Application of the 2022 American Thoracic/European Respiratory Society/Japanese Respiratory Society/Associatión Latinoamericana de Tórax (ATS/ERS/JRS/ALAT) idiopathic pulmonary fibrosis and progressive pulmonary fibrosis clinical practice guideline to a Canadian population: An opinion piece
Bibliographic record
Abstract
In 2022, the American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Associatión Latinoamericana de Tórax (ALAT) produced an updated clinical practice guideline on the diagnosis and management of idiopathic pulmonary fibrosis (IPF), also defining and making treatment recommendations for progressive pulmonary fibrosis (PPF). In this review, we summarize and highlight aspects of this guideline that are most relevant to Canadians. New recommendations in IPF include the use of transbronchial lung cryobiopsy as an alternative to surgical lung biopsy and a recommendation against antacid medications in asymptomatic patients. The guideline also recommends treating PPF with nintedanib, an antifibrotic currently approved for IPF. The guideline definition of PPF should be adopted in Canada, although with flexibility in physiologic parameters of the PPF definition and increased support for community respirologists to care for these patients. Although pirfenidone was not recommended in the guideline for the treatment of PPF, there are multiple clinical trials that support its use as a second-line treatment for PPF. It is imperative that Canadian resources continue to support knowledge generation of this complex group of patients and that Canadians continue to have ongoing involvement in the development of future international clinical practice guidelines.
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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 | 0.013 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.007 | 0.010 |
| Insufficient payload (model declined to judge) | 0.012 | 0.008 |
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".