Determinants of Oral Corticosteroids Use in the Treatment of Asthma Exacerbation
Bibliographic record
Abstract
Abstract Rationale. Oral corticosteroids (OCS) are the mainstay of treatment for severe asthma exacerbation, but some patients do not seem to benefit from them. This can be attributed to a misdiagnosis as many exacerbations are not confirmed with objective tests. It is also possible that a number of exacerbations are not T2-driven and may not require OCS treatment, but this hypothesis has not been validated. Studies using a comprehensive assessment of exacerbations leading to personalized management approaches are lacking. Aim. To compare the characteristics and outcomes of patients treated or not with OCS following a systematic assessment of their exacerbation. Methods. This study is part of a real-life interventional cohort study on optimizing the management of asthma exacerbation. Adult patients with severe asthma presenting symptoms of an exacerbation were recruited for a complete assessment that included pulmonary function tests, blood tests, induced sputum analysis and FeNO measurement. Then, a respirologist confirmed the exacerbation and decided on a treatment plan, which could include OCS. A follow-up call was performed 14 days later to assess outcomes. T2 exacerbations were defined as ≥1 of the following: FeNO ≥25 ppb, sputum eosinophils ≥2%, blood eosinophils ≥300 cells/uL. FEV1 <80% of personal's best was also considered a possible requirement for OCS. Unfavorable outcome was defined as either an initiation or prolongation of antibiotics and/or OCS, or a re-consultation (unplanned medical visit or emergency room visit). Results. We included 66 patients (34 (52%) women, mean (range) age 61 (19-83) years old), of whom 7 came twice, for a total of 73 visits analysed. Of these, 25/73 visits (34%) resulted in OCS prescription. A T2 profile and/or an FEV1 <80% of the personal's best was seen in 18/25 (72%) of the OCS-treated patients and 22/48 (46%) of those not treated with OCS. Unfavorable outcome was reported by 5/25 (20%) patients in the OCS-treated group, 3 of them (60%) presented a T2 profile. In the non-OCS group, 18/48 (38%) visits ended up with an unfavorable outcome, of which 9 (50%) showed a T2 profile. Conclusion. The decision of how to treat severe asthma exacerbations is, to some extent, influenced by the presence of a T2 profile and/or fall in FEV1 but also by other factors possibly related to heterogeneity in the decision process of physicians involved in the study. This reflects the lack of standardized guidelines and the need for a more tailored approach to managing asthma exacerbations.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".