Bronchial Thermoplasty: A Decade of Experience: State of the Art

Abstract

Bronchial thermoplasty (BT) delivers targeted radiofrequency energy to bronchial airway walls and results in the partial ablation of the airway smooth muscle that is responsible for bronchoconstriction. It is approved for the treatment of severe persistent asthma. Multiple, large clinical trials including a recent "real-world" study demonstrate significant improvements in asthma-related quality of life, reduction in asthma exacerbations, emergency department visits, and hospitalizations after BT that is sustained out to 5 years. In this article, we review the state of the art of BT treatment in severe persistent asthma and share a decade of BT research and clinical experience. We share our personal experience and introduce the three "I"s (identification, implementation, and intense follow-up) that we believe promote successful patient outcomes and help build a successful BT program.

<p>Recent Developments In Bronchial Thermoplasty For Severe Asthma</p>

“…Bronchial thermoplasty is a treatment option for patients with severe refractory asthma that remains uncontrolled despite maximal therapy. Recent reviews provide detailed information on the selection of patients for bronchial thermoplasty 13,28–30. The main criteria used to select patients with severe asthma for bronchial thermoplasty are based on those used in the AIR2 and RISA controlled clinical trials of the procedure (Table 1).…”

“…The “Alair” Bronchial Thermoplasty system produces radio-frequency energy that is repeatedly applied for a 10-s period per activation to the medium and large airways via a catheter with an expandable electrode array at its distal end 13,16,49. Bronchial thermoplasty is given over three bronchoscopy sessions at approximately 3-week intervals, one for each lower lobe and one for both upper lobes.…”

“…Treatment sessions are typically completed in 45 mins and around 60 radio-frequency activations delivered to the airways. Details of the equipment and procedure have been reviewed in detail previously 13,32. Hyperpolarized xenon (HXe) MRI is being investigated as a biomarker to prioritize the order of airway treatment by bronchial thermoplasty (ClinicalTrials.gov Identifier: NCT01832363; NCT02263794) 23.…”

“…Bronchial thermoplasty is a non-pharmacological intervention that applies thermal energy to the airways with the aim of reducing the amount of airway smooth muscle and improving asthma control 8. Previously published articles provide detailed information on the preclinical and clinical development of bronchial thermoplasty 8–13. The main evidence for the efficacy and short-term safety of bronchial thermoplasty treatment in patients with moderate to severe asthma is based on the results of three randomized controlled trials,14–16 two of which compared bronchial thermoplasty with usual care, the Asthma Intervention Research (AIR) trial14 and the Research in Severe Asthma (RISA) trial,15 and a third trial (AIR2), which compared bronchial thermoplasty with a sham procedure 16.…”

The Hidden Burden of Severe Asthma: From Patient Perspective to New Opportunities for Clinicians

“…The most recent edition of the GINA guidelines [ 5 ] includes bronchial thermoplasty (BT) as a non-pharmacological, selective treatment of severe asthma [ 97 ]. BT delivers controlled thermal energy to the airway wall through a dedicated catheter during a series of bronchoscopy procedures that result in a prolonged reduction in ASM mass, thus ameliorating symptoms of asthma.…”