Asthma’s 10 treatable traits revealed

Prof Vanessa McDonald

Ten traits in asthma that can help predict exacerbation risk have been identified by Newcastle University respiratory researchers.

Their investigation of severe versus non-severe asthma in adults identified pulmonary traits such as eosinophilic inflammation, extrapulmonary traits such as depression and anxiety, vocal cord dysfunction and obstructive sleep apnoea (OSA), as well as behavioural traits such as inhaler device polypharmacy.

For each additional trait present, there was a 13% increase in exacerbation risk, the study led by Professor Vanessa McDonald found.

The study comprised 434 participants from the Australasian Severe Asthma Web-Based Database (SAWD) and a comparison group of 102 participants with non-severe asthma.

Asthma management skills were optimised and patients were characterised at baseline and then every 6 months for 24 months.

“Being prone to exacerbations prior to the study entry, number of follow-up visits completed, inhaler device polypharmacy, OSA, age and depression emerged as the best predictors of exacerbation risk in patients with severe asthma,” Professor McDonald and colleagues wrote in Respirology.

The researchers from the Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs at the University of Newcastle said there were therapies such as monoclonal antibodies that could target traits such as incompletely reversible airflow limitation.

“But there are other, what we call treatable traits, that don’t necessarily have a good evidence base – for example, neutrophilic inflammation and systemic inflammation. Systemic inflammation was one of the traits which predicted future exacerbations,” Professor McDonald told the limbic.

“So I think what we need to do with this approach is identify what the traits are that make the biggest impact on outcomes and we can start by looking at those that predict exacerbations.”

She said being underweight as a predictor of exacerbation risk was a surprise finding.

“I think what was also really important in terms of the way we practice is the treatable traits of anxiety and depression, which we often under-diagnose and undertreat.”

“So these are the traits that are not necessarily related to the asthma itself but are things we should be assessing and targeting treatment towards.”

She said the finding highlighted the benefits of the multidisciplinary team in managing severe asthma.

“I think what we can take from this study is thinking about the multidimensional assessment that we apply in the severe asthma population and ensure we are looking at those traits that do predict future exacerbations.”

“And then where possible, where we have the evidence, applying treatments to improve them and hopefully improve future outcomes for asthma.”

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