Treatable Traits in Severe Asthma Can Predict Attacks

Marcia Frellick

September 24, 2018

Ten treatable traits in people with severe asthma can help predict asthma attacks, say authors of a study published online September 19 in Respirology.

These traits are more prevalent in those with severe disease compared with nonsevere disease, and can help clinicians develop individual treatment plans, write Vanessa McDonald, PhD, a respiratory clinical nurse consultant with the Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs at the University of Newcastle in Callaghan, New South Wales, Australia, and colleagues.

Table. Treatable Traits in Severe Asthma Linked to Future Attacks

Treatable Trait Incident Rate Ratio 95% Confidence Interval
Exacerbation prone 2.07 1.66 - 2.58
Depression 1.63 1.41 - 1.88
Vocal cord dysfunction 1.51 1.22 - 1.88
Inhaler device polypharmacy 1.51 1.31 - 1.75
Obstructive sleep apnea 1.41 1.05 - 1.89
Systemic inflammation 1.40 1.10 - 1.79
Eosinophilic inflammation 1.35 1.10 - 1.65
Underweight 1.29 1.02 - 1.64
Anxiety 1.27 1.03 - 1.56
Upper airway disease 1.26 1.03 - 1.55
All traits were significant (P < .05).

Researchers used information from the Australasian Severe Asthma Web-Based Database, which is a study that spanned 26 sites in Australia, New Zealand, and Singapore. It was started by the Australasian Severe Asthma Network under the Thoracic Society of Australia and New Zealand.

The Severe Asthma Web-Based Database enrolled 434 patients with severe asthma and compared them with a group of 102 patients with nonsevere asthma. Treatable traits were mapped to registry data fields, and prevalence was assessed. Patients were characterized at baseline and every 6 months for 24 months.

The authors write, "[M]any traits that we have identified as prevalent and associated with future risk are frequently not assessed in severe asthma populations."

Bradley Chipps, MD, president of the American College of Allergy, Asthma, and Immunology, told Medscape Medical News he agrees the data in the paper show the importance of assessing for the treatable traits because they can drive treatment and prophylaxis decisions.

However, he said, these traits are already well known to be predictive of severe disease.

"This is not new information; this has been shown in multiple other studies," he said. "This article puts it all together."

"I think it's important to see that the authors have shown us that anxiety and depression are major factors in the presence of severe asthma. We know that patients have a very poor understanding often of the medications they are using, and they use the inhalers inappropriately and have poor adherence. All these things are important to bring to the prescribing physicians' awareness."

The authors acknowledge that a criticism of the treatable trait approach is that it is complex and the assessments require substantial resources, but they argue the investment is necessary.

Chipps said he agrees and that although assessments do require resources, substantial numbers of patients with asthma will benefit.

The approach has shown great promise in chronic obstructive pulmonary disease and in older patients with airway diseases, the authors write.

The researchers conclude, "The results confirm the marked heterogeneity and greater burden associated with severe asthma and reinforce the need for systematic assessment in patients with severe asthma, although the process for translation to clinical practice needs to be defined."

They note that although the registry database produced a large sample size, it may not have contained data on some traits that may prove to be relevant.

The authors stress the need for clinical trials to test the different assessments and their cost effectiveness.

This study was funded through grants from AstraZeneca, GlaxoSmithKline, Novartis, Boehringer Ingelheim, and Roche. None of these companies had any involvement in the data analysis or manuscript preparation. Individual author disclosures are presented in Appendix S2 of the study's supplementary information. Chipps is the president of the American College of Allergy, Asthma, and Immunology and has been a consultant for or has been part of a speakers bureau for AstraZeneca, Boehringer Ingelheim, Circassia, Genentech, Novartis, Regeneron, Sanofi, and Teva.

Respirology. Published online September 19, 2018. Abstract

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