List of potential treatable traits within the pulmonary domain to consider in patients with chronic airway disease
| Trait | Trait identification marker/diagnostic criteria | Possible treatments | Evidence level I–IV# |
| Airway smooth muscle contraction | Bronchodilator reversibility, peak expiratory flow variability, airway hyperresponsiveness | Bronchodilators: Maintenance: LABA/LAMA; Rescue: SABA/SAMA/rapid-acting LABA | I |
| Systemic allergic inflammation | Elevated serum IgE | Anti-IgE monoclonal antibody therapy | I |
| Dyspnoea | Dyspnoea score ≥2, modified Medical Research Council scale | Pulmonary rehabilitation, breathing retraining | I |
| Emphysema (loss of elastic recoil) | Chest CT, plethysmography, lung compliance | Smoking cessation, lung volume reduction surgery, lung transplantation, α1-antitrypsin replacement if deficient | I |
| Airway inflammation (eosinophilic) | Sputum eosinophils ≥3% and/or FENO ≥30 ppb and/or blood eosinophils ≥0.3×109 cells·L−1 | Corticosteroids, anti-IL-5, -13, -4 monoclonal antibody therapy | I-II |
| Pulmonary hypertension | Doppler echocardiography, brain natriuretic peptide, right heart catheterisation | Oxygen therapy, pulmonary vasodilator therapy, lung transplantation | I-II |
| Bronchiectasis | High-resolution chest CT | Physiotherapy, mucociliary clearance techniques, macrolides, pulmonary rehabilitation, vaccination | I–II¶ |
| Bacterial colonisation | Presence of a recognised bacterial pathogen in sputum (sputum culture, quantitative PCR) | Antibiotics and tailored antibiotic written action plan for infections | II |
| Airway inflammation (neutrophilic) | Sputum neutrophils ≥61% | Macrolides, tetracyclines, roflumilast | II |
| Cough reflex hypersensitivity | Capsaicin challenge, cough counts, cough questionnaire | Speech pathology intervention, gabapentin | II |
| Mucus hypersecretion | Volume ≥25 mL of mucus produced daily for the past week in the absence of an infection | Mucociliary clearance techniques with a physiotherapist, inhaled hypertonic saline, macrolides | II |
| Hypoxaemia | PaO2 ≤55 mmHg; PaO2 56–59 mmHg and evidence of complications of hypoxaemia (e.g. pulmonary hypertension, polycythaemia, right-sided heart failure) | Domiciliary oxygen therapy | II |
LABA: long-acting β2-agonists; LAMA: long-acting muscarinic antagonist; SABA: short-acting β2-agonists; SAMA: short-acting muscarinic antagonist; IgE: immunoglobulin E; CT: computed tomography; IL: interleukin; PaO2: partial pressure of oxygen. #: National Health and Medical Research Council (NHMRC) level of evidence currently available for the management/treatment of each trait; ¶: studies examining the effectiveness of different treatments in bronchiectasis in general, not specifically in chronic airways disease patients with coexisting bronchiectasis. 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).