Treatable traits: a comprehensive precision medicine approach in interstitial lung disease.

Interstitial lung disease (ILD) is a diverse group of inflammatory and fibrotic lung conditions causing significant morbidity and mortality. A multitude of factors beyond the lungs influence symptoms, health-related quality of life, disease progression and survival in patients with ILD. Despite an increasing emphasis on multidisciplinary management in ILD, the absence of a framework for assessment and delivery of comprehensive patient care poses challenges in clinical practice. The treatable traits approach is a precision medicine care model that operates on the premise of individualised multidimensional assessment for distinct traits that can be targeted by specific interventions. The potential utility of this approach has been described in airway diseases, but has not been adequately considered in ILD. Given the similar disease heterogeneity and complexity between ILD and airway diseases, we explore the concept and potential application of the treatable traits approach in ILD. A framework of aetiological, pulmonary, extrapulmonary and behavioural and lifestyle treatable traits relevant to clinical care and outcomes for patients with ILD is proposed. We further describe key research directions to evaluate the application of the treatable traits approach towards advancing patient care and health outcomes in ILD.

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Conflict of interest: Y.H. Khor reports grants from NHMRC (investigator grant), during the conduct of the study; nonfinancial support from Air Liquide Healthcare, outside the submitted work. V. Cottin reports an unrestricted grant from Boehringer Ingelheim (paid to institution), consulting fees from AstraZeneca, Boehringer Ingelheim, Celgene/BMS, CSL Behring, Ferrer/United Therapeutics, GSK, Pliant, Pure Tech, RedX, Roche, Sanofi and Shionogi, fees for lectures and consulting from Boehringer Ingelheim, Ferrer/United Therapeutics and Roche, support for attending meetings from Boehringer Ingelheim and Roche, participation on a data and safety monitoring board for Galapagos and Galecto, and participation on a an adjudication committee for Fibrogen, outside the submitted work. A.E. Holland has nothing to disclose. Y. Inoue reports grants from Japanese Ministry of Health, Labour, and Welfare, grants from Japan Agency for Medical Desearch and Development, advisory board participation and lecture fees from Boehringer Ingelheim, Inc., lecture fees from Shionogi & Co Ltd, Kyorin Pharmaceutical Co Ltd, GSK and Novartis, and advisory board participation for Roche/Promedior, Galapagos, Taiho pharma, CSL Behring and Vicore Pharma, outside the submitted work. V.M. McDonald reports personal fees from GlaxoSmithKline, AstraZeneca and Arterial Group, grants from Ramaciotti Foundation Grant, MRFF, JHH Charitable Trust and NHMRC, outside the submitted work. J. Oldham reports grants from National Institutes of Health and Boehringer Ingelheim, during the conduct of the study; personal fees from Boehringer Ingelheim, Roche/Genentech, Lupin Pharmaceuticals and Gatehouse Bio, and data monitoring committee participation for Novartis, Endeavor BioMedicines and Genenetch, outside the submitted work. E.A. Renzoni reports a research grant from Boehringer Ingelheim (paid to institution), payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boeringher Ingelheim, Roche and Chiesi, support for attending meetings and/or travel from Boehringer Ingelheim, and advisory board participation for Boeringher Ingelheim and Roche, outside the submitted work. A.M. Russell reports lecture fees from Boehringer Ingelheim, Hoffman La Roche, Irish Lung Fibrosis Association, Respiratory Professional Care and the Interstitial Lung Disease Interdisciplinary Network, educational resource development for Boehringer Ingelheim, and consultancy for Hoffman La Roche, Irish Lung Fibrosis Association, Respiratory Professional Care and the Interstitial Lung Disease Interdisciplinary Network, outside the submitted work. M.E. Strek reports grants or contracts from Boehringer Ingelheim and Pulmonary Fibrosis Foundation, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim and American College of Chest Physicians, and participation on Fibrogen adjudication committee, outside the submitted work; and is part of the Chair Scientific Review Committee of the Pulmonary Fibrosis Foundation. C.J. Ryerson reports grants and personal fees from Boehringer Ingelheim and Hoffmann-La Roche, personal fees from Veracyte, Pliant Therapeutics, AstraZeneca, Trevi Therapeutics and Cipla Ltd, and grants from VIDA diagnostics, outside the submitted work.