Are treatable traits interventions effective in obstructive airway diseases?
Published: May 25, 2022
Obstructive airway diseases (OADs), including asthma, chronic obstructive pulmonary disease (COPD), asthma-COPD overlap (ACO), and bronchiectasis, are complex and heterogeneous conditions each characterized by co-morbid conditions as well as risk factors. Such complexity in the management of OADs has led to calls for new approaches to OADs management involving personalized care. The ‘Treatable Traits’ (TTs) approach is a precision medicine model, where treatment is targeted at biological, psychosocial and clinical phenotypic characteristics. This approach for OAD management has been included in clinical guidelines and promoted by key opinion leaders.
In a recent systematic review published in The Journal of Allergy and Clinical Immunology: In Practice, Sarwar and colleagues summarized the evidence for TTs in the management of OADs and determined the effects of this targeted approach on health outcomes. The study authors searched 4 databases (Ovid Embase, Ovid Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus) from inception to March 9th, 2022. Studies of interventions targeting at least 1 TT from pulmonary, extra-pulmonary, and behavioral/lifestyle domains were included. Two reviewers independently extracted relevant data and performed risk of bias assessments. Meta-analyses were performed using random-effects models. Subgroup and sensitivity analyses were carried out to explore heterogeneity and to determine the effects of outlying studies.
Eleven studies were identified that used the TTs approach for OAD management. The number of traits targeted within each study ranged from 13 to 36. Seven controlled trials were included in meta-analyses. TT interventions were effective at improving health-related quality of life (mean difference [MD] = -6.96, 95% CI -9.92 to -4.01); and reducing hospitalizations (odds ratio [OR] = 0.52, 95% CI 0.39 to 0.69), all-cause-1-year mortality (OR = 0.65, 95% CI 0.45 to 0.95), dyspnoea score (MD = -0.29, 95% CI -0.46 to -0.12), anxiety (MD = -1.61, 95% CI -2.92 to -0.30), and depression (MD = -2.00, 95% CI -3.53 to -0.47). These results suggest that characterizing TTs and targeted interventions can improve outcomes in OADs, which offer a promising model of care for OADs
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.