<p>A Proposed Approach to Chronic Airway Disease (CAD) Using Therapeutic Goals and Treatable Traits: A Look to the Future</p>

Abstract

Chronic airflow obstruction affects a wide range of airway diseases, the most frequent of which are asthma, COPD, and bronchiectasis; they are clearly identifiable in their extremes, but quite frequently overlap in some of their pathophysiological and clinical characteristics. This has generated the description of new mixed or overlapping disease phenotypes with no clear biological grounds. In this special article, a group of experts provides their perspective and proposes approaching the treatment of chronic airway disease (CAD) through the identification of a series of therapeutic goals (TG) linked to treatable traits (TT)-understood as clinical, physiological, or biological characteristics that are quantifiable using biomarkers. This therapeutic approach needs validating in a clinical trial with the strategy of identification of TG and treatment according to TT for each patient independently of their prior diagnosis.

Treatable Traits in COPD – A Proposed Approach

“…Given the complexity, some authors propose that the TTs to be address should be more focused, according to the selected therapeutic goal, 19 as mentioned above. However, the authors also recognize that most patients have multiple therapeutic goals and that some, such as mortality, should be assessed ubiquitously.…”

“…A Spanish group published a critical analysis of the treatable traits approach and introduced the concept of therapeutic goal ( Figure 1 ). 19 According to this group, therapeutic goals ‘are not therapeutic targets, but rather clinical problems that must be eliminated or improved’. 19 For each therapeutic goal, there is a set of treatable traits.…”

“… 19 According to this group, therapeutic goals ‘are not therapeutic targets, but rather clinical problems that must be eliminated or improved’. 19 For each therapeutic goal, there is a set of treatable traits. Thus, the treatable traits to address must consider the selected therapeutic goal.…”

“…Within this label-free approach, several candidate traits have already been identified for chronic airway diseases. 14 , 15 , 18 , 19 Some authors have also explored this approach to manage asthma and COPD individually. 20–23 …”

Phenotype-Guided Asthma Therapy: An Alternative Approach to Guidelines

“…20 Another proposal is to separate what we want to improve in each patient, the therapeutic goals (TG) from the characteristics (TT) upon which action may be taken in order to achieve this improvement. 21 TG are, ultimately, the clinical needs of patients (symptoms, exacerbations, quality of life, physical activity) or aspects of the disease (progression, mortality) that should be avoided in order to improve prognosis. They are not truly therapeutic targets, but rather clinical problems that must be eliminated or improved.…”