Bronchial Thermoplasty Induced Airway Smooth Muscle Reduction and Clinical Response in Severe Asthma. The TASMA Randomized Trial
Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass reduction after BT, but appropriate control groups are lacking. Furthermore, as treatment response is variable, identifying optimal candidates fo...
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| Published in: | American journal of respiratory and critical care medicine Vol. 203; no. 2; p. 175 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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15.01.2021
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| ISSN: | 1535-4970, 1535-4970 |
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| Abstract | Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass reduction after BT, but appropriate control groups are lacking. Furthermore, as treatment response is variable, identifying optimal candidates for BT treatment is important.
First, to assess the effect of BT on ASM mass, and second, to identify patient characteristics that correlate with BT response.
Patients with severe asthma (
= 40) were randomized to immediate (
= 20) or delayed (
= 20) BT treatment. Before randomization, clinical, functional, blood, and airway biopsy data were collected. In the delayed control group, reassessment, including biopsies, was performed after 6 months of standard clinical care, followed by BT. In both groups, post-BT data including biopsies were obtained after 6 months. ASM mass (% positive desmin or α-smooth muscle actin area in the total biopsy) was calculated with automated digital analysis software. Associations between baseline characteristics and Asthma Control Questionnaire and Asthma Quality of Life Questionnaire (AQLQ) improvement were explored.
Median ASM mass decreased by >50% in the immediate BT group (
= 17) versus no change in the delayed control group (
= 19) (
= 0.0004). In the immediate group, Asthma Control Questionnaire scores improved with -0.79 (interquartile range [IQR], -1.61 to 0.02) compared with 0.09 (IQR, -0.25 to 1.17) in the delayed group (
= 0.006). AQLQ scores improved with 0.83 (IQR, -0.15 to 1.69) versus -0.02 (IQR, -0.77 to 0.75) (
= 0.04). Treatment response in the total group (
= 35) was positively associated with serum IgE and eosinophils but not with baseline ASM mass.
ASM mass significantly decreases after BT when compared with a randomized non-BT-treated control group. Treatment response was associated with serum IgE and eosinophil levels but not with ASM mass. |
|---|---|
| AbstractList | Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass reduction after BT, but appropriate control groups are lacking. Furthermore, as treatment response is variable, identifying optimal candidates for BT treatment is important.
First, to assess the effect of BT on ASM mass, and second, to identify patient characteristics that correlate with BT response.
Patients with severe asthma (
= 40) were randomized to immediate (
= 20) or delayed (
= 20) BT treatment. Before randomization, clinical, functional, blood, and airway biopsy data were collected. In the delayed control group, reassessment, including biopsies, was performed after 6 months of standard clinical care, followed by BT. In both groups, post-BT data including biopsies were obtained after 6 months. ASM mass (% positive desmin or α-smooth muscle actin area in the total biopsy) was calculated with automated digital analysis software. Associations between baseline characteristics and Asthma Control Questionnaire and Asthma Quality of Life Questionnaire (AQLQ) improvement were explored.
Median ASM mass decreased by >50% in the immediate BT group (
= 17) versus no change in the delayed control group (
= 19) (
= 0.0004). In the immediate group, Asthma Control Questionnaire scores improved with -0.79 (interquartile range [IQR], -1.61 to 0.02) compared with 0.09 (IQR, -0.25 to 1.17) in the delayed group (
= 0.006). AQLQ scores improved with 0.83 (IQR, -0.15 to 1.69) versus -0.02 (IQR, -0.77 to 0.75) (
= 0.04). Treatment response in the total group (
= 35) was positively associated with serum IgE and eosinophils but not with baseline ASM mass.
