10 (ct on th)10 (e pra)10 (ctic)10 (e of r)10 (es)10 (piratory th)10 (era)10 (p)15 (y)50 (.)10 ( )220 ( )]TJ -0.025 Tw 0 -1.2 Td [(T)50 (r)10 (e)15 (atm)10 (ents with positi)20 (v)20 (e pr)10 (ess)10 (ur)10 (e br)10 (e)15 (athin)10 (g m)10 (a)10 (chin)10 (es)10 ( )]TJ 0.557 Tw 0 -1.2 Td [(quickl)5 (y bec)10 (am)10 (e obs)5 (olete an)10 (d w)5 (er)10 (e r)10 (epl)10 (a)10 (c)10 (ed b)15 (y)10 ( )]TJ 0.062 Tw 0 -1.2 Td [(c)10 (om)10 (pr)10 (ess)5 (or dri)20 (v)19.9 (en n)10 (eb)10 (uli)10 (z)10 (ers an)10 (d h)10 (an)10 (d)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 509.3235 631.4401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.062 Tw 11 0 0 11 513.3225 631.4401 Tm [(h)10 (eld m)10 (eter)10 (ed)10 ( )]TJ 0.015 Tw -17.538 -1.2 Td [(dos)5 (e in)10 (h)10.1 (a)9.9 (lers. Thi)10 (s study a)10 (l)10 (s)5 (o rai)10 (s)5 (ed a)20 (w)15 (ar)10 (en)10 (ess of th)10 (e)10 ( )]TJ 0.237 Tw 0 -1.2 Td [(poor a)10 (dh)10 (er)10 (en)10 (c)10 (e with chr)10 (onic)9.9 (a)10 (ll)5 (y pr)10 (es)5 (cri)10 (bed in)10 (h)9.9 (a)10.1 (led)10 ( )]TJ 0.022 Tw 0 -1.2 Td [(m)10 (edic)10 (ation)10 (s, a c)10 (on)10 (dition th)10 (at h)10 (a)10 (s ch)10 (an)10 (ged litt)15 (le to th)10 (e)10 ( )]TJ 0.06 Tw 0 -1.2 Td [(pr)10 (es)5 (ent d)10 (a)25 (y)50 (. Th)10 (e m)10 (etic)9.9 (ulo)10 (us d)9.9 (ata c)10 (ollection m)10 (eth)10 (od)10 (s)10 ( )]TJ 0.167 Tw 0 -1.2 Td [(em)10 (plo)15 (y)20 (ed in th)10 (e IPPB tri)10 (a)10 (l pr)10 (o)20 (vided inf)15 (orm)10 (ation on)10 ( )]TJ 0.042 Tw 0 -1.2 Td [(th)10 (e n)10 (atura)10 (l hi)10 (story of C)20 (OPD th)10 (at h)10 (a)10 (s been v)20 (eri\037ed b)15 (y)10 ( )]TJ 0 Tw 0 -1.2 Td [(num)10 (er)10 (o)10 (us obs)5 (erv)20 (ation)10 (a)10 (l studies.)10 ( )]TJ 0.071 Tw 0 -6.042 Td [(Alth)10 (o)10 (ugh o)10 (xy)20 (gen s)10 (upplem)10 (entation with o)10 (xy)20 (gen tents)10 ( )]TJ 0.241 Tw 0 -1.2 Td [(h)10 (a)10 (d been us)5 (ed in h)10 (os)10 (pita)10 (l)10 (s f)15 (or h)15 (y)10 (po)10 (x)10 (emic p)10 (atients)9.9 ( )]TJ 0.058 Tw 0 -1.2 Td [(with pn)10 (e)10 (um)10 (oni)10 (a an)9.9 (d h)10 (e)15 (art fail)15 (ur)10 (e sin)10 (c)9.9 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 511.3244 446.18 Tm (1798)Tj /T1_1 1 Tf 0.01 Tc 0.058 Tw 11 0 0 11 536.1292 446.18 Tm [(, th)10 (e us)5 (e)10 ( )]TJ 0.164 Tw -19.612 -1.2 Td [(of lon)10 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 355.4915 432.98 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.164 Tw 11 0 0 11 359.4905 432.98 Tm [(term domicili)10 (ary o)10 (xy)19.9 (gen i)10 (s r)10 (el)10 (ati)20 (v)20 (el)5 (y r)10 (ec)10 (ent.)10 ( )404 ( )]TJ 0.003 Tw -3.554 -1.2 Td [(Th)10 (e chr)10 (onic us)5 (e of o)10 (xy)20 (gen in p)10 (atients with C)20 (OPD an)10 (d)10 ( )]TJ 0.207 Tw 0 -1.2 Td [(h)15 (y)10 (po)10 (x)10 (emi)10 (a )0.5 (w)15 (a)10 (s )0.5 (pion)10 (eer)10 (ed b)15 (y )0.5 (Al)5 (v)20 (an )0.5 (Bara)10 (ch, )0.5 (MD)40 (, )0.5 (in)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 339.7749 393.38 Tm (1950)Tj /T1_1 1 Tf 0.01 Tc 0.154 Tw 11 0 0 11 364.5796 393.38 Tm [(s with th)10 (e de)20 (v)20 (elopm)10 (ent of porta)10 (ble o)10 (xy)20 (gen)10 ( )]TJ -0.01 Tw -4.016 -1.2 Td [(c)10 (anni)10 (sters.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 371.2962 384.842 Tm (15)Tj /T1_1 1 Tf 0.01 Tc 0.187 Tw 11 0 0 11 381.419 380.18 Tm [( )0.5 ( )0.5 (Initi)10 (a)10 (l )0.5 (obs)5 (erv)20 (ation)10 (a)10 (l )0.5 (studies )0.5 (in)10 (dic)9.9 (ated)10 ( )]TJ 0.02 Tw -5.547 -1.2 Td [(th)10 (at lon)10 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 363.281 366.98 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.02 Tw 11 0 0 11 367.28 366.98 Tm [(term o)10 (xy)19.9 (gen in h)15 (y)10 (po)10 (x)9.9 (emic p)10 (atients r)10 (educ)10 (ed)9.9 ( )]TJ 0.588 Tw -4.262 -1.2 Td [(dy)10 (s)10 (pn)10 (e)15 (a, in)9.9 (cr)10 (e)15 (a)10.1 (s)4.9 (ed e)10 (x)10 (er)10 (ci)10 (s)4.9 (e c)10 (a)10 (p)10 (a)10 (cit)15 (y)50 (, dimini)10 (s)15 (h)10 (ed)10 ( )]TJ 0.021 Tw 0 -1.2 Td [(p)10 (ulm)10 (on)10 (ary h)15.1 (y)9.9 (perten)10 (sion, an)10 (d im)10 (pr)10 (o)20 (v)20 (ed ps)4.9 (y)20 (ch)10 (ologic)10 (a)10 (l)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(fun)10 (ction.