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Critical Review of Bronchial Thermoplasty: Where Should It Fit into Asthma Therapy?

  • ASTHMA (WJ CALHOUN AND SP PETERS, SECTION EDITORS)
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Abstract

Bronchial thermoplasty is a device-based therapy for treatment of severe refractory asthma that uses radiofrequency energy to reduce airway smooth muscle and decrease bronchoconstriction. BT improves quality of life and decreases the rate of severe exacerbations with no known major long-term complications. The effectiveness of bronchial thermoplasty persists at least 5 years after the treatment is completed. Further investigation is needed to better define the specific subpopulation of patients with severe asthma who would best benefit from this treatment.

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References

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

  1. World health organization (who). Asthma fact sheet no. 207. 2011.

  2. Akinbami LJ, Moorman JE, Bailey C, et al. Trends in asthma prevalence, health care use, and mortality in the United States. NCHS data brief. 2012;2012:1–8.

    Google Scholar 

  3. Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. The Journal of allergy and clinical immunology. 2011;127:145–52.

    Article  PubMed  Google Scholar 

  4. Smith DH, Malone DC, Lawson KA, et al. A national estimate of the economic costs of asthma. Am J Respir Crit Care Med. 1997;156:787–93.

    Article  PubMed  CAS  Google Scholar 

  5. Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. The Journal of allergy and clinical immunology. 2007;119:405–13.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cisternas MG, Blanc PD, Yen IH, et al. A comprehensive study of the direct and indirect costs of adult asthma. The Journal of allergy and clinical immunology. 2003;111:1212–8.

    Article  PubMed  Google Scholar 

  7. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2014;43:343–73.

    Article  CAS  Google Scholar 

  8. Moore WC, Meyers DA, Wenzel SE, et al. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. Am J Respir Crit Care Med. 2010;181:315–23.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brown HM, Storey G, George WH. Beclomethasone dipropionate: a new steroid aerosol for the treatment of allergic asthma. Br Med J. 1972;1:585–90.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. Greening AP, Ind PW, Northfield M, et al. Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Allen & Hanburys Limited UK Study Group. Lancet. 1994;344:219–24.

    Article  PubMed  CAS  Google Scholar 

  11. Price DB, Hernandez D, Magyar P, et al. Randomised controlled trial of montelukast plus inhaled budesonide versus double dose inhaled budesonide in adult patients with asthma. Thorax. 2003;58:211–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Israel E, Cohn J, Dube L, et al. Effect of treatment with zileuton, a 5-lipoxygenase inhibitor, in patients with asthma. A randomized controlled trial. Zileuton Clinical Trial Group. JAMA : the journal of the American Medical Association. 1996;275:931–6.

    Article  CAS  Google Scholar 

  13. Israel E, Rubin P, Kemp JP, et al. The effect of inhibition of 5-lipoxygenase by zileuton in mild-to-moderate asthma. Ann Intern Med. 1993;119:1059–66.

    Article  PubMed  CAS  Google Scholar 

  14. Berger W, De Chandt MT, Cairns CB. Zileuton: Clinical implications of 5-lipoxygenase inhibition in severe airway disease. Int J Clin Pract. 2007;61:663–76.

    Article  PubMed  CAS  Google Scholar 

  15. Busse W, Corren J, Lanier BQ, et al. Omalizumab, anti-IgE recombinant humanized monoclonal antibody, for the treatment of severe allergic asthma. The Journal of allergy and clinical immunology. 2001;108:184–90.

    Article  PubMed  CAS  Google Scholar 

  16. Humbert M, Beasley R, Ayres J, et al. Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): innovate. Allergy. 2005;60:309–16.

    Article  PubMed  CAS  Google Scholar 

  17. Garcia G, Magnan A, Chiron R, et al. A proof-of-concept, randomized, controlled trial of omalizumab in patients with severe, difficult-to-control, nonatopic asthma. Chest. 2013;144:411–9.

