Bronchial thermoplasty and the role of airway smooth muscle: are we on the right direction?

Figures & data

Table 1 History of bronchial thermoplasty: major studies since 2006

Study	Study population	Study design	Results
Cox et al^Citation21	16 patients with mild-to-moderate stable asthma	Non-randomized, prospective study	Significant reduction in airway hyperresponsiveness and increase of symptoms-free days. No changes in FEV1
Cox et al^Citation22	112 patients with moderate-to-severe asthma	Randomized, controlled trial	Improvements of asthma symptoms, symptom-free days, and AQLQ and ACQ scores, and reduction in mild exacerbations. No changes in FEV1 and bronchial hyperreactivity
Pavord et al^Citation23	32 patients with severe uncontrolled asthma	Randomized, double- blind, parallel-group trial	Significant improvement in FEV1 and ACQ scores. Limitation: effective placebo
Castro et al^Citation24	288 patients with severe, uncontrolled asthma	Randomized, double- blind, controlled, multicenter-based trial	Increase of AQLQ score, and reduction of rate of exacerbations, emergency hospital visits, and lost working days
Thomson et al^Citation25	69 patients enrolled in the AIR trial	Long-term follow-up study	Significant reduction in airway hyperreactivity and stability of FEV1. No radiological changes
Pavord et al^Citation26	14 patients enrolled in RISA trial	Long-term follow-up study	Significant decrease of emergency hospital admissions. No changes of FEV1 value
Wechsler et al^Citation27	160 patients enrolled in AIR-2 trial	Long-term follow-up study	Significant decrease of emergency hospital admissions

Abbreviations: FEV₁, forced expiratory volume in one second; AQLQ, Asthma Quality of Life Questionnaire; ACQ, Asthma Control Questionnaire; AIR, Asthma Intervention Research; RISA, Research in Severe Asthma.

Table 2 Patient selection criteria for the use of bronchial thermoplasty

Inclusion criteria	Exclusion criteria
Adults with diagnosis of asthma for more than 24 months according to the Global Initiative for Asthma (GINA) 2016 Global Management and Prevention Guidelines^Citation51	Patients with history of acute life-threatening asthma exacerbations
Patients with two exacerbations within one year before bronchial thermoplasty, or on oral corticosteroids or needing hospitalization or emergency medical care	Use of beta-blocker drugs
Pre-bronchodilator FEV1 ≥60% of predicted	Pacemaker, internal defibrillator, or other implanted electronic devices
Patients unresponsive to biological therapy	Known sensitivity to medications used for bronchoscopy, including lidocaine, atropine, and benzodiazepines
Patients unwilling to undergo a life-long biological therapy	Pregnant women

Abbreviation: FEV₁, forced expiratory volume in one second.

CoxGMillerJDMcWilliamsAFitzgeraldJMLamSBronchial thermoplasty for asthmaAm J Respir Crit Care Med2006173996596916456145

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CoxGThomsonNCRubinASAIR Trial Study GroupAsthma control during the year after bronchial thermoplastyN Engl J Med2007356131327133717392302

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PavordIDCoxGThomsonNCRISA Trial Study GroupSafety and efficacy of bronchial thermoplasty in symptomatic, severe asthmaAm J Respir Crit Care Med2007176121185119117901415

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CastroMRubinASLavioletteMAIR2 Trial Study GroupEffectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trialAm J Respir Crit Care Med2010181211612419815809

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ThomsonNCRubinASNivenRMAIR Trial Study GroupLong-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trialBMC Pulm Med201111821314924

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PavordIDThomsonNCNivenRMResearch in Severe Asthma Trial Study GroupSafety of bronchial thermoplasty in patients with severe refractory asthmaAnn Allergy Asthma Immunol2013111540240724125149

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WechslerMELavioletteMRubinASAsthma Intervention Research 2 Trial Study GroupBronchial thermoplasty: long-term safety and effectiveness in patients with severe persistent asthmaJ Allergy Clin Immunol201313261295130223998657

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Global Initiative for Asthma (GINA)2016Global Management and Prevention Guidelines Available from: http://ginasthma.org/wp-content/uploads/2016/04/GINA-2016-main-report_tracked.pdfAccessed April 30, 2017

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