P252 Gold Category And Optimal Management : A Canadian Perspective
Bibliographic record
Abstract
Hypothesis Current Canadian guidelines and GOLD strategy for COPD management provide a treatment algorithm based on current symptoms and exacerbation history. We wished to assess COPD patient current objective, subjective symptoms, quality of life and exacerbation history of a random sample in primary care and office based chest medicine clinics. A convenience sample of 500 was selected. Results We report the characteristics of the first 250 COPD patients from our ongoing 500 patient survey. Basic demographics 55% Male, 45% Female. Mean age patients 68 ± 12 yrs, all patients were previous smokers with 56 ± 10 pkt/yrs smoking history. 34% remain current smokers. Mean FEV1 48% ± 10%, Mean FEV1/FVC ratio 49% ± 10. Median mMRC dyspnea score 2. Mean CAT score 18 ± 10 (Range 0–38). GOLD Stage Classification 13% GOLD Stage A, 67% GOLD Stage B, 1% GOLD Stage C and 19% GOLD Stage D. Current treatment LAMA (long-acting muscarinic antagonist) was prescribed to over 90% of all patients in groups B, C and D whereas monotherapy with LABA (long acting beta-agonist) or dual bronchodilation with LABA/LAMA therapy was prescribed to less than 5%. There was significant overtreatment with ICS/LABA in all categories with high dose ICS (inhaled corticosteroid) being preferred. 20% of patients in GOLD Stage A where receiving Triple therapy (LAMA + ICS/LABA) and a further 20% where receiving monotherapy with ICS/LABA, yet had no history of exacerbations. 30% of patients in GOLD Stage B where receiving Triple therapy (LAMA + ICS/LABA) yet had no history of exacerbations. Conclusion Current Canadian Guidelines and the GOLD strategy focus on symptom relief and striving to prevent exacerbations with step-wise prescription of short and long-acting bronchodilators with individual or combinations of LAMA, LABA, LAMA/LABA or ICS/LABA inhalers. Patients in GOLD Group C are rare. Current prescription choices in our survey does not reflect current evidence or guidelines. We report a heavy reliance on ICS/LABA along with over prescription of triple therapy at all stages of disease.
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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 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
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".