{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:09:51Z","timestamp":1787026191646,"version":"build-2736575974"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,20]],"date-time":"2023-09-20T00:00:00Z","timestamp":1695168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Allergy"],"abstract":"<jats:p>Asthma continues to be a major cause of illness with a significant mortality, despite its increasing range of treatments. Adoption of a treatable traits approach in specialist centres has led to improvements in control of asthma and reduced exacerbations in patients with severe asthma. However, most patients with this illness, particularly those with mild-to-moderate asthma, are cared for in primary care according to guidelines that emphasise the use of pharmacotherapeutic ladders uniformly implemented across all patients. These pharmacotherapeutic ladders are more consistent with a \u201cone-size-fits-all\u201d approach than the treatable traits approach. This can be harmful, especially in patients whose symptoms and airway inflammation are discordant, and extra-pulmonary treatable traits are often overlooked. Primary care has extensive experience in patient-centred holistic care, and many aspects of the treatable traits approach could be rapidly implemented in primary care. Blood eosinophil counts, as a biomarker of the treatable trait of eosinophilia, are already included in routine haematology tests and could be used in primary care to guide titration of inhaled corticosteroids. Similarly, poor inhaler adherence could be further assessed and managed in primary care. However, further research is needed to guide how some treatable traits could feasibly be assessed and\/or managed in primary care, for example, how to best manage patients in primary care, who are likely suffering from breathing pattern disorders and extra-pulmonary treatable traits, with frequent use of their reliever inhaler in the absence of raised T2 biomarkers. Implementation of the treatable traits approach across the disease severity spectrum will improve the quality of life of patients with asthma but will take time and research to embed across care settings.<\/jats:p>","DOI":"10.3389\/falgy.2023.1240375","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T03:35:57Z","timestamp":1695267357000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Bringing the treatable traits approach to primary care asthma management"],"prefix":"10.3389","volume":"4","author":[{"given":"Paul E.","family":"Pfeffer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitasha","family":"Rupani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"De Simoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2200660","DOI":"10.1183\/13993003.00660-2022","article-title":"Benefits of specialist severe asthma management: demographic and geographic disparities","volume":"60","author":"Redmond","year":"2022","journal-title":"Eur Respir J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.1016\/j.jaip.2019.12.037","article-title":"Systematic assessment for difficult and severe asthma improves outcomes and halves oral corticosteroid burden independent of monoclonal biologic use","volume":"8","author":"Denton","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B3","year":""},{"key":"B4","year":""},{"key":"B5","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/j.jaci.2014.08.042","article-title":"The prevalence of severe refractory asthma","volume":"135","author":"Hekking","year":"2015","journal-title":"J Allergy Clin Immunol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1016\/j.jaip.2020.11.053","article-title":"Potential severe asthma hidden in UK primary care","volume":"9","author":"Ryan","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B7","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/S0140-6736(17)30879-6","article-title":"After asthma: redefining airways diseases","volume":"391","author":"Pavord","year":"2018","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2023.0020","article-title":"Characteristics of patients with asthma overprescribed short-acting beta-agonist (SABA) reliever inhalers stratified by blood eosinophil count in north East London: a cross-sectional observational study","volume":"7","author":"Pfeffer","year":"2023","journal-title":"BJGP Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1136\/bmj.316.7148.1882","article-title":"Primary care: core values. Patient centred primary care","volume":"316","author":"Toop","year":"1998","journal-title":"Br Med J"},{"key":"B10","volume-title":"Quality in general practice: towards a holistic approach","author":"Greenhalgh","year":"1999"},{"key":"B11","year":""},{"key":"B12","doi-asserted-by":"publisher","first-page":"4353","DOI":"10.1016\/j.jaip.2021.07.056","article-title":"Asthma phenotyping in primary care: applying the international severe asthma registry eosinophil phenotype algorithm across all asthma severities","volume":"9","author":"Kerkhof","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B13","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1016\/j.chest.2021.04.013","article-title":"Eosinophilic and noneosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort","volume":"160","author":"Heaney","year":"2021","journal-title":"Chest"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1164\/rccm.200701-085OC","article-title":"A