Usefulness of Computed Tomography for Evaluating the Effects of Bronchial Thermoplasty in Japanese Patients with Severe Asthma

Abstract

Background

Bronchial thermoplasty (BT) improves clinical outcomes and quality of life for patients with severe asthma and has shown sustained reductions in airway narrowing and air trapping in previous CT studies. However, there is a lack of a comprehensive analysis, including CT evaluation, of clinical outcomes in Japanese patients who have undergone BT for severe asthma. This study aimed to evaluate the impact of BT in Japanese asthma patients, with a focus on the CT metric “WA at Pi10” to assess airway disease.

Methods

Twelve patients with severe persistent asthma who underwent BT were assessed using ACQ6, AQLQ, pulmonary function tests, FeNO measurement, blood sampling, and chest CT before BT and one year after the third procedure for the upper lobes.

Results

The median age of the patient was 62.0 years, 7/12 (58.3%) were male, 4/12 (33.3%) used regular oral corticosteroids, and 8/12 (66.7%) received biologics. Median FEV₁% was 73.6%, and median peripheral eosinophil count was 163.8/μL. After one year of BT, ACQ6 scores improved from 2.4 to 0.8 points (p = 0.007), and AQLQ scores improved from 4.3 to 5.8 points (p < 0.001). Significant improvements were also observed in asthma exacerbations, unscheduled visits due to exacerbations, FeNO, and √WA at Pi10 (p < 0.05). The baseline mucus score on the CT findings was negatively correlated with FEV₁ (r = −0.688, p = 0.013) and with the maximum mid-expiratory flow rate (r = −0.631, p = 0.028), and positively correlated with the peripheral blood eosinophil count (r = −0.719, p = 0.008). Changes in √WA at Pi10 after one year were positively correlated with changes in the mucus score (r = 0.742, p = 0.007).

Conclusion

This study has limitations, including its single-arm observational design and the small sample size. However, BT led to a symptomatic improvement in patients with severe asthma. The validated “√WA at Pi10” metric on CT effectively evaluated the therapeutic response in Japanese asthma patients after BT.

Keywords:

• asthma
• bronchial thermoplasty
• chest computed tomography
• asthma control questionnaire
• √WA at Pi10

Abbreviations

ACT, asthma control questionnaire; ACQ, asthma control questionnaire; AQLQ, asthma quality of life questionnaire; BT, bronchial thermoplasty; FeNO, fractional exhaled nitric oxide; FP, fluticasone propionate; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 s; FEV₁%, forced expiratory volume in 1 s/forced vital capacity; ICS, inhaled corticosteroid; MIP, macrophage inflammatory protein; MMF, maximum mid-expiratory flow rate; OCS, oral corticosteroids; PEFR, peak expiratory flow rate; RANTES, regulated on activation, normal T cell expressed and secreted; SD, standard deviation; √WA at Pi10, square root of airway wall area of the theoretical airway with an internal perimeter of 10 mm.

Acknowledgments

The authors would like to thank FORTE Science Communications (https://www.forte-science.co.jp/) for English language editing.

Disclosure

NH reports personal fees from AstraZeneca, GlaxoSmithKline, Kyorin, Novartis, and Sanofi; and grants from AstraZeneca, Daikin, and TOSOH, outside of the submitted work. KTa reports grants and personal fees from Chugai Pharmaceutical Co., Ltd.; and grants from Nippon Boehringer Ingelheim Co., Ltd., Bristol-Myers K.K., Eli Lilly Japan K.K., KYORIN Pharmaceutical Co., Ltd., MSD K.K., ONO PHARMACEUTICAL CO., LTD., Sanofi K.K., TEIJIN PHARMA LIMITED, and TAIHO PHARMACEUTICAL CO., LTD.; and personal fees from AstraZeneca, outside of the submitted work. All other authors declare that they have no conflicts of interest.