Late Breaking Abstract - Is there a role for cardiopulmonary exercise testing in identifying COPD patients most likely to respond to morphine?
Bibliographic record
Abstract
Introduction: Opioids are rarely prescribed for breathlessness in advanced COPD due, in part, to an inability to predict which patient (s) will respond. Objectives: To determine the acute effect of immediate release oral morphine (M) on exertional breathlessness and exercise endurance time (EET) and to also identify predictors of the acute response to M in patients with advanced COPD and refractory breathlessness. Methods: Twenty adults with COPD (FEV1=35±9%predicted) underwent constant-load cardiopulmonary cycle exercise testing (CPET) after single-dose ingestion of M (0.1mg/kg) or placebo (P). Opioid responders (R) were identified as patients reporting a >1 Borg unit decrease in breathlessness during constant-load CPET at isotime after ingestion of M vs. P. Results: In all 20 patients, M decreased isotime breathlessness by 1.2±0.4 Borg units and increased EET by 2.5±0.9 min vs. P (both p<0.05). Baseline patient characteristics, including FEV1%predicted, plethysmographic lung volumes, cardiorespiratory fitness, and mMRC and CAT scores, were not significantly different between R (n=11) and non-responders (NR, n=9). In contrast to NR, EET increased by 3.6±1.3 min and isotime breathlessness decreased by 2.3±0.6 Borg units after ingestion of M vs. P within R (both p<0.01). A higher percentage of R vs. NR identified intolerable breathlessness as the primary reason for stopping incremental CPET: 82 vs. 33% (p=0.03). Conclusions: The locus of symptom-limitation on laboratory-based CPET may help to identify patients with advanced COPD most likely to achieve clinically meaningful relief of exertional breathlessness in response to morphine.
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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) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.017 | 0.004 |
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".