Respiratory Institute, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia.
J Allergy Clin Immunol Pract. 2023 Mar;11(3):713-723. doi: 10.1016/j.jaip.2023.01.011. Epub 2023 Feb 1.
Chronic airway diseases such as asthma and chronic obstructive pulmonary disease are prevalent and complex conditions that often coexist in the same patient. To address this complexity in clinical practice, and to move forward toward personalized and precision medicine of airway diseases, a strategy based on the identification and treatment of so-called "treatable traits" (TTs) has been proposed. A TT is a recognizable phenotypic or endotypic characteristic that can be assessed and successfully targeted by therapy to improve a clinical outcome in a patient with airway disease. Importantly, TTs can coexist in the same patient, so they are not mutually exclusive. The TT strategy proposes to investigate in each individual patient with chronic airway disease the number and type of TTs present and to treat each of them according to guideline recommendations. This strategy is agnostic (ie, independent) to the traditional diagnostic labels (asthma, chronic obstructive pulmonary disease), so it can be applied to any patient with airway disease. Currently, there is firm evidence supporting the adequacy and validity of the TT strategy. Here, we review the current state of the art of this topic, first by presenting its theoretical background and then by discussing how to best implement it in clinical practice.
慢性气道疾病，如哮喘和慢性阻塞性肺疾病，是普遍存在且复杂的疾病，常存在于同一患者中。为了解决临床实践中的这种复杂性，并朝着气道疾病的个体化和精准医学方向前进，提出了一种基于所谓“可治疗特征（treatable traits，TTs）”的识别和治疗策略。TT 是一种可识别的表型或内型特征，可通过治疗进行评估和靶向，以改善气道疾病患者的临床结局。重要的是，TTs 可存在于同一患者中，因此它们并非相互排斥。TT 策略建议在每例慢性气道疾病患者中调查存在的 TT 数量和类型，并根据指南建议对其进行治疗。该策略与传统的诊断标签（哮喘、慢性阻塞性肺疾病）无关，因此可适用于任何气道疾病患者。目前，有确凿的证据支持 TT 策略的充分性和有效性。在这里，我们首先介绍其理论背景，然后讨论如何在临床实践中最佳实施该策略，以回顾该主题的最新进展。
