Beyond bronchial thermoplasty - where to now?

Area of Science:

• Pulmonary Medicine
• Respiratory Research
• Asthma Therapeutics

Background:

• Bronchial thermoplasty (BT) is nearing the end of its clinical application for asthma management.
• Significant learnings from BT's real-world use can inform the development of novel asthma therapies.
• Airway smooth muscle (ASM) remodelling remains a key target for effective asthma treatment.

Purpose of the Study:

• To review the historical context and controversies surrounding BT in asthma treatment.
• To highlight how non-traditional diagnostic methods revealed therapeutic responses missed by standard lung function tests.
• To propose future therapeutic strategies for ASM remodelling based on BT's legacy.

Main Methods:

• This is a viewpoint discussion, not a primary research study.
• Analysis of real-world data and clinical experience with bronchial thermoplasty.
• Review of diagnostic metrics and their effectiveness in assessing BT outcomes.

Main Results:

• Initial controversies regarding BT's impact on forced expiratory volume in 1 second (FEV1) are discussed.
• Underutilization of BT despite demonstrated therapeutic benefits.
• Non-standard diagnostic tools successfully identified treatment responses not captured by traditional pulmonary function tests.

Conclusions:

• The 'saga' of BT provides valuable lessons for future asthma therapies.
• Future iterations of BT, potentially in drug form, could offer greater healthcare impact.
• Treating ASM remodelling as a "treatable trait" is a promising direction for asthma management.