study to evaluate safety and efficacy of mepolizumab in patients with moderate persistent asthma","volume":"176","author":"Flood-Page","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1056\/NEJMoa0808991","article-title":"Mepolizumab and exacerbations of refractory eosinophilic asthma","volume":"360","author":"Haldar","year":"2009","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/S0140-6736(12)60988-X","article-title":"Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial","volume":"380","author":"Pavord","year":"2012","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1016\/S2213-2600(15)00367-7","article-title":"Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study","volume":"3","author":"Price","year":"2015","journal-title":"Lancet Respir Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1016\/j.jaip.2022.11.043","article-title":"Baseline FeNO independently predicts the dupilumab response in patients with moderate-to-severe asthma","volume":"11","author":"Pavord","year":"2023","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B19","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1097\/ACI.0000000000000704","article-title":"Fractional exhaled nitric oxide and asthma treatment adherence","volume":"21","author":"Butler","year":"2021","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1016\/j.chest.2021.10.015","article-title":"Using fractional exhaled nitric oxide measurement in clinical asthma management","volume":"161","author":"Rupani","year":"2022","journal-title":"Chest"},{"key":"B21","doi-asserted-by":"publisher","first-page":"AB205","DOI":"10.1016\/j.jaci.2019.12.214","article-title":"Availability of fractional exhaled nitric oxide (FeNO) and eosinophil (EOS) count data among patients with severe asthma in five European countries","volume":"145","author":"Kamat","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B22","year":""},{"key":"B23","doi-asserted-by":"publisher","first-page":"e809","DOI":"10.3399\/bjgp20X713033","article-title":"Spirometry and FeNO testing for asthma in children in UK primary care: a prospective observational cohort study of feasibility and acceptability","volume":"70","author":"Lo","year":"2020","journal-title":"Br J Gen Pract"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1111\/resp.13134","article-title":"Multidimensional assessment of severe asthma: a systematic review and meta-analysis","volume":"22","author":"Clark","year":"2017","journal-title":"Respirology"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00215-2022","article-title":"Multidisciplinary care in chronic airway diseases: the Newcastle model","volume":"8","author":"McDonald","year":"2022","journal-title":"ERJ Open Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1183\/13993003.01359-2015","article-title":"Treatable traits: toward precision medicine of chronic airway diseases","volume":"47","author":"Agusti","year":"2016","journal-title":"Eur Respir J"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e44453","DOI":"10.2196\/44453","article-title":"Experiences of diagnosis, symptoms and use of reliever inhalers in patients with asthma and concurrent inducible laryngeal obstruction (ILO) or breathing pattern disorder (BPD): qualitative analysis of a UK asthma online community","volume":"25","author":"Byrne","year":"2023","journal-title":"J Med Internet Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1054791","DOI":"10.3389\/falgy.2022.1054791","article-title":"Paroxysmal dyspnoea in asthma: wheeze, ILO or dysfunctional breathing?","volume":"3","author":"Crawford","year":"2022","journal-title":"Front Allergy"},{"key":"B29","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1183\/09031936.03.00017003","article-title":"Systematic assessment of difficult-to-treat asthma","volume":"22","author":"Robinson","year":"2003","journal-title":"Eur Respir J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1164\/rccm.200711-1754OC","article-title":"Cluster analysis and clinical asthma phenotypes","volume":"178","author":"Haldar","year":"2008","journal-title":"Am J Respir Crit Care Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"j1415","DOI":"10.1136\/bmj.j1415","article-title":"Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study","volume":"357","author":"Waljee","year":"2017","journal-title":"Br Med J"},{"key":"B32","doi-asserted-by":"publisher","first-page":"193","DOI":"10.2147\/JAA.S176026","article-title":"Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study","volume":"11","author":"Price","year":"2018","journal-title":"J Asthma Allergy"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1715","DOI":"10.1016\/S0140-6736(02)11679-5","article-title":"Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial","volume":"360","author":"Green","year":"2002","journal-title":"Lancet"},{"key":"B34","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1136\/thoraxjnl-2014-205634","article-title":"External validation of blood eosinophils, FE(NO) and serum periostin as surrogates for sputum eosinophils in asthma","volume":"70","author":"Wagener","year":"2015","journal-title":"Thorax"},{"key":"B35","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/S2213-2600(20)30397-0","article-title":"Composite type-2 biomarker strategy versus a