Bronchial Thermoplasty in Severe Asthma: Best Practice Recommendations from an Expert Panel
Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this “expert best practice” paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to b...
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| Published in: | Respiration Vol. 95; no. 5; pp. 289 - 300 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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Basel, Switzerland
S. Karger AG
01.01.2018
Karger |
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| ISSN: | 0025-7931, 1423-0356, 1423-0356 |
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| Abstract | Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this “expert best practice” paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchoscopy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (Alair TM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40–70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile – i.e., which specific asthma phenotype benefits most – is a topic of current research. |
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| AbstractList | Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this “expert best practice” paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchoscopy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (Alair TM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40–70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile – i.e., which specific asthma phenotype benefits most – is a topic of current research. Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of predniso lone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchoscopy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (Alair[TM] Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile--i.e., which specific asthma phenotype benefits most--is a topic of current research. Keywords Bronchial thermoplasty * Bronchoscopy * Asthma Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this “expert best practice” paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchoscopy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40–70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile – i.e., which specific asthma phenotype benefits most – is a topic of current research. Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchos-copy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile - i.e., which specific asthma phenotype benefits most - is a topic of current research. Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this ``expert best practice'' paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-yearfollow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of predniso- lone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchoscopy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (Alair((TM)) Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)seg mental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main peri procedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile - i.e., which specific asthma phenotype benefits most - is a topic of current research. (C) 2018 S. Karger AG, Basel Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of predniso lone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchoscopy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (Alair[TM] Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile--i.e., which specific asthma phenotype benefits most--is a topic of current research. Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchos-copy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile - i.e., which specific asthma phenotype benefits most - is a topic of current research.Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchos-copy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile - i.e., which specific asthma phenotype benefits most - is a topic of current research. |
| Audience | Academic |
| Author | Annema, Jouke T. Chanez, Pascal Bonta, Peter I. Niven, Robert Shah, Pallav L. |
