Treatable Trait Guided Asthma Management: A Feasibility Study

Area of Science:

• Pulmonology
• Clinical Medicine
• Personalised Medicine

Background:

• Treatable trait-based personalised medicine has shown success in severe asthma management.
• The feasibility of applying this approach outside of specialized severe asthma clinics is not well established.

Purpose of the Study:

• To assess the feasibility of a randomized controlled trial (RCT) for protocolized treatable trait-guided asthma management in patients not attending a severe asthma clinic.
• To evaluate recruitment rates, intervention acceptability, and willingness to enroll in a future RCT.

Main Methods:

• A 10-week, single-group cohort study involving participants with diagnosed asthma, uncontrolled symptoms (ACQ-5 score >1), and recent exacerbations.
• Biomarker-guided asthma medication adjustments based on a protocol targeting type-2 inflammation and airflow obstruction.
• Feasibility outcomes included recruitment, acceptability, willingness for RCT enrollment, need for extended trait assessment, and trait prevalence estimation.

Main Results:

• Recruitment achieved 29/50 participants over 14 months, with a 25% invitation acceptance rate, impacted by COVID-19.
• 92% of participants found the intervention acceptable and were willing to join a future RCT.
• Despite improvements in Asthma Control Questionnaire-5 (ACQ-5) scores and reduced airflow limitation, 65% remained uncontrolled, necessitating extended assessment. 41% required continuous oral corticosteroids.

Conclusions:

• Protocolized treatable trait management is acceptable and offers clinical benefits, supporting the feasibility of a full RCT.
• Targeting type-2 inflammation and airflow obstruction alone was insufficient for achieving asthma control in most participants.
• Significant systemic corticosteroid exposure was noted, highlighting the need for further research into comprehensive asthma management strategies.