In whom should regular asthma controller therapy be initiated?
Bibliographic record
Abstract
Clinical practice guidelines advise daily asthma management with evidence based recommendations. We analyzed international asthma guidelines (last 5 years): Canadian Thoracic Society (CTS), British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) & the Global Initiative for Asthma (GINA) guidelines to determine when one should initiate regular controller therapy for a patient with asthma. While all of the guidelines advise starting an uncontrolled patient on controller therapy with inhaled corticosteroids, the thresholds defining a lack of control differ between guidelines. Patients report any of the following criteria: GINA BTS/SIGN CTS Daytime symptoms /week >2 ≥3 ≥4* Night time symptoms/week Any ≥1 ≥1 Rescue therapy per week >2 ≥3 ≥4 Activity limitations Any Any Exacerbations needing oral steroids Any: last 2 yr Any: no time period given Lung function FEV1 (%predicted) or PEF of personal best <80 ≤90 Other missing work/school. PEF variability >10-15%. Sputum eosinophils ≥ 2-3% Level of evidence B B None provided * A separate part of the CTS recommends starting ICS if asthma symptoms < 3 times/week The threshold for daytime symptom frequency ranges from 2-4 days/week. Lung function criteria differ with an FEV1 or PEF <90% predicted (CTS) & <80% predicted (GINA). The same evidence should lead to similar conclusions, thus differences may arise from methodological differences in evidence collection, critical appraisal, and/or summarization by each committee, and/or a lack of evidence in these areas. Different messages confuse the target audience contributing to guideline distrust among health care practitioners; further limiting the already difficult task of guideline implementation.
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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 | 0.006 | 0.035 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.009 | 0.003 |
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".