    Article  PubMed  CAS  Google Scholar 

  18. Wu AC, Paltiel AD, Kuntz KM, et al. Cost-effectiveness of omalizumab in adults with severe asthma: results from the Asthma Policy Model. The Journal of allergy and clinical immunology. 2007;120:1146–52.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Long AA. Monoclonal antibodies and other biologic agents in the treatment of asthma. mAbs. 2009;1:237–46.

    Article  PubMed  PubMed Central  Google Scholar 

  20. James AL, Elliot JG, Jones RL. Airway smooth muscle hypertrophy and hyperplasia in asthma. Am J Respir Crit Care Med. 2012;185:1058–64. Hyperplasia of airway smooth muscle (ASM) cells occurs in both small and large airways in fatal asthma, whereas hypertrophy occurs in ASM cells of the large airways in both fatal and non-fatal asthma.

    Article  PubMed  Google Scholar 

  21. James AL, Pare PD, Hogg JC. The mechanics of airway narrowing in asthma. The American review of respiratory disease. 1989;139:242–6.

    Article  PubMed  CAS  Google Scholar 

  22. Cohen L, Xueping E, Tarsi J. Epithelial cell proliferation contributes to airway remodeling in severe asthma. Am J Respir Crit Care Med. 2007;176:138–45.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  23. Panettieri Jr RA, Kotlikoff MI, Gerthoffer WT, et al. Airway smooth muscle in bronchial tone, inflammation, and remodeling: basic knowledge to clinical relevance. Am J Respir Crit Care Med. 2008;177:248–52.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Danek CJ, Lombard CM, Dungworth DL, et al. Reduction in airway hyperresponsiveness to methacholine by the application of RF energy in dogs. J Appl Physiol. 2004;97:1946–53.

    Article  PubMed  CAS  Google Scholar 

  25. Brown RH, Wizeman W, Danek C, et al. Effect of bronchial thermoplasty on airway distensibility. The European respiratory journal. 2005;26:277–82.

    Article  PubMed  CAS  Google Scholar 

  26. Brown RH, Wizeman W, Danek C, et al. In vivo evaluation of the effectiveness of bronchial thermoplasty with computed tomography. J Appl Physiol. 2005;98:1603–6.

    Article  PubMed  Google Scholar 

  27. Cox PG, Miller J, Mitzner W, et al. Radiofrequency ablation of airway smooth muscle for sustained treatment of asthma: preliminary investigations. The European respiratory journal. 2004;24:659–63.

    Article  PubMed  CAS  Google Scholar 

  28. Du Rand IA, Blaikley J, Booton R, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013;68(1):i1–i44.

    Article  PubMed  Google Scholar 

  29. Miller JD, Cox G, Vincic L, et al. A prospective feasibility study of bronchial thermoplasty in the human airway. Chest. 2005;127:1999–2006.

    Article  PubMed  Google Scholar 

  30. Cox G, Miller JD, McWilliams A, et al. Bronchial thermoplasty for asthma. Am J Respir Crit Care Med. 2006;173:965–9.

    Article  PubMed  Google Scholar 

  31. Cox G, Thomson NC, Rubin AS, et al. Asthma control during the year after bronchial thermoplasty. N Engl J Med. 2007;356:1327–37.

    Article  PubMed  CAS  Google Scholar 

  32. Juniper EF, O’Byrne PM, Guyatt GH, et al. Development and validation of a questionnaire to measure asthma control. The European respiratory journal. 1999;14:902–7.

    Article  PubMed  CAS  Google Scholar 

  33. Juniper EF, Guyatt GH, Epstein RS, et al. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax. 1992;47:76–83.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  34. 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;176:1185–91.

    Article  PubMed  CAS  Google Scholar 

  35. 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;181:116–24.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Juniper EF, Guyatt GH, Willan A, et al. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol. 1994;47:81–7.

