Treatable traits qualifying for nonpharmacological interventions in COPD patients upon first referral to a pulmonologist: the COPD sTRAITosphere

Hul, Alex J van ’t; Koolen, Noortje; Antons, Jeanine; Man, Marianne de; Djamin, Remco S.; Veen, J.C.C.M. in ’t; Simons, Sami O.; Heuvel, Michel van den; Borst, Bram van den; Spruit, Martijn A.

doi:10.1183/23120541.00438-2020

Cited by 14 publications

(18 citation statements)

References 43 publications

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“…This study is a secondary analysis of the COPD sTRAITosphere study and uses an observational cross-sectional cohort study design [ 16 ]. Data was collected upon referral from the general practitioner to a pulmonologist for a hospital-based outpatient consultation, through a comprehensive diagnostic examination.…”

Section: Methodsmentioning

confidence: 99%

“…The selection of treatable traits was chosen through the availability of evidence-based interventions, as done by van ‘t Hul et al [ 16 ]. Treatable traits include smoking (currently smoking), activity-related dyspnea (MRC grade ≥ 3), frequent exacerbation (≥ 2 exacerbations per year), abnormal BMI (BMI < 21 or > 30 kg/m 2 ), severe fatigue (CIS score ≥ 36 points), poor exercise capacity (6MWD < 70% predicted) and low daily physical activity (< 5000 steps per day) [ 18 – 24 ].…”

Section: Methodsmentioning

confidence: 99%

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Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment

Jacobsen

Hul²,

Djamin

et al. 2021

Respir Res

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Introduction Patients with COPD are vulnerable to workforce detachment. Better knowledge of features associated with paid work loss might be of help to design and select appropriate interventions. Method This cross-sectional study aimed to explore the presence of treatable traits in COPD patients without paid work. Patients with COPD below 65 years at first referral to a hospital-based patient clinic were included. Using binary logistic regression analysis, the relationship between paid work and the following characteristics was explored: low daily physical activity, exercise, active smoking, Medical Research Council dyspnea scale (MRC), poor nutritional status, exacerbations, and fatigue (checklist individual strength (CIS)). Variables were adjusted for age, sex, forced expiratory volume in 1 s (FEV 1), and education level. Results In total, 191 patients (47.3%) were without paid work. The following treatable traits were related to not being in paid work: < 5000 steps/day (OR 2.36, 95% CI (1.52–3.68)), MRC ≥ 3 (OR 1.78, 95%CI (1.14–2.77)), CIS ≥ 36 points (OR 1.78, 95% CI (1.10–2.87)), six-minute walk distance (6MWD) < 70% of predicted (OR 2.62, 95% CI (1.69–4.06)), and ≥ 2 exacerbations per year (OR 1.80, 95% CI (1.12–2.92)). Significant differences were also seen in age (OR 1.06, 95% CI (1.02–1.10) per year), FEV 1% predicted (OR 0.98, 95% CI (0.97–1.00) per % predicted increase), and medium/high education level (OR 0.62, 95% CI (0.41–0.93)). When adjusting for all variables the only treatable trait that remained significant was 6MWD. Conclusion Patients without paid work are more likely to have treatable traits with 6MWD revealing the most significant association.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment

Jacobsen

Hul²,

Djamin

et al. 2021

Respir Res

Self Cite

View full text Add to dashboard Cite

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“…In another study, van't H ul et al . [ 32 ] reported a high prevalence of traits amenable to nonpharmacological management in COPD patients upon their first assessment in a tertiary hospital respiratory clinic. Patients exhibited on average four treatable traits qualifying for nonpharmacological intervention, regardless of their COPD severity.…”

Section: Treatable Traits a Precision Medicine Approach For Chronic Airway Disease Management: The Evidencementioning

confidence: 99%

“…The most prevalent traits were low activation for self-management, severe fatigue, low habitual physical activity and poor exercise tolerance. The identified treatable traits were independent of each other, occurred in unique combinations, and were clinically relevant as there was a significant positive association between the number of traits identified and health status impairment [ 32 ]. There was a poor correlation between the number of treatable traits identified and the FEV 1 (%) predicted, illustrating heterogeneity of COPD beyond airflow limitation [ 32 ].…”

