Asthma and chronic obstructive pulmonary disease (COPD) are common chronic conditions that require continuous treatment to achieve optimal disease management.¹ Both conditions have a tendency to deteriorate, resulting in exacerbations or attacks which are serious events that can be fatal.² Despite the significant strides made in the development of treatment options for both asthma and COPD, the available therapies do not eliminate exacerbations and symptoms or achieve complete disease control.¹

Asthma and COPD are increasingly recognised as heterogenous conditions requiring treatment that must be tailored to the individual patient.^2,3 Cluster analysis has revealed that patients with asthma and COPD can be divided into various subgroups based on phenotypic features and each phenotype requires personalised asthma therapy.³ Personalised treatment should include the identification of ‘treatable traits’ that can be individually assessed and targeted.²  Treatable traits can be categorised into three domains: pulmonary, extra-pulmonary, and behavioural/risk factors.^4,5

Within the pulmonary domain, some traits can be improved without medication, for example with pulmonary rehabilitation and breathing retraining (dyspnoea) and speech and language therapy (cough reflex hypersensitivity).⁴ In contrast, bronchial hyperresponsiveness requires treatment with long- and short-acting B2-agonist and muscarinic antagonists.⁴ Some examples within the extra-pulmonary domain and their associated treatments include:⁴ depression and anxiety (cognitive behavioural therapy, pharmacotherapy, and breathing retraining); dysfunctional breathing (breathing retraining) and physical inactivity (exercise, pulmonary rehabilitation).

The last domain, behavioural and/or risk factors, may have the greatest impact on overall treatment success as it underpins adherence to treatment. Indeed, suboptimal adherence to medication use is the most common reason for treatment failure in asthma.⁶ This is often a result of a false perception of asthma control by the patient.⁶ Personalising treatment plans based on behavioural and/or risk factors is crucial to the improvement of adherence to therapy. For those patients using inhalers, modifications such as a change in inhaler type, a reduced dosage or a reduced number of treatments or devices may translate to a more sustainable treatment plan and improved adherence to therapy.⁴

Integral to the success of any personalised treatment plan is supported self-management, whereby patients are given the information, medication and tools they need to manage their own conditions.⁷ Effective support of self-management can lead to improved health-related quality of life, symptom reductions, and reduced hospitalisation rates.⁷ This support should be based on the health priorities of the individual as well as their personal circumstances and healthcare realities. Ongoing training for HCPs in supporting patient self-management is vital and should focus on effective communication skills.⁷ Chronic respiratory diseases such as asthma and COPD are heterogenous conditions that require tailored diagnosis and treatment strategies.² Personalised and targeted management of these conditions may lead to reduced disease burden and improved treatment outcomes in patients.

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