Impact of Treatable Traits on Asthma Control and Quality of Life

Janssen, Steffi; Helvoort, Hanneke AC van; Tjalma, Tjitske A; Antons, Jeanine; Djamin, Remco S.; Simons, Sami O.; Spruit, Prof Martijn A; Hul, Alex J van ’t

doi:10.1016/j.jaip.2023.02.034

Cited by 11 publications

(7 citation statements)

References 52 publications

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“…There are more potential treatable traits during pregnancy that fell beyond the scope of this review. Dysfunctional breathing, fatigue and vitamin D deficiency in pregnant asthma patients could also be considered treatable traits [159,160]. Whether treatment of these traits leads to an improvement in asthma control and pregnancy outcomes is not yet clarified.…”

Section: Discussionmentioning

confidence: 99%

Treatable Traits in Pregnant Women with Asthma

Ramlal,

Van der Meer,

Bendien

2024

Respiration

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Background: Asthma is the most common chronic respiratory disease in pregnancy, affecting approximately 8–10% of pregnant women. Uncontrolled asthma is associated with adverse perinatal outcomes, including low birth weight, preterm birth, and maternal complications such as pre-eclampsia. Summary: A current approach to the management of chronic airway diseases is based on targeting treatable traits. The aim of this review was to define treatable traits in pregnant women with asthma based on recent literature and to determine personalized treatment options according to these traits. Traits addressed in this review that may improve asthma control and pregnancy outcomes are fractional exhaled nitric oxide-based asthma monitoring and treatment, medication adherence and inhalation technique, impaired lung function, smoking cessation and comorbidity including psychological conditions (depression and anxiety), obesity, rhinitis, gastroesophageal reflux disease, chronic rhinosinusitis with or without nasal polyps, and sleep apnea. Key Messages: All the treatable traits discussed have the potential to improve asthma control and pregnancy outcomes in pregnant women with asthma. Further research is needed to determine which management approaches are best to improve asthma control during pregnancy, to identify other relevant treatable traits, and to determine whether the treatable trait approach is feasible and beneficial in pregnant women with asthma.

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Section: Discussionmentioning

confidence: 99%

Treatable Traits in Pregnant Women with Asthma

Ramlal,

Van der Meer,

Bendien

2024

Respiration

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“…While different authors have applied phenotypic features and TTs slightly differently, applying an airway, non-airway and behavioural lens to clinical features enables a more individualized approach to treatment, encompassing important non-pharmacologic interventions and not only medications. 36 The inclusion of biomarkers such as peripheral eosinophils or raised exhaled nitric oxide adds precision and improves outcomes in difficult to control asthma, 37 although patients with mild asthma may have low eosinophils and be poorly responsive to ICS 38 and at risk of exacerbations. 28 Whichever approach is taken its intention is to personalize and link the individual's traits to therapeutic approaches which have a greater certainty of benefit at an individual level.…”

Section: Implications For the Management Of Mild Asthmamentioning

confidence: 99%

“…The most relevant and readily measured trait to identify a T2-high phenotype is eosinophilia which is usually associated with greater improvements in exacerbation rate and lung function, 40 but predicting response is complex when other traits predominate. 36 Treatment options for mild asthma have been explored in evidence reviews, 41 meta-analyses, 32,42 Delphi consultations with clinicians 43,44 and patient focus groups. 6 Despite strong recommendations in global guidelines for ICS-formoterol as needed, 1,17,45 there remains some disagreement amongst clinicians.…”

Section: Implications For the Management Of Mild Asthmamentioning

confidence: 99%

“…A key strategy for approaching patients as individuals and appraising their phenotypic characteristics, history and risks is a TTs approach. While different authors have applied phenotypic features and TTs slightly differently, applying an airway, non‐airway and behavioural lens to clinical features enables a more individualized approach to treatment, encompassing important non‐pharmacologic interventions and not only medications 36 . The inclusion of biomarkers such as peripheral eosinophils or raised exhaled nitric oxide adds precision and improves outcomes in difficult to control asthma, 37 although patients with mild asthma may have low eosinophils and be poorly responsive to ICS 38 and at risk of exacerbations 28 .…”

Section: Implications For the Management Of Mild Asthmamentioning

confidence: 99%

“…While a T2‐high phenotype is most responsive to the anti‐inflammatory effects of inhaled corticosteroids, 9 many studies have been performed in moderate–severe asthma 39 and more prospective studies are needed in milder, less symptomatic asthma. The most relevant and readily measured trait to identify a T2‐high phenotype is eosinophilia which is usually associated with greater improvements in exacerbation rate and lung function, 40 but predicting response is complex when other traits predominate 36 …”

Section: Implications For the Management Of Mild Asthmamentioning

confidence: 99%

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Mild asthma: Conundrums, complexities and the need to customize care

Jenkins

2023

Respirology

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Mild and moderate asthma cover a wide range of asthma presentations, phenotypes and symptom burden, and account for the majority of people with asthma worldwide. Mild asthma has been difficult to define because of its heterogeneity and wide spectrum of impact and outcomes, including being associated with severe exacerbations. Assessment of mild–moderate asthma is best made by combining asthma symptom control and exacerbation risk as the principle means by which to determine treatment needs. Incontrovertible evidence and guidelines support treatment initiation with anti‐inflammatory medication, completely avoiding reliever‐only treatment of mild asthma. Shared decision making with patients and a treatable traits approach will ensure that a holistic approach is taken to maximize patient outcomes. Most importantly, mild asthma should be regarded as a reversible, potentially curable condition, remaining in long‐term remission through minimizing triggers and optimizing care.

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