Asthma

Novel look at treatable traits in asthma/COPD throws a few surprises


Large scale research investigating treatable traits (TTs) in asthma and/or COPD has significantly advanced understanding of their utility in the personalised management of chronic respiratory diseases, with a surprising finding or two in the mix.

Researchers sought to assess the prevalence of treatable traits (TTs) and their relationship to diagnosis and disease severity as established by a physician in clinical practice, amid the growing prominence of TTs as a disease management strategy around the globe.

The researchers selected 30 frequently occurring TTs observed in the global NOVELTY study for patients diagnosed with asthma (n=5,932, 52.8%), COPD (n=3,898, 34.7%) or both (n=1,396, 12.4%), in primary care or specialised centres.

Key findings included that the prevalence of these “varied widely” within the NOVELTY cohort, and that patients had an average of five TTs.

There were no large variations due to sex, age or geography, but there were significant differences between clinical care settings (primary versus specialised clinics) and disease severity, according to the paper, published in Respirology.

The data showed that six (pulmonary) TTs were “significantly associated” with an ‘asthma’ (allergic and non-allergic rhinosinusitis, nasal sinus polyps and several allergies) or ‘COPD’ (non-reversible airflow limitation and emphysema diagnoses).

However, surprisingly, and importantly for clinical practice, “the prevalence of 18 pulmonary, extra-pulmonary and/or behavioural/environmental TTs was similar, irrespective of the diagnostic label used, including some TTs traditionally considered almost exclusive to ‘asthma’ or ‘COPD’, such as bronchodilator reversibility, Th2 and frequent productive cough,” the authors noted.

“You cannot fix this by changing diagnostic labels or criticising clinician assessment. But you can treat these problems using effective inhaled therapy,” noted Australia-based respiratory physician Professor Peter G. Gibson in a linked comment in the journal.

“This underscores the whole treatable traits premise: do not be locked into ‘old’ diagnostic paradigms, see the patient as an individual and use a treatable traits model of care to identify and treat the relevant problems,” he said.

Also of note, the data showed that asthma-COPD (ACO) overlap, present in 12.4% of participants, had the most traits (mean: 6.4/person), with little impact from disease severity and the “greatest clustering of traits”. ACO was also linked with the worst outcomes.

The study shows ACO to be “a morass of interacting traits that should prompt early referral for systematic assessment and management”, said Prof Gibson, and he suggested that “maybe we need specific ACO or treatable traits clinics to deal with these issues”.

The study authors also proposed new treatable traits – T2low, reduced lung function with preserved ratio (PRISm), and frequent reliever use – though Prof Gibson pointed out that whether these are all clinically relevant, objectively measurable and treatable remains to be established.

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