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Pulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Bronchial thermoplasty offers a non-pharmacological approach to asthma treatment. The technique is targeted at the airway smooth muscle which is considered central to airway dysfunction in asthma. Thermal energy is applied bronchoscopically to the bronchial wall using a wired basket. This leads to the disruption of smooth muscle bundles that disrupts their function. Double-blind randomised clinical trials incorporating a sham bronchoscopy arm have shown small improvements in symptoms and a reduced risk of exacerbations, offset by an increased risk of peri-procedure asthma attacks. The exact place for this treatment has not been well established and it is available in only a few specialised centres.
Asthma and COPD
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Balamugesh Thangakunam, Devasahayam J Christopher
Targeting the specific inflammatory pathway through various biological agents has a definitive role in the management of severe asthma, but such treatment is not available for COPD. Bronchial thermoplasty is a novel method of reducing the thickness of bronchial smooth muscle and has been found to be helpful in a subset of asthmatics. In severe COPD bronchoscopic treatments are available to reduce the volume of hyperinflated emphysematous lobes.
Precision medicine in asthma and chronic obstructive pulmonary disease
Published in Debmalya Barh, Precision Medicine in Cancers and Non-Communicable Diseases, 2018
Bronchial thermoplasty (BT) is only intended for severe asthma adult patients within a research environment (ATS, 2015). BT has proved to be of use in reduction in airway smooth muscle (ASM). BT uses radiofrequency energy to reduce the mass of ASM. The BT modality relies on reducing the mass of ASM by thermal injury and helps in reducing the severity of asthma. The AlairTM Bronchial Thermoplasty System approved by the FDA in 2010 for conditional use in asthma has been used for BT (BlueCross BlueShield Association, 2014).
Bronchial Thermoplasty in Patients with Severe Persistent Asthma: A Literature Review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Ghulam Mustafa Aftab, Sana Rehman, Mudassar Ahmad, Ali Akram, Amar Bukhari
In one study, 300 bronchial specimens were evaluated in 15 patients, with severe asthma, prior to BT treatment and 3 months after treatment. The effect of BT was studied on cellular level in terms of the measurement of airway smooth muscle area and subepithelial thickness. Bronchial thermoplasty led to improvement in asthma control and quality of life. At 3 months, this clinical benefit was associated with a reduction in the area of the airway smooth muscles, thickness of the subepithelial basement membrane (median values before and after BT, respectively, 4.4 μm and 3.9 μm respectively), and epithelial neuroendocrine cells (median values before and after BT, respectively: 4.9/mm and 0.0/mm, respectively) [15].
Bronchial thermoplasty as a treatment for severe asthma: controversies, progress and uncertainties
Published in Expert Review of Respiratory Medicine, 2018
Bronchial thermoplasty is an intervention developed for the treatment of patients with severe asthma, which involves the delivery of radio frequency energy to the airways.Randomized controlled clinical trials of bronchial thermoplasty in patients with moderate and severe asthma show modest improvements in asthma quality of life and reductions in severe exacerbations and emergency department visits.Morbidity from asthma is increased during treatment. Follow-up data beyond one year have not reported any serious adverse effects up to five yearsObservational studies report that bronchial thermoplasty is effective in one half to three-quarters of real-life patients with severe asthma. The procedure can be safely performed in clinical practice although per-procedure adverse effects are commoner than reported in clinical trials of bronchial thermoplasty.Bronchial thermoplasty is a treatment option for selected patients with moderate to severe asthma who have poorly controlled asthma despite maximal therapy. It is not known which subphenotype(s) of severe asthma should be treated with bronchial thermoplasty compared to other treatments, such as biological agents. Currently, bronchial thermoplasty is mainly used in patients with severe asthma associated with non-type 2 inflammation and non-eosinophilic inflammation or as a second-line alternative therapy for patient unresponsive to currently licenced biologics.Preliminary data suggest that certain clinical variables or inflammatory biomarkers might predict a beneficial response to bronchial thermoplasty, but these factors need to be validated in large populations of patients with severe asthma.Modes of action of bronchial thermoplasty under investigation include reduced airway smooth muscle mass or function, alterations to the structure and/or function of airway epithelial cells, nerves or extracellular matrix components.Future research needs to investigate uncertainties about predictors of response, mechanism of action and the place in management of bronchial thermoplasty for severe asthma.