Targeting treatable traits in severe asthma: a randomised controlled trial

Abstract

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.

Conflict of interest statement

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. Conflict of interest: L. Cordova-Rivera has nothing to disclose. Conflict of interest: P.A.B. Wark has nothing to disclose. Conflict of interest: K.J. Baines reports grants from Hunter Medical Research Institute, during the conduct of the study. Conflict of interest: P.G. Gibson reports personal fees for lectures from AstraZeneca, GlaxoSmithKline and Novartis, grants from AstraZeneca and GlaxoSmithKline, outside the submitted work. Conflict of interest: 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.

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