Bronchial Thermoplasty for Uncontrolled Severe Asthma
Thomson NC, Rubin AS, Niven RM, et al
BMC Pulm Med. 2011;11:8
Most cases of asthma can be well controlled by following standard guidelines. However, every practice also has at least one patient whose life, despite adherence to treatment guidelines, is still unacceptably limited as a consequence of severe asthma. What can be added to bring this patient's disease under control? A recently approved novel procedure, bronchial thermoplasty, may help. Bronchial thermoplasty is the first non-drug therapy approved by the US Food and Drug Administration for the treatment of severe asthma. It consists of controlled radiofrequency heating of the central airways through a bronchoscope. About 20 regions of the bronchi from both lungs are treated over the course of 3 sessions separated by 3 weeks. The procedure is often followed by a transient exacerbation of the asthma symptoms and has, occasionally, required a short hospitalization. Performed as an outpatient, the procedure (Alair® Bronchial Thermoplasty System, Asthmatx, Inc., Sunnyvale, California) is described in more detail in a video from the manufacturer.
The efficacy of the procedure was reported in a previous publication that described 101 patients with severe asthma that was not optimally controlled by any standard therapy. They found, 1 year after completion of bronchial thermoplasty or sham intervention, that the treated group had fewer acute exacerbations, significant improvements in lung function and asthma control by standard questionnaires, as well as more symptom-free days and less use of rescue medication.
The present study reports the safety of the same patients 4 years later and 5 years after the procedure. The rate of adverse events, which included healthcare utilization and hospitalization, was low and remained consistent from years 2 through 5, indicating no rebound of asthma severity. Lung function improvements were also maintained. Thomson and colleagues conclude that these results support the long-term safety of the procedure out to 5 years.
Patients whose asthma cannot be controlled by current guidelines, although thankfully rare, present a real problem, so any new option that provides benefit is welcome. Bronchial thermoplasty is, of course, invasive and still relatively new. Controlled studies such as the present one, however, indicate that the condition can be ameliorated and that the benefit is maintained without safety concerns for at least 5 years. It must be stressed that the major reason for treatment failure in asthma is poor compliance, namely failure to take or maintain important components of asthma care, particularly appropriate anti-inflammatory medication. Bronchial thermoplasty should not be considered an alternative to standard therapy; rather, it complements standard therapy. So before considering whether to refer the patient for bronchial thermoplasty, every effort should be made to optimize usual treatment for severe asthma according to current guidelines.
Abstract
Long-term (5 Year) Safety of Bronchial Thermoplasty: Asthma Intervention Research (AIR) Trial
Thomson NC, Rubin AS, Niven RM, et al
BMC Pulm Med. 2011;11:8
Study Summary
Most cases of asthma can be well controlled by following standard guidelines. However, every practice also has at least one patient whose life, despite adherence to treatment guidelines, is still unacceptably limited as a consequence of severe asthma. What can be added to bring this patient's disease under control? A recently approved novel procedure, bronchial thermoplasty, may help. Bronchial thermoplasty is the first non-drug therapy approved by the US Food and Drug Administration for the treatment of severe asthma. It consists of controlled radiofrequency heating of the central airways through a bronchoscope. About 20 regions of the bronchi from both lungs are treated over the course of 3 sessions separated by 3 weeks. The procedure is often followed by a transient exacerbation of the asthma symptoms and has, occasionally, required a short hospitalization. Performed as an outpatient, the procedure (Alair® Bronchial Thermoplasty System, Asthmatx, Inc., Sunnyvale, California) is described in more detail in a video from the manufacturer.
The efficacy of the procedure was reported in a previous publication that described 101 patients with severe asthma that was not optimally controlled by any standard therapy. They found, 1 year after completion of bronchial thermoplasty or sham intervention, that the treated group had fewer acute exacerbations, significant improvements in lung function and asthma control by standard questionnaires, as well as more symptom-free days and less use of rescue medication.
The present study reports the safety of the same patients 4 years later and 5 years after the procedure. The rate of adverse events, which included healthcare utilization and hospitalization, was low and remained consistent from years 2 through 5, indicating no rebound of asthma severity. Lung function improvements were also maintained. Thomson and colleagues conclude that these results support the long-term safety of the procedure out to 5 years.
Viewpoint
Patients whose asthma cannot be controlled by current guidelines, although thankfully rare, present a real problem, so any new option that provides benefit is welcome. Bronchial thermoplasty is, of course, invasive and still relatively new. Controlled studies such as the present one, however, indicate that the condition can be ameliorated and that the benefit is maintained without safety concerns for at least 5 years. It must be stressed that the major reason for treatment failure in asthma is poor compliance, namely failure to take or maintain important components of asthma care, particularly appropriate anti-inflammatory medication. Bronchial thermoplasty should not be considered an alternative to standard therapy; rather, it complements standard therapy. So before considering whether to refer the patient for bronchial thermoplasty, every effort should be made to optimize usual treatment for severe asthma according to current guidelines.
Abstract
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