Bronchial Thermoplasty for Very Severe Asthma

Abstract

SESSION TITLE: Allergy and Asthma SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Bronchial thermoplasty (BT) is an FDA approved procedure for the treatment of severe asthma. Previous studies have reported improvement in Asthma Quality of Life Questionnaire (AQLQ) score in patients who underwent BT. However, they did not include patients with very severe asthma who had pre-procedure FEV1s less than 60% predicted, were ever intubated for asthma, or required more than 10 mg of prednisone daily. We report that BT can be safely performed on patients with very severe asthma resulting in improved AQLQ score. We also intend to report a reduction in the corticosteroid use and exacerbation rates after the procedure. METHODS: 22 adult patients were enrolled in the study and underwent three thermoplasty procedures (RLL, LLL, upper lobes) under general anesthesia via endotracheal intubation. Most patients had a pre-procedure FEV1 less than 60% predicted and were using more than 10mg/d oral corticosteroids. The difference in AQLQ scores from baseline to those of 6, 9 and 12 months post thermoplasty were evaluated. Changes in dosage of oral corticosteroids, rates of exacerbation, and FEV1 and FVC were monitored. Adverse events were collected for safety assessment. RESULTS: 66 thermoplasty procedures were performed on 22 patients. All patients reported improved or stable AQLQ scores after BT as seen in previous studies. Oral corticosteroid use declined following thermoplasty, and fewer exacerbations were experienced. Spirometry was improved or unchanged in all patients. 7 of the 66 procedures required hospital admission after the procedure. 1 patient was re-intubated for vocal cord spasm (not bronchospasm), and another reported persistent increased airway secretions after thermoplasty. No deaths or serious adverse events were reported. CONCLUSIONS: BT can be safely performed in patients with very severe asthma who are dependent on oral corticosteroids. Intubation should be considered to optimally apply thermal energy to airway smooth muscle. BT may result in improved AQLQ score along with a decrease in oral corticosteroid use, exacerbations and improved FEV1 and FVC in patients with very severe asthma. CLINICAL IMPLICATIONS: Bronchial thermoplasty is safe in patients with very severe oral corticosteroid dependent asthma, and may improve quality of life along with reducted oral corticosteroid use. A multicenter randomized control trial comparing thermoplasty to standard therapy should be performed in very severe asthmatics to clarify potential benefit. DISCLOSURE: The following authors have nothing to disclose: Taha Khan, Brent Brown No Product/Research Disclosure Information