Section: Treatable Traits a Precision Medicine Approach For Chronic Airway Disease Management: The Evidencementioning

confidence: 99%

The use of treatable traits to address COPD complexity and heterogeneity and to inform the care

Duszyk

McLoughlin

Gibson

et al. 2021

Breathe

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COPD is complex and heterogeneous with respect to its aetiology, clinical presentation, phenotypes and biological mechanisms. Despite this, COPD is still diagnosed and treated according to simple clinical measures, including airflow limitation, symptoms and exacerbation frequency, leading to failure to recognise the disease's heterogeneity and/or to provide targeted interventions. COPD continues to have a very large burden of disease with suboptimal outcomes for people with the disease, including frequent hospitalisation with exacerbations, rapid lung function decline, multimorbidity and death from respiratory failure. In light of this, there have been increasing calls for a renewed taxonomy with better characterisation of COPD phenotypes and endotypes. This would allow the unravelling of COPD's complexity and heterogeneity, the implementation of targeted interventions and improved patient outcomes. The treatable traits strategy is a proposed vehicle for the implementation of precision medicine in chronic airway diseases. In this review, in addition to summarising the key knowledge on the heterogeneity of COPD, we refer to the existing evidence pertaining to the treatable traits strategy as applied in COPD and discuss implementation in different settings.

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“…15 A new paradigm in COPD management-the concept of "treatable traits"-uses a personalized approach to treatment to improve outcomes through individualized and multifaceted assessments of factors that may lead to decreased lung function and quality of life. Treatable traits may be pulmonary, extrapulmonary, or behavioral in nature, 5,16,17 but they must be clinically relevant, identifiable and measurable, and treatable. 5,16,18 One such trait may be an elevated BEC, which is recommended by GOLD as a valid identifying marker of 3 important factors: the presence of eosinophilic airway inflammation, a higher exacerbation risk, and better treatment response to ICS.…”

Section: Introductionmentioning

confidence: 99%

Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy

Chen¹,

Miravitlles²,

Rhee³

et al. 2022

COPD

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Background Some patients with chronic obstructive pulmonary disease (COPD) experience frequent exacerbations despite maximal inhaled therapy (“triple therapy”), possibly leading to high health care resource utilization (HCRU). Aim Describe characteristics, future HCRU, and mortality of patients with COPD who experience frequent exacerbations despite triple therapy; characterize individuals who may be candidates for biologic therapies. Methods This descriptive observational study used primary care data of patients aged ≥40 years in the United Kingdom receiving maintenance therapy for COPD who had ≥1 year of data prior to index date and ≥1 year of follow-up data. We described these patients’ clinical and demographic characteristics, including blood eosinophil counts (BEC), pattern of exacerbations, hospitalizations, and corticosteroid exposure, as well as future exacerbations, hospitalizations, and death. Results Of 43,753 patients with maintenance-treated COPD, 6480 experienced exacerbations despite ≥3 months of triple therapy. Of these, 5669 had available BEC: 1287 (22.7%) had BEC ≥250 cells/µL and ≥3 exacerbations in the year prior to the index date; 471 (36.6%) received ≥4 acute courses of oral corticosteroids. Patients with a pattern of high disease burden continued to have high disease burden: 51.1% experienced ≥3 exacerbations and 2.6% experienced ≥3 hospitalizations. Patients who experienced exacerbations despite triple therapy had a significantly higher risk of COPD-related death than other maintenance-treated patients (5.8% vs 2.1%). Conclusion Nearly one-quarter of patients receiving triple therapy for COPD who experienced frequent exacerbations had elevated BEC and ≥3 exacerbations, suggesting a potential mechanism of persistent eosinophilic inflammation that could be a target for eosinophil-depleting biologic therapy.

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Treatable traits qualifying for nonpharmacological interventions in COPD patients upon first referral to a pulmonologist: the COPD sTRAITosphere

Cited by 14 publications

References 43 publications

Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment

Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment

The use of treatable traits to address COPD complexity and heterogeneity and to inform the care

Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy

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