| AuthorAffiliation | c Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom d National Heart and Lung Institute, Imperial College London, London, United Kingdom e Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom f MAHSC, University of Manchester and Manchester Foundation Trust, Manchester, United Kingdom a Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands b Aix-Marseille Université, Clinique des bronches, allergie et sommeil/APHM, Marseille C2VN Center INSEM INRA UMR1062, Marseille, France |
| AuthorAffiliation_xml | – name: f MAHSC, University of Manchester and Manchester Foundation Trust, Manchester, United Kingdom – name: e Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom – name: b Aix-Marseille Université, Clinique des bronches, allergie et sommeil/APHM, Marseille C2VN Center INSEM INRA UMR1062, Marseille, France – name: a Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands – name: d National Heart and Lung Institute, Imperial College London, London, United Kingdom – name: c Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom |
| Author_xml | – sequence: 1 givenname: Peter I. surname: Bonta fullname: Bonta, Peter I. email: p.i.bonta@amc.uva.nl – sequence: 2 givenname: Pascal surname: Chanez fullname: Chanez, Pascal – sequence: 3 givenname: Jouke T. surname: Annema fullname: Annema, Jouke T. – sequence: 4 givenname: Pallav L. orcidid: 0000-0002-9052-4638 surname: Shah fullname: Shah, Pallav L. – sequence: 5 givenname: Robert surname: Niven fullname: Niven, Robert |
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| Keywords | Bronchoscopy Bronchial thermoplasty Asthma |
| Language | English |
| License | This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. https://creativecommons.org/licenses/by-nc-nd/4.0 2018 S. Karger AG, Basel. Distributed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0 |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 PMCID: PMC6492603 1 British Thoracic Society, Scottish Intercollegiate Guidelines Network: British guideline on the management of asthma, 2016 (www.brit-thoracic.org.uk_document-library_clinical-information_asthma_btssign-asthmaguideline-2016); Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention, 2016 (www.ginasthma.org); Trivedi et al. [26]. 1 Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention, 2016 (www.ginasthma.org). |
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| References | Chung KF: Clinical management of severe therapy-resistant asthma. Expert Rev Respir Med 2017; 11: 395–402. d’Hooghe JN, Eberl S, Annema JT, Bonta PI: Propofol and remifentanil sedation for bronchial thermoplasty: a prospective cohort trial. Respiration 2017; 93: 58–64. Chupp G, Laviolette M, Cohn L, McEvoy C, Bansal S, Shifren A, et al: Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies. Eur Respir J 2017; 50: 1700017. Pavord ID, Cox G, Thomson NC, Rubin AS, Corris PA, Niven RM, et al: Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med 2007; 176: 1185–1191. 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: 723–729. Iikura M, Hojo M, Nagano N, Sakamoto K, Kobayashi K, Yamamoto S, et al: Bronchial thermoplasty for severe uncontrolled asthma in Japan. Allergol Int 2017, Epub ahead of print. d’Hooghe JNS, van den Berk IAH, Annema JT, Bonta PI: Acute radiological abnormalities after bronchial thermoplasty: a prospective cohort trial. Respiration 2017; 94: 258–262. Salem IH, Boulet LP, Biardel S, Lampron N, Martel S, Laviolette M, et al: Long-term effects of bronchial thermoplasty on airway smooth muscle and reticular basement membrane thickness in severe asthma. Ann Am Thorac Soc 2016; 13: 1426–1428. d’Hooghe JNS, Ten Hacken NHT, Weersink EJM, Sterk PJ, Annema JT, Bonta PI: Emerging understanding of the mechanism of action of Bronchial Thermoplasty in asthma. Pharmacol Ther 2018; 181: 101–107. Bel EH, Sousa A, Fleming L, Bush A, Chung KF, Versnel J, et al: Diagnosis and definition of severe refractory asthma: an international consensus statement from the Innovative Medicine Initiative (IMI). Thorax 2011; 66: 910–917. Balu A, Ryan D, Niven R: Lung abscess as a complication of bronchial thermoplasty. J Asthma 2015; 52: 740–742. Hekking PP, Wener RR, Amelink M, Zwinderman AH, Bouvy ML, Bel EH: The prevalence of severe refractory asthma. J Allergy Clin Immunol 2015; 135: 896–902. Cox G, Miller JD, McWilliams A, Fitzgerald JM, Lam S: Bronchial thermoplasty for asthma. Am J Respir Crit Care Med 2006; 173: 965–969. Adams DC, Hariri LP, Miller AJ, Wang Y, Cho JL, Villiger M, et al: Birefringence microscopy platform for assessing airway smooth muscle structure and function in vivo. Sci Transl Med 2016; 8: 359ra131. Pretolani M, Dombret MC, Thabut G, Knap D, Hamidi F, Debray MP, et al: Reduction of airway smooth muscle mass by bronchial thermoplasty in patients with severe asthma. Am J Respir Crit Care Med 2014; 190: 1452–1454. Cox G, Thomson NC, Rubin AS, Niven RM, Corris PA, Siersted HC, et al: Asthma control during the year after bronchial thermoplasty. N Engl J Med 2007; 356: 1327–1337. O’Reilly A, Browne I, Watchorn D, Egan JJ, Lane S: The efficacy and safety of bronchial thermoplasty in severe persistent asthma on extended follow-up. QJM 2018; 111: 155–159. d’Hooghe JNS, Bonta PI, van den Berk IAH, Annema JT: Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood? Eur Respir J 2017; 50: 1701537. Trivedi A, Pavord ID, Castro M: Bronchial thermoplasty and biological therapy as targeted treatments for severe uncontrolled asthma. Lancet Respir Med 2016; 4: 585–592. Fuhlbrigge AL, Adams RJ, Guilbert TW, Grant E, Lozano P, Janson SL, et al: The burden of asthma in the United States: level and distribution are dependent on interpretation of the National Asthma Education and Prevention Program guidelines. Am J Respir Crit Care Med 2002; 166: 1044–1049. Watchorn DC, Sahadevan A, Egan JJ, Lane SJ: The efficacy of bronchial thermoplasty for severe persistent asthma: the first national experience. Ir Med J 2016; 109: 406. Debray MP, Dombret MC, Pretolani M, Thabut G, Alavoine L, Brillet PY, et al: Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood? Eur Respir J 2017; 50: 1702067. Busse WW, Banks-Schlegel S, Wenzel SE: Pathophysiology of severe asthma. J Allergy Clin Immunol 2000; 106: 1033–1042. Langton D, Sha J, Ing A, Fielding D, Thien F, Plummer V: Bronchial thermoplasty: activations predict response. Respir Res 2017; 18: 134. Arrigo R, Failla G, Scichilone N, La Sala A, Galeone C, Battaglia S, et al: How effective and safe is bronchial thermoplasty in “real life” asthmatics compared to those enrolled in randomized clinical trials? Biomed Res Int 2016; 2016: 9132198. Pavord ID, Thomson NC, Niven RM, Corris PA, Chung KF, Cox G, et al: Safety of bronchial thermoplasty in patients with severe refractory asthma. Ann Allergy Asthma Immunol 2013; 111: 402–407. Mayse ML, Laviolette M, Rubin AS, Lampron N, Simoff M, Duhamel D, et al: Clinical pearls for bronchial thermoplasty. J Bronchology Interv Pulmonol 2007; 14: 115–123. Nguyen DV, Murin S: Bronchial artery pseudoaneurysm with major hemorrhage after bronchial thermoplasty. Chest 2016; 149:e95–e97. Benayoun L, Druilhe A, Dombret MC, Aubier M, Pretolani M: Airway structural alterations selectively associated with severe asthma. Am J Respir Crit Care Med 2003; 167: 1360–1368. Chakir J, Haj-Salem I, Gras D, Joubert P, Beaudoin ÈL, Biardel S, et al: Effects of bronchial thermoplasty on airway smooth muscle and collagen deposition in asthma. Ann Am Thorac Soc 2015; 12: 1612–1618. Pretolani M, Bergqvist A, Thabut G, Dombret MC, Knapp D, Hamidi F, et al: Effectiveness of bronchial thermoplasty in patients with severe refractory asthma: clinical and histopathologic correlations. J Allergy Clin Immunol 2017; 139: 1176–1185. Thomson NC, Rubin AS, Niven RM, Corris PA, Siersted HC, Olivenstein R, et al: Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial. BMC Pulm Med 2011; 11: 8. Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL, et al: Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med 2010; 181: 116–124. Funatsu A, Kobayashi K, Iikura M, Ishii S, Izumi S, Sugiyama H: A case of pulmonary cyst and pneumothorax after bronchial thermoplasty. Respirol Case Rep 2018; 6:e00286. Wechsler ME, Laviolette M, Rubin AS, Fiterman J, Lapa e Silva JR, Shah PL, et al: Bronchial thermoplasty: long-term safety and effectiveness in patients with severe persistent asthma. J Allergy Clin Immunol 2013; 132: 1295–1302. Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al: International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343–373. Lee JA, Rowen DW, Rose DD: Bronchial thermoplasty: a novel treatment for severe asthma requiring monitored anesthesia care. AANA J 2011; 79: 480–483. d’Hooghe JNS, Goorsenberg AWM, de Bruin DM, Roelofs J, Annema JT, Bonta PI: Optical coherence tomography for identification and quantification of human airway wall layers. PLoS One 2017; 12:e0184145. Debray MP, Dombret MC, Pretolani M, Thabut G, Alavoine L, Brillet PY, et al: Early computed tomography modifications following bronchial thermoplasty in patients with severe asthma. Eur Respir J 2017; 49: 1601565. |
| References_xml | – reference: Cox G, Thomson NC, Rubin AS, Niven RM, Corris PA, Siersted HC, et al: Asthma control during the year after bronchial thermoplasty. N Engl J Med 2007; 356: 1327–1337. – reference: Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL, et al: Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med 2010; 181: 116–124. – reference: d’Hooghe JNS, van den Berk IAH, Annema JT, Bonta PI: Acute radiological abnormalities after bronchial thermoplasty: a prospective cohort trial. Respiration 2017; 94: 258–262. – reference: Adams DC, Hariri LP, Miller AJ, Wang Y, Cho JL, Villiger M, et al: Birefringence microscopy platform for assessing airway smooth muscle structure and function in vivo. Sci Transl Med 2016; 8: 359ra131. – reference: Lee JA, Rowen DW, Rose DD: Bronchial thermoplasty: a novel treatment for severe asthma requiring monitored anesthesia care. AANA J 2011; 79: 480–483. – reference: Wechsler ME, Laviolette M, Rubin AS, Fiterman J, Lapa e Silva JR, Shah PL, et al: Bronchial thermoplasty: long-term safety and effectiveness in patients with severe persistent asthma. J Allergy Clin Immunol 2013; 132: 1295–1302. – reference: d’Hooghe JNS, Goorsenberg AWM, de Bruin DM, Roelofs J, Annema JT, Bonta PI: Optical coherence tomography for identification and quantification of human airway wall layers. PLoS One 2017; 12:e0184145. – reference: Fuhlbrigge AL, Adams RJ, Guilbert TW, Grant E, Lozano P, Janson SL, et al: The burden of asthma in the United States: level and distribution are dependent on interpretation of the National Asthma Education and Prevention Program guidelines. Am J Respir Crit Care Med 2002; 166: 1044–1049. – reference: d’Hooghe JN, Eberl S, Annema JT, Bonta PI: Propofol and remifentanil sedation for bronchial thermoplasty: a prospective cohort trial. Respiration 2017; 93: 58–64. – reference: 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: 723–729. – reference: Bel EH, Sousa A, Fleming L, Bush A, Chung KF, Versnel J, et al: Diagnosis and definition of severe refractory asthma: an international consensus statement from the Innovative Medicine Initiative (IMI). Thorax 2011; 66: 910–917. – reference: Nguyen DV, Murin S: Bronchial artery pseudoaneurysm with major hemorrhage after bronchial thermoplasty. Chest 2016; 149:e95–e97. – reference: d’Hooghe JNS, Ten Hacken NHT, Weersink EJM, Sterk PJ, Annema JT, Bonta PI: Emerging understanding of the mechanism of action of Bronchial Thermoplasty in asthma. Pharmacol Ther 2018; 181: 101–107. – reference: Funatsu A, Kobayashi K, Iikura M, Ishii S, Izumi S, Sugiyama H: A case of pulmonary cyst and pneumothorax after bronchial thermoplasty. Respirol Case Rep 2018; 6:e00286. – reference: Chupp G, Laviolette M, Cohn L, McEvoy C, Bansal S, Shifren A, et al: Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies. Eur Respir J 2017; 50: 1700017. – reference: Pavord ID, Thomson NC, Niven RM, Corris PA, Chung KF, Cox G, et al: Safety of bronchial thermoplasty in patients with severe refractory asthma. Ann Allergy Asthma Immunol 2013; 111: 402–407. – reference: Mayse ML, Laviolette M, Rubin AS, Lampron N, Simoff M, Duhamel D, et al: Clinical pearls for bronchial thermoplasty. J Bronchology Interv Pulmonol 2007; 14: 115–123. – reference: Chung KF: Clinical management of severe therapy-resistant asthma. Expert Rev Respir