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 362.4083 332.042 Tm (16,17)Tj /T1_1 1 Tf 0.01 Tc -0.128 Tw 11 0 0 11 385.2642 327.38 Tm [( Th)10 (e us)5 (e of o)10 (xy)20 (gen in th)10 (e h)10 (om)10 (e f)15 (or chr)10 (onic)10 ( )]TJ 0.08 Tw -5.897 -1.2 Td [(us)5 (e w)15 (a)10 (s g)10 (ainin)10 (g a)10 (c)10 (c)10 (eptan)10 (c)10 (e a)10 (s pra)10 (ctic)10 (e in th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 544.3535 314.18 Tm (1960)Tj /T1_1 1 Tf 11 0 0 11 569.1582 314.18 Tm [(s)-10 (, )]TJ 0.01 Tc 0.16 Tw -22.614 -1.2 Td [(a)10 (c)10 (c)10 (elerated b)14.9 (y th)10 (e us)5 (e of liquid o)10 (xy)20 (gen an)9.9 (d o)10 (xy)20 (gen)10 ( )]TJ 0.358 Tw 0 -1.2 Td [(c)10 (on)10 (c)10 (entrators. Alth)10 (o)10 (ugh m)9.9 (an)15 (y p)10 (atients per)10 (c)10 (ei)20 (v)20 (ed)10 ( )]TJ 0.142 Tw 0 -1.2 Td [(im)10 (pr)10 (o)20 (v)20 (em)10 (ent in th)10 (eir qua)10 (lit)15.1 (y of lif)15 (e usin)10 (g lon)10 (g)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 549.9023 274.58 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 553.9013 274.58 Tm [(term)10 ( )]TJ 0.178 Tw -21.227 -1.2 Td [(o)10 (xy)20 (gen tr)10 (e)15 (atm)10 (ent, it w)15 (a)10 (s un)10 (kn)10 (o)5 (wn h)10 (o)5 (w m)10 (an)14.9 (y h)10 (o)10 (urs)10 ( )]TJ 0.071 Tw 0 -1.2 Td [(of o)10 (xy)20 (gen w)5 (er)10 (e n)10 (eeded to c)9.9 (onf)15 (er ben)9.9 (e\037t an)10 (d w)5 (h)9.9 (eth)10.1 (er)10.1 ( )]TJ 0.2 Tw 0 -1.2 Td [(th)10 (er)10 (e w)15 (a)10 (s an im)10 (pr)10 (o)20 (v)20 (em)10 (ent in s)10 (urvi)20 (v)20 (a)10 (l. Th)9.9 (e U)30 (nited)10 ( )]TJ 0.15 Tw 0 -1.2 Td [(K)-30 (in)10 (g)10 (dom M)19.9 (edic)9.9 (a)10 (l R)10 (es)5 (e)15 (ar)10 (ch C)30 (o)10 (un)9.9 (cil \(MRC\) initi)10 (ated)10 ( )]TJ 0.096 Tw 0 -1.2 Td [(a tri)10.1 (a)10 (l in w)5 (hich p)10 (artici)15 (p)10 (ants w)5 (er)10 (e ran)10 (doml)5 (y a)10 (lloc)10 (ated)10 ( )]TJ 0.172 Tw 0 -1.2 Td [(to eith)10 (er )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 366.5579 195.38 Tm (15)Tj /T1_1 1 Tf 0.01 Tc 0.172 Tw 11 0 0 11 378.9603 195.38 Tm [( h)10 (o)10 (urs of o)10 (xy)20 (gen/)100 (d)10 (a)25 (y or n)10 (o o)10 (xy)20 (gen an)10 (d)10 ( )]TJ 0.248 Tw -5.324 -1.2 Td [(e)15 (arl)5 (y r)10 (eports in)10 (dic)10 (ated an im)9.9 (pr)10 (o)20 (v)20 (em)10 (ent in s)10 (urvi)20 (v)20 (a)10 (l)10 ( )]TJ 0.049 Tw 0 -1.2 Td [(with o)10 (xy)20 (gen.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 380.8336 173.642 Tm (18,19)Tj /T1_1 1 Tf 0.01 Tc 0.049 Tw 11 0 0 11 403.6896 168.98 Tm [( W)14.9 (ith c)10 (on)10 (c)10 (ern)10 (s, th)10 (er)10 (ef)15 (or)10 (e)9.9 (, th)10 (at a n)10 (o)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 572.001 168.98 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.169 Tw 11 0 0 11 320.4 155.78 Tm [(o)10 (xy)20 (gen tr)10 (e)15 (atm)10 (ent gr)10 (o)10 (up w)5 (o)10 (uld be un)10 (a)10 (c)10 (c)10 (epta)10 (ble)9.9 (, th)10 (e)10 ( )]TJ 0.168 Tw 0 -1.2 Td [(NHLBI c)10 (on)10 (ducted th)10 (e N)15 (octurn)10 (a)10 (l Oxy)20 (gen T)50 (r)10 (e)15 (atm)10 (ent)10 ( )]TJ 0.106 Tw 0 -1.2 Td [(T)50 (ri)10 (a)10 (l \(NO)20 (TT\) study th)10 (at c)10 (om)10 (p)10 (ar)10 (ed n)10 (octurn)10 (a)10 (l o)10 (xy)20 (gen)10 ( )]TJ 0.02 Tc 0.265 Tw 0 -1.2 Td [(tr)10 (e)15 (atm)10 (ent )0.5 (\()]TJ /TT0 1 Tf -0.02 Tw 10 0 0 10 376.9888 116.18 Tm (12)Tj /T1_1 1 Tf 0.265 Tw 11 0 0 11 389.7911 116.18 Tm [( )0.5 (h)10 (o)10 (urs)10 (\) )0.5 (with )0.5 (c)10 (ontinuo)10 (us )0.5 (o)10 (xy)20 (gen )0.5 (\()]TJ /TT0 1 Tf -0.02 Tw 10 0 0 10 563.3976 116.18 Tm (24)Tj /T1_1 1 Tf 0 Tc 0 Tw 11 0 0 11 576 116.18 Tm ( )Tj 0.01 Tc 0.296 Tw -23.236 -1.2 Td [(hou)-10 (r)-10 (s)-10 (/)90 (d)10 (a)25 (y\). Th)10 (e in)10 (cl)15 (usion criteri)10 (a )0.5 (r)9.9 (equir)9.9 (ed s)5 (e)20 (v)20 (er)10 (e)10 ( )]TJ 0.275 Tw 0 -1.2 Td [(r)10 (estin)10 (g r)9.9 (oom air h)15.1 (y)9.9 (po)10 (x)10 (emi)10 (a, de\037n)10 (ed a)10 (s an arteri)10 (a)10 (l)10 ( )]TJ 0.065 Tw 0 -1.2 Td [(positi)20 (v)20 (e pr)10 (ess)10 (ur)10 (e of o)10 (xy)20 (gen \(P)25 (aO)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 479.778 75.917 Tm (2)Tj /T1_1 1 Tf 0.01 Tc 0.065 Tw 11 0 0 11 483.7549 76.58 Tm [(\) less th)10 (an or equa)10 (l)10 ( )]TJ ET 0 0.1 0.15 0 scn /GS0 gs 320.4 486.68 255.6 26.32 re f BT 0 0 0 1 scn /GS1 gs /T1_2 1 Tf 0 Tc 0 Tw 14 0 0 14 324.9 494.59 Tm [(Nocturnal O)20.1 (xygen T)82 (reatment T)82 (rial)]TJ /T1_1 1 Tf 0.01 Tc 0.041 Tw 11 0 0 11 36 710.6401 Tm [(gr)10 (o)10 (ups in term)10 (s of ch)10 (an)10 (ge in l)15 (un)10 (g fun)10 (ction, m)10 (orta)10 (lit)15.1 (y)49.9 (,)10 ( )]TJ 0.298 Tw 0 -1.2 Td [(h)10 (os)10 (pita)10 (li)10 (z)10 (ation)9.9 (s, or qua)10 (lit)15 (y of lif)15 (e)10 (. Th)10 (er)10 (e w)5 (er)10 (e n)10 (o)10 ( )]TJ -0.036 Tw 0 -1.2 Td [(s)10 (u)10 (bgr)10 (o)10 (ups s)15 (h)10 (o)5 (wn to ben)10 (e\037t with on)10 (e of th)10 (e tr)9.9 (e)15.1 (atm)10 (ents.)10 ( )204 ( )]TJ 0.456 Tw 0 -1.2 Td [(Des)10 (pite th)10 (e fr)10 (equent h)10 (om)10 (e vi)10 (sits an)10 (d unm)9.9 (a)10.1 (s)14.9 (k)10.1 (ed)9.9 ( )]TJ 0.376 Tw 0 -1.2 Td [(objecti)20 (v)20 (e m)10 (e)15 (a)10 (s)10 (ur)10 (em)10 (ents of a)10 (dh)10 (er)10 (en)10 (c)10 (e)10 (, p)10 (artici)15 (p)10 (ants)10 ( )]TJ 0.277 Tw 0 -1.2 Td [(took on a)25 (v)20 (era)10 (ge on)10 (l)5 (y a)10 (bo)10 (ut h)10 (a)10 (lf of th)10.1 (e pr)10 (es)5 (cri)10 (bed)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(tr)10 (e)15 (atm)10 (ents.