Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan-Feb;37(1):86-96.
doi: 10.4103/lungindia.lungindia_418_19.

Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society

Karan Madan  1 , Saurabh Mittal  1 , Tejas M Suri  1 , Avinash Jain  1 , Anant Mohan  1 , Vijay Hadda  1 , Pavan Tiwari  1 , Randeep Guleria  1 , Deepak Talwar  2 , Sudhir Chaudhri  3 , Virendra Singh  4 , Rajesh Swarnakar  5 , Sachidanand J Bharti  6 , Rakesh Garg  6 , Nishkarsh Gupta  6 , Vinod Kumar  6 , Ritesh Agarwal  7 , Ashutosh N Aggarwal  7 , Irfan I Ayub  8 , Prashant N Chhajed  9 , Amit Dhamija  10 , Raja Dhar  11 , Sahajal Dhooria  7 , Hari K Gonuguntla  12 , Rajiv Goyal  13 , Parvaiz A Koul  14 , Raj Kumar  15 , Nagarjuna Maturu  12 , Ravindra M Mehta  16 , Ujjwal Parakh  10 , Vallandaramam Pattabhiraman  17 , Narasimhan Raghupathi  18 , Inderpaul Singh Sehgal  7 , Arjun Srinivasan  18 , Kavitha Venkatnarayan  19
Affiliations

Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society

Karan Madan et al. Lung India. 2020 Jan-Feb.

Abstract

Bronchial thermoplasty (BT) is an interventional bronchoscopic treatment for severe asthma. There is a need to define patient selection criteria to guide clinicians in offering the appropriate treatment options to patients with severe asthma.

Methodology: An expert group formed this statement under the aegis of the Indian Chest Society. We performed a systematic search of the MEDLINE and EMBASE databases to extract evidence on patient selection and the technical performance of BT.

Results: The experts agreed that the appropriate selection of patients is crucial and proposed identification of the asthma phenotype, a screening algorithm, and inclusion/exclusion criteria for BT. In the presence of atypical clinical or chest radiograph features, there should be a low threshold for obtaining a thoracic computed tomography scan before BT. The patient should not have had an asthma exacerbation in the preceding two weeks from the day of the procedure. A 5-day course of glucocorticoid should be administered, beginning three days before the procedure day, and continued until the day following the procedure. General Anesthesia (total intravenous anesthesia with a neuromuscular blocker) provides ideal conditions for performing BT. A thin bronchoscope with a 2.0 mm working channel is preferable. An attempt should be made to deliver the maximum radiofrequency activations. Middle lobe treatment is not recommended. Following the procedure, overnight observation in the hospital, and a follow-up visit, a week following each treatment session, is desirable.

Conclusion: This position statement provides practical guidance regarding patient selection and the technical performance of BT for severe asthma.

Keywords: Anesthesia; bronchial asthma; bronchial thermoplasty; prednisolone.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Figure showing the Alair bronchial thermoplasty controller and the flexible basket catheter
Figure 2
Figure 2
Figure summarizing the screening and approach to patient selection for bronchial thermoplasty
See this image and copyright information in PMC

References

    1. India State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: The global burden of disease study 1990-2016. Lancet Glob Health. 2018;6:e1363–e1374. - PMC - PubMed
    1. Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, et al. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH) Int J Tuberc Lung Dis. 2012;16:1270–7. - PubMed
    1. Antonicelli L, Bucca C, Neri M, De Benedetto F, Sabbatani P, Bonifazi F, et al. Asthma severity and medical resource utilisation. Eur Respir J. 2004;23:723–9. - PubMed
    1. Hartley R, Berair R, Brightling CE. Severe asthma: Novel advances in the pathogenesis and therapy. Pol Arch Med Wewn. 2014;124:247–54. - PubMed
    1. Tan LD, Yoneda KY, Louie S, Hogarth DK, Castro M. Bronchial thermoplasty: A Decade of experience: State of the art. J Allergy Clin Immunol Pract. 2019;7:71–80. - PubMed