Patient Factors and Clinical Efficacy of Early Identification and Treatment of Chronic Obstructive Pulmonary Disease and Asthma
Notice bibliographique
Résumé
Abstract Rationale The Undiagnosed COPD and Asthma Population trial showed that early diagnosis and treatment of asthma and chronic obstructive pulmonary disease (COPD) by pulmonologists improved healthcare use, respiratory symptoms, and quality of life. Objectives To determine if the benefits of early diagnosis and treatment were greater in individuals with more advanced disease or in individuals with asthma as opposed to COPD. We also assessed whether pulmonologist-directed care benefited asthma and COPD subgroups equally. Methods Case finding was used to identify adults with undiagnosed chronic respiratory symptoms in the community. A total of 508 newly diagnosed participants with COPD or asthma were randomized to receive pulmonologist-care intervention or usual care. Low and high disease burden categories for the St. George’s Respiratory Questionnaire (SGRQ) and COPD Assessment Test were defined using a median-split of baseline scores, and minimal clinically important difference thresholds were used to define significant responses. Benefits of pulmonologist care were assessed by evaluating treatment effects within subgroups and by assessing treatment-by-subgroup interactions. Measurements and Main Results Patients with higher disease burden at diagnosis were more likely to benefit from early diagnosis and treatment compared with those with lower disease burden. A total of 71% of those with high disease burden showed an improvement in COPD Assessment Test score by ≥2 points over 12 months compared with 47% with low disease burden (odds ratio, 2.78; 95% confidence interval, 1.90–4.07; P < 0.001). Similar results were seen for SGRQ and FEV1 improvements. In contrast, responses to early diagnosis and treatment were similar for those with asthma versus COPD. Individuals with asthma randomized to undergo pulmonologist-directed care showed greater 1-year improvements in COPD Assessment Test score, SGRQ score, 36-item Short Form score, and FEV1 compared with individuals randomized to receive primary care. However, individuals with COPD experienced similar improvements regardless of whether their treatment was managed by a pulmonologist or primary care provider. Treatment-by-disease interaction terms were not statistically significant. Conclusions Patients with greater disease burden who exhibited more advanced and symptomatic asthma and COPD at the time of diagnosis benefited more from earlier diagnosis and treatment. Patients with asthma tended to derive greater benefit from pulmonologist-directed care than patients with COPD.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».