List of potential treatable traits within the behaviour/risk-factor domain to consider in patients with chronic airway disease
Trait | Trait identification marker/diagnostic criteria | Possible treatments | Evidence level I–IV# |
Suboptimal inhaler technique | Direct observation and standardised assessment checklists, assessment via chipped inhalers | Education including demonstration and regular reassessment | I |
Suboptimal adherence | Prescription refill rates, self-reported use of <80% of prescribed medication, chipped inhalers, FENO suppression test, measurement of drug concentrations | Self-management support, education, simplification of medication regime (i.e., reduce number of medications, frequency of doses and number of devices) | I |
Smoking | Self-reported current smoking, elevated exhaled carbon monoxide, urinary cotinine | Smoking cessation counselling ± pharmacotherapy | I |
Side-effects of treatments | Patient report, monitored withdrawal | Optimisation of treatment, alternative therapy, change device | I |
Absence of a written action plan | Patient does not possess a written action plan, or reports not using the prescribed plan during exacerbations | Individualised self-management education with a written action plan | I |
Exercise intolerance | <350 m on 6MWT | Pulmonary rehabilitation | I |
Decreased bone mineral density (osteoporosis) | T-score ≤−2.5 | Pharmacotherapy based on osteoporosis guidelines, vitamin D supplementation, resistance training | I¶, II |
Sarcopenia | Appendicular skeletal muscle mass index: Males <7.26 kg·m−2 Females <5.45 kg·m−2 | Diet (high protein), resistance training | I¶, II |
#: NHMRC level of evidence currently available for the management/treatment of each trait; ¶: evidence from the general population. Content has been reproduced with permission from the Centre of Excellence in Treatable Traits, originally developed as part of the Centre of Excellence in Treatable Traits (https://treatabletraits.org.au).