Targeting Treatable Traits in Severe Asthma: A Randomised Controlled Trial
Vanessa M.Â McDonald,Â Vanessa L.Â Clark,Â LauraÂ Cordova-Rivera,Â Peter A. B.Â Wark,Â Katherine J.Â Baines,Â Peter G.Â Gibson
European Respiratory JournalÂ 2019;Â DOI:Â 10.1183/13993003.01509-2019
RationaleÂ Treatable traits have been proposed as a new paradigm for airway disease management.
ObjectivesÂ To characterise treatable traits in a severe asthma population and to determine the efficacy of targeting treatments to these treatable traits in severe asthma.
MethodsÂ Participants (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 endpoint.
Main ResultsÂ Participants with severe asthma had a mean (sd) of 10.44 (3.03) traits per person, comprising 3.01 (1.54) pulmonary, 4.85 (1.86) extrapulmonary and 2.58 (1.31) risk-factor/behavioural traits. 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).
ConclusionsÂ Multidimensional 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 addresss the complexity of severe asthma.
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Conflict of interest: Dr. McDonald reports grants from Hunter Medical Research Institute, grants from National Health and Medical Research Council, grants from John Hunter Hospital Charitable Trust Research Grants, during the conduct of the study; grants and personal fees from GSK, grants and personal fees from Astra Zeneca, outside the submitted work.
Conflict of interest: Dr Vanessa Clark receives a fellowship from the National Health and Medical Research Council, Centre of Research Excellence in Severe Asthma.
Conflict of interest: Dr. Wark has nothing to disclose.
Conflict of interest: Dr. Baines reports grants from Hunter Medical Research Institute, during the conduct of the study.
Conflict of interest: Dr. Gibson reports personal fees from AstraZeneca, GlaxoSmithKline, Novartis, grants from AstraZeneca, GlaxoSmithKline, outside the submitted work.
Conflict of interest: Dr. Cordova has nothing to disclose.
- ReceivedÂ July 30, 2019.
- AcceptedÂ November 23, 2019.
- Copyright Â©ERS 2019