symptom-risk-based algorithm to adjust corticosteroid dose in patients with severe asthma: a multicentre, single-blind, parallel group, randomised controlled trial","volume":"9","author":"Heaney","year":"2021","journal-title":"Lancet Respir Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1038\/s41591-022-01714-5","article-title":"Metabolomic profiling reveals extensive adrenal suppression due to inhaled corticosteroid therapy in asthma","volume":"28","author":"Kachroo","year":"2022","journal-title":"Nat Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1136\/thoraxjnl-2012-201772","article-title":"Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis","volume":"68","author":"Andrejak","year":"2013","journal-title":"Thorax"},{"key":"B38","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1016\/j.jaci.2012.12.1564","article-title":"Corticosteroid resistance in patients with asthma and chronic obstructive pulmonary disease","volume":"131","author":"Barnes","year":"2013","journal-title":"J Allergy Clin Immunol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"3890601","DOI":"10.1155\/2017\/3890601","article-title":"The role of lower airway dysbiosis in asthma: dysbiosis and asthma","volume":"2017","author":"Lu","year":"2017","journal-title":"Mediators Inflamm"},{"key":"B40","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1136\/thoraxjnl-2014-206096","article-title":"Not all wheeze is asthma: time for patients to exercise their rights","volume":"70","author":"Hull","year":"2015","journal-title":"Thorax"},{"key":"B41","doi-asserted-by":"publisher","first-page":"3868","DOI":"10.1016\/j.jaip.2021.08.028","article-title":"Asthma and comorbid conditions-pulmonary comorbidity","volume":"9","author":"Gibson","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e619","DOI":"10.3399\/BJGP.2021.0725","article-title":"Reducing short-acting beta-agonist overprescribing in asthma: lessons from a quality-improvement prescribing project in east London","volume":"72","author":"De Simoni","year":"2022","journal-title":"Br J Gen Pract"},{"key":"B43","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1164\/rccm.200901-0055CC","article-title":"The beta-agonist saga and its clinical relevance: on and on it goes","volume":"179","author":"Taylor","year":"2009","journal-title":"Am J Respir Crit Care Med"},{"key":"B44","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jaci.2021.11.029","article-title":"The impact of the overuse of short-acting \u03b22-agonists on the risk of sepsis and septic shock","volume":"150","author":"Lai","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e15469","DOI":"10.7759\/cureus.15469","article-title":"Reverse Takotsubo cardiomyopathy in the setting of acute asthma exacerbation","volume":"13","author":"Khan","year":"2021","journal-title":"Cureus"},{"key":"B46","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1097\/SPC.0000000000000364","article-title":"The burden of chronic breathlessness across the population","volume":"12","author":"Ahmadi","year":"2018","journal-title":"Curr Opin Support Palliat Care"},{"key":"B47","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1136\/thoraxjnl-2020-215168","article-title":"Characterisation of patients with severe asthma in the UK severe asthma registry in the biologic era","volume":"76","author":"Jackson","year":"2021","journal-title":"Thorax"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01251-2020","article-title":"Incidence of osteoporosis and fragility fractures in asthma: a UK population-based matched cohort study","volume":"57","author":"Chalitsios","year":"2021","journal-title":"Eur Respir J"},{"key":"B49","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s001980050063","article-title":"Reduced pulmonary function in patients with spinal osteoporotic fractures","volume":"8","author":"Schlaich","year":"1998","journal-title":"Osteoporos Int"},{"key":"B50","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1080\/17476348.2018.1506331","article-title":"The effect of obesity on lung function","volume":"12","author":"Dixon","year":"2018","journal-title":"Expert Rev Respir Med"},{"key":"B51","doi-asserted-by":"publisher","first-page":"222","DOI":"10.4104\/pcrj.2012.00035","article-title":"Poor asthma control?\u2014then look up the nose. The importance of co-morbid rhinitis in patients with asthma","volume":"21","author":"Scadding","year":"2012","journal-title":"Prim Care Respir J"},{"key":"B52","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S2213-2600(20)30389-1","article-title":"Efficacy and safety of once-daily single-inhaler triple therapy (FF\/UMEC\/VI) versus FF\/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial","volume":"9","author":"Lee","year":"2021","journal-title":"Lancet Respir Med"},{"key":"B53","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.jaci.2014.07.016","article-title":"Symptom- and fraction of exhaled nitric oxide-driven strategies for asthma control: a cluster-randomized trial in primary care","volume":"135","author":"Honkoop","year":"2015","journal-title":"J Allergy Clin Immunol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.jaci.2021.01.007","article-title":"Extrafine triple therapy and asthma exacerbation seasonality: TRIMARAN and TRIGGER post hoc analyses","volume":"148","author":"Papi","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"100720","DOI":"10.1016\/j.waojou.2022.100720","article-title":"Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: from multicenter real-world cohort data in Korea","volume":"15","author":"Shim","year":"2022","journal-title":"World Allergy Organ J"},{"key":"B56","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1002\/pds.1803","article-title":"What can primary care prescribing data tell us about individual adherence to long-term medication?