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Bronchiale Thermoplastie

Interventionelle Therapie bei Asthma bronchiale

Bronchial thermoplasty

Interventional therapy of bronchial asthma

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Die bronchiale Thermoplastie ist eine neue Therapieoption für Patienten mit schwerem Asthma bronchiale, die trotz maximaler medikamentöser Therapie weiterhin ein unkontrolliertes Asthma aufweisen. Das Ziel dieser interventionellen Therapieoption ist es, durch kontrollierte endobronchiale Applikation von Wärme die Masse der glatten Muskulatur in den zentralen und peripheren Atemwegen zu reduzieren, um die symptomatische Bronchokonstriktion zu verringern. Eine vollständige bronchiale Thermoplastie wird aufgrund der Anzahl der zu behandelnden Atemwege in 3 Bronchoskopien aufgeteilt. In randomisierten kontrollierten klinischen Studien konnten eine Zunahme der Lebensqualität, eine Abnahme der Exazerbationen, der notfallmäßigen Arztbesuche sowie der Fehltage in der Schule oder bei der Arbeit gezeigt werden. Eine Reduktion der Hyperreagibilität oder eine Verbesserung des forcierten exspiratorischen Volumens in 1 s (FEV1) konnte nicht nachgewiesen werden. Im kurzfristigen postinterventionellen Verlauf kommt es durch die bronchiale Thermoplastie zu einer Zunahme von Exazerbationen, häufigeren respiratorischen Infekten sowie der Notwendigkeit einer stationären Behandlung. Langfristig konnte in den bisher vorliegenden Studien in bis zu 5 Jahren nach der Behandlung eine klinische und funktionelle Stabilität gezeigt werden. Weitere Studien zum Langzeitverlauf sowie zur Identifizierung eines auf das Verfahren gut ansprechenden Phänotyps sind jedoch notwendig.

Abstract

Bronchial thermoplasty is a novel treatment option for patients with severe bronchial asthma who remain symptomatic despite maximum medical therapy. The aim of this interventional therapy option is the reduction of smooth muscle in the central and peripheral airways in order to reduce symptomatic bronchoconstriction by the application of warmth. A complete treatment with bronchial thermoplasty is divided into three bronchoscopies. Randomized controlled clinical trials have shown an increase in the quality of life, a reduction in severe exacerbation, a decrease in emergency department visits as well as days lost from occupation. The trial did not show a reduction in hyperresponsiveness or an improvement in forced expiratory volume per second (FEV1). Short-term postinterventional adverse effects include an increase in exacerbation rate, increase in respiratory infections and an increase in hospitalization. In the 5-year follow-up of the studies available there was evidence of clinical and functional stability of the treated patients. Further studies are necessary to identify an asthma phenotype of patients who respond well to this treatment.

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Abbreviations

ACQ:

Asthma Control Questionnaire

AIR:

Asthma Intervention Research

AQLQ:

Asthma Quality of Life Questionnaire

ASS:

Acetylsalicylsäure

AWMF:

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

BAL:

bronchioloalveoläre Lavage

CT:

Computertomographie

FEV1 :

forciertes exspiratorisches Volumen in 1 s

ICD:

implantierter Kardioverter-Defibrillator

IgE:

Immunglobulin E

IL:

Interleukin

NSAR:

nichtsteroidale Antirheumatika

RISA:

Research in Severe Asthma

VC:

Vitalkapazität

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Kaukel, R. Eberhardt und F. Herth geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Amalienstr. 5, 69126, Heidelberg, Deutschland

    P. Kaukel, R. Eberhardt & F. Herth

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  1. P. Kaukel
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  2. R. Eberhardt
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  3. F. Herth
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Correspondence to P. Kaukel.

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Kaukel, P., Eberhardt, R. & Herth, F. Bronchiale Thermoplastie. Pneumologe 10, 426–432 (2013). https://doi.org/10.1007/s10405-013-0705-4

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