Trait profiles in difficult‐to‐treat asthma: Clinical impact and response to systematic assessment

• DOI: 10.1111/all.15719
• Publication Date: 2023-03-20T18:43:01Z
• Authors: Tiffany Lin; Jonathan Pham; Eve Denton; Joy Lee; Fiona Hore‐Lacy; Asger Sverrild; Stephanie Stojanovic; Tunn Ren Tay; Kavitha Garuna Mu...; Naghmeh Radhakrishna; Monique Dols; Janet Bondarenko; Janine Mahoney; Robyn E. O'Hehir; Eli Dabscheck; Mark Hew
• Keywords: Adult; Adrenal Cortex Hormones; Respiration; latent class analysis; Quality of Life; Humans; Comorbidity; treatable traits; Anxiety; asthma phenotype; difficult-to-treat asthma; Asthma; 3. Good health

Multidisciplinary systematic assessment improves outcomes in difficult-to-treat asthma, but without clear response predictors. Using a treatable-traits framework, we stratified patients by trait profile, examining clinical impact and treatment responsiveness to assessment.We performed latent class analysis using 12 traits on asthma undergoing at our institution. We examined Asthma Control Questionnaire (ACQ-6) Quality of Life (AQLQ) scores, FEV1 , exacerbation frequency, maintenance oral corticosteroid (mOCS) dose, baseline following assessment.Among 241 patients, two airway-centric profiles were characterized early-onset with allergic rhinitis (n = 46) adult onset eosinophilia/chronic rhinosinusitis 60), respectively, minimal comorbid or psychosocial traits; three non-airway-centric exhibited either (obesity, vocal cord dysfunction, dysfunctional breathing) dominance 51), (anxiety, depression, smoking, unemployment) 72), multi-domain impairment 12). Compared profiles, had worse ACQ-6 (2.7 vs. 2.2, p < .001) AQLQ (3.8 4.5, scores. Following assessment, the cohort showed overall improvements across all outcomes. However, more improvement (5.6% 2.2% predicted, .05) while trended greater reduction (1.7 1.0, .07); mOCS dose was similar (3.1 mg 3.5 mg, .782).Distinct are associated different assessment. These findings yield mechanistic insights into offer conceptual framework address disease heterogeneity, highlight areas responsive targeted intervention.