Precision medicine in united airways disease: a “treatable traits” approach

ACA Yii, TR Tay, XN Choo, MSY Koh, AKH Tee… - Allergy, 2018 - Wiley Online Library
ACA Yii, TR Tay, XN Choo, MSY Koh, AKH Tee, DY Wang
Allergy, 2018Wiley Online Library
United airways disease (UAD) is the concept that the upper and lower airways, which are
anatomically and immunologically related, form a single organ. According to this concept,
upper and lower airway diseases are frequently comorbid because they reflect
manifestations of a single underlying disease at different sites of the respiratory tract. Allergic
asthma‐allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a
heterogeneous condition and consists of multiple phenotypes (observable clinical …
Abstract
United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma‐allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a “treatable traits” approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.
Wiley Online Library