“Treatable traits” have been proposed as a new paradigm for the management of airway diseases, particularly complex disease, which aims to apply personalised medicine to each individual to improve outcomes. Moving new treatment approaches from concepts to practice is challenging, but necessary. In an effort to accelerate progress in research and practice relating to the treatable traits approach, the Treatable Traits Down Under International Workshop was convened in Melbourne, Australia in May 2018. Here, we report the key concepts and research questions that emerged in discussions during the meeting. We propose a programme of research that involves gaining international consensus on candidate traits, recognising the prevalence of traits, and identifying a potential hierarchy of traits based on their clinical impact and responsiveness to treatment. We also reflect on research methods and designs that can generate new knowledge related to efficacy of the treatable traits approach and consider multidisciplinary models of care that may aid its implementation into practice.

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Objective: To estimate the level of dispensing of oral corticosteroids (OCS) for managing asthma in Australia, with a particular focus on the cumulative dispensing of doses associated with long term toxicity (≥ 1000 mg prednisolone-equivalent). Design: Retrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. Participants, setting: People aged 12 years or more treated for asthma during 2014-2018, according to dispensing of controller inhaled corticosteroids (ICS). the raw Pharmaceutical Benefits Scheme (PBS) data for our analysis. AstraZeneca provided funding to an independent data company, Model Solutions, to request and manage PBS data, but played no other role in this study.

C hronic obstructive pulmonary disease (COPD) is the cardinal smoking-related respiratory illness. 1,2 Diagnosis requires exposure to noxious inhalants, respiratory symptoms, and spirometry demonstrating airflow obstruction, defined by a post-bronchodilator forced expiratory volume in one second (FEV 1 ) divided by forced vital capacity ratio < 0.70. 1,2 COPD is the fifth leading cause of disability-adjusted life-years worldwide, affecting about 14% of Australians above the age of 40 years. 2 COPD has a profound impact on the Australian hospital system. In 2015-16, it was the most common cause of potentially preventable hospitalisations related to chronic conditions in Australia; it was followed by heart failure. 3 In Australian general practice, both respiratory presentations and cardiovascular issues are common, so co-occurrence is frequent. 4 Cardiovascular disease (CVD) has compelling links to COPD. Individuals with COPD have a nearly 2.5-fold risk of CVD in comparison with controls. 5 Moreover, patients with comorbid COPD and CVD report more breathlessness and worse quality of life, are more frequently hospitalised and have higher mortality than those with COPD alone. 6 More than a quarter of patients with COPD will die from a cardiovascular event, and 40% of patients with COPD and a cardiovascular history will die following a cardiovascular event. 6Despite this, under-diagnosis of CVD in patients with COPD is frequent. For example, in patients with COPD and electrocardiographic evidence of myocardial infarction, less than one-third had been diagnosed with CVD. 7 COPD and CVD share risk factors and symptoms with significant overlap in clinical presentations. Determining the presence and contributions of the individual diseases can help clinicians prognosticate and manage this complex population.We searched PubMed for COPD and cardiovascular terms. We examined clinically relevant aspects of their relationship, diagnostic challenges and current and future therapeutic strategies. COPD and CVD: shared pathophysiologyDisease processes in COPD and CVD overlap, and salient clinical aspects are outlined below. Shared risk factorsPatients with COPD generally have multiple major risk factors for CVD. They have almost invariably smoked, and tend to be older, male and less physically active (Box 1). Hypertension is highly prevalent and present in up to 77% of some COPD cohorts. 1,5 However, these are insufficient to explain the excess CVD prevalence seen in COPD. 6 1