Asthma and fixed airflow obstruction: Long‐term trajectories suggest distinct endotypes
Bibliographic record
Abstract
Abstract Background Long‐term trajectories of asthma with fixed airflow obstruction (FAO) may reveal links to inflammatory endotypes. Objective We investigated whether measures of asthma control and airway inflammation and remodelling differed by long‐term FAO status in moderate‐to‐severe asthma. Methods Adults enrolled in the Difficult Asthma Study assessed initially using serial Asthma Control Questionnaire (ACQ), exacerbation history, spirometry and sputum cytology over 12 months, as well as endoscopic bronchial biopsy with airway smooth muscle (ASM) quantification, were revaluated three or more years later with questionnaires and spirometry. FAO was defined as a persistent post‐bronchodilator forced expired volume in one second (FEV 1 )‐to‐forced vital capacity ratio below 0.70. Results Sixty‐two participants (mean ± SD age 48 ± 11 years; 50% female; 75% atopic; asthma duration 24 ± 14 years) returned for follow‐up assessment (median interval 7.9 years; IQR: 5.4‐8.8 years). Compared to participants without FAO (n = 28), those with FAO at baseline and long‐term follow‐up (n = 18) had higher baseline sputum neutrophil content and ASM, and a higher exacerbation frequency that persisted at long‐term follow‐up. Sputum eosinophils, ACQ and long‐term FEV 1 decline did not differ. Participants with incident FAO at long‐term follow‐up (n = 16) had higher baseline exacerbation frequency, sputum eosinophil content, higher ACQ scores and greater decline in FEV 1 , whereas baseline ASM was similar to those without FAO. Conclusion In moderate‐to‐severe asthma, long‐term FAO is characterized by neutrophilic sputum inflammation and airway remodelling, but FEV 1 decline is similar to those without FAO. Long‐term incident FAO is preceded by higher exacerbation frequency, higher sputum eosinophil content and significant FEV 1 decline.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 teacher head, 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".