Bronchial thermoplasty in the treatment of severe asthma

Abstract

To assess the effectiveness and safety of bronchial thermoplasty (BT) in the treatment of severe asthma. The safety and effectiveness of BT were studied prospectively in 6 patients with poorly controlled severe asthma on long-term inhaled high-dose glucocorticoids and long-acting beta2-agonists in the First Affiliated Hospital of Guangzhou Medical University. Outcomes assessed after BT included asthma symptoms, frequency of acute exacerbations, pulmonary function, medication adjustment, and postoperative complications at 6 and 12 months after treatment. The mini-AQLQ scores (6.4±0.5), the frequency of acute exacerbations [0.4(0.1-1.3) times/month], and the symptom-free days [(21.2±7.2) days/month] were significantly improved at 6 months after operation compared to those before operation [5.2±0.9, 2.0 (0.9-4.0) times/month, (14.5±3.7) days/month, respectively, P<0.05]. Data collected at the 6(th) month indicated significant improvements in the variation rate of PEF, the dose of inhaled glucocorticoids and oral glucocorticoids [(5.6±3.3)% vs. (21.1±7.8)%), (800±620) vs. (1 133±432) μg/d), 9.7 (1.3-10.0) vs. 15.0 (10-20) mg/d, P<0.05]. Outcomes mentioned above were improved as well at the 12(th) month. But the ACQ-6 scores, ACT scores, the ratio of PEF and its predicted value (%), the ratio of FVC and its predicted value (%), the ratio of FEV1 and its predicted value (%) were not changed significantly (P>0.05). The PEF values and lung function measurements remained stable throughout the study period. The most common complications were cough (24.1%), wheezing (13.8%), followed by lower respiratory infection and atelectasis during the treatment. Pneumothorax and respiratory failure occurred in 1 patient 12 h after the third procedure. Our preliminary study demonstrated promising effect of BT in the treatment of severe asthma, although there are some complications which need further observation.