Patient Factors and Clinical Efficacy of Early Identification and Treatment of Chronic Obstructive Pulmonary Disease and Asthma
Bibliographic record
Abstract
Abstract Rationale The Undiagnosed COPD and Asthma Population trial showed that early diagnosis and treatment of asthma and chronic obstructive pulmonary disease (COPD) by pulmonologists improved healthcare use, respiratory symptoms, and quality of life. Objectives To determine if the benefits of early diagnosis and treatment were greater in individuals with more advanced disease or in individuals with asthma as opposed to COPD. We also assessed whether pulmonologist-directed care benefited asthma and COPD subgroups equally. Methods Case finding was used to identify adults with undiagnosed chronic respiratory symptoms in the community. A total of 508 newly diagnosed participants with COPD or asthma were randomized to receive pulmonologist-care intervention or usual care. Low and high disease burden categories for the St. George’s Respiratory Questionnaire (SGRQ) and COPD Assessment Test were defined using a median-split of baseline scores, and minimal clinically important difference thresholds were used to define significant responses. Benefits of pulmonologist care were assessed by evaluating treatment effects within subgroups and by assessing treatment-by-subgroup interactions. Measurements and Main Results Patients with higher disease burden at diagnosis were more likely to benefit from early diagnosis and treatment compared with those with lower disease burden. A total of 71% of those with high disease burden showed an improvement in COPD Assessment Test score by ≥2 points over 12 months compared with 47% with low disease burden (odds ratio, 2.78; 95% confidence interval, 1.90–4.07; P < 0.001). Similar results were seen for SGRQ and FEV1 improvements. In contrast, responses to early diagnosis and treatment were similar for those with asthma versus COPD. Individuals with asthma randomized to undergo pulmonologist-directed care showed greater 1-year improvements in COPD Assessment Test score, SGRQ score, 36-item Short Form score, and FEV1 compared with individuals randomized to receive primary care. However, individuals with COPD experienced similar improvements regardless of whether their treatment was managed by a pulmonologist or primary care provider. Treatment-by-disease interaction terms were not statistically significant. Conclusions Patients with greater disease burden who exhibited more advanced and symptomatic asthma and COPD at the time of diagnosis benefited more from earlier diagnosis and treatment. Patients with asthma tended to derive greater benefit from pulmonologist-directed care than patients with COPD.
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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 | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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) | 0.003 | 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".