Thermal ablation for asthma: current status and technique

Abstract

Bronchial thermoplasty (BT) is a novel technique used in the treatment of severe asthma.A catheter is advanced through the bronchoscope and directed radiofrequency waves are applied to the segmental bronchi to reduce airway smooth muscle mass. Several randomized clinical trials demonstrate improvement in quality of life and reduction in exacerbation rates after treatment. BT is a safe and cost effective treatment option for severe asthma which is refractory to medical treatment. Further studies are needed in order to better describe the mechanism of action and the asthma subphenotype that was best benefit from this treatment.

Asthma Diagnosis: The Changing Face of Guidelines

“…Type 2 inflammation inhibitors have emerged over the last one to two decades, including drugs that target IgE such as omalizumab, and those that target IL-5 such as mepolizumab, reslizumab and benralizumab [15]. Other potential individualised strategies include bronchial thermoplasty, a technique that uses radiofrequency waves to target smooth muscle and reduce smooth muscle mass in patients that have airway remodelling with smooth muscle hypertrophy and hyperplasia [29].…”

Tentative study on radial endobronchial ultrasonography evaluating airway wall thickness before and after bronchial thermoplasty

“…Chronic airflow obstruction and low quality of life. Bronchial thermoplasty (BT), as a novel intervention aiming at reducing airway smooth muscle (ASM) mass and even partially reversing airway remodeling [ 4 ], has attracted increasing attention of asthma specialists. Therefore, It is of great clinical significant to find a simple, non-invasive, fast and accurate method to identify the thickness change before and after BT for evaluating the efficacy of the treatment by measuring the improvement of airway remodeling [ 5 ].…”

Asthma management updates

“…3,4 Performed under moderate sedation/analgesia, bronchial thermoplasty involves applying heat via a device that delivers localized controlled radiofrequency waves to the airways during bronchoscopy, which reduces the increased mass of airway smooth muscle associated with asthma. 46,47 The procedure has a small benefit-torisk ratio with uncertain long-term outcomes. 3,4,32…”

“…Bronchial thermoplasty is a newer invasive procedure reserved for uncontrolled moderate-to-severe asthma in adults 18 years of age or older who have failed conventional asthma therapy (conditional recommendation, low evidence) 3,4. Performed under moderate sedation/analgesia, bronchial thermoplasty involves applying heat via a device that delivers localized controlled radiofrequency waves to the airways during bronchoscopy, which reduces the increased mass of airway smooth muscle associated with asthma 46,47. The procedure has a small benefit-to-risk ratio with uncertain long-term outcomes 3,4,32…”