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 89.0411 636.1021 Tm (2)Tj /T1_1 1 Tf 0.01 Tc -0.057 Tw 11 0 0 11 94.1024 631.4401 Tm [( S)10 (u)10 (bs)5 (equent an)10 (a)10 (l)5 (y)10 (s)5 (es r)9.9 (e)20 (v)20 (e)15 (a)10 (led th)10 (at high)10 (er)10 ( )]TJ 0.365 Tw -5.282 -1.2 Td [(s)5 (ocioec)10 (on)10 (omic status an)10 (d gr)10 (e)15 (ater di)10 (s)5 (e)15 (a)9.9 (s)5.1 (e s)5 (e)20 (v)20 (erit)15 (y)10 ( )]TJ 0.158 Tw 0 -1.2 Td [(w)5 (er)10 (e pr)10 (edicti)20 (v)20 (e of better a)10 (dh)10 (er)10 (en)10 (c)10 (e with tr)9.9 (e)15.1 (atm)10 (ents.)10 ( )398 ( )]TJ -0.028 Tw 0 -1.2 Td [(Th)10 (e a)10.1 (uth)10 (ors c)10 (on)10 (cl)15 (uded: \223W)75 (e s)5 (a)19.9 (w n)10 (o a)10 (dv)20 (anta)10 (ge of IPPB)9.9 ( )]TJ 0.029 Tw 0 -1.2 Td [(o)20 (v)20 (er c)10 (om)10 (pr)10 (ess)5 (or n)10 (eb)10 (uli)10 (z)10 (er th)10.1 (era)10.1 (p)15 (y in thi)10 (s l)10 (ar)10 (ge gr)10 (o)10 (up)10 ( )]TJ -0.029 Tw 0 -1.2 Td [(of p)10 (atients, an)10.1 (d c)10 (on)10 (cl)15 (ude th)10 (at, if an a)10 (dv)20 (anta)10 (ge e)10 (xi)10 (sts, it)10 ( )]TJ 0 Tw 0 -1.2 Td [(must be m)10 (ar)10 (gin)10 (a)10 (l.)30 (\224)]TJ 0.115 Tw 0.818 -1.2 Td [(Gi)20 (v)20 (en th)10 (e th)10 (era)10 (pe)10 (utic simil)10 (arit)15 (y of th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 235.5134 539.04 Tm (2)Tj /T1_1 1 Tf 0.01 Tc 0.115 Tw 11 0 0 11 241.7146 539.04 Tm [( tr)10 (e)15 (atm)10 (ent)10 ( )]TJ 0.331 Tw -18.701 -1.2 Td [(arm)10 (s, th)10 (e IPPB tri)9.9 (a)10.1 (l pr)10 (o)19.9 (vided a w)5 (ell)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 224.0329 525.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 228.0319 525.8401 Tm [(ch)10 (ara)10 (cteri)10 (z)10 (ed)10 ( )]TJ -0.009 Tw -17.457 -1.2 Td [(c)10 (oh)10 (ort of C)20 (OPD p)10 (atients with a wide ran)10 (ge of s)5 (e)19.9 (v)20 (erit)15 (y)50 (.)10 ( )231 ( )]TJ 0.383 Tw 0 -1.2 Td [(Thus, it pr)10 (o)20 (vided m)10 (an)15 (y in)10 (sights into th)10 (e n)10 (atura)10 (l)10 ( )]TJ 0.346 Tw 0 -1.2 Td [(hi)10 (story of C)20 (OPD th)10 (at ar)10 (e c)9.9 (on)9.9 (si)9.9 (stent with c)10 (urr)10 (ent)10 ( )]TJ -0.01 Tw 0 -1.2 Td [(obs)5 (erv)20 (ation)10 (s.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 98.8532 477.7021 Tm (3)Tj /T1_1 1 Tf 0.01 Tc 0.108 Tw 11 0 0 11 103.9145 473.0401 Tm [( Th)10 (e a)10 (uth)10 (ors r)10 (ec)10 (ogni)10 (z)10 (ed th)10 (at th)10 (e post)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 287.601 473.0401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.231 Tw 11 0 0 11 36 459.8401 Tm [(br)10 (on)10 (ch)10 (odil)10 (ator FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 132.2207 459.1771 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.231 Tw 11 0 0 11 136.1976 459.8401 Tm [( w)15.1 (a)10 (s, b)15 (y far)30 (, th)10 (e best pr)10 (edictor)10 ( )]TJ 0.146 Tw -9.109 -1.2 Td [(of s)10 (urvi)20 (v)20 (a)10 (l. Oth)10 (er less im)9.9 (portant pr)10 (edictors of poor)10 ( )]TJ -0.05 Tw 0 -1.2 Td [(s)10 (urvi)20 (v)20 (a)10 (l in)10 (cl)14.9 (uded h)15 (y)10 (perin\035)10 (ation, ta)10 (ch)15 (y)19.9 (c)10 (ar)10 (di)10 (a, im)10 (p)10 (air)10 (ed)10 ( )]TJ 0.078 Tw 0 -1.2 Td [(e)10 (x)10 (er)10 (ci)10 (s)5 (e c)10 (a)10 (p)10 (a)10 (cit)15 (y)50 (, an)10 (d br)10 (e)15 (athlessn)10 (ess. Th)10 (e declin)10 (e in)9.9 ( )]TJ 0 Tc 0 Tw 0 -1.2 Td [(F)-10 (EV)]TJ /TT0 1 Tf 6.413 0 0 6.413 56.7239 406.3771 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.073 Tw 11 0 0 11 60.7007 407.0401 Tm [( w)15.1 (a)9.9 (s widel)5 (y v)19.9 (ari)10 (a)10 (ble)10 (, b)10 (ut th)10 (os)5 (e with better FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 287.6232 406.3771 Tm (1)Tj /T1_1 1 Tf 11 0 0 11 291.6 407.0401 Tm ( )Tj 0.01 Tc 0.168 Tw -23.236 -1.2 Td [(s)15 (h)10 (o)5 (w)5 (ed, on a)25 (v)20 (era)10 (ge)10 (, m)10 (or)10 (e ra)10 (pid declin)10 (es th)10 (an th)10 (os)5 (e)10 ( )]TJ 0.195 Tw 0 -1.2 Td [(with a)10 (dv)20 (an)10 (c)10 (ed di)10 (s)4.9 (e)15 (a)10 (s)5 (e)10 (. L)10 (o)5 (w body w)5 (eight an)9.9 (d poor)10 ( )]TJ 0.116 Tw 0 -1.2 Td [(nutrition)10 (a)10.1 (l status w)5 (er)10 (e a)10 (l)10 (s)5 (o f)15 (o)10 (un)10 (d to be in)10 (dic)10 (ati)20 (v)20 (e of)10 ( )]TJ 0.2 Tw 0 -1.2 Td [(poor o)10 (utc)10 (om)10 (es.