Skip to main content

Advertisement

SpringerLink
Log in

Role of Bronchoscopy in the Diagnosis and Treatment of Severe Asthma

  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Abstract

Purpose of Review

Severe asthma can be difficult to manage. While not always indicated, bronchoscopy has a role in the diagnosis and management of asthma, particularly in ruling out other differential diagnoses. Additionally, the emergence of biologic therapies has changed the landscape for treating severe asthma, but bronchoscopic techniques such as bronchial thermoplasty (BT) may also play a role.

Recent Findings

More data has emerged regarding the longevity and efficacy of BT as well as in identifying ideal candidates. Other bronchoscopic techniques may also be useful in treating patients with severe asthma but more studies are needed.

Summary

This review focuses on the use of bronchoscopy to aid in diagnosis and treatment of asthma with a focus on bronchial thermoplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Most Recent National Asthma Data | CDC. Published May 26, 2022. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm Accessed October 8 2022.

  2. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2022. Available from: www.ginaasthma.org. https://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf. Accessed October 8 2022. This article reviews the current Asthma guidelines.

  3. Brusselle GG, Koppelman GH. Biologic therapies for severe asthma. Taichman DB, ed. N Engl J Med. 2022;386(2):157–171. https://doi.org/10.1056/NEJMra2032506

  4. Hashmi MD, Khan A, Shafiq M. Bronchial thermoplasty: state of the art. Respirology. 2022;27(9):720–9. https://doi.org/10.1111/resp.14312. This is a comprehensive,up-to-date review of bronchial thermoplasty.

    Article  PubMed  Google Scholar 

  5. Slebos DJ, Klooster K, Koegelenberg CFN, et al. Targeted lung denervation for moderate to severe COPD: a pilot study. Thorax. 2015;70(5):411–9. https://doi.org/10.1136/thoraxjnl-2014-206146.

    Article  PubMed  Google Scholar 

  6. Gibeon D, Zhu J, Sogbesan A, et al. Lipid-laden bronchoalveolar macrophages in asthma and chronic cough. Respir Med. 2014;108(1):71–7. https://doi.org/10.1016/j.rmed.2013.10.005.

    Article  CAS  PubMed  Google Scholar 

  7. Good JT, Kolakowski CA, Groshong SD, Murphy JR, Martin RJ. Refractory asthma. Chest. 2012;141(3):599–606. https://doi.org/10.1378/chest.11-0741.

    Article  PubMed  Google Scholar 

  8. Ichikawa T, Panariti A, Audusseau S, et al. Effect of bronchial thermoplasty on structural changes and inflammatory mediators in the airways of subjects with severe asthma. Respir Med. 2019;150:165–72. https://doi.org/10.1016/j.rmed.2019.03.005.

    Article  PubMed  Google Scholar 

  9. Miller JD, Cox G, Vincic L, Lombard CM, Loomas BE, Danek CJ. A prospective feasibility study of bronchial thermoplasty in the human airway. Chest. 2005;127(6):1999–2006. https://doi.org/10.1378/chest.127.6.1999.

    Article  PubMed  Google Scholar 

  10. Cox G, Thomson NC, Rubin AS, et al. Asthma control during the year after bronchial thermoplasty. N Engl J Med. 2007;356(13):1327–37. https://doi.org/10.1056/NEJMoa064707.

    Article  CAS  PubMed  Google Scholar 

  11. Pavord ID, Cox G, Thomson NC, et al. Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med. 2007;176(12):1185–91. https://doi.org/10.1164/rccm.200704-571OC.

    Article  CAS  PubMed  Google Scholar 

  12. Castro M, Rubin AS, Laviolette M, et al. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med. 2010;181(2):116–24. https://doi.org/10.1164/rccm.200903-0354OC.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wechsler ME, Laviolette M, Rubin AS, et al. Bronchial thermoplasty: long-term safety and effectiveness in patients with severe persistent asthma. J Allergy Clin Immunol. 2013;132(6):1295-1302.e3. https://doi.org/10.1016/j.jaci.2013.08.009.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chupp G, Laviolette M, Cohn L, et al. Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies. Eur Respir J. 2017;50(2):1700017. https://doi.org/10.1183/13993003.00017-2017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Chupp G, Kline JN, Khatri SB, et al. Bronchial thermoplasty in patients with severe asthma at 5 years. Chest. 2022;161(3):614–28. https://doi.org/10.1016/j.chest.2021.10.044.

    Article  PubMed  Google Scholar 

  16. Chaudhuri R, Rubin A, Sumino K, et al. Safety and effectiveness of bronchial thermoplasty after 10 years in patients with persistent asthma (BT10+): a follow-up of three randomised controlled trials. Lancet Respir Med. 2021;9(5):457–66. https://doi.org/10.1016/S2213-2600(20)30408-2. This the first study to followup patients>5 years after bronchial thermoplasty.

    Article  PubMed  Google Scholar 

  17. Goorsenberg AWM, d’Hooghe JNS, Srikanthan K, et al. Bronchial thermoplasty induced airway smooth muscle reduction and clinical response in severe asthma The TASMA Randomized Trial. Am J Respir Crit Care Med. 2021;203(2):175–84. https://doi.org/10.1164/rccm.201911-2298OC.

    Article  CAS  PubMed  Google Scholar 

  18. Ladjemi MZ, Di Candia L, Heddebaut N, et al. Clinical and histopathologic predictors of therapeutic response to bronchial thermoplasty in severe refractory asthma. J Allergy Clin Immunol. 2021;148(5):1227-1235.e6. https://doi.org/10.1016/j.jaci.2020.12.642.

