Treatable traits and personalised management of moderate-severe asthma: implications for reliever use, symptom control and exacerbation risk

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Introduction: Patient characteristics affect symptom control, reliever medication (Rmed) use and exacerbation risk in asthma, but the overall impact of these potentially treatable traits is poorly understood. Aim: To evaluate how regular treatment (with fluticasone propionate [FP] monotherapy, FP-salmeterol [FP/SAL], or budesonide-formoterol [BUD/FOR]) affects personalised management of moderate-severe asthma. Methods: Simulation scenarios used models previously developed from pooled clinical trial data. Individual Rmed use patterns, symptom control levels (ACQ-5) and time to first exacerbation were predicted over 1 year. Switching patients with poor control from FP to FP/SAL or BUD/FOR was assessed, and treatment differences were tested for each endpoint. Results: Stepping up FP to FP/SAL or BUD/FOR led to significant reductions in Rmed use. Improvement in symptoms and decrease in Rmed use was less in patients with asthma history >10 years, higher baseline ACQ-5, obesity and in smokers. These patients had greater reductions in Rmed use and lower exacerbation risks with FP/SAL relative to BUD/FOR (p<0.01 for all comparisons; Figure 1). Conclusions: Treatment choice and patient baseline characteristics contribute to significant differences in immediate and long-term response. These findings support personalised management. Funding: GSK (ID 215310). erj;64/suppl_68/PA1181/F1 F1 F1

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