A Proposed Approach to Chronic Airway Disease (CAD) Using Therapeutic Goals and Treatable Traits: A Look to the Future

Figures & data

Figure 1 Conceptual approach to treatment of CAD.

Abbreviations: Eos, eosinophils; OCS, oral corticosteroids; PCR, polymerase chain reaction; FEV₁, Forced expiratory volume in 1 second; COHb, carboxyhemoglobin; TAI, test of the adherence to inhalers; pO₂, partial pressure of oxygen; pCO₂, partial pressure of carbon dioxide; ICS, inhaled corticosteroids; LABA, long-acting beta agonists; LAMA, long-acting muscarinic antagonists; NRT, nicotine replacement therapy; NIV, non-invasive ventilation.

Table 1 Definition and Characteristics of Therapeutic Goals and Treatable Traits

	Definition	Characteristics
Therapeutic goals	These are the clinical needs of patients (symptoms, exacerbations, quality of life, physical activity) or aspects of the disease upon which action must be taken to improve their prognosis (progression of the disease, mortality)	-These are not therapeutic targets, but rather clinical problems that must be eliminated or improved -Most patients have several TG -It is possible to improve different TG with a single therapeutic intervention
Treatable traits	These are the clinical, physiological, or biological characteristics present in each individual patient, and they are quantifiable through biomarkers or specific diagnostic tests. They must have effective treatment to improve the value of the variable	-They must themselves have an impact on one of the TG (that is, there must be a clear relationship between the value the characteristic takes and that of the objective in question; eg: more eosinophils, more exacerbations) -Treatment, through the improvement of the value of the treatable trait must, as a result, improve one or more TG

Table 2 Therapeutic Goals and Treatable Traits in CAD

Therapeutic Goals	Treatable Traits	Biomarker Associated to Therapeutic Trait
Reduction of symptoms: -Dyspnoea -Night awakenings -Health-related quality of life Reduction of risk: -Reduce mortality -Reduce progression of the disease -Prevent exacerbations -Reduce adverse effects of medication	- Bronchial obstruction -Non-adherence -Aggravating factors (allergens, environmental pollution, etc.) -Smoking -Comorbidities -Eosinophilia - Chronic infection - Chronic bronchitis - Chronic hypoxemia - Chronic hypercapnia -Deficit of alfa1-AT -Lung hyperinflation	-FEV1 -Questionnaires -Environmental levels -CO-oximetry -Variable in each case -Eosinophils in blood or airways -Germ isolation - Chronic bronchitis -PaO2/SaO2 -PaCO2 -AAT levels - Inspiratory capacity