In The Centre of Excellence in Treatable Traits, we have identified two overarching themes in which we will generate new knowledge, translate it to practice and build a new generation of researchers in this area.
Theme 1: The Treatable Traits strategy - Clinical trials programme
Our clinical trials programme will develop new knowledge regarding the effectiveness and implementation of the Treatable Traits strategy. We will develop and test tools to support the implementation of this approach.
We have identified fundamental areas in asthma that require immediate action in terms of new knowledge development and implementation.
- Severe refractory asthma and difficult-to-treat asthma, which occur in between 3-10% of people with the disease but are responsible for over 50% of asthma healthcare costs;
- Asthma in primary care (moderate asthma), one of the most common reasons for seeing a general practitioner; and
- Asthma in pregnancy, a life event that leads to poor asthma control in one-third of women, increases the risk of asthma attacks and is associated with adverse fetal outcomes.
Each of these areas has different needs and requires a Treatable Traits strategy that addresses the specific priorities of each situation.
Theme 2: Establishing new Treatable Traits - A platform that advances assessment and management of traits that are clinically relevant and important
Through consumer and clinician consultation, we have identified traits that are strongly linked to clinical outcomes but lack a systematic approach to management. They are physical inactivity, vocal cord dysfunction and side effects of treatments (Oral Corticosteroids (OCS) and maintenance antibiotic use).
We will evaluate these using the predetermined Treatable Traits evaluation criteria, which will determine whether they are: 1) clinically relevant, 2) identifiable and measurable, and 3) treatable.
Our programmes of research/projects:
Severe Refractory Asthma
Severe Refractory Asthma is defined as poorly controlled asthma despite high-intensity treatment, optimal self-management skills and effective management of triggers and aggravating factors. Despite advances in treatment, people with severe asthma continue to
experience a significant burden from asthma attacks.
We aim to address this residual burden from acute attacks, symptoms and quality of life impairment by determining the efficacy, safety, and cost-effectiveness of novel therapeutic approaches for people with severe refractory asthma.
Difficult to Treat Asthma
Difficult to Treat Asthma is asthma that is uncontrolled despite medium or high dose inhaled corticosteroids and a second controller. We have developed an innovative personalised-medicine approach called Treatable Traits to improve outcomes for
people with airways disease. This model of care incorporates a label-free approach to diagnosis, whereby individualised treatment is based on a multidimensional assessment that identifies traits that are clinically important, recognisable via trait identification markers, and treatable.
Our aim is to develop new knowledge regarding the efficacy and implementation of the Treatable Traits model of care. We will also develop and test tools and initiatives to support patients and clinicians in the implementation of such an approach into practice.
Moderate asthma occurs when symptoms persist despite treatment. Management based on the Treatable Traits model-of-care in tertiary severe asthma clinics is associated with improvements in asthma control and quality of life and a reduction in severe attacks. However, the use of this approach in primary care is unknown.
We aim to develop new knowledge regarding the efficacy and feasibility of the Treatable Traits model of care in a primary care setting.
Asthma in pregnancy
Asthma affects 13% of Australian pregnancies, and children born to mothers with asthma are at increased risk of poor perinatal outcomes, wheeze, asthma, and adverse developmental outcomes. Interventions during pregnancy have the potential to alter the life course of health or disease.
We aim to: (1) develop novel models-of-care for the management of asthma during pregnancy, including virtual models; (2) improve clinician training and develop resources to assist clinicians in managing pregnant women with asthma; (3) host roundtable discussions with key stakeholders to inform research agendas in this area, and (4) develop consensus statements on the management of asthma during pregnancy.
Physical activity and sedentary behaviour are important modifiable risk factors that have a major impact on health and survival. Physical activity is clinically relevant since there are multiple health benefits of light to moderate physical activity, including a reduction in deaths. It is also measurable, and we have identified that decreased physical activity is common and independently associated with HRQoL impairment in severe asthma.
We will develop and test a novel physical activity intervention that has been co-designed with severe asthma patients and that addresses the needs of this population.
Vocal cord dysfunction
Vocal cord dysfunction (VCD) is common in asthma, particularly in people with severe disease. It is frequently misdiagnosed as asthma, which leads to delayed VCD diagnosis, increased morbidity and excessive healthcare costs. While people with VCD report a high
symptom burden, there are currently no data that explores the experience of patients with VCD. Furthermore, both evidence-based treatments for patients with VCD and access to efficacious treatments are limited. Recognition of VCD as a specific trait is important
because it confounds the assessment of asthma control and is an independent risk factor for both severe asthma attacks and quality of life impairment.
We will investigate VCD as a treatable trait by improving recognition, standardising diagnosis, and evaluating treatment for VCD.
OCS and antibiotic stewardship in asthma -Side effects of treatments
Patients with severe asthma suffer frequent negative effects of OCS use. Furthermore, international guidelines now recommend maintenance of oral macrolide antibiotics (azithromycin) for the management of some patients. While promising, there are concerns about long-term antibiotic use. Stewardship involves the ethical and responsible planning and management of prescription drugs known to have serious short- or long-term effects.
We will develop a research and stewardship programme focusing on optimising a balance between OCS efficacy and safety, and continued promotion of alternative agents (such as azithromycin) that allow minimisation of OCS.