Concern of underdiagnosing asthma–COPD overlap syndrome if age limit of 40 years for asthma is used
Bibliographic record
Abstract
M. Tommola and colleagues raise an important and hotly debated diagnostic criterion of asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS): an age threshold of 40 years for the asthma component of ACOS. We agree with their comment that asthma can develop later in life and these patients may respond well to inhaled corticosteroids and novel biologics, similar to those with childhood-onset asthma [1]. Thus, in the roundtable consensus report [2], we suggested that the asthma component of ACOS could be fulfilled by a clinical diagnosis of asthma before age 40 years or in those without a clinical diagnosis of asthma before 40 years by demonstrating an improvement in forced expiratory volume in 1 s (FEV1) of ≥400 mL following short-acting β2-agonist therapy. While a significant bronchodilatory response (BDR) is a common feature in both asthma and chronic obstructive pulmonary disease (COPD) [3], it is very unusual for COPD patients to demonstrate a BDR of ≥400 mL in FEV1 without a concomitant diagnosis of asthma [4]. To further improve the specificity of the asthma component of ACOS, we also suggested that in addition to all three major criteria, patients fulfil at least one of the three minor criteria: 1) a history of atopy or allergic rhinitis; 2) a BDR of ≥200 mL in FEV1 on two separate visits; or 3) peripheral eosinophil count of ≥300 cells per μL. While none of these criteria has been validated in ACOS, we believe that these criteria are clinically workable and may be useful in identifying patients with asthma with reasonable precision. Future work will be needed to refine these criteria based on high-grade data. While the ACOS criteria have not been validated, they are clinically workable and may identify asthma precisely
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 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 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
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".