Beyond the Inhaler: Tackling Treatable Traits in Primary Care Asthma

Asthma is now understood to be a heterogeneous condition influenced by a wide range of clinical, physiological and behavioural factors. Research over the past two decades has shown that many individuals with ongoing symptoms have underlying characteristics such as airway hyper‑responsiveness, small airways involvement, inflammatory markers, or behavioural factors like inhaler technique errors and non-adherence that contribute to poor control and frequent exacerbations.¹

Despite this, these contributing factors are not always routinely explored in clinical practice. Evidence indicates that a substantial proportion of people with difficult to manage asthma have unrecognised features that affect day‑to‑day stability, symptom burden and long‑term outcomes.²

There also remains variability in how clinicians assess these factors, with some relying primarily on symptom history and spirometry alone. Qualitative work has highlighted that important elements such as small‑airways involvement, environmental triggers, psychological influences and behavioural patterns may not be consistently discussed during routine asthma reviews. ^2-3

Michelle Treasure focuses on the behavioural and psychological aspects of asthma that significantly influence day‑to‑day control. She discusses real‑world challenges such as inhaler‑technique difficulties, adherence patterns and patient beliefs, and how these factors can be better recognised during routine consultations.

We also recommend watching the on-demand video “Personalising Asthma Care in Practice: The Treatable Traits Approach” by Dr Suresh Babu, who explores the treatable traits approach to asthma.

References

1. Siora A, et al. Small airways in asthma: From inflammation and pathophysiology to treatment response. Respir Med. 2024.

2. van der Berge M, et al. Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. Lancet Respir Med. 2019.

3. Carr TF, Bleecker E. Asthma heterogeneity and severity. World Allergy Organ J. 2016.

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• Michelle Treasure

  Independent Respiratory Nurse Educator

  Read biography
  Michelle Treasure

  Independent Respiratory Nurse Educator

  Michelle Treasure MSc, BN (Hons), PGCE, is an Independent Respiratory Nurse Educator with extensive experience in delivering clinical education across primary and secondary care. Specialises in supporting healthcare professionals to improve the assessment and management of respiratory conditions, with a particular focus on small‑airways involvement, inhaler‑technique optimisation and behavioural factors influencing asthma control. Her teaching is shaped by many years of frontline respiratory practice and her ongoing work training clinicians across the UK.

  She has delivered educational sessions and speaker engagements for national respiratory programmes, bringing practical, patient‑centred insights to help clinicians recognise and address real‑world barriers to disease stability.