Bringing the treatable traits approach to primary care asthma management
Asthma continues to be a major cause of illness with a significant mortality, despite its increasing range of treatments. Adoption of a treatable traits approach in specialist centres has led to improvements in control of asthma and reduced exacerbations in patients with severe asthma. However, most...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Allergy |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/falgy.2023.1240375/full |
| _version_ | 1797679261645012992 |
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| author | Paul E. Pfeffer Paul E. Pfeffer Hitasha Rupani Anna De Simoni |
| author_facet | Paul E. Pfeffer Paul E. Pfeffer Hitasha Rupani Anna De Simoni |
| author_sort | Paul E. Pfeffer |
| collection | DOAJ |
| description | Asthma continues to be a major cause of illness with a significant mortality, despite its increasing range of treatments. Adoption of a treatable traits approach in specialist centres has led to improvements in control of asthma and reduced exacerbations in patients with severe asthma. However, most patients with this illness, particularly those with mild-to-moderate asthma, are cared for in primary care according to guidelines that emphasise the use of pharmacotherapeutic ladders uniformly implemented across all patients. These pharmacotherapeutic ladders are more consistent with a “one-size-fits-all” approach than the treatable traits approach. This can be harmful, especially in patients whose symptoms and airway inflammation are discordant, and extra-pulmonary treatable traits are often overlooked. Primary care has extensive experience in patient-centred holistic care, and many aspects of the treatable traits approach could be rapidly implemented in primary care. Blood eosinophil counts, as a biomarker of the treatable trait of eosinophilia, are already included in routine haematology tests and could be used in primary care to guide titration of inhaled corticosteroids. Similarly, poor inhaler adherence could be further assessed and managed in primary care. However, further research is needed to guide how some treatable traits could feasibly be assessed and/or managed in primary care, for example, how to best manage patients in primary care, who are likely suffering from breathing pattern disorders and extra-pulmonary treatable traits, with frequent use of their reliever inhaler in the absence of raised T2 biomarkers. Implementation of the treatable traits approach across the disease severity spectrum will improve the quality of life of patients with asthma but will take time and research to embed across care settings. |
| first_indexed | 2024-03-11T23:11:57Z |
| format | Article |
| id | doaj.art-e34573dc02244ce29c2076840786b4e0 |
| institution | Directory Open Access Journal |
| issn | 2673-6101 |
| language | English |
| last_indexed | 2024-03-11T23:11:57Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Allergy |
| spelling | doaj.art-e34573dc02244ce29c2076840786b4e02023-09-21T07:35:31ZengFrontiers Media S.A.Frontiers in Allergy2673-61012023-09-01410.3389/falgy.2023.12403751240375Bringing the treatable traits approach to primary care asthma managementPaul E. Pfeffer0Paul E. Pfeffer1Hitasha Rupani2Anna De Simoni3Department of Respiratory Medicine, Barts Health NHS Trust, London, United KingdomWilliam Harvey Research Institute, Queen Mary University of London, London, United KingdomDepartment of Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United KingdomWolfson Institute of Population Health and Asthma UK Centre for Applied Research, Queen Mary University of London, London, United KingdomAsthma continues to be a major cause of illness with a significant mortality, despite its increasing range of treatments. Adoption of a treatable traits approach in specialist centres has led to improvements in control of asthma and reduced exacerbations in patients with severe asthma. However, most patients with this illness, particularly those with mild-to-moderate asthma, are cared for in primary care according to guidelines that emphasise the use of pharmacotherapeutic ladders uniformly implemented across all patients. These pharmacotherapeutic ladders are more consistent with a “one-size-fits-all” approach than the treatable traits approach. This can be harmful, especially in patients whose symptoms and airway inflammation are discordant, and extra-pulmonary treatable traits are often overlooked. Primary care has extensive experience in patient-centred holistic care, and many aspects of the treatable traits approach could be rapidly implemented in primary care. Blood eosinophil counts, as a biomarker of the treatable trait of eosinophilia, are already included in routine haematology tests and could be used in primary care to guide titration of inhaled corticosteroids. Similarly, poor inhaler adherence could be further assessed and managed in primary care. However, further research is needed to guide how some treatable traits could feasibly be assessed and/or managed in primary care, for example, how to best manage patients in primary care, who are likely suffering from breathing pattern disorders and extra-pulmonary treatable traits, with frequent use of their reliever inhaler in the absence of raised T2 biomarkers. Implementation of the treatable traits approach across the disease severity spectrum will improve the quality of life of patients with asthma but will take time and research to embed across care settings.https://www.frontiersin.org/articles/10.3389/falgy.2023.1240375/fullasthmapersonalised medicineinducible laryngeal obstructionbiomarkeradherencebreathing pattern disorder |
| spellingShingle | Paul E. Pfeffer Paul E. Pfeffer Hitasha Rupani Anna De Simoni Bringing the treatable traits approach to primary care asthma management Frontiers in Allergy asthma personalised medicine inducible laryngeal obstruction biomarker adherence breathing pattern disorder |
| title | Bringing the treatable traits approach to primary care asthma management |
| title_full | Bringing the treatable traits approach to primary care asthma management |
| title_fullStr | Bringing the treatable traits approach to primary care asthma management |
| title_full_unstemmed | Bringing the treatable traits approach to primary care asthma management |
| title_short | Bringing the treatable traits approach to primary care asthma management |
| title_sort | bringing the treatable traits approach to primary care asthma management |
| topic | asthma personalised medicine inducible laryngeal obstruction biomarker adherence breathing pattern disorder |
| url | https://www.frontiersin.org/articles/10.3389/falgy.2023.1240375/full |
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