Bronchial thermoplasty: Difference between revisions
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{{Asthma}} | {{Asthma}} | ||
{{CMG}}; {{ | {{CMG}}; {{AE}} {{LG}} | ||
==Overview== | ==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.<ref name="pmid19815809">Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19815809 Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial.] ''Am J Respir Crit Care Med'' 181 (2):116-24. [http://dx.doi.org/10.1164/rccm.200903-0354OC DOI:10.1164/rccm.200903-0354OC] PMID: [http://pubmed.gov/19815809 19815809]</ref> The procedure uses controlled thermal energy to reduce the surface area of the smooth muscle in the [[bronchiole]]; thereby, | 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.<ref name="pmid19815809">Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19815809 Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial.] ''Am J Respir Crit Care Med'' 181 (2):116-24. [http://dx.doi.org/10.1164/rccm.200903-0354OC DOI:10.1164/rccm.200903-0354OC] PMID: [http://pubmed.gov/19815809 19815809]</ref> 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== | ==Bronchial Thermoplasty== | ||
===Mechanisms of Benefit=== | ===Mechanisms of Benefit=== | ||
*The objective of the procedure is to reduce the | *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. | *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. | *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=== | ===Supportive Trial Data=== | ||
The AIR2 trial, involved 288 patients with [[Asthma severity classification#Severe Persistent Asthma|severe asthma]] who remained symptomatic despite treatment with [[steroids|high-dose inhaled corticosteroids]] and [[Bronchodilator#Long-acting β2-agonists|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 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 [[Asthma severity classification#Severe Persistent Asthma|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.<ref name="pmid19815809">Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19815809 Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial.] ''Am J Respir Crit Care Med'' 181 (2):116-24. [http://dx.doi.org/10.1164/rccm.200903-0354OC DOI:10.1164/rccm.200903-0354OC] PMID: [http://pubmed.gov/19815809 19815809]</ref> | The AIR2 trial, involved 288 patients with [[Asthma severity classification#Severe Persistent Asthma|severe asthma]] who remained symptomatic despite treatment with [[steroids|high-dose inhaled corticosteroids]] and [[Bronchodilator#Long-acting β2-agonists|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 [[Asthma severity classification#Severe Persistent Asthma|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.<ref name="pmid19815809">Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19815809 Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial.] ''Am J Respir Crit Care Med'' 181 (2):116-24. [http://dx.doi.org/10.1164/rccm.200903-0354OC DOI:10.1164/rccm.200903-0354OC] PMID: [http://pubmed.gov/19815809 19815809]</ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Immunology]] | [[Category:Immunology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
Latest revision as of 20:43, 29 July 2020
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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.[1] 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.[1]
References
- ↑ 1.0 1.1 Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL et al. (2010) Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med 181 (2):116-24. DOI:10.1164/rccm.200903-0354OC PMID: 19815809