\u2014comparison to pharmacy dispensing data","volume":"18","author":"Mabotuwana","year":"2009","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"B57","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1183\/16000617.0088-2015","article-title":"Dysfunctional breathing: a review of the literature and proposal for classification","volume":"25","author":"Boulding","year":"2016","journal-title":"Eur Respir Rev"},{"key":"B58","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s10484-008-9052-3","article-title":"Evaluation of breathing pattern: comparison of a manual assessment of respiratory motion (MARM) and respiratory induction plethysmography","volume":"33","author":"Courtney","year":"2008","journal-title":"Appl Psychophysiol Biofeedback"},{"key":"B59","doi-asserted-by":"publisher","first-page":"620955","DOI":"10.3389\/fphys.2020.620955","article-title":"Cardiopulmonary exercise testing in the assessment of dysfunctional breathing","volume":"11","author":"Ionescu","year":"2020","journal-title":"Front Physiol"},{"key":"B60","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1111\/resp.13173","article-title":"Novel assessment tool to detect breathing pattern disorder in patients with refractory asthma","volume":"23","author":"Todd","year":"2018","journal-title":"Respirology"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1111\/cea.13856","article-title":"Reliability of the breathing pattern assessment tool for in-person or remote assessment in people with asthma","volume":"51","author":"Bondarenko","year":"2021","journal-title":"Clin Exp Allergy"},{"key":"B62","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.jaip.2013.09.002","article-title":"A novel scoring system to distinguish vocal cord dysfunction from asthma","volume":"2","author":"Traister","year":"2014","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B63","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta21530","article-title":"A randomised controlled study of the effectiveness of breathing retraining exercises taught by a physiotherapist either by instructional DVD or in face-to-face sessions in the management of asthma in adults","volume":"21","author":"Thomas","year":"2017","journal-title":"Health Technol Assess"},{"key":"B64","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1097\/ACI.0000000000000597","article-title":"Pulmonary rehabilitation: promising nonpharmacological approach for treating asthma?","volume":"20","author":"Zampogna","year":"2020","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s12931-021-01627-w","article-title":"Effects of exercise-based pulmonary rehabilitation on adults with asthma: a systematic review and meta-analysis","volume":"22","author":"Feng","year":"2021","journal-title":"Respir Res"},{"key":"B66","doi-asserted-by":"publisher","first-page":"300","DOI":"10.4104\/pcrj.2009.00037","article-title":"The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control","volume":"18","author":"Clatworthy","year":"2009","journal-title":"Prim Care Respir J"},{"key":"B67","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1002\/alr.22516","article-title":"Aspirin-exacerbated respiratory disease: longitudinal assessment of a large cohort and implications of diagnostic delay","volume":"10","author":"Kshirsagar","year":"2020","journal-title":"Int Forum Allergy Rhinol"},{"key":"B68","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1016\/j.jaip.2023.02.034","article-title":"Impact of treatable traits on asthma control and quality of life","volume":"11","author":"Janssen","year":"2023","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B69","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1080\/02770903.2020.1847927","article-title":"Impact of interventions targeting anxiety and depression in adults with asthma","volume":"59","author":"Cooley","year":"2022","journal-title":"J Asthma"},{"key":"B70","doi-asserted-by":"publisher","first-page":"e652","DOI":"10.3399\/BJGP.2020.0963","article-title":"Effectiveness and perceptions of using templates in long-term condition reviews: a systematic synthesis of quantitative and qualitative studies","volume":"71","author":"Morrissey","year":"2021","journal-title":"Br J Gen Pract"}],"container-title":["Frontiers in Allergy"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/falgy.2023.1240375\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T03:36:01Z","timestamp":1695267361000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/falgy.2023.1240375\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,20]]},"references-count":70,"alternative-id":["10.3389\/falgy.2023.1240375"],"URL":"https:\/\/doi.org\/10.3389\/falgy.2023.1240375","relation":{},"ISSN":["2673-6101"],"issn-type":[{"value":"2673-6101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,20]]},"article-number":"1240375"}}