Trait assessed | Treatment |
Airways | |
Airflow limitation | Bronchodilators (maintenance: LABA/LAMA; rescue: SABA/SAMA/rapid-acting LABA) |
Airway hyperresponsiveness | Increase ICS, LABA |
Mucus hypersecretion | Mucociliary clearance techniques with a physiotherapist, inhaled hypertonic saline, macrolides |
Type 2 airway inflammation | Corticosteroids, anti-IL-5, -13 and -4 monoclonal antibody therapy |
Frequent exacerbation | Written action plans, vaccination, education |
Bronchiectasis | Physiotherapy, mucociliary clearance techniques, macrolides, pulmonary rehabilitation, vaccination |
Emphysema | Smoking cessation, endobronchial valves, lung transplantation |
Pathogen colonisation | Antibiotics and tailored antibiotic written action plan for infections |
Oxygen desaturation | Domiciliary oxygen therapy assessment |
Dyspnoea | Pulmonary rehabilitation, breath retraining |
Systemic allergic inflammation | Anti-IgE monoclonal antibody therapy |
Comorbidities | |
Dysfunctional breathing | Breath retraining |
Vocal cord dysfunction | Speech pathology intervention, gabapentin/pregabalin, psychology/psychiatry |
Anaemia | Haematinic (iron/B12) supplementation |
Obstructive sleep apnoea | Continuous positive airway pressure, mandibular advancement splint, positional therapy, weight loss |
Obesity | Caloric restriction, exercise, bariatric surgery, pharmacotherapy |
Depression and/or anxiety | Cognitive behavioural therapy, pharmacotherapy |
Osteopenia/osteoporosis | Pharmacotherapy based on osteoporosis guidelines, vitamin D supplementation, resistance training |
Risk factors/behaviours | |
Suboptimal adherence | Self-management education |
Inadequate inhaler technique | Self-management education, including demonstration and assessment |
Inhaler device polypharmacy | Asthma self-management education |
No written asthma action plan | Provide written action plan with education and shared decision making |
Smoking | Smoking cessation counselling, nicotine replacement therapy, pharmacotherapy |
Underweight and sarcopenia | Nutrition and resistance training |
Exercise intolerance | Pulmonary rehabilitation and physical activity |
LABA: long-acting β-agonists; LAMA: long-acting muscarinic antagonists; SABA: short-acting β-agonists; SAMA: short-acting muscarinic antagonists; ICS: inhaled corticosteroids; IL: interleukin.