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 110.5802 358.9021 Tm (4)Tj /T1_1 1 Tf 0.01 Tc 0.2 Tw 11 0 0 11 115.6416 354.2401 Tm [( T)70 (a)10 (k)10 (en togeth)10 (er)30 (, th)10 (es)5 (e obs)5 (erv)19.9 (ation)10 (s)10 ( )]TJ 0.394 Tw -7.24 -1.2 Td [(pr)10 (es)5 (a)10 (ged th)10 (e de)20 (v)20 (elopm)10 (ent of th)10 (e widel)5 (y a)10 (dopted)10 ( )]TJ 0.5 Tw 0 -1.2 Td [(body w)5 (eight)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 99.975 327.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 103.974 327.8401 Tm (obstruction)Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 158.5771 327.8401 Tm (-)Tj /T1_1 1 Tf 11 0 0 11 162.5761 327.8401 Tm [(d)-10 (ysp)-10 (ne)5 (a)]TJ /TT0 1 Tf 10 0 0 10 201.9228 327.8401 Tm (-)Tj /T1_1 1 Tf 0.51 Tw 11 0 0 11 205.9218 327.8401 Tm [(exe)-10 (rc)-10 (is)-5 (e)-10 ( capac)-10 (i)-10 (t)5.1 (y )]TJ 0.01 Tc 0.266 Tw -15.447 -1.2 Td [(s)5 (c)10 (or)10 (e)10 (, \(BODE\) an)10 (d a)10 (ge)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 152.1137 314.6401 Tm (-)Tj /T1_1 1 Tf 11 0 0 11 156.1127 314.6401 Tm [(d)-10 (ysp)-10 (ne)5 (a)]TJ /TT0 1 Tf 10 0 0 10 195.4594 314.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.266 Tw 11 0 0 11 199.4585 314.6401 Tm [(obstruction \()10 (ADO)10 (\))10 ( )]TJ 0.195 Tw -14.86 -1.2 Td [(s)5 (c)10 (or)10 (e )0.5 (f)15 (or )0.5 (pr)10 (edictin)10 (g )0.5 (s)10 (urvi)20 (v)20 (a)10 (l )0.5 (in )0.5 (C)20 (OPD)40 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 227.0076 306.1021 Tm (5,6)Tj /T1_1 1 Tf -0.01 Tc -0.22 Tw 11 0 0 11 239.7408 301.4401 Tm [( )-434.5 (Mo)-20 (r)-10 (e)-20 (ove)-20 (r)10.1 (,)-10 ( )]TJ 0.01 Tc 0.111 Tw -18.522 -1.2 Td [(th)10 (e r)10 (ec)10 (ognition th)10 (at a)10 (c)10 (c)10 (elerated declin)10 (e in FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 266.2707 287.5771 Tm (1)Tj /T1_1 1 Tf 0.121 Tw 11 0 0 11 270.2475 288.2401 Tm [( w)5 (as )]TJ 0.01 Tc -0.004 Tw -21.295 -1.2 Td [(a)10 (ss)5 (oci)10 (ated with c)10 (urr)10 (ent sm)10 (okin)10 (g an)10 (d w)15 (a)10 (s n)10 (ot a f)15 (e)15 (atur)10 (e)10 ( )]TJ 0.176 Tw 0 -1.2 Td [(of l)9.9 (ate)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 67.3016 261.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.176 Tw 11 0 0 11 71.3006 261.8401 Tm [(sta)10 (ge di)10.1 (s)4.9 (e)15 (a)10 (s)5 (e)10 (, failed to s)10 (upport th)10 (e F)9.9 (letch)10 (er)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 287.601 261.8401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.12 Tw 11 0 0 11 36 248.6401 Tm [(P)20 (eto m)10 (odel of a)10 (c)10 (c)10 (eleratin)10 (g declin)10 (es in l)15 (un)9.9 (g fun)10 (ction)10 ( )]TJ 0 Tw 0 -1.2 Td [(thr)10 (o)10 (ugh th)10 (e c)10 (o)10 (urs)5 (e of C)20 (OPD)40 (.)]TJ /TT0 1 Tf 0 Tc 8.162 0 0 8.162 172.6844 240.1021 Tm (7)Tj /T1_1 1 Tf 0.01 Tc 0.214 Tw 11 0 0 11 45 222.2401 Tm [(It h)10 (a)10 (s n)10 (ot been widel)5 (y a)10 (ppr)10 (eci)10 (ated th)10 (at th)9.9 (e IPPB)10 ( )]TJ 0.181 Tw -0.818 -1.2 Td [(study m)10 (a)10 (de a c)10 (on)10 (c)10 (erted e\034)15 (ort to obtain l)15 (un)10 (g ti)10 (ss)10 (ue)10 ( )]TJ 0.07 Tw 0 -1.2 Td [(fr)10 (om a)9.9 (utopsied p)10 (artici)15 (p)10 (ants w)5 (h)10 (o died. Thi)10 (s pr)10 (o)20 (vided)10 ( )]TJ 0.147 Tw 0 -1.2 Td [(m)10 (ateri)10 (a)10 (l fr)9.9 (om )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 106.0681 182.6401 Tm (46)Tj /T1_1 1 Tf 0.01 Tc 0.147 Tw 11 0 0 11 118.4704 182.6401 Tm [( a)10.1 (utopsies f)15 (or a s)5 (eries of structur)10 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 287.601 182.6401 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.181 Tw 11 0 0 11 36 169.4401 Tm [(fun)10 (ction)10 (a)10 (l )0.5 (c)10 (orr)10 (el)10 (ation)10 (s )0.5 (b)15 (y Thurl)10 (beck )0.5 (an)10 (d )0.5 (c)10 (olle)15 (a)10 (g)10 (ues)10.1 ( )]TJ -0.003 Tw 0 -1.2 Td [(o)20 (v)20 (er th)10 (e n)10 (e)10 (xt dec)10 (a)10 (de)10 (.)]TJ /TT0 1 Tf 0 Tc 0 Tw 8.162 0 0 8.162 135.2985 160.9021 Tm (8-13)Tj /T1_1 1 Tf 0.01 Tc -0.003 Tw 11 0 0 11 153.7466 156.2401 Tm [( Am)10 (on)10 (g m)9.9 (an)15 (y \037n)10 (din)10 (g)15 (s, th)10 (es)5 (e)10 ( )]TJ 0.283 Tw -10.704 -1.2 Td [(studies r)10 (e)20 (v)20 (e)15 (a)10 (led th)10 (at airw)15 (a)25 (y w)15 (a)10 (ll mus)5 (cle thickn)10 (ess)10 ( )]TJ 0.381 Tw 0 -1.2 Td [(c)10 (orr)10 (el)10 (ated with br)10 (on)10 (ch)10 (odil)10 (ator r)10 (es)10 (pon)10 (si)20 (v)20 (en)10 (ess an)9.9 (d)10 ( )]TJ 0.114 Tw 0 -1.2 Td [(th)10 (at muc)10 (us gl)10 (an)10 (d h)15 (y)10 (perpl)10 (a)10 (si)10 (a h)10 (a)10 (d a poor c)10 (orr)10 (el)10 (ation)10 ( )]TJ 0.47 Tw 0 -1.2 Td [(with em)10 (ph)15 (y)10 (s)5 (em)10 (a, s)10 (upportin)10 (g th)10 (e dich)10 (otomi)9.9 (z)10 (ation)10 ( )]TJ 0.302 Tw 0 -1.2 Td [(of C)19.9 (OPD into chr)10 (onic br)10 (on)10 (chiti)10 (s an)9.9 (d em)10 (ph)15 (y)10 (s)5 (em)10 (a.)10 ( )542 ( )]TJ 0.076 Tw 0 -1.2 Td [(M)10 (an)15 (y of Thurl)10 (beck\222)35 (s s)5 (emin)10 (a)10 (l obs)5 (erv)20 (ation)10 (s h)10 (a)25 (v)20 (e been)10 ( )]TJ ET endstream endobj 69 0 obj <>stream q /GS0 gs 0 TL/Fm0 Do Q BT /CS0 cs 0 0 0 0 scn /GS0 gs /T1_0 1 Tf 0.052 Tc -0.052 Tw 12 0 0 12 13.8882 772 Tm (360)Tj ET q 0 Tc 0 Tw 0 g 0 TL/Fm1 Do Q BT 0 0 0 1 scn /GS1 gs /T1_1 1 Tf 0.01 Tc 0.278 Tw 11 0 0 11 36 679.02 Tm [(On th)10 (e c)10 (elebration of th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 172.266 679.02 Tm (50)Tj /T1_1 1 Tf 0.01 Tc 0.278 Tw 11 0 0 11 184.6683 679.02 Tm [(th anni)20 (v)20 (ers)5 (ary of th)10 (e)10 ( )]TJ 0.146 Tw -13.515 -1.2 Td [(N)30 (ation)10 (a)10 (l H)20 (e)15 (art, L)30 (un)10 (g)50 (, an)10 (d Blood In)10 (stitute\222)35 (s \(NHLBI\))10 ( )]TJ 0.282 Tw 0 -1.2 Td [(Di)20 (vi)10 (sion of L)30 (un)10 (g Di)10 (s)4.9 (e)15.1 (a)9.9 (s)5.1 (es \(DLD)10 (\) it i)10 (s a)10 (ppr)10 (opri)10 (ate)9.9 ( )]TJ 0.163 Tw 0 -1.2 Td [(to r)10 (e)20 (vie)10 (w th)10 (e m)10 (a)10 (jor c)10 (ontri)10 (b)10 (ution)10 (s of th)10 (e Di)20 (vi)10 (sion in)10 ( )]TJ 0.285 Tw 0 -1.2 Td [(th)10 (e )0.5 (m)10 (an)10 (a)10 (gem)10 (ent )0.5 (of chr)10 (onic obstructi)19.9 (v)20 (e )0.5 (p)10 (ulm)10 (on)10 (ary)10 ( )]TJ 0.045 Tw 0 -1.2 Td [(di)10 (s)5 (e)15 (a)10 (s)5 (e \()10 (C)19.9 (OPD)10.1 (\) in term)9.9 (s of m)10 (a)10 (jor clinic)10 (a)10 (l tri)10 (a)10 (l)10 (s. Thi)10 (s)10 ( )]TJ 0.264 Tw 0 -1.2 Td [(article will r)10 (e)20 (vie)10 (w th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 151.054 599.8199 Tm (5 )Tj /T1_1 1 Tf 0.01 Tc 0.264 Tw 11 0 0 11 164.1195 599.8199 Tm [(m)10 (a)10 (jor multic)10 (enter clinic)10 (a)10 (l)10 ( )]TJ 0.265 Tw -11.647 -1.2 Td [(tri)10 (a)10 (l)10 (s th)10 (at th)10 (e NHLBI h)10 (a)10 (s initi)10 (ated an)10 (d s)10 (pon)10 (s)5 (or)10 (ed.)10 ( )504.9 ( )]TJ 0.251 Tw 0 -1.2 Td [(Th)10 (es)5 (e )0.5 (tri)10 (a)10 (l)10 (s )0.5 (h)10 (a)25 (v)20 (e )0.5 (ch)10 (an)10 (ged )0.5 (th)10 (e )0.5 (l)10 (an)10 (d)9.9 (s)5 (c)10 (a)10 (pe )0.5 (of )0.5 (C)20 (OPD)10 ( )]TJ 0.245 Tw 0 -1.2 Td [(an)10 (d h)10 (a)25 (v)20 (e s)5 (et th)10 (e stan)10 (d)10 (ar)10 (d)9.9 (s b)15 (y w)5 (hich clinic)10 (a)10 (l tri)10 (a)10 (l)10 (s)10 ( )]TJ 0.109 Tw 0 -1.2 Td [(ar)10 (e c)10 (on)10.1 (ducted pr)10 (es)5 (ent)15 (l)5 (y)49.9 (. Thi)10 (s r)10 (e)20 (vie)10 (w will r)9.9 (e)20.1 (vie)10 (w th)10 (e)10 ( )]TJ 0.009 Tw 0 -1.2 Td [(l)10 (an)10 (dm)10 (ark clinic)10 (a)10 (l tri)10 (a)10 (l)10 (s th)10 (at h)10 (a)25 (v)20 (e been initi)10 (ated b)15 (y th)10 (e)10 ( )]TJ 0.088 Tw 0 -1.2 Td [(NHLBI an)10 (d th)10 (e DLD an)10 (d will n)10 (ot in)10 (cl)15 (ude th)10 (e do)10 (z)10 (en)9.9 (s)10 ( )]TJ -0.026 Tw 0 -1.2 Td [(of in)25 (v)20 (estig)10 (ator)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 104.474 507.42 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.026 Tw 11 0 0 11 108.4731 507.42 Tm [(initi)10 (ated r)10 (es)5 (e)15 (ar)10 (ch th)10 (at h)10 (a)25 (v)20 (e a)10 (l)10 (s)5 (o m)10 (o)20 (v)20 (ed)10 ( )]TJ 0.296 Tw -6.588 -1.2 Td [(th)10 (e \037eld f)15 (orw)15 (ar)10 (d an)10 (d th)10.1 (e s)10 (u)10 (bstanti)10 (a)10 (l c)10 (ontri)10 (b)10 (ution)10 (s)10 ( )]TJ 0.114 Tw 0 -1.2 Td [(fr)10 (om clinic)10 (a)10 (l tri)10 (a)10 (l n)10 (etw)5 (ork)10 (s an)10 (d r)10 (es)5 (e)15 (ar)10 (ch gr)9.9 (o)10 (ups th)10 (at)10 ( )]TJ 0.088 Tw 0 -1.2 Td [(h)10 (a)25 (v)20 (e been s)10 (upported b)15 (y th)10 (e NHLBI. T)60 (y)10 (pic)10 (a)10 (ll)5 (y)50 (, th)10 (es)4.9 (e)10 ( )]TJ 0.327 Tw 0 -1.2 Td [(tri)10 (a)10 (l)10 (s h)10 (a)25 (v)20 (e a)10 (ddr)10 (ess)5 (ed pra)9.9 (ctic)9.9 (a)10 (l c)10 (on)10 (c)10 (ern)10 (s th)10 (at h)10 (a)25 (v)19.9 (e)10 ( )]TJ 0.132 Tw 0 -1.2 Td [(been rai)10 (s)5 (ed b)15 (y th)10 (e p)10 (ulm)10 (on)10 (ary a)9.9 (c)10 (a)10 (demic an)10 (d clinic)10 (a)10 (l)10 ( )]TJ -0.075 Tw 0 -1.2 Td [(c)10 (ommunit)15 (y)50 (. Often, th)10 (e h)15 (y)10 (poth)10 (es)5 (es tested in th)10 (es)5 (e tri)9.9 (a)10.1 (l)9.9 (s)10 ( )]TJ 0.09 Tw 0 -1.2 Td [(w)5 (er)10 (e th)10 (e pr)10 (oduct of a f)15 (orm)10 (a)10 (l w)5 (ork)10 (s)15 (h)10 (op c)9.9 (on)10 (ducted b)15 (y)10 ( )]TJ 0.082 Tw 0 -1.2 Td [(NHLBI, f)15 (ollo)5 (w)5 (ed b)15 (y a f)15 (orm)10 (a)10 (l r)9.9 (equest f)15 (or a)10 (pplic)10 (ation)9.9 (s)10.1 ( )]TJ 0 Tw 0 -1.2 Td [(or a f)15 (orm)10 (a)10 (l r)10 (equest f)15 (or pr)10 (opos)5 (a)10 (l)10 (s.)10 ( )-10 ( )]TJ 0.015 Tc -0.015 Tw 0.818 -1.2 Td (NHLBI)Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 79.6387 375.42 Tm (-)Tj /T1_1 1 Tf 0.015 Tc 1.182 Tw 11 0 0 11 83.7877 375.42 Tm [(initi)10.1 (ated clinic)10 (a)10 (l tri)10 (a)10 (l)10 (s h)10 (a)25 (v)20 (e )0.5 (been)15 ( )]TJ 0.01 Tc 0.516 Tw -4.344 -1.2 Td [(c)-5 (h)5 (a)-5 (r)-5 (a)5 (c)-5 (t)-5 (e)-5 (r)-5 (i)5 (z)5 (e)-5 (d)-5 ( )-5.3 (b)15 (y th)10 (e high)10 (est le)20 (v)19.9 (el)10 (s of s)5 (cienti\037c)10 ( )]TJ -0.114 Tw 0 -1.2 Td [(integrit)15 (y an)10 (d state)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 120.2765 349.02 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 124.2755 349.02 Tm (of)Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 133.6143 349.02 Tm (-)Tj /T1_1 1 Tf 11 0 0 11 137.6133 349.02 Tm [(t)-10 (he)]TJ /TT0 1 Tf 10 0 0 10 152.6501 349.02 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.114 Tw 11 0 0 11 156.6491 349.02 Tm [(art c)10 (on)10 (duct an)10 (d or)10 (g)10 (ani)10 (z)10 (ation.)10 ( )126 ( )]TJ 0.219 Tw -10.968 -1.2 Td [(Th)10 (e t)15 (y)10 (pic)9.9 (a)10.1 (l tri)10 (a)10 (l h)10 (a)10 (s been or)10 (g)10 (ani)10 (z)10 (ed ar)10 (o)10 (un)10 (d a d)10 (ata)10 ( )]TJ 0.72 Tw 0 -1.2 Td [(c)10 (oor)10 (din)10 (atin)10 (g c)10 (enter an)10 (d a steerin)10 (g c)10 (ommittee)10 ( )]TJ 0.506 Tw 0 -1.2 Td [(c)10 (om)10 (pos)5 (ed of th)10 (e in)10 (di)20 (vidua)10 (l study site prin)10 (ci)15.1 (p)9.9 (a)10.1 (l)9.9 ( )]TJ -0.027 Tw 0 -1.2 Td [(in)25 (v)20 (estig)10 (ators. )0.6 ( )0.5 (Th)10 (e )0.6 (steerin)10 (g )0.5 (c)10 (ommittee )0.6 (h)10 (a)10 (s )0.5 (been )0.6 (led )0.5 (b)15 (y)10 ( )]TJ 0.141 Tw 0 -1.2 Td [(a study ch)10 (air)30 (, a)10 (ppointed b)15 (y th)10 (e NHLBI, w)5 (h)10 (o m)10 (a)25 (y or)10 ( )]TJ 0.036 Tw 0 -1.2 Td [(m)10 (a)25 (y n)10 (ot be on)10 (e of th)10 (e study in)25 (v)20 (estig)10 (ators. Th)10 (e s)5 (af)15 (et)15 (y)10 ( )]TJ 0.103 Tw 0 -1.2 Td [(of p)10 (artici)15 (p)10 (ants an)10 (d th)10 (e qua)10 (lit)15 (y of th)10 (e d)10 (ata h)10 (a)25 (v)20 (e been)10 ( )]TJ 0.148 Tw 0 -1.2 Td [(s)10 (u)10 (bject )0.5 (to r)10 (e)20 (vie)10 (w )0.5 (an)10 (d )0.5 (o)20 (v)20 (ersight )0.5 (of a d)10 (ata )0.5 (an)10 (d )0.5 (s)5 (af)15 (et)15 (y)10 ( )]TJ 0.105 Tw 0 -1.2 Td [(m)10 (onitorin)10 (g )0.6 (c)9.9 (ommittee )0.5 (th)10 (at )0.6 (r)9.9 (eports )0.5 (to )0.5 (th)10 (e )0.6 (NHLBI. )0.5 ( )0.5 (A)10 ( )]TJ 0.037 Tw 0 -1.2 Td [(pr)10 (oject o\036c)10 (er w)5 (ork)10 (s clos)5 (el)5 (y with th)10 (e study le)14.9 (a)10.1 (ders)15.1 (hi)15 (p)10 ( )]TJ 0.084 Tw 0 -1.2 Td [(to en)10 (s)10 (ur)10 (e th)10 (at s)5 (cienti\037c go)10 (a)10 (l)10 (s of th)10 (e tri)10 (a)10 (l ar)9.9 (e m)10 (et. In)10 ( )]TJ 0.213 Tw 0 -1.2 Td [(r)10 (ec)10 (ent y)20 (e)15 (ars th)10 (er)10 (e h)10 (a)10 (s been in)25 (v)20 (ol)5 (v)20 (em)10 (ent of clinic)10 (a)10 (l)10 ( )]TJ -0.005 Tw 0 -1.2 Td [(tri)10 (a)10 (l )0.5 (s)10 (peci)10 (a)10 (li)10 (sts w)5 (h)10 (o )0.5 (ar)10 (e )0.5 (e)10 (xperien)10 (c)10 (ed )0.5 (in)10 (di)20 (vidua)10 (l)10 (s )0.5 (in )0.5 (th)10 (e)10 ( )]TJ -0.015 Tc 0.015 Tw 0 -1.2 Td [(d)-15 (ay)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 52.8189 164.22 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.01 Tw 11 0 0 11 56.8179 164.22 Tm (to)Tj /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 66.2667 164.22 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.185 Tw 11 0 0 11 70.2657 164.22 Tm [(d)10 (a)25 (y m)10 (an)10 (a)10 (gem)10 (ent of clinic)10 (a)10 (l r)10 (es)5 (e)15 (ar)10 (ch. Th)10 (es)4.9 (e)10 ( )]TJ 0.27 Tw -3.115 -1.2 Td [(clinic)10 (a)10 (l tri)10 (a)10 (l s)9.9 (peci)10 (a)10 (li)10 (sts a)10 (ssi)10 (st th)10 (e pr)10 (oject o\036c)9.9 (er in)10 ( )]TJ 0.17 Tw 0 -1.2 