Canadian physicians are concerned about the use of inhaled corticosteroids (ICS) in COPD management
Bibliographic record
Abstract
Intro: A 2012 provincial Canadian database study (1) including 160,000 COPD patients concluded that ICS increases the risk of serious pneumonia in COPD patients1. How this article and knowledge has impacted the practice of family physicians (FP) and respirologists (RESP) remains unknown. Aim: To better understand how physicians perceive the role of ICS in the management of COPD. Methods: 45 minutes online survey; FP (n=75) and RESP (n=40) across Canada. Complementary questions were asked during 45 separate one-on-one interviews to understand perception of safety and efficacy around ICS. Results: Concerns around ICS were common amongst FP and RESP; the most common being the risk of pneumonia There was a lower level concern regarding other COPD co-morbities such as diabetes, osteoporosis and glaucoma. However, some physicians remained skeptical on the direct correlation between osteoporosis and inhaled corticosteroid. Overall, FP at 59% and RESP at 53% confirmed that ICS usage should decrease for the treatment of COPD, alone or in combination with a LABA. FP at 76% and RESP at 78% admitted that a possible solution could be to change treatment of symptomatic patients from ICS/LABA FDC to a LABA/LAMA combination, once this new class is available. Conclusion: The raised awareness around risk linked to long-term usage of ICS coupled with the questionable benefit of ICS in non-exacerbating COPD patients may well lead to a future decrease in usage of ICS in COPD management. 1-Suissa S, et al. Thorax 2013;68:1029–1036. doi:10.1136/thoraxjnl-2012-202872 1029.
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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 | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".