Lung India (Jan 2020)

Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society

  • Karan Madan,
  • Saurabh Mittal,
  • Tejas M Suri,
  • Avinash Jain,
  • Anant Mohan,
  • Vijay Hadda,
  • Pavan Tiwari,
  • Randeep Guleria,
  • Deepak Talwar,
  • Sudhir Chaudhri,
  • Virendra Singh,
  • Rajesh Swarnakar,
  • Sachidanand J Bharti,
  • Rakesh Garg,
  • Nishkarsh Gupta,
  • Vinod Kumar,
  • Ritesh Agarwal,
  • Ashutosh N Aggarwal,
  • Irfan I Ayub,
  • Prashant N Chhajed,
  • Amit Dhamija,
  • Raja Dhar,
  • Sahajal Dhooria,
  • Hari K Gonuguntla,
  • Rajiv Goyal,
  • Parvaiz A Koul,
  • Raj Kumar,
  • Nagarjuna Maturu,
  • Ravindra M Mehta,
  • Ujjwal Parakh,
  • Vallandaramam Pattabhiraman,
  • Narasimhan Raghupathi,
  • Inderpaul Singh Sehgal,
  • Arjun Srinivasan,
  • Kavitha Venkatnarayan

DOI
https://doi.org/10.4103/lungindia.lungindia_418_19
Journal volume & issue
Vol. 37, no. 1
pp. 86 – 96

Abstract

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Bronchial thermoplasty (BT) is an interventional bronchoscopic treatment for severe asthma. There is a need to define patient selection criteria to guide clinicians in offering the appropriate treatment options to patients with severe asthma. Methodology: An expert group formed this statement under the aegis of the Indian Chest Society. We performed a systematic search of the MEDLINE and EMBASE databases to extract evidence on patient selection and the technical performance of BT. Results: The experts agreed that the appropriate selection of patients is crucial and proposed identification of the asthma phenotype, a screening algorithm, and inclusion/exclusion criteria for BT. In the presence of atypical clinical or chest radiograph features, there should be a low threshold for obtaining a thoracic computed tomography scan before BT. The patient should not have had an asthma exacerbation in the preceding two weeks from the day of the procedure. A 5-day course of glucocorticoid should be administered, beginning three days before the procedure day, and continued until the day following the procedure. General Anesthesia (total intravenous anesthesia with a neuromuscular blocker) provides ideal conditions for performing BT. A thin bronchoscope with a 2.0 mm working channel is preferable. An attempt should be made to deliver the maximum radiofrequency activations. Middle lobe treatment is not recommended. Following the procedure, overnight observation in the hospital, and a follow-up visit, a week following each treatment session, is desirable. Conclusion: This position statement provides practical guidance regarding patient selection and the technical performance of BT for severe asthma.

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