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Bronchial Thermoplasty Benefits Are Sustained for 5 Years

Summary and Comment |
October 15, 2013

Bronchial Thermoplasty Benefits Are Sustained for 5 Years

  1. David J. Amrol, MD

Long-term improvements must be weighed against short-term risks for adult asthma patients.

  1. David J. Amrol, MD

Bronchial thermoplasty is a bronchoscopic therapy for asthma in which controlled thermal energy is delivered to the airway wall during a series of three procedures. The result is a prolonged reduction in airway smooth muscle mass. In a 2010 study, 288 adults with severe asthma were randomized to bronchial thermoplasty or sham procedures and were followed for 1 year. A statistically significant improvement in asthma-related quality-of-life scores was not clinically significant because of greater-than-expected improvement in the sham group. Hospitalizations during the initial 6-week treatment period were 6% in the thermoplasty group; during weeks 6 to 52, severe exacerbations (defined by new or higher-dose oral corticosteroids or doubling of inhaled corticosteroids) were 33% less likely in the thermoplasty group. However, most outcomes were similar in the two groups (Am J Respir Crit Care Med 2010; 181:116).

Most of the thermoplasty patients were followed for an additional 4 years. Rates of respiratory-related adverse events and hospitalizations remained unchanged in years 2 to 5 compared with year 1. Exacerbations were 44% less likely to occur, and emergency department visits were 78% less likely to occur in years 2 to 5 than in the year preceding thermoplasty. Inhaled corticosteroid use was 18% lower than in the year before thermoplasty.

Comment

Reductions in hospitalization rates after bronchial thermoplasty were maintained for 5 years, and no late-onset adverse events were reported. These encouraging data must be tempered by the short-term rise in hospitalizations on the days of the procedures and the marginal benefits seen in quality-of-life scores in the initial study. Thermoplasty is FDA approved and is available in most metropolitan areas; it is an option for patients who continue to have exacerbations despite maximal medical treatment, but patients must be warned of the short-term risks. Also, because patients with ≥3 hospitalizations for asthma exacerbations or ≥4 pulses of oral steroids were excluded from this study, we don't know how patients with the most-severe asthma will respond.

Dr. Amrol is an Associate Professor of Clinical Internal Medicine and Director of the Division of Allergy and Immunology at the University of South Carolina School of Medicine in Columbia.

  • Disclosures for David J. Amrol, MD at time of publication Consultant / advisory board Dyax Leadership positions in professional societies South Carolina Allergy Society (President)

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