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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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Autores principales: Pfeffer, Paul E., Rupani, Hitasha, De Simoni, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548136/
https://www.ncbi.nlm.nih.gov/pubmed/37799134
http://dx.doi.org/10.3389/falgy.2023.1240375
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author Pfeffer, Paul E.
Rupani, Hitasha
De Simoni, Anna
author_facet Pfeffer, Paul E.
Rupani, Hitasha
De Simoni, Anna
author_sort Pfeffer, Paul E.
collection PubMed
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.
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spelling pubmed-105481362023-10-05 Bringing the treatable traits approach to primary care asthma management Pfeffer, Paul E. Rupani, Hitasha De Simoni, Anna Front Allergy Allergy 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. Frontiers Media S.A. 2023-09-20 /pmc/articles/PMC10548136/ /pubmed/37799134 http://dx.doi.org/10.3389/falgy.2023.1240375 Text en © 2023 Pfeffer, Rupani and De Simoni. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Allergy
Pfeffer, Paul E.
Rupani, Hitasha
De Simoni, Anna
Bringing the treatable traits approach to primary care asthma management
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 Allergy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548136/
https://www.ncbi.nlm.nih.gov/pubmed/37799134
http://dx.doi.org/10.3389/falgy.2023.1240375
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