Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma

Bronchial Thermoplasty

“…BT can be considered as an alternative to chronic systemic steroids or biologics for patients with severe uncontrolled nonallergic, allergic, or eosinophilic asthma. 5 Patients may prefer BT to biologics because it can be completed in three sessions in contrast to the burden of taking an injected therapy indefinitely, and has been shown to reduce the use of inhaled and systemic steroids. 6,7 Multiple cost-effectiveness analyses using Markov modeling have shown a high probability that BT is cost-effective compared with high-dose combination therapy and/or omalizumab among patients with severe allergic asthma.…”

Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain

“…For non-Th 2 severe asthma, BT can be a first option for patients with persistent symptoms after failure of triple therapy with high-dose ICS plus long-acting beta-2 agonists (LABA) and tiotropium, before the use of oral corticosteroids (OCS). BT can also be considered an alternative therapy for patients with allergic or eosinophilic asthma who had an inadequate response to initial biologic therapy [9,10].…”

“…Bronchial thermoplasty (BT) has proven an effective therapeutic option for patients with a nonallergic, noneosinophilic (non-Th 2 ) type inflammation asthma phenotype [9][10][11]. Furthermore, BT has shown similar efficacy in patients with other asthma phenotypes and airway smooth muscle hypertrophy [9,10]. For non-Th 2 severe asthma, BT can be a first option for patients with persistent symptoms after failure of triple therapy with high-dose ICS plus long-acting beta-2 agonists (LABA) and tiotropium, before the use of oral corticosteroids (OCS).…”

“…> 800 µg budesonide or equivalent) plus a second drug (and/or systemic CS) to prevent it from becoming uncontrolled or which remains uncontrolled despite this therapy in patients with a correct diagnosis of asthma and their comorbidities identified and treated" [7]. In these patients, phenotype-oriented treatments to modulate Th 2 inflammatory response are effective in controlling symptoms and exacerbations; however, not all patients eligible for these therapies will achieve the desired control [3,[8][9][10]. Bronchial thermoplasty (BT) has proven an effective therapeutic option for patients with a nonallergic, noneosinophilic (non-Th 2 ) type inflammation asthma phenotype [9][10][11].…”

“…In these patients, phenotype-oriented treatments to modulate Th 2 inflammatory response are effective in controlling symptoms and exacerbations; however, not all patients eligible for these therapies will achieve the desired control [3,[8][9][10]. Bronchial thermoplasty (BT) has proven an effective therapeutic option for patients with a nonallergic, noneosinophilic (non-Th 2 ) type inflammation asthma phenotype [9][10][11]. Furthermore, BT has shown similar efficacy in patients with other asthma phenotypes and airway smooth muscle hypertrophy [9,10].…”