    Article  PubMed  CAS  Google Scholar 

  37. Pavord ID, Thomson NC, Niven RM. Safety of bronchial thermoplasty in patients with severe refractory asthma. Annals of Allergy, Asthma & Immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2013;111:402–7. This study shows 5-year safety and efficacy data relating to subjects that underwent bronchial thermoplasty; the 5-year data also showed no deterioration in lung function.

    Article  Google Scholar 

  38. Wechsler ME, Laviolette M, Rubin AS. Bronchial thermoplasty: long-term safety and effectiveness in patients with severe persistent asthma. The Journal of allergy and clinical immunology. 2013;132:1295–302. This study concluded that 5 years after the AIR2 trial, there was a significant decrease in severe exacerbations and ED visits by bronchial thermoplasty subjects.

    Article  PubMed  Google Scholar 

  39. Grenier P, Mourey-Gerosa I, Benali K, et al. Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability. Eur Radiol. 1996;6:199–206.

    Article  PubMed  CAS  Google Scholar 

  40. Schatz M, Zeiger RS, Mosen D, et al. Asthma-specific quality of life and subsequent asthma emergency hospital care. The American journal of managed care. 2008;14:206–11.

    PubMed  Google Scholar 

  41. Global Initiative for Asthma. Global strategy for asthma management and prevention: Updated 2014. National Institutes of Health 2014.

  42. Niimi A, Matsumoto H, Amitani R, et al. Airway wall thickness in asthma assessed by computed tomography. Relation to clinical indices. Am J Respir Crit Care Med. 2000;162:1518–23.

    Article  PubMed  CAS  Google Scholar 

  43. Park SW, Park JS, Jeong SH, et al. Air trapping is a major determinant of persistent airway obstruction in asthmatics. Respir Med. 2012;106:786–93.

    Article  PubMed  Google Scholar 

  44. Sarikonda KS, Sheshadri A, Koch T et al. Predictors of bronchial thermoplasty response in patients with severe asthma. American journal of respiratory and critical care medicine 2014; A2429.

  45. Bender B, Milgrom H, Rand C. Nonadherence in asthmatic patients: is there a solution to the problem? Annals of Allergy, Asthma & Immunology : official publication of the American College of Allergy, Asthma, & Immunology. 1997;79:177–85. quiz 185–176.

    Article  CAS  Google Scholar 

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Acknowledgments

The authors wish to note sources of funding: UL1 TR00048, TL1 TR000449, and T32 HL007317-34.

Compliance with Ethics Guidelines

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Conflict of Interest

Ajay Sheshadri and Matthew McKenzie have no professional or financial interests to disclose.

Mario Castro has received grants from NIH, Boston Scientific, Amgen, Ception/Cephalon/TEVA, Genentech, Medimmune, Merck, Novartis, GSK, Sanofi Aventis, Vectura, NexBio, and Kalabios and personal fees from GSK, Genentech, IPS/Holaira, Neostem, Asthmatx/Boston Scientific, Boehringer Ingelheim, and TEVA, has stock options in Sparo, Inc, and receives royalties from Elsevier.

Human and Animal Rights and Informed Consent

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

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, Campus Box 8052, 660 S. Euclid, St. Louis, MO, 63110-1093, USA

    Ajay Sheshadri & Mario Castro

  2. St. Louis College of Pharmacy, 4588 Parkview Pl, St. Louis, MO, 63110-1093, USA

    Matthew McKenzie

Authors
  1. Ajay Sheshadri
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  2. Matthew McKenzie
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Correspondence to Mario Castro.

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This article is part of the Topical Collection on Asthma

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Sheshadri, A., McKenzie, M. & Castro, M. Critical Review of Bronchial Thermoplasty: Where Should It Fit into Asthma Therapy?. Curr Allergy Asthma Rep 14, 470 (2014). https://doi.org/10.1007/s11882-014-0470-4

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