ASM mass significantly decreases after BT when compared with a randomized non-BT-treated control group. Treatment response was associated with serum IgE and eosinophil levels but not with ASM mass. Rationale: Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass reduction after BT, but appropriate control groups are lacking. Furthermore, as treatment response is variable, identifying optimal candidates for BT treatment is important.Objectives: First, to assess the effect of BT on ASM mass, and second, to identify patient characteristics that correlate with BT response.Methods: Patients with severe asthma (n = 40) were randomized to immediate (n = 20) or delayed (n = 20) BT treatment. Before randomization, clinical, functional, blood, and airway biopsy data were collected. In the delayed control group, reassessment, including biopsies, was performed after 6 months of standard clinical care, followed by BT. In both groups, post-BT data including biopsies were obtained after 6 months. ASM mass (% positive desmin or α-smooth muscle actin area in the total biopsy) was calculated with automated digital analysis software. Associations between baseline characteristics and Asthma Control Questionnaire and Asthma Quality of Life Questionnaire (AQLQ) improvement were explored.Measurements and Main Results: Median ASM mass decreased by >50% in the immediate BT group (n = 17) versus no change in the delayed control group (n = 19) (P = 0.0004). In the immediate group, Asthma Control Questionnaire scores improved with -0.79 (interquartile range [IQR], -1.61 to 0.02) compared with 0.09 (IQR, -0.25 to 1.17) in the delayed group (P = 0.006). AQLQ scores improved with 0.83 (IQR, -0.15 to 1.69) versus -0.02 (IQR, -0.77 to 0.75) (P = 0.04). Treatment response in the total group (n = 35) was positively associated with serum IgE and eosinophils but not with baseline ASM mass.Conclusions: ASM mass significantly decreases after BT when compared with a randomized non-BT-treated control group. Treatment response was associated with serum IgE and eosinophil levels but not with ASM mass.Rationale: Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass reduction after BT, but appropriate control groups are lacking. Furthermore, as treatment response is variable, identifying optimal candidates for BT treatment is important.Objectives: First, to assess the effect of BT on ASM mass, and second, to identify patient characteristics that correlate with BT response.Methods: Patients with severe asthma (n = 40) were randomized to immediate (n = 20) or delayed (n = 20) BT treatment. Before randomization, clinical, functional, blood, and airway biopsy data were collected. In the delayed control group, reassessment, including biopsies, was performed after 6 months of standard clinical care, followed by BT. In both groups, post-BT data including biopsies were obtained after 6 months. ASM mass (% positive desmin or α-smooth muscle actin area in the total biopsy) was calculated with automated digital analysis software. Associations between baseline characteristics and Asthma Control Questionnaire and Asthma Quality of Life Questionnaire (AQLQ) improvement were explored.Measurements and Main Results: Median ASM mass decreased by >50% in the immediate BT group (n = 17) versus no change in the delayed control group (n = 19) (P = 0.0004). In the immediate group, Asthma Control Questionnaire scores improved with -0.79 (interquartile range [IQR], -1.61 to 0.02) compared with 0.09 (IQR, -0.25 to 1.17) in the delayed group (P = 0.006). AQLQ scores improved with 0.83 (IQR, -0.15 to 1.69) versus -0.02 (IQR, -0.77 to 0.75) (P = 0.04). Treatment response in the total group (n = 35) was positively associated with serum IgE and eosinophils but not with baseline ASM mass.Conclusions: ASM mass significantly decreases after BT when compared with a randomized non-BT-treated control group. Treatment response was associated with serum IgE and eosinophil levels but not with ASM mass. |
| Author | Weersink, Els J M Srikanthan, Karthikan Ten Hacken, Nick H T d'Hooghe, Julia N S Roelofs, Joris J T H Goorsenberg, Annika W M Shah, Pallav L Kemp, Samuel V Bonta, Peter I Bel, Elisabeth H Annema, Jouke T |
| Author_xml | – sequence: 1 givenname: Annika W M surname: Goorsenberg fullname: Goorsenberg, Annika W M organization: Department of Respiratory Medicine and – sequence: 2 givenname: Julia N S surname: d'Hooghe fullname: d'Hooghe, Julia N S organization: Department of Respiratory Medicine and – sequence: 3 givenname: Karthikan surname: Srikanthan fullname: Srikanthan, Karthikan organization: Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands – sequence: 4 givenname: Nick H T surname: Ten Hacken fullname: Ten Hacken, Nick H T organization: Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom – sequence: 5 givenname: Els J M surname: Weersink fullname: Weersink, Els J M organization: Department of Respiratory Medicine and – sequence: 6 givenname: Joris J T H surname: Roelofs fullname: Roelofs, Joris J T H organization: Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 7 givenname: Samuel V surname: Kemp fullname: Kemp, Samuel V organization: National Heart & Lung Institute, Imperial College, London, United Kingdom; and – sequence: 8 givenname: Elisabeth H surname: Bel fullname: Bel, Elisabeth H organization: Department of Respiratory Medicine and – sequence: 9 givenname: Pallav L orcidid: 0000-0002-9052-4638 surname: Shah fullname: Shah, Pallav L organization: Department of Pulmonology, Chelsea & Westminster Hospital, London, United Kingdom – sequence: 10 givenname: Jouke T surname: Annema fullname: Annema, Jouke T organization: Department of Respiratory Medicine and – sequence: 11 givenname: Peter I surname: Bonta fullname: Bonta, Peter I organization: Department of Respiratory Medicine and |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32721210$$D View this record in MEDLINE/PubMed |
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| Snippet | Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass... Rationale: Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown... |
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| SubjectTerms | Adolescent Adult Aged Airway Remodeling Asthma - diagnosis Asthma - pathology Asthma - physiopathology Asthma - surgery Biopsy Bronchi - pathology Bronchi - surgery Bronchial Thermoplasty Bronchoscopy Female Follow-Up Studies Humans Male Middle Aged Muscle, Smooth - pathology Muscle, Smooth - surgery Severity of Illness Index Treatment Outcome Young Adult |
| Title | Bronchial Thermoplasty Induced Airway Smooth Muscle Reduction and Clinical Response in Severe Asthma. The TASMA Randomized Trial |
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