Treatable traits in an English cohort: prevalence and predictors of future decline in lung function and quality of life in COPD

Abstract

Background“Treatable traits (TTs)” is a precision medicine approach for facilitating multidimensional assessment of every patient with chronic airway disease to determine the core traits associated with disease outcomes, where targeted treatments are applied.ObjectivesTo determine the prevalence of TTs in chronic obstructive pulmonary disease (COPD) and which traits predict future decline in lung function and quality of life (QoL).MethodsA 4 year longitudinal evaluation was conducted using data from 3726 participants in the English Longitudinal Study of Ageing (ELSA). TTs were identified based on published recommendations. Traits that predicted decline in lung function and QoL were analysed using generalised estimating equations.ResultsOverall, 21 TTs, including pulmonary (n=5), extra-pulmonary (n=13) and behavioural/lifestyle risk-factors (n=3) were identified. In multivariate analyses, traits of chronic bronchitis (β=−0.186; 95%CI=−0.290 to −0.082), breathlessness (β=−0.093; 95%CI=−0.164 to −0.022), underweight (β=−0.216; 95%CI=−0.373 to −0.058), sarcopaenia (β=−0.162; 95%CI=−0.262 to −0.061), and current smoking (β=−0.228; 95%CI=−0.304 to −0.153), predicted decline in forced expiratory volume in 1 s (FEV1). Of the seven traits that predicted decline in QoL, depression (β=−7.19; 95%CI=−8.81 to −5.57) and poor family and social support (β=−5.12; 95%CI=−6.65 to −3.59) were the strongest.ConclusionThe core TTs of COPD associated with a decline in lung function and QoL were identified. Targeting these impactful traits and individualised treatment using a precision medicine approach may improve outcomes in people with COPD.

The use of treatable traits to address COPD complexity and heterogeneity and to inform the care

“…Of the 22 treatable traits identified, the best model for predicting HRQoL was comprised of five traits across the pulmonary, extrapulmonary and behavioural domains: frequent chest infections, inadequate inhaler technique, systemic inflammation, depression and breathing pattern disorder/dysfunctional breathing [ 39 ]. Traits that predict general quality of life and decline in lung function have also been explored in patients with COPD specifically [ 40 ]. In a 4-year longitudinal prospective evaluation of an English cohort of patients with COPD, seven traits that predicted quality of life were identified: chronic bronchitis, arthritis, depression, cardiovascular disease, anaemia, disability, and poor social and family support; while five traits were found to be associated with decline in lung function [ 40 ].…”

“…Traits that predict general quality of life and decline in lung function have also been explored in patients with COPD specifically [ 40 ]. In a 4-year longitudinal prospective evaluation of an English cohort of patients with COPD, seven traits that predicted quality of life were identified: chronic bronchitis, arthritis, depression, cardiovascular disease, anaemia, disability, and poor social and family support; while five traits were found to be associated with decline in lung function [ 40 ]. These included chronic bronchitis, breathlessness, sarcopenia, underweight, and current smoking [ 40 ].…”

“…In a 4-year longitudinal prospective evaluation of an English cohort of patients with COPD, seven traits that predicted quality of life were identified: chronic bronchitis, arthritis, depression, cardiovascular disease, anaemia, disability, and poor social and family support; while five traits were found to be associated with decline in lung function [ 40 ]. These included chronic bronchitis, breathlessness, sarcopenia, underweight, and current smoking [ 40 ]. This is not to say that the other treatable traits should not be considered priorities in the management of individuals with COPD, particularly given the absence of endotypes in this analysis.…”

COPD profiles and treatable traits using minimal resources: identification, decision tree and stability over time

“…Research efforts have been made to advance knowledge in this field, namely through the identification of homogeneous subgroups of patients with COPD [ 3 , 4 ], the so-called clinical phenotypes or profiles, grouped by different type of personal characteristics (e.g., genetic, clinical, biochemical, radiological) for prognostic and therapeutic purposes [ 3 – 12 ]. More recently, a new approach, “treatable traits”, i.e., pulmonary, extra-pulmonary and behaviour/lifestyle characteristics of each person that are clinically relevant, identifiable and treatable, emerged [ 13 – 15 ]. Although studies on clinical profiles and treatable traits have been conducted, their cross-sectional nature, narrow eligibility criteria, main focus on physiological/pulmonary measures often not available across settings [ 5 , 6 ], absence of decision trees and lack of validation with independent samples [ 3 ], limits our understanding of the heterogeneous manifestations of COPD and hinders their applicability in daily clinical practice.…”

“…Few studies have tried to identify profiles and their treatable traits using clinical and patient-reported outcomes beyond pulmonary measures and understand their behaviour over time [ 9 , 14 , 15 ]. Moreover, to be easily applied and useful in clinical practice, these profiles need predicting tools, such as decision trees [ 5 ].…”