Walking the path of treatable traits in interstitial lung diseases

Abstract

Interstitial lung diseases (ILDs) are complex and heterogeneous diseases. The use of traditional diagnostic classification in ILD can lead to suboptimal management, which is worsened by not considering the molecular pathways, biological complexity, and disease phenotypes. The identification of specific “treatable traits” in ILDs, which are clinically relevant and modifiable disease characteristics, may improve patient’s outcomes. Treatable traits in ILDs may be classified into four different domains (pulmonary, aetiological, comorbidities, and lifestyle), which will facilitate identification of related assessment tools, treatment options, and expected benefits. A multidisciplinary care team model is a potential way to implement a “treatable traits” strategy into clinical practice with the aim of improving patients’ outcomes. Multidisciplinary models of care, international registries, and the use of artificial intelligence may facilitate the implementation of the “treatable traits” approach into clinical practice. Prospective studies are needed to test potential therapies for a variety of treatable traits to further advance care of patients with ILD.

First Report of the Prevalence at Baseline and after 1-Year Follow-Up of Treatable Traits in Interstitial Lung Diseases

“…A "treatable trait (TT)" strategy was recently proposed as a precision medicine model of care to improve the management of ILD patients [8][9][10]. This strategy encompasses the multidimensional assessment of every patient to identify specific TTs leading to a type of management tailored to specific TTs [8][9][10].…”

“…A "treatable trait (TT)" strategy was recently proposed as a precision medicine model of care to improve the management of ILD patients [8][9][10]. This strategy encompasses the multidimensional assessment of every patient to identify specific TTs leading to a type of management tailored to specific TTs [8][9][10]. A "TT" personalized strategy is developed around the identification of a validated biomarker that could help in understanding the biological mechanism (endotype) as well as the clinical, radiological, and functional manifestation (phenotype) of the disease [11].…”

“…A "TT" personalized strategy is developed around the identification of a validated biomarker that could help in understanding the biological mechanism (endotype) as well as the clinical, radiological, and functional manifestation (phenotype) of the disease [11]. Experts suggested different TTs to be identified in ILD patients across four domains [8,9]. Indeed, this strategy relies on the identification and management of TTs that are not restricted to the pulmonary domain [8].…”

Are there over 200 distinct types of interstitial lung diseases?

“…The review by Amati and colleagues elegantly illustrates how historically ILD recognition has evolved from a handful group of histological categories described in the 1960s to the 1990s first radiological-histological classification to today’s collection of distinct clinical diagnoses. However, the study by Amati and colleagues, [ 1 ] along with numerous other articles, cite that there are over 200 ILDs. This staggering statistic has become a common introductory catchphrase for pharmaceutical and ILD educational websites.…”

Response to: are there over 200 distinct types of interstitial lung diseases?

“…Thus, the splitting and the lumping approaches are not mutually exclusive. We believe that the ILD field will move to a dynamic disease classification in which treatment approaches will be governed not only by the classification based on etiologies, phenotypes and endotypes but also by the disease behavior [ 9 ]. In this context, a treatable traits approach could provide a comprehensive patient-centered precision medicine strategy [ 9 , 10 ].…”