Bronchial Thermoplasty Benefits Asthma Sufferers Long Term

PHILADELPHIA, Pennsylvania — The heat is on for patients with asthma, and the news is good. Bronchial thermoplasty gives long-lasting relief after just a few treatments.

Results from the AIR2 pivotal trial show efficacy lasting up to 5 years, and new research suggests that an increasing number of patients will likely benefit from therapy.

Investigators presenting here at the American Thoracic Society 2013 International Conference say that one third of patients at the Severe and Brittle Asthma Unit at Birmingham Heartlands Hospital in the United Kingdom were good candidates for therapy.

The treatment uses a catheter tipped with a wire probe to deliver thermal energy to the airway wall to reduce the mass of airway smooth muscle.

It "reduced the need for reliever medication and led to better overall symptoms," Adel Mansur, MD, a consultant physician and honorary senior lecturer at Birmingham Heartlands, told Medscape Medical News. He also reported a pattern of reduction in the exacerbation rate.

The research team, led by Sushil Agarwal, MD, reviewed the clinical profiles of patients who had attended the asthma unit at the hospital and had at least 1 year of follow-up by a multidisciplinary team.

The Severe and Brittle Asthma Unit has developed its own criteria for suitable candidates. Previous trials of bronchial thermoplasty have used similar but slightly different selection criteria. Of 136 patients in this study, 34% were eligible for the therapy.

Table. Candidates Suitable for Bronchial Thermoplasty

Inclusion Criteria	Parameter
Age	>18 years
Prebronchodilator FEV₁	≥50%
Bronchial provocation test	Positive
	Reversible
	Unknown from specialist clinic
Asthma control	Stable control >6 weeks
	Uncontrolled symptoms
	High-dose inhaled corticosteroids
	Long-acting beta-agonists
Smoking status	Nonsmoker
	Exsmoker ≥1 year; <10 pack-years
Exclusion Criteria
Asthma	Life-threatening disease
	3 or more lower respiratory tract infections
Other pulmonary diagnosis	Bronchiectasis
Other nonpulmonary reasons	Clotting abnormalities
	Electronic device such as pacemaker
	Sensitivities to medications used in bronchoscopy

The mean dose of inhaled corticosteroids was equivalent to 2300 μg beclomethasone dipropionate; 41% of the patients received maintenance oral corticosteroids.

Five patients had at least 1 admission to the high dependency unit or intensive therapy unit of the hospital, and nearly half had at least 1 admission to the hospital. Ten started on omalizumab.

The investigators concluded that a significant proportion of patients with difficult-to-treat asthma could be candidates for bronchial thermoplasty, which would potentially reduce maintenance treatment.

Dr. Mansur pointed out that the AIR2 trial showed a "70% improvement in asthma control, including exacerbation reductions," and success was expected in about two thirds of treated patients. Although there are 5-year data from clinical trials, he advised that there is still a need "to see if the expected benefit will be realized in real life."

The asthma center at Birmingham Heartlands is a "very respected and very busy center in the United Kingdom," said Christine Bucknall, MD, from the Glasgow Royal Infirmary in the United Kingdom, who was asked by Medscape Medical News to comment on the study.

She noted that bronchial thermoplasty is not without risks, particularly exacerbations and hospitalizations immediately after the procedures. Once patients get past this period, "they've shown good benefits," she noted. "This is now accepted good practice.... It's quite expensive, but it's not as expensive as omalizumab.... Once you've got them through that treatment, they have the benefit and you don't have to keep treating them."

When asked about the long-terms risks, Dr. Bucknall cited early safety work in humans and in dogs, which showed "no increase in bronchiectasis or increase in infections."

This study received no commercial funding. Dr. Mansur and Dr. Bucknall have disclosed no relevant financial relationships.

American Thoracic Society (ATS) 2013 International Conference: Abstract A1271. Presented May 19, 2013.

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