Association Between Asthma Control Trajectories in Preschoolers and Disease Remission
Bibliographic record
Abstract
In few studies have researchers characterized the relationship between the frequency (and severity) of early events and long-term disease evolution in preschoolers with asthma. The purpose of this study was to investigate if asthma control trajectories 2 years postdiagnosis in preschoolers were associated with subsequent disease remission and recurrence.The study included a population cohort in 4 Canadian provinces consisting of 48 687 children with asthma diagnosed before 5 years of age and born between 1990 and 2013 who had prolonged disease activity postdiagnosis.Prolonged disease activity was defined as ≥1 medical visits or medications for asthma every 6-month period for at least 4 of the 6 periods postdiagnosis. Remission was defined as 2 consecutive years without drug claims or medical visits for asthma. Asthma control trajectories were classified by using the validated Pharmacoepidemiologic Pediatric Asthma Control Index. Cox regression models within each Canadian province were used to estimate associations between asthma control trajectories and time to remission or recurrence, with children controlled 2 years postdiagnosis as a reference control category. Province specific hazard ratios (HRs) and 95% confidence intervals (CIs) were summarized by using random-effects meta-analysis.All suboptimal control trajectories were associated with a lower likelihood of remission, compared with that of children who were controlled throughout, with a pooled adjusted HR for remission of 0.51 (95% CI: 0.45 to 0.59) for those out of control throughout. An older age at diagnosis, atopy, and asthma diagnosis on the basis of hospitalization outside of the winter season were associated with a lower likelihood of remission. Suboptimal control trajectories were also associated with a higher likelihood of recurrence (HR: 1.17; 95% CI: 1.11 to 1.24), compared with children controlled throughout. Stratifying by sex or atopy did not significantly alter estimated HRs between trajectories. Girls in the study had higher recurrence rates than boys did. Children without atopy in early life were more likely to experience recurrence, compared with atopic children.In the 2 years after an asthma diagnosis in preschoolers, worse asthma control trajectories were associated with incrementally lower likelihoods of remission.With this study, the authors are the first to investigate the association between asthma control trajectories after a preschool diagnosis and remission. The asthma control trajectory in the 2 years after diagnosis in preschoolers appears to be an important predictor of both remission and recurrence, with poorer control associated with a lower likelihood of remission. With the study, the authors support previous studies in which researchers reported potential predictors of persistence, including older age at diagnosis, male sex, and diagnosis in a season other than winter.
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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 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".