    Article  CAS  PubMed  Google Scholar 

  19. Langton D, Wang W, Thien F, Plummer V. The acute effects of bronchial thermoplasty on FEV1. Respir Med. 2018;137:147–51. https://doi.org/10.1016/j.rmed.2018.03.003.

    Article  PubMed  Google Scholar 

  20. Langton D, Ing A, Fielding D, et al. Safety and effectiveness of bronchial thermoplasty when FEV1 is less than 50%. Chest. 2020;157(3):509–15. https://doi.org/10.1016/j.chest.2019.08.2193.

    Article  PubMed  Google Scholar 

  21. Cangelosi MJ, Ortendahl JD, Meckley LM, et al. Cost–effectiveness of bronchial thermoplasty in commercially-insured patients with poorly controlled, severe, persistent asthma. Expert Rev Pharmacoecon Outcomes Res. 2015;15(2):357–64. https://doi.org/10.1586/14737167.2015.978292.

    Article  PubMed  Google Scholar 

  22. Nguyen HV, Bose S, Mital S, et al. Is bronchial thermoplasty cost-effective as treatment for problematic asthma patients? Singapore’s perspective on a global model: is bronchial thermoplasty cost-effective. Respirology. 2017;22(6):1102–9. https://doi.org/10.1111/resp.13027.

    Article  PubMed  Google Scholar 

  23. Zafari Z, Sadatsafavi M, Marra CA, Chen W, FitzGerald JM. Cost-effectiveness of bronchial thermoplasty, omalizumab, and standard therapy for moderate-to-severe allergic asthma. Feenstra TL, ed. PLOS ONE. 2016;11(1):e0146003. https://doi.org/10.1371/journal.pone.0146003

  24. Perotin JM, Dewolf M, Launois C, Dormoy V, Deslee G. Bronchoscopic management of asthma. COPD and emphysema Eur Respir Rev. 2021;30(159):200029. https://doi.org/10.1183/16000617.0029-2020.

    Article  PubMed  Google Scholar 

  25. Valipour A, Shah PL, Pison C, et al. Safety and dose study of targeted lung denervation in moderate/severe COPD patients. Respiration. 2019;98(4):329–39. https://doi.org/10.1159/000500463.

    Article  PubMed  Google Scholar 

  26. Pison C, Shah PL, Slebos DJ, et al. Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes. Respir Res. 2021;22(1):62. https://doi.org/10.1186/s12931-021-01664-5.

    Article  CAS  PubMed  Google Scholar 

  27. Slebos DJ, Shah PL, Herth FJF, et al. Safety and adverse events after targeted lung denervation for symptomatic moderate to severe chronic obstructive pulmonary disease (AIRFLOW) A multicenter randomized controlled clinical trial. Am J Respir Crit Care Med. 2019;200(12):1477–86. https://doi.org/10.1164/rccm.201903-0624OC.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Valipour A, Shah PL, Herth FJ, et al. Two-year outcomes for the double-blind, randomized, sham-controlled study of targeted lung denervation in patients with moderate to severe COPD: AIRFLOW-2. Int J Chron Obstruct Pulmon Dis. 2020;15:2807–16. https://doi.org/10.2147/COPD.S267409.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. on behalf of the AIRFLOW-3 Trial Study Group, Slebos DJ, Degano B, et al. Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira® lung denervation system in subjects with chronic obstructive pulmonary disease AIRFLOW-3. BMC Pulm Med. 2020;20(1):41. https://doi.org/10.1186/s12890-020-1058-5.

    Article  CAS  PubMed Central  Google Scholar 

  30. Hartman JE, Srikanthan K, Caneja C, et al. Bronchoscopic targeted lung denervation in patients with severe asthma: preliminary findings. Respiration. 2022;101(2):184–9. https://doi.org/10.1159/000518515.

    Article  PubMed  Google Scholar 

  31. Li X, Xie SS, Li GS, Zeng J, Duan HX, Wang CH. Effects of bronchial thermoplasty and cryoablation on airway smooth muscle. Chin Med J (Engl). 2021;134(18):2166–74. https://doi.org/10.1097/CM9.0000000000001681.

    Article  CAS  PubMed  Google Scholar 

  32. Valipour A, Fernandez-Bussy S, Ing AJ, et al. Bronchial rheoplasty for treatment of chronic bronchitis Twelve-month results from a multicenter clinical trial. Am J Respir Crit Care Med. 2020;202(5):681–9. https://doi.org/10.1164/rccm.201908-1546OC.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cramer N, Jabbour N, Tavarez MM, Taylor RS. Foreign body aspiration. In: StatPearls. StatPearls Publishing; 2022. http://www.ncbi.nlm.nih.gov/books/NBK531480/ Accessed October 9, 2022.

  34. Piccione J, Hysinger EB, Vicencio AG. Pediatric advanced diagnostic and interventional bronchoscopy. Semin Pediatr Surg. 2021;30(3):151065. https://doi.org/10.1016/j.sempedsurg.2021.151065.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of California, Los Angeles, CA, USA

    Miki Ueoka MD & Scott Oh DO

Authors
  1. Miki Ueoka MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott Oh DO
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miki Ueoka MD.

Ethics declarations

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pediatric Dermatology and Allergy.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ueoka, M., Oh, S. Role of Bronchoscopy in the Diagnosis and Treatment of Severe Asthma. Curr Treat Options Allergy 10, 106–119 (2023). https://doi.org/10.1007/s40521-023-00341-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-023-00341-w

Keywords

Search

Navigation