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The following is a summary of “Effect of a systematic multi-dimensional assessment in severe uncontrolled asthma: a literature review and protocol for an investigator-initiated, open-label, randomized-controlled trial (EXACT@home study),” published in the May 2025 issue of BMC Pulmonary Medicine by Bult et al. 

About 3.6% of individuals are affected with severe asthma, with many remaining uncontrolled despite optimal therapy and management of treatable traits, making identification of these traits prior to diagnosis difficult.  

Researchers conducted a retrospective study to determine whether a systematic multi-dimensional assessment identified hidden treatable traits and reduced unnecessary use of biological therapies in individuals with severe asthma.  

They reviewed existing literature to address the knowledge gap regarding the effectiveness and added benefit of systematic assessment and treatment approaches in individuals with difficult-to-treat or severe asthma. This was followed by outlining a study protocol aimed at applying this assessment strategy in those diagnosed with severe asthma.  

The results showed that the literature review found limited evidence of the effectiveness of systematic assessments in difficult-to-treat severe asthma, primarily due to varied methodologies and outcome measures. Only 1 selected study applied a randomized controlled trial design. To address this gap, the EXpert Asthma Copd Trajectory with digital support (EXACT\@home) trial was proposed using a prospective, open label, randomized controlled format. The study targeted individuals with severe uncontrolled asthma eligible for biological treatment. The intervention group completed a 6-week structured assessment for treatable traits followed by personalized therapy, while the control group began biological therapy directly. Both groups were followed for 12 months, with secondary endpoints assessing asthma control, QoL and exacerbation rates.  

Investigators concluded that systematic assessment targeting treatable traits improved management strategies in individuals with severe uncontrolled asthma and addressed gaps identified in existing literature. 

Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-025-03646-5