The Impact of Number of Treatable Traits to Clinical Remission in patients with Asthma

<bold>Background:</bold> Treatable traits (TTs) have been highlighted as a therapeutic strategy for personalized asthma care. <bold>Objective:</bold> We hypothesized that the number of TTs correlates with the CR rate in asthma. Additionally, we aimed to identify TTs that significantly influence the achievement of CR. <bold>Methods:</bold> A multicenter cross-sectional questionnaire survey of bronchial asthma patients and their physicians was conducted at 26 Japanese centers in 2021. CR criteria defined as ACT≥20, no asthma exacerbations, no systemic steroid administration, and %FEV1≥80% for a year. TTs in this study were peripheral blood eosinophil count (PB-EOS) ≥300/μL, exhaled NO ≥25 ppb, systemic allergic inflammation, obesity, depression, dysfunctional breathing, and current smoking. <bold>Results:</bold> A total of 2,154 patients participated in this study, and 679 cases with missing data and 125 biologic users were excluded. Because the use of biologics directly treats type 2 inflammation which is the major TTs. As a result, 1,350 patients were included in the final analysis. The CR rate decreased as the number of TTs increased, and this trend was significant (p<0.05, Cochran-Armitage test). Furthermore, logistic regression analysis showed that the number of TTs was an independent risk factor on CR (odds ratio (OR): 0.685, p<0.001), and for each TT, PB-EOS ≥ 300/μL, FeNO ≥ 25 ppb, and depression were extracted as independent risk factors (OR: 0.622, 0.617, 0.340, respectively; p<0.05, respectively). <bold>Conclusion:</bold> In biologic-free bronchial asthma patients, a higher number of TTs was associated with a lower CR rate. Therefore, intensified treatment targeting type 2 inflammation and supportive care for depression may contribute to achieving CR.