Bronchial Thermoplasty

Indications

Asthma (see Asthma, [[Asthma]])

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  • Air Trial in Moderate-Severe Asthma (NEJM, 2007) [MEDLINE]

    • Bronchial Thermoplasty Decreased Asthma Exacerbations
    • At 12 mo, Bronchial Thermoplasty Improved Morning Peak Expiratory Flow, Scores on AQLQ, ACQ, Percentage of Symptom-Free Days, Symptom Scores, Need for Rescue Medication
    • Bronchial Thermoplasty Had No Impact on FEV1
  • AIR-2 Trial Studying the Long-Term Safety and Efficacy of Bronchial Thermoplasty in Patients with Severe Persistent Asthma (J Allergy Clin Immunol, 2013) [MEDLINE]
    • Bronchial Thermoplasty Has Durable 5-Year Benefits with Regard to Asthma Control (Maintained Decrease in Severe Exacerbations and ED Visits for Respiratory Symptoms) and Safety
  • Systematic Review of Bronchial Thermoplasty in Moderate-Severe Asthma (Cochrane Database Syst Rev, 2014 [MEDLINE]
    • Bronchial Thermoplasty Provides a Modest Clinical Benefit in Quality of Life and Lower Rates of Asthma Exacerbation
    • Bronchial Thermoplasty Provides No Significant Difference in Asthma Control Scores

  • Technique: use of thermal energy to directly target the airway smooth muscle responsible for bronchoconstriction
    • Alair Bronchial Thermoplasty System (Boston Scientific; Marlborough, Massachusetts)
  • Adverse Effects
    • Bronchial Irritation
    • Cough (see Cough, [[Cough]])
    • Discolored Sputum
    • Upper Respiratory Infection
    • Wheezing
    • Worsening of Dyspnea (see Dyspnea, [[Dyspnea]])

References

  • AIR Trial. Asthma control during the year after bronchial thermoplasty. N Engl J Med 2007;156:1327-1337 [MEDLINE]
  • Bronchial thermoplasty: Long-term safety and effectiveness in patients with severe persistent asthma. J Allergy Clin Immunol. 2013 Dec;132(6):1295-302. doi: 10.1016/j.jaci.2013.08.009. Epub 2013 Aug 30 [MEDLINE]
  • Bronchial thermoplasty: a novel therapy for severe asthma. Clin Chest Med. 2013 Sep;34(3):437-44. doi: 10.1016/j.ccm.2013.03.003. Epub 2013 Aug 1 [MEDLINE]
  • Bronchial thermoplasty for moderate or severe persistent asthma in adults. Cochrane Database Syst Rev. 2014 Mar 3;3:CD009910. doi: 10.1002/14651858.CD009910.pub2 [MEDLINE]
  • Bronchial thermoplasty: a review of the evidence. Ann Allergy Asthma Immunol. 2016 Feb;116(2):92-8. doi: 10.1016/j.anai.2015.11.002. Epub 2015 Dec 2 [MEDLINE]