Personalising Asthma Care in Practice: The Treatable Traits Approach

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

Dr Suresh Babu outlines key clinical traits relevant to asthma presentations, including airway hyper‑responsiveness, small airways involvement and markers of airway inflammation. He explores how these features contribute to variability in symptoms, exacerbation risk and the overall complexity of asthma as a condition.

We also recommend watching the on-demand video “Beyond the inhaler: Tackling Treatable Traits in Primary Care Asthma” by Michelle Treasure for addressing behavioural, lifestyle and management factors in the treatment of 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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• Dr Suresh Babu

  Consultant Respiratory Physician

  Read biography
  Dr Suresh Babu

  Consultant Respiratory Physician Portsmouth Hospitals University NHS Trust

  Role and Location
  Dr Suresh Babu is a Consultant Respiratory Physician at Portsmouth Hospitals University NHS Trust, where he has practised for the past 15 years. His clinical focus is in severe asthma and interstitial lung disease.

  Education
  Dr Babu holds MBBS, MD, DNB (Respiratory Medicine), FRCP (UK) and DM (UK) qualifications. He is a former member of the BTS/SIGN Asthma Guideline Group (2014–2016) and an active member of the British Thoracic Society, European Respiratory Society and Indian Chest Society.

  Research Interests
  His research has centred on severe asthma, with particular focus on the role of TNF‑alpha and potential therapeutic strategies involving TNF blockade. He has authored more than 20 original research papers, over 50 published abstracts, contributed to multiple book chapters and written four books.

  Memberships
  Dr  Suresh Babu is an active member of the British Thoracic Society, the European Respiratory Society, and the Indian Chest Society.