Treatable Traits in Asthma: The importance of extra- pulmonary traits - GERD, CRSwNP, Atopic Dermatitis, and Depression/Anxiety

Treatable traits is a personalised medicine approach to the management of airway disease. Assessing traits within the three domains of pulmonary, extra pulmonary and behavioral/lifestyle/risk-factors traits, and applying targeted treatments to effectively manage these traits enables a holistic and personalised approach to care. Asthma is a heterogeneous and complex airway disease that is frequently complicated by several extrapulmonary traits that impact asthma outcomes and predict future outcomes. We propose that the identification of extra pulmonary, and behavioral risk factor traits and the implementation of targeted therapy will lead to improved management of people with asthma. Furthermore many extrapulmonary traits also present as ‘connected comorbidities’ that is, they co-exist with asthma, have an impact on asthma, and effective treatment improves both asthma and the comorbidity or the comorbidities may share similar mechanism. In this review we explore this concept and look at atopic dermatitis, chronic rhinosinusitis with nasal polyps (CRSwNP), gastroesophageal reflux disease, anxiety, and depression as treatable traits of asthma and how these can be managed using this approach.