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Randomized Controlled Trial
. 2020 Mar 5;55(3):1901509.
doi: 10.1183/13993003.01509-2019. Print 2020 Mar.

Targeting treatable traits in severe asthma: a randomised controlled trial

Vanessa M McDonald  1   2   3   4   5 , Vanessa L Clark  6   2   3   5 , Laura Cordova-Rivera  6   2   3 , Peter A B Wark  6   2   3   4 , Katherine J Baines  6   2   3 , Peter G Gibson  6   2   3   4
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Free article
Randomized Controlled Trial

Targeting treatable traits in severe asthma: a randomised controlled trial

Vanessa M McDonald et al. Eur Respir J. .
Free article

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.

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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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