Targeting Treatable Traits in Severe Asthma: A Randomised Controlled Trial

  1. Vanessa M. McDonald1,2,3,4,5⇑,
  2. Vanessa L. Clark1,2,3,5,
  3. Laura Cordova-Rivera1,2,3,
  4. Peter A. B. Wark1,2,3,4,
  5. Katherine J. Baines1,2,3 and
  6. Peter G. Gibson1,2,3,4
  1. 1National Health and Medical Research Council Centre of Excellence in Severe Asthma
  2. 2Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia
  3. 3Hunter Medical Research Institute, Newcastle, Australia
  4. 4Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
  5. 5School of Nursing and Midwifery, University of Newcastle, Australia
  1. Vanessa M. McDonald, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. E-mail: Vanessa.McDonald{at}newcastle.edu.au

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 endpoint.

Main Results 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).

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 addresss the complexity of severe asthma.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

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.

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  • Received July 30, 2019.
  • Accepted November 23, 2019.