Targeting treatable traits allows a personalised approach to management of (severe) asthma

The concept of targeting “treatable traits” allows for a more holistic management of complex conditions. More recently, an expert panel proposed several pulmonary and extra-pulmonary treatable traits for (severe) asthma and COPD [1]. Dr Florence Schleich (University of Liège, Belgium) pleaded for a treatable traits approach to be applied more broadly in uncontrolled asthma. To avoid corticosteroids overtreatment and associated side effects, pheno/endotyping should be performed. Type 2/eosinophilic inflammation should be treated with targeted biologics and prominent airflow obstruction in the absence of inflammation should be adequately addressed with long-acting muscarinic antagonists [LAMA]/long-acting beta2-agonists [LABA], and/or thermoplasty. Lifestyle adjustments should be implemented: e.g. smoking cessation for smokers, weight loss and physical activity for overweight/obese patients.

By identifying treatable traits in individual patients, a personalised medicine approach may be developed which can help improve outcomes for the individual patient [1,2]. In patients with uncontrolled or severe asthma, pulmonary treatable traits include blood and sputum eosinophils, FeNO, allergy, fixed airflow limitation, small airway dysfunction, airway infections, as well as extrapulmonary treatable traits such as chronic rhinosinusitis (CRS) with or without nasal polyps, gastroesophageal reflux disease (GERD), obesity, metabolic and cardiovascular disease, and behavioural traits: especially anxiety and depression [3-5]. Dr Schleich showed results from a small study (n=55) with a duration of 16 weeks in which the feasibility and effects of a multidisciplinary treatment plan targeted at predefined treatable traits was compared with usual care in patients with uncontrolled severe asthma. The primary endpoint was the patient-reported outcome of health-related quality of life. Patients presented with on mean 10.44 traits per individual patient (3.01 pulmonary and 4.85 extrapulmonary traits, and 2.58 behavioural/risk factors). Researchers showed that an individualised treatment strategy aimed at treatable traits of individual patients was feasible in a clinical setting and significantly improved health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ) (0.86 units, P<0.001) and asthma control according to the Asthma Control Questionnaire (ACQ) (0.73, P=0.01). Thus, in patients with uncontrolled asthma, identifying and targeting of treatable traits may offer a clinically useful approach to effectively deal with the complexity of the disease in individual patients [6,7].

1. Agusti A, et al. ERJ. 2017;50:1701655.
2. McDonald VM, et al. ERJ. 2019;53:1802058.
3. Couillard S, et al. Thorax. 2022;77:199–202.
4. Dunican EM, et al. J Clin Invest. 2018 Mar 1;128(3):997-1009.
5. Gibson PG, et al. Lancet. 2017;390(10095):659-668.
6. McDonald VM, et al. ERJ. 2020;55:1901509.
7. Schleich F. Asthma. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

 

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Posted on 17 August, 202216 August, 2022