Targeting treatable traits in severe asthma: a randomised controlled trial

Abstract

RationaleTreatable traits have been proposed as a new paradigm for airway disease management.ObjectivesTo characterise treatable traits in a severe asthma population and to determine the efficacy of targeting treatments to these treatable traits in severe asthma.MethodsParticipants (n=140) with severe asthma were recruited to a cross-sectional study and underwent a multidimensional assessment to characterise treatable traits. Eligible participants with severe asthma (n=55) participated in a 16-week parallel-group randomised controlled trial to determine the feasibility and efficacy of management targeted to predefined treatable traits, compared to usual care in a severe asthma clinic. The patient-reported outcome of health-related quality of life was the trial's primary end-point.Main resultsParticipants with severe asthma had a mean±sd of 10.44±3.03 traits per person, comprising 3.01±1.54 pulmonary and 4.85±1.86 extrapulmonary traits and 2.58±1.31 behavioural/risk factors. Individualised treatment that targeted the traits was feasible and led to significantly improved health-related quality of life (0.86 units, p<0.001) and asthma control (0.73, p=0.01).ConclusionsMultidimensional assessment enables detection of treatable traits and identifies a significant trait burden in severe asthma. Targeting these treatable traits using a personalised-medicine approach in severe asthma leads to improvements in health-related quality of life, asthma control and reduced primary care acute visits. Treatable traits may be an effective way to address the complexity of severe asthma.

Treatable traits: a step closer to the “holy grail” of asthma control?

“…Why do I feel that the findings of MCDONALD et al [11] are important and represent an advance for future consideration? As the authors state, and I fully agree, there is a need to rethink treatment approaches for complex diseases like asthma.…”

“…In this issue of the European Respiratory Journal, MCDONALD et al [11] have taken a major step toward testing the hypothesis that targeting treatable traits in severe asthma patients represents an effective step forward to gain greater asthma control. From my review and perspective, their current findings, with promises for future implications, are a significant advance in our quest to improve asthma control through personalised treatment approaches.…”

“…When I evaluated the findings of MCDONALD et al [11], a number of key elements highlighted their proof-of-concept study of treatable-traits directed treatment and suggested to me why their findings represent a significant advance towards precise, comprehensive, and, thus, improved treatment of severe asthma.…”

“…As the authors state, and I fully agree, there is a need to rethink treatment approaches for complex diseases like asthma. Their findings [11] lay out guiding steps to achieve an improvement for such outcomes. Second, in addition to being a complex and chronic disease, asthma is multidimensional; focusing on only one or two aspects of contributing factors to a patient's asthma will likely result in less effective treatment outcomes.…”

“…Finally, the study was only 16 weeks and a detection of differences in exacerbations was not a powered outcome, though a favourable trend toward fewer exacerbations in the intervention group was noted (table S7). These limitations and considerations aside, MCDONALD et al [11] are to be congratulated as they are the first to systematically explore the effects of targeting treatable traits in severe asthma. We now await larger and longer studies for future directions as we search to gain more complete control of asthma and discover whether the treatable traits approach is a step towards our desired Holy Grail in this respect.…”