A decade of treatable traits in patients with COPD: lessons learned about its application

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory condition with potentially major implications for the lives of those it affects. In the past decade, the identification of clinically relevant patient characteristics-'treatable traits' (TTs)-has received wide support as an important means of improving care. These traits can be categorised into three domains: pulmonary, extra-pulmonary and behavioural. Many patients with COPD have multiple TTs in various combinations. For this reason, the successful application of a TT approach requires a thorough assessment of the patient's health status to elicit relevant TTs. Combined with the patient's preferences and priorities, these traits enable the formulation of an individualised treatment plan. Execution of this plan often requires interprofessional collaboration among relevant healthcare providers and case management. Although international consensus appears to exist concerning the benefits of providing care according to the TT concept, widespread implementation in care is slow. Although pulmonary rehabilitation programmes have adopted the concept by definition, it has yet to be applied widely in practice, especially in primary and secondary care. We have used the TT model to develop a comprehensive model of care that contains all three elements (assessment, treatment plan and execution) and that provides insight into considerations and decisions regarding where such care should be provided. This paper describes the process, results and challenges of our attempts to design and implement this integrated care concept.