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Safety and Efficacy of Bronchial Thermoplasty in Symptomatic, Severe Asthma

¹ Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; ² St. Joseph's Healthcare–McMaster University, Hamilton, Canada; ³ Gartnavel General Hospital, University of Glasgow, Glasgow, United Kingdom; ⁴ Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil; ⁵ Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom; ⁶ Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom; ⁷ National Heart and Lung Institute, Imperial College, London, United Kingdom; and ⁸ Laval Hospital, Laval University, Quebec, Canada

Correspondence and requests for reprints should be addressed to Ian D. Pavord, M.D., Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicester LE3 9QP, United Kingdom. E-mail: ian.pavord{at}uhl-tr.nhs.uk

Rationale: Bronchial thermoplasty (BT) is designed to reduce airway smooth muscle and improve asthma control.

Objectives: This study was conducted to determine the safety and efficacy of this procedure in subjects with symptomatic, severe asthma.

Methods: Adults who were symptomatic despite treatment with fluticasone or equivalent at more than 750 µg/day, a long-acting β₂-agonist, and other medications, which could include 30 mg or less of oral prednisolone/day, were randomized to BT or to a control group. After treatment, subjects entered a 16-week steroid stable phase (Weeks 6–22), a 14-week steroid wean phase (Weeks 22–36), and a 16-week reduced steroid phase (Weeks 36–52).

Measurements and Main Results: BT resulted in a transient worsening of asthma symptoms. Seven hospitalizations for respiratory symptoms occurred in 4 of 15 BT subjects during the treatment period. Five hospitalizations were within 3 days of treatment. Two subjects had segmental collapse involving the most recently treated lobe; one required bronchoscopy and aspiration of a mucus plug. There were no hospitalizations during this period in the 17 control subjects. The rate of hospitalizations was similar in both groups in the post-treatment period. At 22 weeks, BT subjects had significant improvements versus control subjects in rescue medication use (–26.6 ± 40.1 vs. –1.5 ± 11.7 puffs/7 d, P < 0.05), prebronchodilator FEV₁% predicted (14.9 ± 17.4 vs. –0.94 ± 22.3%, P = 0.04), and Asthma Control Questionnaire scores (–1.04 ± 1.03 vs. –0.13 ± 1.00, P = 0.02). Improvements in rescue medication use and Asthma Control Questionnaire scores remained significantly different from those of controls at 52 weeks.

Conclusions: BT is associated with a short-term increase in asthma-related morbidity. However, there is preliminary evidence of long-lasting improvement in asthma control.

Clinical trial registered with www.clinicaltrials.gov (NCT 00214539).

Key Words: bronchial thermoplasty • asthma • bronchoscopy • airway smooth muscle • radiofrequency energy

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Bronchial thermoplasty is a technique for reducing airway smooth muscle mass and bronchoconstriction. What This Study Adds to the Field Bronchial thermoplasty was associated with a short-term increase in asthma-related symptoms but a longer term improvement in symptoms, lung function, and rescue bronchodilator use in patients with symptomatic severe asthma.

 

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