Tackling ‘Treatable Traits' in Obstructive Lung Disease

If only managing a patient with an obstructive lung disease — like asthma or chronic obstructive pulmonary disease (COPD) — were as easy as writing a prescription.
As it stands now, physicians also have to worry about whether their patients are using their inhalers correctly, or even taking their medications at all, as well as numerous other factors that can complicate their prognosis.
'Every patient is different,' said Amy Attaway, MD, a pulmonologist with Cleveland Clinic in Cleveland. 'Every patient has these barriers that are impacting their COPD or asthma that is making it difficult to treat them optimally.'
What Are Treatable Traits?
Amy Attaway, MD
A recent study published in the International Journal of Chronic Obstructive Pulmonary Disease described how many primary care patients exhibit various combinations of treatable traits, thus requiring personalized attention to help get their symptoms under control.
Attaway said she likes the treatable trait concept, which includes assessing each patient and developing personalized approaches for their specific issues. 'If you don't define a problem, it's really hard to treat it,' she said. 'This highlights that every patient is different, and you have to personalize their therapy.'
The study authors specifically looked at the following traits in people with asthma, COPD, or a combination of both:
Insufficient inhaler technique
Poor adherence to lung medication
Type 2 eosinophilic inflammation
Current smoking
Obesity
Physical activity
Reversible airflow limitation
Anxiety and/or depression
All these treatable traits can pose challenges by themselves — potential combinations only drive up the complexity.
Primary care physicians are already addressing many of the treatable traits, such as obesity and physical activity, as well as anxiety and depression. But there are still ongoing challenges.
That's particularly true for most patients with COPD because the condition often exists in tandem with other comorbidities that must be managed, according to Wilson Pace, MD, a family medicine physician and professor emeritus in family medicine at the University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Then, there's the time element — or the lack of time — as the case may be. 'That's the great burden of a primary care physician,' said Stephanie LaBedz, MD, a pulmonologist with UI Health in Chicago.
Stephanie LaBedz, MD
Having a checklist of treatable traits can help physicians keep track of all the factors that may be influencing their patients, said Attaway. But clinicians may not have the time in a single visit to address all of them. Even a short inhaler technique training session or refresher can take some time.
'If you see multiple patients a day, that 5 minutes really adds up,' said Edward Len, MD, a pulmonologist with the Mid-Atlantic Permanente Medical Group in Largo, Maryland.
Social determinants of health that affect medication adherence may also need addressing, said Len. For example, physicians may need to determine if their patients have transportation to and from a pharmacy to pick up medications, as well as money for the copays.
Medication Use Challenges
Some treatable traits may be harder than others to manage from a primary care setting.
Each type of inhaler requires a specific inhalation technique , and some patients must use multiple different types of inhaled medications to manage their obstructive lung disease — which requires them to master different techniques.
Edward Len, MD
Additionally, age and cognitive function can also affect a patient's ability to use their inhaled medications correctly, according to research.
'They don't recognize that they don't have optimal inhaler technique,' LaBedz said. 'They think they're doing it correctly.'
Perhaps not surprisingly, perfect inhalation technique by patients is rare, which means that patients may not be receiving as much benefit from their inhaled medication as they should.
And that's assuming that they're diligent about trying to use their medications. Theaforementioned study cited people forgetting to use their medication as one of its treatable traits.
According to LaBedz, medication adherence among patients with COPD is below 50%.
In fact, some research estimates that adherence among patients with obstructive lung disease is between 10% and 40%, even though they're more likely to experience exacerbations that lead to hospitalization when they're not properly taking their meds.
'If they're not using the inhaler, it's not going to work,' said Len.
LaBedz said she would not expect a primary care provider to handle insufficient inhaler technique — at least not all by themselves. As a pulmonary specialist, she can offer an in-depth assessment of inhaler technique education and training.
However, while primary care physicians may not always have time, primary care practices can designate and train a nurse to educate patients on proper inhalation technique, Pace suggested.
'Well-running primary care practices try to make sure that everyone is working at the peak of their license,' he said.
Having in-house staff to work with patients on inhaler technique could also reduce the burden on the patient since they wouldn't have to make an additional visit elsewhere to receive training, Pace said. It may also reduce the likelihood that a patient would be a no-show at their follow-up visit, which research suggests is a common phenomenon among patients who receive a referral from a primary care physician to see a specialist.
Getting Patients on Board
One challenge not included in the above study's treatable traits list: Patient motivation.
Sometimes, physicians may find themselves having to persuade patients to make changes in their behavior, and that can be its own challenge.
'If they don't care enough about it, getting them to change behavior is tough,' said Pace.
Even similar motivations can require different approaches. What works for one patient may not be as effective for another.
'You always have to come to the middle with patients,' said Geoffrey Chupp, MD, a professor of medicine in pulmonary, critical care and sleep medicine at the Yale School of Medicine, New Haven, Connecticut. 'Everybody has their own journey. Some people are more adept at these things than others. You have to find what works for any core individual. You have to reinforce it and give them positive feedback.'

