Bronchial Thermoplasty Effective for Severe Persistent Asthma

September 17, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Sep 17 - Bronchial thermoplasty has lasting benefits for patients with severe persistent asthma, according to long-term results from the Asthma Intervention Research 2 (AIR2) trial.

The procedure uses mild heat to destroy smooth muscle tissue in the airways, reducing constriction during attacks.

"Bronchial thermoplasty (BT) treatments safely provide asthma control and reduction in severe exacerbations and emergency room visits out to at least 5 years," Dr. Michael E. Wechsler from National Jewish Health in Denver, Colorado, told Reuters Health by email. "BT is an important option for patients with severe asthma who remain symptomatic despite taking current standard of care medications."

The new study was supported by Boston Scientific Corporation, which markets a system to deliver BT, and was published online September 3 in the Journal of Allergy and Clinical Immunology.

About one in 20 patients with asthma have severe persistent asthma with symptoms despite current state-of-the-art medications. In these patients, AIR2 showed a 32% reduction in severe exacerbations, an 84% reduction in emergency department visits for respiratory symptoms, a 73% reduction in hospitalizations for respiratory symptoms, and a 66% reduction in time lost from work/school/other daily activities because of asthma symptoms.

In the latest report, Dr. Wechsler and colleagues describe the long-term safety and durability of BT in 162 of 190 patients from the AIR2 trial.

The reduction in the proportion of patients experiencing severe exacerbations was maintained for the entire five-year follow-up period, with an average decrease of 44%, according to the report.

The reduction in patients having emergency department visits for respiratory symptoms was 78% over the five years. The proportion of patients experiencing any respiratory adverse events, asthma adverse events, and hospitalizations for respiratory symptoms did not increase over the five years of follow-up.

Lung function remained consistent over the study, with increases in percent predicted FEV1 of 8.2% at baseline and 5.9% at five years.

Patients were able to reduce their average dose of inhaled corticosteroids by 18% at five years; 12% were completely weaned off long-acting beta2-agonists, and 7% were no longer taking any maintenance asthma medications.

At the end of follow-up, high-resolution CT showed no significant changes in 71% of patients. Similar proportions of patients showed improvements (14%) and deteriorations (15%), mostly as changes in gas trapping, bronchial wall thickening, or consolidation.

"A single BT treatment comprising 3 procedures provides long-term benefit to at least 5 years," the authors conclude. "Whether BT is a disease-modifying therapy will depend on the results of future appropriately designed clinical studies."

"BT is now one option for this kind of patient," Dr. Wechsler said. "Approved by FDA and with 5-yr data available, it should be incorporated in guidelines as an option."

"It is primarily used in major academic medical centers and in asthma centers," he added, noting that the procedure's popularity is growing.


J Allergy Clin Immunol 2013.


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