High inhaled corticosteroids adherence in childhood asthma: the role of medication beliefs
Bibliographic record
Abstract
For two decades, maintenance inhaled corticosteroids have been recommended by international guidelines as the mainstay of treatment in children and adults with persistent asthma. As asthma control criteria have become increasingly more stringent, an even larger proportion of individuals are labelled as having “uncontrolled persistent” asthma. Indeed, while in 1996, we accepted as criteria for acceptable control as up to 10 doses per week of rescue β2-agonists, that is to say one dose per day for the prevention of exercise-induced asthma and three doses per week for the relief of symptoms [1], they were progressively reduced to two doses per week since 2006 [2]. An expanding proportion of individuals with mild asthma now qualify for maintenance controller therapy. The preference for daily inhaled corticosteroids over leukotriene receptor antagonists and placebo is solidly supported by systematic reviews of the efficacy of randomised controlled trials [3, 4] in children and adults [5–7]. However, most patients with mild persistent asthma do not use maintenance inhaled corticosteroids and most individuals remain poorly controlled [8–10]. Insufficient use of inhaled corticosteroids may be due to suboptimal medical prescriptions and to limited patient access to healthcare and medications [11, 12]. However, even in settings where patients have free access to medications, adherence remains suboptimal; many discontinue asthma controllers when asymptomatic and restart therapy when deemed required [11–13]. Reasons for poor patient adherence include: side effects, fear of side effects, forgetfulness, inconvenience of medication use, the erroneous conception that no symptoms equate to no disease, and negative beliefs about always having asthma, having airway inflammation, and about the importance of using inhaled corticosteroids [10, 13, 14]. Yet, suboptimal adherence to …
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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 | 0.003 | 0.020 |
| 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 | 0.002 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 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".