Treatable traits in asthma: moving beyond diagnostic labels

McDonald, Vanessa M.; Gibson, Peter G.

doi:10.5694/mja2.51464

Cited by 22 publications

(20 citation statements)

References 17 publications

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“…Those that do not improve with standard inhaled therapy have been labelled “severe” or more correctly “difficult to treat” asthma ( 35 ). More recently, there have been substantial advances in our understanding of the treatable traits that contribute to an individual's asthma complex ( 36 ). This has been followed by an increasing uniformity in how these are measured, and in the consistency of terminology used to describe them.…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal dyspnoea in asthma: Wheeze, ILO or dysfunctional breathing?

2022

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Paroxysms of dyspnoea in the general population are commonly reported and are frequently assumed to be asthma-related, especially if this diagnostic label has been previously applied. Often, this is not the case. Inducible Laryngeal Obstruction (ILO) and Dysfunctional Breathing (DB) are common comorbid conditions that go unrecognised in many difficult-to-treat asthmatics. On average, these patients have a delay in diagnosis of almost 5 years. This delay, along with ineffective, inappropriate escalation of asthma therapy, frequent hospital presentations for uncontrolled symptoms, and even intensive care admissions, magnifies patient morbidity and poor quality of life. ILO and DB have similar presentations and triggers to asthma. Differentiating between them can be challenging, especially in centres that do not have access to multidisciplinary subspecialty asthma services. Objectively confirming the diagnosis can likewise be challenging as symptoms fluctuate, and gold-standard investigations require extensive experience. This mini-review will summarise the clinical features of ILO and DB, with particular focus in the context of individuals treated for asthma. This narrative review will define each condition, highlight poignant aspects of the history and describe elements of the diagnostic pathway to gain objective confirmation.

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Section: Discussionmentioning

confidence: 99%

Paroxysmal dyspnoea in asthma: Wheeze, ILO or dysfunctional breathing?

2022

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“…Level changes of small metabolites could be used as diagnostic and prognostic biomarkers as well as therapeutic targets. 320 , 369 – 372 Metabolome is in constant change, and thus a more reflection of body phenotype than the other “-omics”, such as transcriptomics, proteomics or genomics. Metabolomics tool in clinic measuring variations of metabolites will play a key role for biomarker research, the identification of biochemical pathways involved in the treatment follow-up.…”

Section: Exploring Phenotype Signaturesmentioning

confidence: 99%

Small molecule metabolites: discovery of biomarkers and therapeutic targets

Qiu

Cai

et al. 2023

Sig Transduct Target Ther

228

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Metabolic abnormalities lead to the dysfunction of metabolic pathways and metabolite accumulation or deficiency which is well-recognized hallmarks of diseases. Metabolite signatures that have close proximity to subject’s phenotypic informative dimension, are useful for predicting diagnosis and prognosis of diseases as well as monitoring treatments. The lack of early biomarkers could lead to poor diagnosis and serious outcomes. Therefore, noninvasive diagnosis and monitoring methods with high specificity and selectivity are desperately needed. Small molecule metabolites-based metabolomics has become a specialized tool for metabolic biomarker and pathway analysis, for revealing possible mechanisms of human various diseases and deciphering therapeutic potentials. It could help identify functional biomarkers related to phenotypic variation and delineate biochemical pathways changes as early indicators of pathological dysfunction and damage prior to disease development. Recently, scientists have established a large number of metabolic profiles to reveal the underlying mechanisms and metabolic networks for therapeutic target exploration in biomedicine. This review summarized the metabolic analysis on the potential value of small-molecule candidate metabolites as biomarkers with clinical events, which may lead to better diagnosis, prognosis, drug screening and treatment. We also discuss challenges that need to be addressed to fuel the next wave of breakthroughs.

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“…Once the probability of an airway disease is determined the traits are then assessed in the pulmonary, extrapulmonary and behaviour/lifestyle risk factors domains, and individualized treatments are applied. Advantages of this label free approach are that the diagnosis does not need to be clearly established to commence the patient on the best treatments, as this is guided by the individuals' identified traits 1,20 . It also means that this approach is adaptable to different health care settings, 17,34 and as we have seen, to other patient populations with respiratory disease 2,3,5,35,36 …”

Section: Different Models Of Carementioning

confidence: 99%

“…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%

“…12,14 Treatable traits is a potential solution to these challenges. 1, [14][15][16][17][18][19][20][21][22] Treatable traits is an approach that facilitates the delivery of personalized medicine, the approach can be delivered as a model of care, with several models now proposed. A 'model of care' has been defined as the way health services are delivered.…”

Section: Introductionmentioning

confidence: 99%

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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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Treatable traits in asthma: moving beyond diagnostic labels

Cited by 22 publications

References 17 publications

Paroxysmal dyspnoea in asthma: Wheeze, ILO or dysfunctional breathing?

Paroxysmal dyspnoea in asthma: Wheeze, ILO or dysfunctional breathing?

Small molecule metabolites: discovery of biomarkers and therapeutic targets

Treatable traits models of care

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