What is included in the long-term monitoring following bronchial thermoplasty (BT) to treat asthma?

Updated: Mar 30, 2021
  • Author: Said A Chaaban, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Because asthma is a heterogeneous disease with different phenotypes, not all patients with severe asthma will respond to BT. Biopsies, pulmonary function tests (PFTs), exhaled nitric oxide, and sputum eosinophils have been studied as markers to evaluate for treatment response; however, those markers cannot provide information regarding remodeling happening at the airway level.

Computed tomography (CT) of the chest and magnetic resonance imaging (MRI) of the chest with inhaled contrast would enable indirect evaluation of the airway. Optical coherence tomography (OCT) is a minimally invasive imaging technique that offers the benefit of visualizing airway remodeling. This modality was assessed for the selection process of BT in a pilot study performed on two patients, which concluded that a larger study was required to determine whether OCT can help select asthma patients who will benefit from BT and to evaluate long-term effects of BT. [39]

OCT may be considered as an effective screening tool for BT. The TASMA trial, a large multicenter, randomized, international trial, is investigating BT patients by OCT next to airway biopsies and radiographic imaging to evaluate for the immediate and late effects of this treatment on airway smooth muscle (ASM). [40, 41]

Helium MRI and multidetector CT have been validated for the quantification of regional pulmonary ventilation at the segmental level. The importance of those imaging studies is that they allow assessment of regional structure-function relations. This would help in the pretreatment and posttreatment assessments for BT. [42] Ventilation defects are increased in the pretreatment but get better in the posttreatment period. [43]

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