Abstract
BackgroundBronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe asthma. The predictive factors for clinical response to BT are unknown. We examined the relationship between the number of radiofrequency activations applied and the treatment response observed.MethodsData were collected from 24 consecutive cases treated at three Australian centres from June 2014 to March 2016. The baseline characteristics were collated along with the activations delivered. The primary response measure was change in the Asthma Control Questionnaire-5 (ACQ-5) score measured at 6 months post BT. The relationship between change in outcome parameters and the number of activations delivered was explored.ResultsAll patients met the ERS/ATS definition for severe asthma. At 6 months post treatment, mean ACQ-5 improved from 3.3 ± 1.1 to 1.5 ± 1.1, p < 0.001. The minimal clinically significant improvement in ACQ-5 of ≥0.5 was observed in 21 out of 24 patients. The only significant variable that differed between the 21 responders and the three non-responders was the number of activations delivered, with 139 ± 11 activations in the non-responders, compared to 221 ± 45 activations in the responders (p < 0.01). A significant inverse correlation was found between change in ACQ-5 score and the number of activations, r = −0.43 (p < 0.05).ConclusionsThe number of activations delivered during BT has a role in determining clinical response to treatment.
Highlights
Bronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe asthma
Clinical studies have demonstrated that 12 months following treatment, significant improvements are achieved in patient symptom scores, reliever medication usage, and asthma exacerbations requiring prednisolone [3,4,5]
Patients were chosen for bronchial thermoplasty at the discretion of the treating team
Summary
Bronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe asthma. Bronchial thermoplasty (BT) has been shown to be an effective and safe additional modality for the management of patients with poorly controlled asthma despite standard therapy [3,4,5]. BT is performed during flexible bronchoscopy using a radiofrequency catheter to deliver thermal injury to airways between 3 and 10 mm in size [6]. Both animal and human studies have demonstrated that, as result, there is a reduction in airway smooth muscle mass in the areas treated, whilst the airway mucosa recovers undamaged [7,8,9]. There is very little data regarding the characteristics of those who fail to respond to BT, nor the contributing reasons
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