Individualizing Treatment of Asthma in Primary Care (iTREAT)
Keywords
Asthma; primary care
Types of Research
Practice-based research
Summary
Asthma is the leading cause of missed school or work for children and young adults and has a high degree of disparities and outcomes. iTREAT is a PCORI-funded, randomized study designed to compare the effectiveness of 4 different ways of managing asthma. The key interventions being compared in this study are inhaled corticosteroids (as part of SMART or PARTICS therapy), Azithromycin, inhaled corticosteroids plus Azithromycin, and standard of care (Asthma Symptom Monitoring). This study will help primary care clinicians tailor asthma treatments, including newer asthma therapies, to individuals.
Significance
Currently, we know little about how to tailor newer asthma therapies to individuals. iTREAT will help clinicians and providers know which evidence-based interventions work best for their specific patients’ situation.
Impact
Despite new medications, drug regimens, treatment guidelines, the number of people with asthma exacerbations in the previous year has decreased only slightly over the past 20 years. This study aims to compare the effectiveness of currently evidenced based interventions to lower asthma symptoms and improve patient quality of life.
Translational Science Benefits Model* Benefits | ||
| Demonstrated: Benefits are those that have been observed and verifiable. Potential: Benefits are those logically expected with moderate to high confidence | ||
| Implement and evaluate 3 interventions among people with different asthma phenotypes, with annualized asthma exacerbation rate. Demonstrated |  | Therapeutic Procedures |
| Analyze the impact on secondary outcomes of asthma control, asthma quality of life, and missed days of school or work across the 3 effector arms, and multiple asthma phenotypes, compared to control participants as well as head-to-head comparisons between arms. Potential |  | Life Expectancy and Quality of Life |
*The Translational Science Benefits Model is a framework designed to help public health and clinical scientists demonstrate the impact of their work in the real world. The Translational Science Benefits Model and Translating for Impact Toolkit © 2017-2023, created by the Institute of Clinical and Translational Sciences at Washington University in St. Louis and available at translationalsciencebenefitsmodel.wustl.edu, is licensed under Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).
Lessons Learned
One key lesson from our feasibility work was the disconnect between clinical and patient perspectives on asthma control. While clinicians may define "uncontrolled asthma" as asthma symptoms requiring rescue inhaler 2 or more times per week, many patients reported feeling their asthma was well-controlled because their inhaler improves their asthma symptoms. This gap highlights the need for shared language and understanding around asthma management goals.