Role of bronchial thermoplasty in asthma

Abstract

Bronchial thermoplasty is a novel treatment for patients with severe asthma who continue to be symptomatic despite medical treatment.It aims at reducing smooth muscle mass in the airways by delivering controlled thermal energy to the airway walls during a series of three bronchoscopies. Randomizedtrials of bronchial thermoplasty in severe asthma have not been able to show a reduction in airway hyper responsiveness or change in FEV1 but have suggested an improvement in quality of life, as well as reduction in rate of severe exacerbation, emergency department visits and days lost from work .Strict inclusion and exclusion criteria of these trials resulted in elimination of patients with severe asthma who experienced more than three exacerbation per year. Therefore the generalizability of this treatment to the severe asthma population still needs to be determined. The short term adverse events consists primarily of airway inflammation and occasionally more severe events requiring hospitalization. Long term safety data are evolving and have shown thus far clinical and functional stability up to 5 years after bronchial thermoplasty treatment. Additional studies on bronchial thermoplasty are needed to establish accurate phenotyping of positive responders, durability of effect, long term safety.