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Asthma control during the year after bronchial thermoplasty
Gerard Cox1, Neil C Thomson, Adalberto S Rubin
1St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada. coxp@mcmaster.ca
The New England Journal of Medicine
|March 30, 2007
Summary
Bronchial thermoplasty significantly improved asthma control in patients with moderate to severe persistent asthma. This procedure reduced exacerbations and enhanced quality of life compared to the control group.
Area of Science:
- Pulmonary Medicine
- Interventional Pulmonology
- Asthma Research
Background:
- Bronchial thermoplasty is a bronchoscopic treatment designed to reduce airway smooth muscle mass and decrease bronchoconstriction.
- Persistent asthma, particularly moderate to severe cases, often presents challenges in achieving adequate symptom control with standard therapies.
Purpose of the Study:
- To evaluate the efficacy of bronchial thermoplasty in improving asthma control among patients with moderate or severe persistent asthma.
- To assess the impact of bronchial thermoplasty on exacerbation frequency, symptom burden, and quality of life.
Main Methods:
- A randomized controlled trial involving 112 subjects with impaired asthma control despite inhaled corticosteroids and long-acting beta2-adrenergic agonists (LABA).
- Participants were assigned to either bronchial thermoplasty or a control group, with assessment of outcomes during periods of LABA withdrawal at 3, 6, and 12 months.
- Primary outcome was mild exacerbation frequency; secondary outcomes included airflow, airway responsiveness, symptoms, symptom-free days, rescue medication use, and quality of life scores (AQLQ, ACQ).
Main Results:
- Bronchial thermoplasty significantly reduced the rate of mild exacerbations compared to baseline, while the control group showed no change.
- At 12 months, the bronchial thermoplasty group demonstrated significant improvements in morning peak expiratory flow, AQLQ and ACQ scores, symptom-free days, and reduced rescue medication use.
- While immediate post-treatment adverse events were more frequent in the bronchial thermoplasty group, long-term adverse events were similar between groups.
Conclusions:
- Bronchial thermoplasty is an effective treatment for improving asthma control in individuals with moderate to severe persistent asthma.
- The procedure leads to a reduction in exacerbations and an enhancement in patient-reported outcomes, including quality of life.
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