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Treatable Traits for Asthma Management in Pregnancy (TTAP): protocol for an Australian multicentre prospective
Jane E Grehan1,2, Janet Bristow3,2, Kelly Steel3,2
1College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia jane.grehan@newcastle.edu.au.
Insights
This study introduces the Treatable Traits for Asthma Management in Pregnancy (TTAP) study, aiming to personalize asthma care for expectant mothers by identifying key health traits. The research will help improve outcomes for pregnant women with asthma and their babies.
Area of Science:
- Respiratory Medicine
- Maternal-Fetal Medicine
- Personalized Medicine
Background:
- Asthma is a common condition in pregnancy, with poor control linked to adverse maternal and fetal outcomes.
- Current asthma management in pregnancy is often a 'one size fits all' approach, proving ineffective for many.
- A personalized medicine strategy, like the treatable traits approach, is needed for better airways disease management.
Purpose of the Study:
- To determine the prevalence of treatable traits in pregnant women with asthma.
- To identify traits associated with asthma exacerbation risk, poor asthma control, and reduced quality of life.
- To compare trait prevalence and clinical relevance across regional and metropolitan hospitals and different antenatal care models.
Main Methods:
- A multicentre, prospective observational cohort study involving pregnant women with asthma.
- Data collection at 12-16, 22-26, and 32-36 weeks gestation, and 2-4 weeks postpartum.
- Assessment of pulmonary, extrapulmonary, and behavioural traits using questionnaires, direct questioning, biomarkers, physical measurements, and medical records.
Main Results:
- The study is designed to establish the prevalence of various treatable traits in pregnant asthmatics.
- It will identify specific traits linked to increased risk of asthma exacerbations and poorer control.
- Differences in trait prevalence and impact will be analyzed based on geographical location and antenatal care models.
Conclusions:
- The Treatable Traits for Asthma Management in Pregnancy (TTAP) study protocol is approved and ready for implementation.
- Findings will inform personalized asthma management strategies for pregnant women.
- Dissemination through peer-reviewed publications, conferences, and an online toolkit will support clinicians and patients.
Introduction:
Asthma is one of the most prevalent long-term health conditions affecting pregnant women. Poorly controlled asthma during pregnancy is associated with adverse maternal and fetal outcomes and may predispose offspring to long-term respiratory morbidity. The current 'one size fits all' approach to asthma management during pregnancy is not optimally effective for approximately half of the pregnant women with asthma. A personalised medicine approach to managing airways disease is required. The treatable traits approach focuses on the identification and treatment of traits in the pulmonary, extra-pulmonary and behavioural domains, which are identifiable, measurable, clinically relevant (linked to exacerbation risk or poor asthma control) and treatable. This manuscript outlines the protocol for the Treatable Traits for Asthma Management in Pregnancy (TTAP) study. The purpose of the TTAP study is to prospectively determine the prevalence of a range of treatable traits from these three domains in pregnant women with asthma and determine which traits are associated with exacerbation risk, poor asthma control and poor asthma-related quality of life. Additionally, this study will assess differences in trait prevalence and clinical relevance in pregnant women from regional versus metropolitan hospitals in Australia and in different antenatal models of care.
Methods And Analysis:
The TTAP study is a multicentre, prospective observational cohort study. Study participants are pregnant women with asthma attending antenatal clinics at 10 metropolitan and regional hospitals (public and private) in NSW and Victoria, Australia. Assessment of traits from the pulmonary, extrapulmonary and behavioural domains as well as asthma outcomes is conducted at three gestational timepoints: 12-16 weeks, 22-26 weeks and 32-36 weeks of pregnancy. A follow-up assessment of asthma outcomes is conducted at 2-4 weeks postpartum. The outcomes assessed are asthma exacerbations requiring medical intervention (primary outcome), asthma symptom control and asthma-related quality of life. Traits and outcomes will be assessed using questionnaires, direct questioning, measurement of biomarkers, physical measurements and assessment of routinely collected data from medical records.
Ethics And Dissemination:
The Hunter New England Human Ethics Committee (2024/ETH01289) has approved the TTAP study protocol. Outcomes will be published in peer-reviewed journals, presented at scientific conferences and disseminated online to participants, clinicians and other pregnant women with asthma and their families via the Asthma in Pregnancy Toolkit website https://asthmapregnancytoolkit.org.au/.
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