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Schweres Asthma: Interventionelle Therapieoptionen?

Severe asthma: interventional treatment options?

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Zusammenfassung

Die bronchiale Thermoplastie ist eine seit 2011 zugelassene Therapieoption für Patienten mit schwerem Asthma bronchiale, die trotz maximal ausgeschöpfter medikamentöser Therapie weiterhin ein unkontrolliertes Asthma aufweisen. Ziel dieser interventionellen Therapie ist es, durch kontrollierte endobronchiale Applikation von Wärme die Masse der glatten Muskulatur in den zentralen und peripheren Atemwegen zu reduzieren, um die Symptome verursachende Bronchokonstriktion zu verringern. In randomisierten kontrollierten klinischen Studien konnten eine Abnahme der Exazerbationen, eine Zunahme der Lebensqualität, eine Reduktion der notfallmäßigen Arztbesuche sowie der Fehltage in der Schule oder bei der Arbeit gezeigt 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, funktionelle und radiologische Stabilität gezeigt werden. Weitere Studien zum Langzeitverlauf sowie zur genaueren Identifizierung eines auf das Verfahren gut ansprechenden Phänotyps sind notwendig.

Abstract

Since 2011 bronchial thermoplasty has been an approved treatment option for patients with severe bronchial asthma who remain symptomatic despite maximum pharmaceutical therapy. The aim of this interventional therapy option is the controlled reduction of smooth muscle in the central and peripheral airways in order to reduce symptomatic bronchoconstriction via the application of warmth. Randomized controlled clinical trials showed an increase in the quality of life, a decrease in emergency department visits as well as days lost from school or work and a reduction in severe exacerbations. Short-term adverse effects include an increase in exacerbation rates, increase in hospitalizations and an increase in respiratory infections. In the 5‑year follow-up of the long-term studies available there was evidence of clinical, functional and radiological stability of the treated patients. Further studies are necessary to identify an asthma phenotype which responds 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:

Bronchoalveoläre Lavage

BRSK:

Bronchoskopie

COPD:

Chronisch obstruktive Lungenerkrankung

CT:

Computertomographie

FEV1:

Exspiratorische Einsekundenkapazität („forced expiratory volume in 1 second“)

ICD:

Implantierter Kardioverterdefibrillator

IgE:

Immunglobulin E

IL:

Interleukin

NSAR:

Nichtsteroidale Antirheumatika

OCT:

Optical coherence tomography

PAS2:

Post-FDA approval clinical trial evaluation bronchial thermoplasty in severe persistent asthma

RANTES:

Regulated upon activation, normal T‑cell expressed and secreted

RISA:

Research in severe asthma

TGF-ß:

Transformin-growth-factor-ß

VC:

Vitalkapazität

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Authors and Affiliations

  1. Abteilung Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland

    P. Kaukel

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P. Kaukel gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Rolke, Aschaffenburg

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Kaukel, P. Schweres Asthma: Interventionelle Therapieoptionen?. Pneumologe 15, 183–188 (2018). https://doi.org/10.1007/s10405-018-0168-8

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