Safety and Feasibility of Bronchial Thermoplasty in Asthma Patients with Very Severe Fixed Airflow Obstruction: A Case Series

Abstract

Objective. Bronchial thermoplasty (BT) can provide relief for patients with severe, uncontrolled asthma despite maximal medical therapy. However, it is unclear whether BT is safe in patients with very severe airflow obstruction. Methods. We performed BT in eight patients with severe asthma as defined by Expert Panel Report 3 (EPR-3) guidelines who were poorly controlled despite step 5 therapy. Data were available on each subject for 1 year prior to and 15–72 weeks following BT. Results. The mean (±SEM) pre-bronchodilator forced expiratory volume in one second (FEV₁) prior to BT was 51.8 ± 8.6% of predicted, and the mean (±SEM) number of hospitalizations for asthma in the year prior to BT was 2.9 ± 1.2. No subject had an unexpected severe adverse event due to BT. Among the eight patients with follow-up of at least 15 weeks, there was no significant decline in FEV₁ (p = .4). Conclusion. We suggest that BT may be safe for asthma patients with severe airflow obstruction and higher hospitalization rates than previously reported.

• airway smooth muscle
• persistent airflow obstruction
• poorly controlled asthma
• radiofrequency ablation
• refractory asthma