Prevalence of treatable traits in patients with obstructive lung disease in Dutch primary care

Background: Clinical guidelines for the management of obstructive lung diseases recommend a stepwise diagnostic and management approach for asthma and COPD, but a more personalised approach targeting “treatable traits” (TTs) may be more effective in achieving better control of these heterogeneous diseases. However, the prevalence of these TTs in a real-life setting is unclear. Methods: Data from the Dutch asthma/COPD service (1 Jan 2007 – 18 Dec 2023) were studied retrospectively. Patients ≥18 years of age attending the service for the first time, receiving a working diagnosis of asthma, COPD, or Asthma-COPD overlap (ACO) from a pulmonologist were studied. The prevalence of 8 TTs were estimated with 95% confidence intervals (CI): [1] Insufficient inhaler technique [2] Poor medication-adherence [3] Type 2 eosinophilic inflammation [4] Current Smoking [5] Obesity [6] Physical inactivity [7] Reversible airflow limitation [8] Anxiety and/or depression. Results: In total, 16244 patients (asthma n=9289; COPD n=5074; ACO n=1881) were included in the analysis. In the total population, the highest proportions of TTs were found for insufficient inhaler technique: 43.6% (CI: 42.9-44.4), poor medication adherence: 40.3% (CI: 39.2-41.4), Type 2 eosinophilic inflammation: 36.9% (CI: 35.8 – 38.1), see Figure 1. There were no differences observed among the working diagnosis, except for poor medication adherence (most prominent in people with asthma); reversible airflow limitation (most prominent in ACO), see Figure 1. In total, 83.3% of patients had ≥ 1 TTs, and 48.9% of patients had ≥ 2 TTs. Conclusion: Most patients with obstructive lung disease show characteristics of at least one TT. Approximately half of the patients presented with two or more TTs during their first attendance at the Asthma/COPD service, pointing to the overlap of these TTs within patients. A personalised approach targeting these traits with tailored interventions, may improve disease control in patients with obstructive lung disease.