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Record W1894818698 · doi:10.4187/respcare.06510062

Conflicting Methacholine Challenge Tests

2006· article· en· W1894818698 on OpenAlexaboutno aff
Jeffrey M Haynes

Bibliographic record

VenueRespiratory Care · 2006
Typearticle
Languageen
FieldMedicine
TopicAsthma and respiratory diseases
Canadian institutionsnot available
Fundersnot available
KeywordsMedicineFluticasoneMethacholineAsthmaAnesthesiaSpirometryNebulizerBronchodilatorInhalationInternal medicineRespiratory diseaseLung

Abstract

fetched live from OpenAlex

An 11-year-old boy experienced almost daily wheezing, dyspnea on exertion, and sleep perturbation because of cough. In addition, nadir peak expiratory flow (PEF) was below 100 L/min, which was 30% of predicted (328 L/min),1 compatible with severe persistent asthma.2 After the initiation of therapy with 180 g of albuterol 3 times per day, the patient’s domiciliary PEF rose to 200 L/min and his symptoms improved. The patient was subsequently prescribed fluticasone 220 g twice daily. After weeks of combined albuterol and fluticasone therapy, the patient’s PEF was 300 L/min and his symptoms had regressed to a mild intermittent status.2 Three weeks after the initiation of fluticasone therapy the patient presented to the hospital for a methacholine challenge test (test 1). The patient did not take his albuterol or fluticasone on the day of testing. The baseline spirometry was normal (Table 1). Methacholine challenge testing was performed with a modified 5-breath dosimeter technique, nebulizing Provocholine (Methapharm, Brantford, Ontario, Canada) with a DeVilbiss 646 nebulizer (DeVilbiss, Health Care, Somerset, Pennsylvania). The methacholine challenge test revealed a PC20 (the provocational concentration of methacholine that resulted in a 20% decrease in forced expiratory volume in the first second [FEV1]) of 20 mg/mL (Table 2). In response to this “negative” methacholine challenge, the patient was declared “nonasthmatic” by his pediatrician, and the albuterol and fluticasone therapy was discontinued. Shortly after the discontinuance of therapy, the patient’s symptoms and variable PEF returned. Two weeks following the discontinuance of therapy, the patient returned for a repeat methacholine challenge test (test 2). The baseline spirometry was again normal (Table 3); however, this time the patient demonstrated substantial bronchoconstriction in response to methacholine inhalation, with a PC20 of 8.85 mg/mL (Table 4). A PC20 of 4 –16 mg/mL is classified as borderline bronchial hyperresponsiveness;3 however, given the change in PC20 and the accompanying changes in symptoms and PEF variability, methacholine challenge test 2 was interpreted as a positive test for asthma. Jeffrey M Haynes RRT RPFT is affiliated with the Department of Respiratory Therapy, St Joseph Hospital, Nashua, New Hampshire.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: none
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.843
Threshold uncertainty score0.753

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0000.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

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.

Opus teacher head0.023
GPT teacher head0.336
Teacher spread0.313 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreEmpirical

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".

Quick stats

Citations0
Published2006
Admission routes1
Has abstractyes

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