Td [(th)10 (e )0.5 (d)10 (ail)5 (y )0.5 (i)10 (ss)9.9 (ues th)10 (at )0.5 (ari)10 (s)5 (e )0.5 (in )0.5 (th)10 (e )0.5 (c)10 (on)10 (duct of clinic)10 (a)10 (l)10 ( )]TJ -0.047 Tw 0 -1.2 Td [(r)10 (es)5 (e)15 (ar)10 (ch an)10 (d a)10 (ct a)10 (s li)9.9 (ai)10 (s)4.9 (on with th)10 (e in)25 (v)20 (estig)10 (ators. Ov)19.9 (er)10 ( )]TJ 0.097 Tw 0 -1.2 Td [(th)10 (e y)20 (e)15 (ars, th)10 (e m)10 (eth)10.1 (od)10 (s an)10 (d structur)10 (e of clinic)10 (a)10 (l tri)10 (a)10 (l)10 (s)10 ( )]TJ 0.094 Tw 0 -1.2 Td [(c)10 (on)10 (ducted b)15 (y th)10 (e NIHLBI h)10 (a)25 (v)20 (e bec)10 (om)10 (e th)10 (e stan)10 (d)10 (ar)9.9 (d)10 ( )]TJ 0 Tw 0 -1.2 Td [(b)15 (y w)5 (hich C)20 (OPD clinic)10 (a)10 (l r)10 (es)5 (e)15 (ar)10 (ch i)10 (s c)10 (on)10 (ducted.)10 ( )-10 ( )]TJ ET 0 0.1 0.15 0 scn /GS0 gs 36 694.3 255.6 25.14 re f BT 0 0 0 1 scn /GS1 gs /T1_2 1 Tf 0 Tc 14 0 0 14 40.5 701.62 Tm (Introduction )Tj /T1_1 1 Tf 0.01 Tc 0.271 Tw 11 0 0 11 320.4 671.02 Tm [(In th)10 (e )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 356.8796 671.02 Tm (1960)Tj /T1_1 1 Tf 0.01 Tc 0.271 Tw 11 0 0 11 381.6843 671.02 Tm [(s an)10 (d )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 415.436 671.02 Tm (70)Tj /T1_1 1 Tf 0.01 Tc 0.271 Tw 11 0 0 11 427.8384 671.02 Tm [(s, it w)15 (a)10 (s c)9.9 (omm)10 (on pra)10 (ctic)10 (e to)10 ( )]TJ 0.011 Tw -9.767 -1.2 Td [(a)10 (dmini)10 (ster )0.5 (br)9.9 (on)10 (ch)10 (odil)10 (ators or )0.5 (s)5 (a)10 (lin)10 (e with )0.5 (intermittent)10 ( )]TJ 0.336 Tw 0 -1.2 Td [(positi)20 (v)20 (e pr)10 (ess)10 (ur)10 (e br)10 (e)15 (athin)10 (g \(IPPB)10 (\) de)20 (vic)10 (es. Th)10 (e)10 ( )]TJ 0.386 Tw 0 -1.2 Td [(th)10 (eor)10 (etic)10 (a)10 (l ben)10 (e\037t of s)10 (uch de)20 (vic)10 (es w)15 (a)10 (s b)10 (a)10 (s)5 (ed on)10 ( )]TJ 0.331 Tw 0 -1.2 Td [(th)10 (e ide)15 (a th)10 (at it w)15 (a)10 (s possi)10 (ble to di)10 (s)10 (pers)5 (e a)10 (er)10 (os)5 (ol)10 (s)10 ( )]TJ 0.02 Tc 0.821 Tw 0 -1.2 Td [(m)20 (o)10 (r)20 (e)10 ( )9.9 (eff)15.1 (ecti)20 (v)20 (el)5 (y with positi)20 (v)20 (e pr)10 (ess)9.9 (ur)10.1 (e th)10 (an)20 ( )]TJ 0.01 Tc 0.514 Tw 0 -1.2 Td [(w)-10 (i)-10 (t)-10 (h)-10 ( )-9.9 (sp)-10 (o)-10 (n)-10 (t)-10 (a)-10 (ne)-10 (ou)-10 (s)-10 ( )-9.9 (br)10 (e)15 (athin)10 (g)50 (. S)10 (om)10 (e h)10 (e)15 (a)10 (lth c)9.9 (ar)9.9 (e)10 ( )]TJ 0.277 Tw 0 -1.2 Td [(esta)10 (bli)10 (s)15 (hm)10 (ents pr)10 (o)20 (vided s)10 (uch tr)10 (e)15 (atm)10 (ents to C)20 (OPD)10 ( )]TJ -0.004 Tw 0 -1.2 Td [(p)10 (atients a)10 (s a c)10 (om)10 (pon)10 (ent of c)10 (om)10 (pr)10 (eh)10 (en)10 (si)20 (v)20 (e p)10 (ulm)10 (on)10 (ary)10 ( )]TJ 0.541 Tw 0 -1.2 Td [(r)10 (eh)10 (a)10 (bilitation. IPPB de)20 (vic)10 (es w)5 (er)10 (e e)10 (xpen)10 (si)20 (v)20 (e an)10 (d)10 ( )]TJ 0.192 Tw 0 -1.2 Td [(c)10 (um)10 (bers)5 (om)10 (e)10 (. Th)10 (e s)10 (uperiorit)15 (y of IPPB de)20 (vic)9.9 (es o)20 (v)20 (er)10 ( )]TJ -0.023 Tw 0 -1.2 Td [(c)10 (om)10 (pr)10 (ess)5 (ed air n)10 (eb)10 (uli)10 (z)10 (ers w)15 (a)10 (s un)10 (kn)10 (o)5 (wn. A)10 (c)10 (c)10 (or)10 (din)10 (gl)5 (y)50 (,)10 ( )]TJ 0 Tw 0 -1.2 Td [(th)10 (e NHLBI initi)10 (ated th)10 (e IPPB tri)9.9 (a)10.1 (l.)]TJ /TT0 1 Tf 0 Tc 8.162 0 0 8.162 483.0103 517.282 Tm (1)Tj /T1_1 1 Tf 11 0 0 11 488.0717 512.62 Tm ( )Tj 0.01 Tc -0.087 Tw -14.425 -1.2 Td [(A tota)10 (l of )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 373.181 499.42 Tm (985)Tj /T1_1 1 Tf 0.01 Tc -0.087 Tw 11 0 0 11 391.7845 499.42 Tm [( p)10 (artici)14.9 (p)10 (ants at )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 462.6799 499.42 Tm (5)Tj /T1_1 1 Tf 0.01 Tc -0.087 Tw 11 0 0 11 468.881 499.42 Tm [( c)10 (enters w)5 (er)9.9 (e ran)10 (doml)5 (y)10 ( )]TJ 0.145 Tw -13.498 -1.2 Td [(a)10 (ssign)10 (ed to eith)10 (er IPPB or c)10 (om)10 (pr)10 (ess)5 (ed air n)10 (eb)10 (uli)10 (z)10 (er)10 ( )]TJ 0.015 Tc 0.714 Tw 0 -1.2 Td [(tr)10 (e)15 (atm)10.1 (ent. Entry criteri)10 (a in)10 (cl)15 (uded s)5 (ym)10 (ptom)10 (atic)15 ( )]TJ 0.01 Tc 0.176 Tw 0 -1.2 Td [(a)-5 (i)-5 (r)-5 (\035)-5 (ow)-5 ( )-5.4 (obstruction with a pr)10 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 467.5966 459.8199 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.176 Tw 11 0 0 11 471.5956 459.8199 Tm [(br)10 (on)10 (ch)10 (odil)10 (ator f)15 (or)10 (c)10 (ed)10 ( )]TJ 0.11 Tw -13.745 -1.2 Td [(e)10 (xpiratory )0.5 (v)20 (ol)14.9 (um)9.9 (e )0.5 (in )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 425.1038 446.62 