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Multicenter Study
. 2017 May;47(5):536-541.
doi: 10.1111/imj.13372.

Bronchial thermoplasty in severe asthma in Australia

David Langton  1   2 , Joy Sha  1 , Alvin Ing  3 , David Fielding  4 , Erica Wood  2
Affiliations
Multicenter Study

Bronchial thermoplasty in severe asthma in Australia

David Langton et al. Intern Med J. 2017 May.

Abstract

Background: Bronchial thermoplasty (BT) is an approved bronchoscopic intervention for the treatment of severe asthma. However, limited published experience exists outside of clinical trials regarding patient selection and outcomes achieved.

Aims: To evaluate the effectiveness and safety of BT in patients with severe asthma encountered in clinical practice.

Methods: This is a retrospective analysis of the first 'real world' data from Australia. The following outcomes were measured prior to, and 6 months following BT: spirometry, Asthma Control Questionnaire-5 (ACQ-5) score, reliever and preventer medication use and exacerbation history.

Results: Twenty patients were treated from June 2014 to December 2015 at three university teaching hospitals. All subjects met the European Respiratory Society/American Thoracic Society definition of severe asthma. Mean pre-bronchodilator forced expiratory volume in 1 s was 62.8 ± 16.6% predicted (range: 33-95%). All patients were being treated with high dose inhaled corticosteroids, long-acting beta2 agonists and long-acting muscarinic antagonists. Ten patients (50%) were taking maintenance oral prednisolone. Most subjects also required at least one of montelukast (65%), omalizumab (30%) and methotrexate (20%). ACQ-5 improved from 3.6 ± 1.1 at baseline to 1.6 ± 1.2 at 6 months, P < 0.001. Short-acting reliever use decreased from a median of 8.0-0.25 puffs/day, P < 0.001, and exacerbations requiring corticosteroids also significantly reduced. Five of 10 patients completely discontinued maintenance oral corticosteroids. Ten patients with a baseline forced expiratory volume in 1 s of <60% predicted significantly improved from 49.2 ± 9.6% to 61.8 ± 17.6%, P < 0.05. Only two procedures required hospitalisation beyond the planned overnight admission.

Conclusion: BT is a safe procedure which can achieve clinical improvement in those with uncontrolled symptoms and severe airflow obstruction.

Keywords: airflow obstruction; asthma; asthma management; bronchial thermoplasty; bronchoscopy.

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