Treatable traits in an English cohort: prevalence and predictors of future decline in lung function and quality of life in COPD

Muhammad Rehan Sarwar; Vanessa Marie McDonald; Michael John Abramson; Eldho Paul; Johnson George

doi:10.1183/23120541.00934-2020

Treatable traits in an English cohort: prevalence and predictors of future decline in lung function and quality of life in COPD

ERJ Open Res. 2021 May 31;7(2):00934-2020. doi: 10.1183/23120541.00934-2020. eCollection 2021 Apr.

Authors

Muhammad Rehan Sarwar¹, Vanessa Marie McDonald^{2

3

4}, Michael John Abramson⁵, Eldho Paul⁵, Johnson George¹

Affiliations

¹ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
² National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and Centre of Excellence in Treatable Traits, The University of Newcastle, Callaghan, Australia.
³ The Priority Research Centre for Healthy Lungs, School of Nursing and Midwifery, Callaghan, Australia.
⁴ Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Abstract

Background: "Treatable traits (TTs)" is a precision medicine approach for facilitating multidimensional assessment of every patient with chronic airway disease, in order to determine the core traits associated with disease outcomes where targeted treatments may be applied.

Objectives: To determine the prevalence of TTs in chronic obstructive pulmonary disease (COPD) and which traits predict future decline in lung function and quality of life (QoL).

Methods: A 4-year longitudinal evaluation was conducted using data from 3726 participants in the English Longitudinal Study of Ageing (ELSA). TTs were identified based on published recommendations. Traits that predicted decline in lung function and QoL were analysed using generalised estimating equations.

Results: Overall, 21 TTs, including pulmonary (n=5), extra-pulmonary (n=13) and behavioural/lifestyle risk-factors (n=3) were identified. In multivariate analyses, the traits of chronic bronchitis (β -0.186, 95% CI -0.290 to -0.082), breathlessness (β -0.093, 95% CI -0.164 to -0.022), underweight (β -0.216, 95% CI -0.373 to -0.058), sarcopenia (β -0.162, 95% CI -0.262 to -0.061) and current smoking (β -0.228, 95% CI -0.304 to -0.153) predicted decline in forced expiratory volume in 1 s (FEV₁). Of the seven traits that predicted decline in QoL, depression (β -7.19, 95% CI -8.81 to -5.57) and poor family and social support (β -5.12, 95% CI -6.65 to -3.59) were the strongest.

Conclusion: The core TTs of COPD associated with a decline in lung function and QoL were identified. Targeting these impactful traits with individualised treatment using a precision medicine approach may improve outcomes in people with COPD.