Pulmonary treatable traits of airway diseases

Treatable traits  (can coexist)Imp.Rec.Diagnostic criteriaTreatmentMain expected benefit
First choiceEfficacySecond choice
Airflow limitation [9]++++++FEV1/FVC <0.7 (or lower limit of normal)S
 Airway smooth muscle contraction+++++Bronchodilator reversibility, peak expiratory flow variability, positive PC20Maintenance: long-acting β2-adrenergic agonists/muscarinic antagonists; rescue: short-acting β2-adrenergic agonists/muscarinic antagonists+++Inhaled corticosteroids, bronchial thermoplastyS
 Loss of elastic recoil (emphysema)+++++Chest computed tomography, DLCO, complianceSmoking cessation+Lung volume reduction surgery, lung transplantation, α1-anti-trypsin replacement if deficient, valves, coilsS, P
 Airway mucosal oedema+++Chest computed tomography, spirometry-induced bronchoconstrictionInhaled corticosteroids++Oral corticosteroids, anti-interleukin-5, -13, -4E
Eosinophilic airway inflammation [55, 56]++++++Sputum eosinophils, blood eosinophils, FeNO, (periostin)Inhaled corticosteroids+++Oral corticosteroids, leukotriene receptor antagonists, anti-IgE, anti-interleukin-5, -13, -4E
Chronic bronchitis+++++Cough and sputum 3 months×2 years (no eosinophilic airway inflammation)Smoking cessation+Carbocysteine, macrolides, roflumilastE
Airway bacterial colonisation#++++Sputum culture, quantitative PCRAntibiotics++Long-term low-dose macrolides, vaccinationE/S
Bronchiectasis#++++Chest computed tomographyDrainage+Macrolides, nebulised antibiotics, surgery, vaccinationE/S
Cough reflex hypersensitivity [49, 57]+++++Capsaicin challenge, cough counts, cough questionnaireSpeech and language treatment [58]+Gabapentin [56]S
Pre-capillary pulmonary hypertension#++++Doppler echocardiography, brain natriuretic peptide, right heart catheterisationLong-term (domiciliary) oxygen therapy++Noninvasive ventilation, lung transplantationS, E, P
Chronic respiratory failure#
 Arterial hypoxaemia++++++PaO2 <55 mmHgLong-term (domiciliary) oxygen therapy++P
 Arterial hypercapnia++++++PaCO2 >45 mmHg+Noninvasive ventilation, lung transplantation
  • Imp.: importance; Rec.: recognisability. Diagnostic criteria and treatments options in italics should be considered as experimental (under current investigation) or having an unfavourable risk–benefit ratio. Expected treatment benefits on: E: exacerbations (rate/severity); S: symptoms; P: prognosis. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; PC20: provocative concentration causing a 20% fall in FEV1; DLCO: diffusing capacity of the lung for carbon monoxide; FeNO: exhaled nitric oxide fraction; PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension. #: treatable traits probably best dealt with in a specialist setting; : not studied in COPD-like airway disease.