Overdiagnosis of Asthma in the Community
Bibliographic record
Abstract
BACKGROUND: Overdiagnosis of asthma may be an emerging problem after years of attention to the rising prevalence and reported underdiagnosis of the disease. OBJECTIVES: A sample of adult asthmatics from the community was investigated to determine whether they met the current diagnostic criteria for asthma. METHODS: Ninety participants were studied from a self-referred sample of physician-labelled, adult asthmatics from the community. The setting was a tertiary care, university-affiliated teaching hospital in Halifax, Nova Scotia. Three diagnostic criteria from the Canadian Thoracic Society Asthma Guidelines were used to demonstrate the presence of asthma: first, positive symptom history, and either, second, reversible airflow obstruction demonstrable on spirometry or documented peak expiratory flow rate diurnal variability, or, third, bronchial hyperreactivity to methacholine. RESULTS: At the time of the study, 41% of a sample of physician-labelled asthmatics showed no evidence of reversible airflow obstruction and had a negative methacholine challenge. By backward logistical regression analysis, a higher mean number of medications used (P<0.01), a lower forced expiratory volume in 1 s (P<0.05) and using inhaled steroids (P<0.05) were predictive of meeting the diagnostic criteria for asthma. Sixty-two per cent of subjects who did not meet the criteria for asthma were currently taking medications for "asthma". Only 52.2% of the subjects reported ever having undergone pulmonary function testing. CONCLUSIONS: Overdiagnosis of asthma is a potential problem, which may result in unnecessary or inappropriate medication use, increased health care costs and mislabelling of patients. The authors recommend greater use of objective diagnostic tests such as spirometry, peak flow diaries and bronchial provocation to establish a clinical diagnosis of asthma.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".