Treatable Traits

Treatable Traits is a new treatment paradigm proposed for the management of people with airway diseases. The treatment approach has been suggested as a way to progress precision or personalised medicine in COPD and asthma (Agusti 2017, Agusti 2016, McDonald 2019b). Patients are first assessed through a detailed clinical history and identification of airway disease risk factors (e.g. smoking history, history of allergies, occupational exposures, family history, respiratory disease in early life); spirometry and measures of airway inflammatory biomarkers, including exhaled nitric oxide fraction (FeNO) and blood eosinophils. These assessments will indicate a high or low probability of the presence of an airway disease (Agusti 2016).

Following this confirmation, it is recommended that each individual undergoes a multidimensional assessment to identify treatable traits and an individualised treatment plan is implemented based on the presence of traits.

In order to be considered a trait, the following criteria should be met. Traits should be identifiable using a trait identification marker, clinically relevant and modifiable (McDonald 2019b).

Traits are grouped into three domains – pulmonary and extrapulmonary traits and behaviours/ risk-factors. While overall management according to treatable traits is a concept, the treatment of each individual trait is supported in most cases through RCT evidence. A proof of concept clinical trial in patients with COPD demonstrated that the treatable traits approach can lead to significant improvements in health-related quality of life (HRQoL) and inflammatory biomarkers (McDonald 2013) with similar results in an RCT in people with severe asthma (McDonald 2019a).