Treatable traits: a new paradigm for 21st century management of chronic airway diseases: Treatable Traits Down Under International Workshop report

Abstract

“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.

Treatable traits and their application in high‐, middle‐ and low‐income countries

“…Traits are recognized within the domains of pulmonary and extra‐pulmonary traits and behavioural/risk factors. Inherent to the approach is a multidimensional assessment to identify traits followed by individualized treatments implemented to target each trait …”

“…In recognition of this, personalized medicine approaches have been proposed for the management of chronic obstructive airway diseases. These approaches seek to deliver the most appropriate treatments to the most appropriate patients, 4 and limit the implementation of treatments that are not likely to be effective.…”

“…Treatable traits is a model of care that has recently been designed to address the limitations of the step-care approach in the management of obstructive airway diseases. 4,5 The key elements of a treatable traits strategy include a 'labelfree' approach to diagnosis, and the identification of traits that are clinically important, recognizable via the use of trait identification markers and treatable. Traits are recognized within the domains of pulmonary and extra-pulmonary traits and behavioural/risk factors.…”

“…Inherent to the approach is a multidimensional assessment to identify traits followed by individualized treatments implemented to target each trait. 4 As treatable traits is a model of care, a key aspect is implementation to practice. Effective implementation of new models of care needs to consider the healthcare setting, accessibility and the healthcare professional and patient populations.…”

“…This means that prioritization of dominant and important traits and how to address these are required. Proposals of how to set these priorities have been described 4 and may include identifying the prevalence and severity of traits in each setting, the impact of specific traits, for example, does the trait predict future attacks, symptoms or death, what is the expected benefit (effect size) when treating a specific trait and do certain traits and their treatments impact the long-term natural history of the disease, or indeed the development of new and associated conditions.…”