Bronchial thermoplasty

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Bronchial thermoplasty is a new investigational outpatient procedure that is performed in the hospital bronchoscopy suite and is currently performed only in conjunction with the AIR2 Trial. The procedure uses controlled thermal energy to reduce the surface area of the smooth muscle in the bronchiole; thereby, helping to prevent future asthma attacks.

Bronchial Thermoplasty

Mechanisms of Benefit

• The objective of the procedure is to reduce the airway smooth muscle in all airways reachable by the bronchoscope in hopes of reducing the airways ability to constrict.
• A bronchial thermoplasty treatment session is expected to take less than an hour to complete; it is expected that three treatment sessions will be required to treat the entire lung system.
• Bronchial thermoplasty is an outpatient procedure. No general anesthesia is used, no incision is necessary, and there is no need to stay overnight. However, the patient will need to continue on their current asthma medications for the duration of the study.

Supportive Trial Data

The AIR2 trial, involved 288 patients with severe asthma who remained symptomatic despite treatment with high-dose inhaled corticosteroids and long-acting β2-agonists, who underwent bronchial thermoplasty (BT) to evaluate the effectiveness and safety of BT. The study demonstrated significant improvement from the baseline based on the Asthma Quality of Life Questionnaire (AQLQ) in the BT group (BT, 1.35 +/- 1.10; sham, 1.16 +/- 1.23). Changes in the AQLQ score of 0.5 or greater was observed in 79% of BT group and 64% of sham group. Although the hospitalization rate was 6% higher among the BT group during the treatment period (up to 6 wk after BT), in the posttreatment period (6-52 wk after BT), the BT group experienced fewer severe exacerbations, emergency department visits, and days missed from work/school compared with the sham group (PPS, 95.5, 99.9, and 99.3%, respectively). Thus, the study concluded that in patients with severe asthma, bronchial thermoplasty significantly improved asthma-specific quality of life with a reduction in severe exacerbations and healthcare use noted in the posttreatment period.