Treatable Traits in Airway Disease: From Theory to Practice

Agustí, Àlvar; Gibson, Péter G.; McDonald, Vanessa M.

doi:10.1016/j.jaip.2023.01.011

Cited by 38 publications

(49 citation statements)

References 53 publications

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“…12 The treatable traits approach is a model of care that has been designed to address the limitations of the step-care approach to the management of obstructive airway diseases. [13][14][15] The key elements of a treatable traits strategy include the identification of traits that are clinically important, identifiable and treatable. Inherent to the approach is a multidimensional assessment to identify traits followed by individualized treatments implemented to target each trait.…”

Section: Treatable Traitsmentioning

confidence: 99%

“…severeasthma.org.au), smart phone applications and digital control panels that can be used at the point-of-care. 13 Strategies to support individual patients and the MDT are also needed. In tertiary care, this can be achieved by case manager.…”

Section: Treatable Traits Implementationmentioning

confidence: 99%

“…The 2017 Lancet Commission on asthma specifically recommends ‘A revolution in thinking about asthma, delivering precision medicine (i.e., treatable traits)’ 12 . The treatable traits approach is a model of care that has been designed to address the limitations of the step‐care approach to the management of obstructive airway diseases 13–15 . The key elements of a treatable traits strategy include the identification of traits that are clinically important, identifiable and treatable.…”

Section: Introductionmentioning

confidence: 99%

“…From the clinicians' perspective, support and education about treatable traits approach is necessary. This can be achieved through the development of digital education platforms, like the Severe Asthma Toolkit 57 (https://toolkit.severeasthma.org.au), smart phone applications and digital control panels that can be used at the point‐of‐care 13 …”

Section: Introductionmentioning

confidence: 99%

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Treatable traits, combination inhaler therapy and the future of asthma management

2023

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The landscape of asthma has considerably changed in the last decade. Effective medications and inhaler devices have been developed and integrated into the asthma pharmacopoeia, but unfortunately, the proportion of uncontrolled patients remains unacceptably high. This is now recognized to be mainly due to the inappropriate use of medications or inhaler devices, heterogeneity of the disease or other factors contributing to the disease. Currently, inhaled corticosteroids (ICS), with or without long‐acting beta agonists (LABA), are the cornerstone of asthma management, and recently international guidelines recognized the importance of combination inhaler therapy (ICS/LABA) even in mild asthma. In future, ultra‐long‐acting personalized medications and smart inhalers will complement combination inhaler therapy in order to effectively addresses issues such as adherence, inhaler technique and polypharmacy (both of drugs and devices). Asthma is now acknowledged as a multifaceted cluster of disorders and the treatment model has evolved from one‐size‐fits‐all to precision medicine approaches such as treatable traits (TTs, defined as measurable and treatable clinically important factors) which encourages the quality use of medications and identification and management of all underlying behavioural and biological treatable risk factors. TT requires research and validation in a clinical context and the implementation strategies and efficacy in various settings (primary/secondary/tertiary care, low‐middle income countries) and populations (mild/moderate/severe asthma) are currently evolving. Combination inhaler therapy and the TTs approach are complementary treatment approaches. This review examines the current status of personalized medicine and combination inhaler therapy, and describes futuristic views for these two strategies.

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Section: Treatable Traitsmentioning

confidence: 99%

Section: Treatable Traits Implementationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatable traits, combination inhaler therapy and the future of asthma management

2023

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“…In terms of the latter, as a respiratory community clinicians, researchers and patients have recognized that one size does not fit all! 12,13 That chronic respiratory diseases are complex, heterogeneous and associated with either an increasing or continuing disease burden, and that new approaches to improve outcomes for patients are urgently needed 12,14 . Treatable traits is a potential solution to these challenges 1,14–22 …”

Section: Introductionmentioning

confidence: 99%

Treatable traits models of care

McDonald,

Holland

2023

Respirology

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Treatable traits is a personalized approach to the management of respiratory disease. The approach involves a multidimensional assessment to understand the traits present in individual patients. Traits are phenotypic and endotypic characteristics that can be identified, are clinically relevant and can be successfully treated by therapy to improve clinical outcomes. Identification of traits is followed by individualized and targeted treatment to those traits. First proposed for the management of asthma and chronic obstructive pulmonary disease (COPD) the approach is recommended in many other areas of respiratory and now immunology medicine. Models of care for treatable traits have been proposed in different diseases and health care setting. In asthma and COPD traits are identified in three domains including pulmonary, extrapulmonary and behavioural/lifestyle/risk‐factors. In bronchiectasis and interstitial lung disease, a fourth domain of aetiological traits has been proposed. As the core of treatable traits is personalized and individualized medicine; there are several key aspects to treatable traits models of care that should be considered in the delivery of care. These include person centredness, consideration of patients' values, needs and preferences, health literacy and engagement. We review the models of care that have been proposed and provide guidance on the engagement of patients in this approach to care.

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Is ‘Cardiopulmonary’ the New ‘Cardiometabolic’? Making a Case for Systems Change in COPD

Hawkins,

Kaplan,

et al. 2024

Pulm Ther

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Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) have a syndemic relationship with shared risk factors and complex interplay between genetic, environmental, socioeconomic, and pathophysiological mechanisms. CVD is among the most common comorbidities in patients with COPD and vice versa. Patients with COPD, irrespective of their disease severity, are at increased risk of CVD morbidity and mortality, driven in part by COPD exacerbations. Despite these known interrelationships, CVD is underestimated and undertreated in patients with COPD. Similarly, COPD is an independent risk-enhancing factor for adverse cardiovascular (CV) events, yet it is not incorporated into current CV risk assessment tools, leading to under-recognition and undertreatment. There is a pressing need for systems change in COPD management to move beyond symptom control towards a comprehensive cardiopulmonary disease paradigm with proactive prevention of exacerbations and adverse cardiopulmonary outcomes and mortality. However, there is a dearth of evidence defining optimal cardiopulmonary care pathways. Fortunately, there is a precedent to support systems-level change in the field of diabetes, which evolved from glycemic control to comprehensive multi-organ risk assessment and management. Key elements included integrated multidisciplinary care, intensive risk factor management, coordination between primary and specialist care, care pathways and protocols, education and self management, and disease-modifying therapies. This commentary article draws parallels between the cardiometabolic and cardiopulmonary paradigms and makes a case for systems change towards multidisciplinary, integrated cardiopulmonary care, using the evolution in diabetes care as a potential framework. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-024-00270-2.

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Treatable Traits in Airway Disease: From Theory to Practice

Cited by 38 publications

References 53 publications

Treatable traits, combination inhaler therapy and the future of asthma management

Treatable traits, combination inhaler therapy and the future of asthma management

Treatable traits models of care

Is ‘Cardiopulmonary’ the New ‘Cardiometabolic’? Making a Case for Systems Change in COPD

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