Med 2017; 11: 395–402. – reference: Cox G, Miller JD, McWilliams A, Fitzgerald JM, Lam S: Bronchial thermoplasty for asthma. Am J Respir Crit Care Med 2006; 173: 965–969. – reference: Iikura M, Hojo M, Nagano N, Sakamoto K, Kobayashi K, Yamamoto S, et al: Bronchial thermoplasty for severe uncontrolled asthma in Japan. Allergol Int 2017, Epub ahead of print. – reference: O’Reilly A, Browne I, Watchorn D, Egan JJ, Lane S: The efficacy and safety of bronchial thermoplasty in severe persistent asthma on extended follow-up. QJM 2018; 111: 155–159. – reference: Pretolani M, Dombret MC, Thabut G, Knap D, Hamidi F, Debray MP, et al: Reduction of airway smooth muscle mass by bronchial thermoplasty in patients with severe asthma. Am J Respir Crit Care Med 2014; 190: 1452–1454. – reference: Arrigo R, Failla G, Scichilone N, La Sala A, Galeone C, Battaglia S, et al: How effective and safe is bronchial thermoplasty in “real life” asthmatics compared to those enrolled in randomized clinical trials? Biomed Res Int 2016; 2016: 9132198. – reference: Busse WW, Banks-Schlegel S, Wenzel SE: Pathophysiology of severe asthma. J Allergy Clin Immunol 2000; 106: 1033–1042. – reference: Pavord ID, Cox G, Thomson NC, Rubin AS, Corris PA, Niven RM, et al: Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med 2007; 176: 1185–1191. – reference: Watchorn DC, Sahadevan A, Egan JJ, Lane SJ: The efficacy of bronchial thermoplasty for severe persistent asthma: the first national experience. Ir Med J 2016; 109: 406. – reference: Debray MP, Dombret MC, Pretolani M, Thabut G, Alavoine L, Brillet PY, et al: Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood? Eur Respir J 2017; 50: 1702067. – reference: d’Hooghe JNS, Bonta PI, van den Berk IAH, Annema JT: Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood? Eur Respir J 2017; 50: 1701537. – reference: Chakir J, Haj-Salem I, Gras D, Joubert P, Beaudoin ÈL, Biardel S, et al: Effects of bronchial thermoplasty on airway smooth muscle and collagen deposition in asthma. Ann Am Thorac Soc 2015; 12: 1612–1618. – reference: Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al: International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343–373. – reference: Hekking PP, Wener RR, Amelink M, Zwinderman AH, Bouvy ML, Bel EH: The prevalence of severe refractory asthma. J Allergy Clin Immunol 2015; 135: 896–902. – reference: Balu A, Ryan D, Niven R: Lung abscess as a complication of bronchial thermoplasty. J Asthma 2015; 52: 740–742. – reference: Thomson NC, Rubin AS, Niven RM, Corris PA, Siersted HC, Olivenstein R, et al: Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial. BMC Pulm Med 2011; 11: 8. – reference: Salem IH, Boulet LP, Biardel S, Lampron N, Martel S, Laviolette M, et al: Long-term effects of bronchial thermoplasty on airway smooth muscle and reticular basement membrane thickness in severe asthma. Ann Am Thorac Soc 2016; 13: 1426–1428. – reference: Benayoun L, Druilhe A, Dombret MC, Aubier M, Pretolani M: Airway structural alterations selectively associated with severe asthma. Am J Respir Crit Care Med 2003; 167: 1360–1368. – reference: Trivedi A, Pavord ID, Castro M: Bronchial thermoplasty and biological therapy as targeted treatments for severe uncontrolled asthma. Lancet Respir Med 2016; 4: 585–592. – reference: Debray MP, Dombret MC, Pretolani M, Thabut G, Alavoine L, Brillet PY, et al: Early computed tomography modifications following bronchial thermoplasty in patients with severe asthma. Eur Respir J 2017; 49: 1601565. – reference: Pretolani M, Bergqvist A, Thabut G, Dombret MC, Knapp D, Hamidi F, et al: Effectiveness of bronchial thermoplasty in patients with severe refractory asthma: clinical and histopathologic correlations. J Allergy Clin Immunol 2017; 139: 1176–1185. – reference: Langton D, Sha J, Ing A, Fielding D, Thien F, Plummer V: Bronchial thermoplasty: activations predict response. Respir Res 2017; 18: 134. |
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| Title | Bronchial Thermoplasty in Severe Asthma: Best Practice Recommendations from an Expert Panel |
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