Targeting treatable traits in severe asthma: A randomised controlled trial

Vanessa M. McDonald, Vanessa L. Clark, Laura Cordova-Rivera, Peter A.B. Wark, Katherine J. Baines, Peter G. Gibson

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Rationale: Treatable traits have been proposed as a new paradigm for airway disease management. Objectives: To characterise treatable traits in a severe asthma population and to determine the efficacy of targeting treatments to these treatable traits in severe asthma. Methods: 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 end-point. Main results: Participants with severe asthma had a mean±SD of 10.44±3.03 traits per person, comprising 3.01±1.54 pulmonary and 4.85±1.86 extrapulmonary traits and 2.58±1.31 behavioural/risk factors. 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). Conclusions: 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 address the complexity of severe asthma.

Original languageEnglish
Article number1901509
JournalEuropean Respiratory Journal
Issue number3
Publication statusPublished - 1 Mar 2020
Externally publishedYes

Bibliographical note

Funding Information:
Support statement: This work was supported by the National Health and Medical Research Council, Hunter Medical Research Institute, The University of Newcastle, The John Hunter Hospital Charitable Trust. Funding information for this article has been deposited with the Crossref Funder Registry.

Funding Information:
Conflict of interest: V.L. Clark reports personal fees for research and providing educations from AstraZeneca, and receives a fellowship from the National Health and Medical Research Council, Centre of Research Excellence in Severe Asthma. L. Cordova-Rivera has nothing to disclose. P.A.B. Wark has nothing to disclose. K.J. Baines reports grants from Hunter Medical Research Institute, during the conduct of the study. P.G. Gibson reports personal fees for lectures from AstraZeneca, GlaxoSmithKline and Novartis, grants from AstraZeneca and GlaxoSmithKline, outside the submitted work. V.M. McDonald reports grants from Hunter Medical Research Institute, National Health and Medical Research Council and John Hunter Hospital Charitable Trust Research Grants, during the conduct of the study; grants and personal fees for educational lectures from GSK and AstraZeneca, outside the submitted work.

Publisher Copyright:
Copyright © ERS 2020


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