The Evolving Role of Biologics and TSLP Inhibition in Severe Asthma and Upper Airway Disease - Episode 4
Treatable Traits in Asthma: Targeting Comorbidities Beyond the Lung
A treatable trait is easier to endorse than to define. The panel works through what qualifies, and why extrapulmonary traits deserve the same attention as the airway itself.
In "Treatable Traits in Asthma: Targeting Comorbidities Beyond the Lung," our experts turn to what the treatable traits framework looks like at the bedside.
Dr. Chupp asks Dr. Hanania for a concrete example, listing the candidates on the table: nitric oxide levels, blood eosinophils, allergic sensitization on skin testing, and specific IgE on blood testing. Which of these, he asks, actually counts as a treatable trait? Dr. Hanania offers allergic asthma as one, with the upper airway to be taken up later in the program. He notes some clinicians use eosinophilic asthma as a treatable trait, then immediately concedes the problem. Others would call it an endotype, and others still a phenotype. He admits the framework is not foolproof and that people argue about it.
He then widens the lens. Treatable traits have been applied across other pulmonary diseases, and the framework distinguishes pulmonary traits from extrapulmonary ones. That distinction carries his main clinical point. Even though he and Dr. Wechsler are pulmonologists trained to focus on the lung, these patients arrive with a long list of comorbidities that sit outside it. He names sleep apnea and gastroesophageal reflux as examples of extrapulmonary traits that need addressing alongside the airway.
Dr. Ross says this falls squarely into her camp. Allergists tend to see patients head to toe, and her patients carry the traits of allergic sensitization and a type 2 background: atopic dermatitis, eosinophilic esophagitis, and nasal polyps. Those traits, she argues, genuinely guide what a given patient is likely to respond to.
Dr. Chupp closes with the recurring challenge. There is tremendous overlap between the biomarkers and the clinical features in any individual patient. Even so, he says, the biomarkers available can still be used to personalize the approach.
Up next, in "Asthma Biomarkers: Using Eosinophils, FeNO, and IgE to Guide Therapy," Dr. Wechsler walks through how he reads the three biomarkers clinicians actually have.