Try Our AI Features

Explore what Daily8 AI can do for you:

Learn with AIFact CheckingText to SpeechAI Summary

Related Articles

New York Times

33 minutes ago

• New York Times

Insurers Pledge to Ease Controversial Prior Approvals for Medical Care

Facing regulatory crackdowns and intensifying criticism from patients and doctors, the nation's biggest health insurers said on Friday that they would retreat from tactics that have delayed medical care and led at times to denials for necessary treatments. For years, the widespread practice known as prior authorization has vexed patients who might not have been notified until the day of surgery whether a procedure would be covered by their insurance or if a prescription medicine would be denied for no clear reason. Insurers often send unintelligible form letters, leaving patients to puzzle out the basis for the denial or what their next steps should be. Patients may delay or even abandon necessary medical care because they may not even be aware that they can appeal the decisions. Lawmakers, regulators and public outrage have drawn attention to abuses of the system, leading to mounting calls for reforms. Insurers have also been the target of myriad lawsuits, some of which attributed patient deaths to those denials and delays. The murder of Brian Thompson, a UnitedHealthcare executive, last December renewed criticisms of the tactic, unleashing a barrage of complaints that the practice was deployed to avoid covering care. 'Prior authorization is a huge issue for people who are in managed care plans because it is one of the ways plans use to control their costs,' said David A. Lipschutz, co-director for the Center for Medicare Advocacy. He pointed to several studies showing that insurers may have inappropriately denied care, particularly in private Medicare plans. Various reports from federal regulators and researchers show that the vast majority of appeals are successful. Want all of The Times? Subscribe.

Fast Company

43 minutes ago

• Fast Company

Neuroscientists find brain cells that explain why stress keeps you up at night

If your anxiety before a big test or a high-stakes presentation has ever kept you up at night, you can rest easier knowing that scientists are trying to get to the bottom of things. A new study published this month in The Journal of Neuroscience explores how stress interferes with sleep, causing cascading negative effects on memory and other cognitive processes. By pinpointing the specific neural mechanisms involved in stress-related memory problems and sleep disruptions, scientists hope to figure out stress-zapping treatments in the future. A group of researchers from the University of Pennsylvania School of Medicine's Chronobiology and Sleep Institute simulated human stress in lab mice, restraining the animals so they couldn't move. They then observed the animals' neural activity while they slept and gave the mice a spatial memory test. Much like a human stressed out before a big test, the mice slept poorly and showed memory deficits. The researchers went on to simulate the effects of the stress scenario without actually restraining the mice. By activating neurons that release the stress hormone corticotropin in a specific part of the hypothalamus known as the paraventricular nucleus, the research team stressed the mice out and went on to observe the same sleep and memory issues as if the animals had actually been restrained. When they blocked the same stress hormone-releasing neurons during the stress-inducing event, the mice slept a little better and had significantly less trouble during their spatial memory test – a hopeful finding understanding how to mitigate the problems that stress creates in the human brain. The researchers called the findings on the pathways of corticotropin-releasing hormone neurons in that region of the hypothalamus 'an important step toward improving sleep and ameliorating cognitive deficits associated with stress-related disorders' – a conclusion that anyone tired of having that one same stress dream can definitely get behind.

Fox News

44 minutes ago

• Fox News

Eating more fruits and vegetables linked to surprising effect on sleep

Your daily meal selections could influence the quality of your sleep, new research says. A study from the University of Chicago Medicine and Columbia University found that increasing your intake of fruits and vegetables could help promote more restful sleep. Previous research has shown that people who lack quality sleep may be more likely to indulge in unhealthy foods that are high in fat and sugar — and now this new finding sheds more light on how consumed foods impact sleep. In the small study — which was published in "Sleep Health: The Journal of the National Sleep Foundation" — 34 healthy young adults reported their daily food consumption and wore a tracker to measure how often they woke up or changed sleep patterns during the night, according to a press release. Those who reported eating more fruits and vegetables during the day were found to have "deeper, more uninterrupted sleep." Greater amounts of healthy carbohydrates, like whole grains, were found to have that same benefit, the study found. "Dietary modifications could be a new, natural and cost-effective approach to achieve better sleep," said co-senior author Esra Tasali, MD, director of the UChicago Sleep Center, in the release. "The temporal associations and objectively-measured outcomes in this study represent crucial steps toward filling a gap in important public health knowledge." Based on the study findings, the researchers concluded that people who eat at least five cups of fruits and veggies per day could have a 16% increase in quality of sleep compared to those who eat none of those foods. "Small changes can impact sleep. That is empowering — better rest is within your control." "16 percent is a highly significant difference," Tasali said in the release. "It's remarkable that such a meaningful change could be observed within less than 24 hours." "Based on current data, the experts confidently advise that regularly eating a diet rich in complex carbohydrates, fruits and vegetables is best for long-term sleep health," the release stated. The American Heart Association provides the following examples of fruit and veggie servings that equate to 1 cup of produce. Dr. Chelsie Rohrscheib, head sleep expert at Wesper in Michigan, said that most sleep professionals recognize that a healthy diet supports overall well-being, including sleep quality — "so the findings of this study are not entirely unexpected." "However, it's important to note that this was a relatively small study composed primarily of young adult male participants, which limits generalizability," Rohrscheib, who was not involved in the study, told Fox News Digital. "While the results were statistically significant, the overall reduction in sleep fragmentation was modest, about 16%." The study was also observational in nature, she noted, which means it lacked the control of a randomized trial. "Ideally, future research would compare a group consuming a fruit- and vegetable-rich diet to a control group with limited intake to better establish causality," the doctor added. The researchers plan to conduct more studies to confirm that eating produce causes better sleep and to determine the "underlying mechanisms of digestion, neurology and metabolism" driving this impact, the release stated. For more Health articles, visit "People are always asking me if there are things they can eat that will help them sleep better," said co-senior author Marie-Pierre St-Onge, PhD, director of the Center of Excellence for Sleep & Circadian Research at Columbia, in the release. "Small changes can impact sleep. That is empowering — better rest is within your control."