Dysfunctional breathing and depression are core extrapulmonary and behavior/risk factor traits in type 2-high severe asthma
Published online March 20, 2025
A treatable trait approach has recently been proposed as an effective treatment strategy for severe asthma, targeting recognizable traits that are identifiable and treatable in pulmonary, extrapulmonary, and behavior/risk factor domains. Current guidelines list several extrapulmonary and behavior/risk factor traits, including obesity, chronic rhinosinusitis, gastroesophageal reflux disease, depression, and smoking, in parallel without any priority. These traits have typically been assessed as a panel in clinical studies. However, given limited medical resources in clinical practice, there is a need to identify core treatable traits for delivering efficient and effective patient care. While obesity and smoking are core treatable traits in type 2 (T2)-low asthma, contributing to its pathophysiology, core extrapulmonary and behavior/risk factor traits remain unclear in T2-high asthma.
A recent study by Hamada et al., published in The Journal of Allergy and Clinical Immunology: In Practice, conducted a cross-sectional study on 151 people (aged ≥18 years) with type 2-high severe asthma who completed a multidimensional assessment. They identified core treatable traits among 9 extrapulmonary and 4 behavior/risk factor traits using network analysis and dominance analysis for the Asthma Control Questionnaire scores, the Asthma Quality of Life Questionnaire scores, exacerbation frequency, and lung function. They also examined the association between the core treatable traits and biomarkers.
The study found that the core treatable traits in extrapulmonary and behavior/risk factor domains in T2-high severe asthma were dysfunctional breathing and depression, contributing most to worse asthma symptoms, impaired quality of life, and frequent exacerbations. These conditions in T2-high asthma were associated with elevated systemic inflammation, including blood neutrophils, neutrophil-lymphocyte ratio, and serum high-sensitivity C-reactive protein, independent of obesity, oral corticosteroid dose, and anxiety. The authors concluded that the core treatable traits may differ between asthma inflammatory phenotypes and that elevated systemic inflammatory biomarkers may help in recognizing the presence of dysfunctional breathing and depression in people with T2-high severe asthma.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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