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.11 Tw 11 0 0 11 431.305 446.62 Tm [( )0.5 (s)4.9 (ec)10 (on)10 (d )0.5 (\(FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 496.7664 445.957 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.11 Tw 11 0 0 11 500.7433 446.62 Tm [(\) )0.5 (to f)15 (or)10 (c)10 (ed )0.5 (vita)10 (l)10 ( )]TJ -0.027 Tw -16.395 -1.2 Td [(c)10 (a)10 (p)10 (a)10 (cit)15 (y \(F)20 (V)30 (C\) ratio )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 417.8357 433.42 Tm (<)Tj /T1_1 1 Tf 11 0 0 11 423.8366 433.42 Tm ( )Tj /TT0 1 Tf 10 0 0 10 426.1793 433.42 Tm (0)Tj /T1_1 1 Tf 11 0 0 11 432.3805 433.42 Tm (.)Tj /TT0 1 Tf 10 0 0 10 434.5144 433.42 Tm (60)Tj /T1_1 1 Tf 0.01 Tc -0.027 Tw 11 0 0 11 446.9167 433.42 Tm [(, a pr)10 (e)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 474.6467 433.42 Tm (-)Tj /T1_1 1 Tf 0.01 Tc -0.027 Tw 11 0 0 11 478.6457 433.42 Tm [(br)10 (on)10 (ch)10 (odil)10 (ator FE)10 (V)]TJ /TT0 1 Tf 0 Tc 0 Tw 6.413 0 0 6.413 572.0232 432.757 Tm (1)Tj /T1_1 1 Tf 11 0 0 11 576 433.42 Tm ( )Tj /TT0 1 Tf 10 0 0 10 320.4 420.22 Tm (<)Tj /T1_1 1 Tf 11 0 0 11 326.401 420.22 Tm ( )Tj /TT0 1 Tf 10 0 0 10 328.1022 420.22 Tm (60%)Tj /T1_1 1 Tf 0.01 Tc -0.085 Tw 11 0 0 11 349.5036 420.22 Tm [( pr)10 (edicted, a)10 (ge )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 418.7036 420.22 Tm (30-74)Tj /T1_1 1 Tf 0.01 Tc -0.085 Tw 11 0 0 11 447.5074 420.22 Tm [( y)20 (e)15 (ars an)10 (d a)10 (bilit)15 (y to perf)14.9 (orm)10 ( )]TJ -0.075 Tw -11.555 -1.2 Td [(c)10 (y)20 (cle er)10 (gom)10 (etry)50 (. P)25 (artici)15 (p)10 (ants w)5 (er)10 (e e)10 (x)10 (cl)15 (uded if th)10 (e)15 (y h)10.1 (a)10 (d)10 ( )]TJ 0.022 Tw 0 -1.2 Td [(us)5 (ed IPPB f)15 (or )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 388.3461 393.8199 Tm (1)Tj /T1_1 1 Tf 0.01 Tc 0.022 Tw 11 0 0 11 394.5472 393.8199 Tm [( m)9.9 (onth or lon)10 (ger within th)10 (e pr)10 (ec)10 (edin)10 (g)10 ( )]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 320.4 380.62 Tm (6)Tj /T1_1 1 Tf 0.01 Tc 0.272 Tw 11 0 0 11 326.6012 380.62 Tm [( )0.5 (m)10 (onth)10.1 (s, )0.5 (w)5 (er)10 (e )0.5 (s)5 (e)20 (v)20 (er)10 (el)4.9 (y )0.6 (h)15 (y)10 (po)10 (x)10 (emic, )0.5 (or )0.6 (n)9.9 (orm)10 (a)10 (li)10 (z)10 (ed)10 ( )]TJ 0 Tw -0.564 -1.2 Td [(th)10 (eir s)10 (pir)10 (om)10 (etry after in)10 (h)10 (a)10 (lin)10 (g i)10 (s)5 (opr)10 (oter)10 (en)10 (ol.)10 ( )-10 ( )]TJ 0.532 Tw 0.818 -1.2 Td [(Th)10 (e n)10 (eb)10 (uli)10 (z)10 (er th)10 (at gen)10 (erated th)10 (e a)10 (er)10 (os)5 (ol )0.5 (w)15 (a)10 (s)10 ( )]TJ 0.104 Tw -0.818 -1.2 Td [(identic)10 (a)10 (l f)15 (or both tr)10 (e)15 (atm)10 (ent arm)10 (s. 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A)25 (dh)10 (er)10 (en)10 (c)10 (e to tr)10 (e)15 (atm)10 (ent w)15 (a)10 (s)10 ( )]TJ 0 Tw 0 -1.2 Td [(a)10 (ss)5 (ess)5 (ed b)15 (y s)5 (elf)]TJ /TT0 1 Tf 0 Tc 10 0 0 10 395.3014 248.62 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 11 0 0 11 399.3004 248.62 Tm [(r)10 (eport an)10 (d b)15 (y us)5 (e of electr)10 (onic tim)10 (ers)10 ( )]TJ 0.251 Tw -7.173 -1.2 Td [(atta)10 (ch)10 (ed to th)10 (e r)10 (es)10 (piratory equi)15 (pm)10 (ent. S)10 (pir)10 (om)10 (etry)10 ( )]TJ 0.325 Tw 0 -1.2 Td [(w)15 (a)10 (s perf)15 (orm)10 (ed quarterl)4.9 (y)50 (, an)10 (d c)10 (om)10 (plete p)10 (ulm)9.9 (on)9.9 (ary)10 ( )]TJ 0.046 Tw 0 -1.2 Td [(fun)10 (ction )0.5 (tests )0.5 (w)5 (er)10 (e )0.5 (perf)15 (orm)10 (ed )0.5 (annua)10 (ll)5 (y)49.9 (. )0.5 ( )0.5 (Ex)10 (er)10 (ci)10 (s)5 (e )0.5 (w)15 (a)10 (s)10 ( )]TJ 0.11 Tw 0 -1.2 Td [(tested with s)5 (ym)10 (ptom)]TJ /TT0 1 Tf 0 Tc 0 Tw 10 0 0 10 421.9774 195.8199 Tm (-)Tj /T1_1 1 Tf 0.01 Tc 0.11 Tw 11 0 0 11 425.9764 195.8199 Tm [(limited bic)10 (y)20 (cle er)10 (gom)10 (etry tests)10 ( )]TJ 0.152 Tw -9.598 -1.2 Td [(an)10 (d fun)10 (ction)10 (a)10 (l status w)15 (a)10 (s e)20 (v)19.9 (a)10 (l)15 (uated with a m)10 (odi\037ed)10 ( )]TJ 0.426 Tw 0 -1.2 Td [(M)20 (edic)10 (a)10 (l R)10 (es)5 (e)14.9 (ar)10 (ch C)30 (o)10.1 (un)10 (cil \(mMRC\) questionn)9.9 (air)10 (e)10 (.)10 ( )665.9 ( )]TJ 0.356 Tw 0 -1.2 Td [(Mild dy)10 (s)10 (pn)10 (e)15 (a w)15 (a)10 (s de\037n)10 (ed a)10 (s s)15 (h)10 (ortn)10 (ess of br)10 (e)15 (ath)10 ( )]TJ 0.212 Tw 0 -1.2 Td [(w)15 (a)10 (lkin)10 (g up steps or on an in)10 (clin)10 (e b)10 (ut n)9.9 (ot on le)20 (v)20 (el)10 ( )]TJ 0.164 Tw 0 -1.2 Td [(gr)10 (o)10 (un)10 (d. 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