Journal of Asthma and Allergy (Apr 2024)
Bronchial Thermoplasty Improves Ventilation Heterogeneity Measured by Functional Respiratory Imaging in Severe Asthma
Abstract
Chuan T Foo,1,2 Graham M Donovan,3 Francis Thien,1,2 David Langton,2,4 Peter B Noble5 1Department of Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia; 2Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; 3Department of Mathematics, University of Auckland, Auckland, New Zealand; 4Department of Thoracic Medicine, Peninsula Health, Frankston, VIC, Australia; 5School of Human Sciences, The University of Western Australia, Crawley, WA, AustraliaCorrespondence: Chuan T Foo, Department of Respiratory Medicine, Eastern Health, Melbourne, Victoria, Australia, Tel +613 9095 2414, Email [email protected]: Bronchial thermoplasty (BT) is a bronchoscopic intervention for the treatment of severe asthma. Despite demonstrated symptomatic benefit, the underlying mechanisms by which this is achieved remain uncertain. We hypothesize that the effects of BT are driven by improvements in ventilation heterogeneity as assessed using functional respiratory imaging (FRI).Patient and Methods: Eighteen consecutive patients with severe asthma who underwent clinically indicated BT were recruited. Patients were assessed at baseline, 4-week after treatment of the left lung, and 12-month after treatment of the right lung. Data collected included short-acting beta-agonist (SABA) and oral prednisolone (OCS) use, asthma control questionnaire (ACQ-5) and exacerbation history. Patients also underwent lung function tests and chest computed tomography. Ventilation parameters including interquartile distance (IQD; measure of ventilation heterogeneity) were derived using FRI.Results: 12 months after BT, significant improvements were seen in SABA and OCS use, ACQ-5, and number of OCS-requiring exacerbations. Apart from pre-bronchodilator FEV1, no other significant changes were observed in lung function. Ventilation heterogeneity significantly improved after treatment of the left lung (0.18 ± 0.04 vs 0.20 ± 0.04, p=0.045), with treatment effect persisting up to 12 months later (0.18 ± 0.05 vs 0.20 ± 0.04, p=0.028). Ventilation heterogeneity also improved after treatment of the right lung, although this did not reach statistical significance (0.18 ± 0.05 vs 0.19 ± 0.04, p=0.06).Conclusion: Clinical benefits after BT are accompanied by improvements in ventilation heterogeneity, advancing our understanding of its mechanism of action. Beyond BT, FRI has the potential to be expanded into other clinical applications.Keywords: asthma, computed tomography, computational fluid dynamics, imaging, mechanism of action, pathophysiology
