{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T20:12:16Z","timestamp":1788293536193,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:00:00Z","timestamp":1679875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["pericles.pericles-gcp.literatumonline.com"],"crossmark-restriction":true},"short-container-title":["Allergy"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Multidisciplinary systematic assessment improves outcomes in difficult\u2010to\u2010treat asthma, but without clear response predictors. Using a treatable\u2010traits framework, we stratified patients by trait profile, examining clinical impact and treatment responsiveness to systematic assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed latent class analysis using 12 traits on difficult\u2010to\u2010treat asthma patients undergoing systematic assessment at our institution. We examined Asthma Control Questionnaire (ACQ\u20106) and Asthma Quality of Life Questionnaire (AQLQ) scores, FEV<jats:sub>1<\/jats:sub>, exacerbation frequency, and maintenance oral corticosteroid (mOCS) dose, at baseline and following systematic assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 241 patients, two <jats:italic>airway\u2010centric profiles<\/jats:italic> were characterized by early\u2010onset with allergic rhinitis (<jats:italic>n<\/jats:italic>\u2009=\u200946) and adult onset with eosinophilia\/chronic rhinosinusitis (<jats:italic>n<\/jats:italic>\u2009=\u200960), respectively, with minimal comorbid or psychosocial traits; three <jats:italic>non\u2010airway\u2010centric profiles<\/jats:italic> exhibited either comorbid (obesity, vocal cord dysfunction, dysfunctional breathing) dominance (<jats:italic>n<\/jats:italic>\u2009=\u200951), psychosocial (anxiety, depression, smoking, unemployment) dominance (<jats:italic>n<\/jats:italic>\u2009=\u200972), or multi\u2010domain impairment (<jats:italic>n<\/jats:italic>\u2009=\u200912). Compared to <jats:italic>airway\u2010centric<\/jats:italic> profiles, <jats:italic>non\u2010airway\u2010centric<\/jats:italic> profiles had worse baseline ACQ\u20106 (2.7 vs. 2.2, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and AQLQ (3.8 vs. 4.5, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) scores. Following systematic assessment, the cohort showed overall improvements across all outcomes. However, <jats:italic>airway\u2010centric<\/jats:italic> profiles had more FEV<jats:sub>1<\/jats:sub> improvement (5.6% vs. 2.2% predicted, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05) while <jats:italic>non\u2010airway\u2010centric<\/jats:italic> profiles trended to greater exacerbation reduction (1.7 vs. 1.0, <jats:italic>p<\/jats:italic>\u2009=\u2009.07); mOCS dose reduction was similar (3.1\u2009mg vs. 3.5\u2009mg, <jats:italic>p<\/jats:italic>\u2009=\u2009.782).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Distinct trait profiles in difficult\u2010to\u2010treat asthma are associated with different clinical outcomes and treatment responsiveness to systematic assessment. These findings yield clinical and mechanistic insights into difficult\u2010to\u2010treat asthma, offer a conceptual framework to address disease heterogeneity, and highlight areas responsive to targeted intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/all.15719","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T18:43:01Z","timestamp":1679337781000},"page":"2418-2427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Trait profiles in difficult\u2010to\u2010treat asthma: Clinical impact and response to systematic assessment"],"prefix":"10.1111","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5255-0130","authenticated-orcid":false,"given":"Tiffany","family":"Lin","sequence":"first","affiliation":[{"name":"Allergy, Asthma &amp; Clinical Immunology Service Alfred Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Pham","sequence":"additional","affiliation":[{"name":"Allergy, Asthma &amp; 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