An Australian study also finds a surprise benefit from treating airway diseases with statins.
An Australian study has identified several treatable traits that predict patients’ health status and treatment response in COPD and severe asthma.
“Treatable traits” is a personalised approach to care that aims to improve treatment outcomes for people with complex airway disease by targeting an individual’s symptoms, underlying pathological processes such as inflammation, lifestyle and behavioural traits.
In the study, recurrent chest infections and poor inhaler technique were among the traits associated with poorer quality of life in patients with complex airway disease, while improved outcomes were observed when systemic inflammation was treated with statins.
The retrospective analysis, conducted by researchers at the University of Newcastle and published in the Journal of Allergy & Clinical Immunology: In Practice, pooled data from two controlled trials which had compared standard care to personalised care targeting specific treatable traits in patients with COPD and severe asthma.[1],[2]
From the two trials, 22 treatable traits were identified and analysed among some 90 patients with either COPD or severe asthma (i.e. uncontrolled despite high-dose medication). Forty-five of those had received tailored treatment, consisting of
assessments to screen for a range of problems (treatable traits); a multidisciplinary treatment plan based on their identified treatable traits; medication prescribed according to biomarkers; and co-ordination of care by a case-manager.
In a bid to untangle the effects of multicomponent interventions, the analysis examined these treatable traits in combination, not separately.
The strongest predictors of poor health-related quality of life (HRQoL) were:
- recurrent chest infections
- dysfunctional breathing (Nijmegen questionnaire score ?23)
- poor inhaler technique
- systemic inflammation
- depression
“Although these were the best predictors of HRQoL in the current dataset, this is not to say that the other treatable traits are unimportant for explaining health burden in patients with airway diseases,” the authors wrote.
Other traits such as a lack of exercise, muscle wasting and producing too much mucus were also associated with poorer health status, although to a lesser extent.
“More data will likely improve our ability to predict outcomes and consequently, the relative importance of treatable traits may change,” the authors said.
According to Professor Greg King, a respiratory physician researching complex airway disease at the Woolcock Institute of Medical Research in Sydney, the study’s findings should reinforce the benefits of taking a multidimensional approach to managing complex airway disease and remind clinicians of the importance of addressing easily identifiable traits.
“If you take a generalist approach, if you have all these traits in the back of your mind, regardless of whether the patient has severe asthma or COPD, we should identify each one, thoroughly assess it and then treat accordingly,” Professor King said.
The best treatment outcomes in the study, indicated by the largest improvements in HRQoL, were achieved by treating systemic inflammation with a statin, and treating allergic airway inflammation with oral corticosteroids.
Professor King said this observed benefit from statins was surprising. Statins aren’t routinely used in COPD after a prospective randomised placebo-controlled trial, published in the New England Journal of Medicine in 2014, reported no benefit with statins in reducing exacerbations in COPD patients.
“We don’t use statins specifically to address systemic inflammation, so I think that’s a really interesting finding that definitely needs follow-up,” Professor King said.
He noted, however, that the study analysed an extremely heterogenous group, combining relatively small numbers of patients with COPD and severe asthma in the one analysis.
The findings were therefore cause for further research, said Professor King, who suggested inhaled steroids might also be an alternative treatment for allergic airway inflammation that could be explored.
“Rather than radically altering management, [this study] generates a hypothesis about whether there are [better] ways that we can approach complex airways disease to improve patients’ wellbeing,” he said.
