Treatable Traits Can Predict Exacerbation Risk in Severe Asthma

September 20, 2018
Krista Rossi

Some of the most impactful predictors of future asthma attacks include a history of prior attacks, depression, and vocal cord dysfunction, investigators found.

Vanessa McDonald

Severe asthma has been linked to 10 treatable traits from investigators in a new taxonomic and management approach. By identifying these treatable traits, the team also determined whether particular treatable traits correlated with future exacerbation risk and at what degree in severity.

In an interview with MD Magazine®, Vanessa McDonald, lead study author and professor at the School of Nursing and Midwifery at the University of Newcastle, said that treatable traits have been proposed as “new paradigm for complex airway disease management.” That said, few studies have reported on it in relevant patients.

“We saw the value inassessing the prevalence of treatable traits in severe asthma compared with non-severe asthma, and importantly to assess the relationship between treatable traits and future asthma exacerbation risk,” McDonald said.

Through use of the Australasian Severe Asthma Web‐Based Database (SAWD)—a multi-national observational registry of individuals with confirmed severe refractory asthma and non-severe controlled asthma—the team rook a closer look at severe asthma patients. With the database, 434 patients with severe asthma and 102 participants with non‐severe asthma

were enrolled.

Aside from being mapped to registry fields, the published treatable traits were also described. Participants were characterized at baseline and every 6 months for 24 months.

McDonald noted that the traits that predict future asthma attack, in order of most impactful to least, are as follows:

- History of prior attacks

- Depression

- Vocal cord dysfunction

- Inhaler device polypharmacy

- Obstructive sleep apnea

- Systemic inflammation

- Eosinophilic airway inflammation

- Being underweight

- Anxiety

- Upper airway disease

As these traits predict future attacks, McDonald noted, they are considered “highly clinically important.”

Upon analysis in SAWD, 3 domains—pulmonary, extrapulmonary and behavioral/risk factors—had 24 treatable traits identified in them. More pulmonary and extrapulmonary treatable traits were expressed in patients with severe asthma compared to patients with non‐severe asthma.

In severe asthma, common traits were allergic sensitization, upper‐airway disease, airflow limitation, eosinophilic inflammation, and frequent exacerbation.

Among the 10 traits found to predict exacerbation risk, the traits found to correlate the strongest with the risk depression, inhaler device polypharmacy, vocal cord dysfunction, and obstructive sleep apnea.

From the results, the team concluded a severe asthma registry can be used to assess treatable traits and that patients with severe asthma express more treatable traits compared to non-severe asthma.

"We report the higher burden experienced by patients with severe asthma compared to non-severe and importantly identify which treatable traits are predictive of future asthma attacks. This highlights the usefulness of the treatable traits approach in severe asthma and identifies important targets for treatment," McDonald said.

Looking forward, the team concluded that individualized management strategies for patients with severe asthma may be further assisted as the data may help clinicians develop therapies. Specifically, the clinical utility of assessing treatable traits may be associated with future asthma exacerbation risk.

“The next steps are to conduct prospective treatment trials of the treatable traits approach and to evaluate its efficacy and cost effectiveness,” McDonald concluded.