The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Mario Castro - One of the best experts on this subject based on the ideXlab platform.
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evidence based assessment of Bronchial Thermoplasty in asthma mechanisms and outcomes
Current Pulmonology Reports, 2018Co-Authors: George Cheng, Jose Cardenasgarcia, Mario CastroAbstract:Asthma is a heterogenous, chronic respiratory disease characterized by airway inflammation, obstruction, and hyperresponsiveness that results in debilitating respiratory symptoms. Despite advances in management strategies, severe asthmatics are often not responsive to the standard management and are disproportionately impacted. Bronchial Thermoplasty offers a treatment option for this subgroup of severe asthmatics. Multiple clinical studies have examined Bronchial Thermoplasty effectiveness and safety in severe asthma. Recent post-market and translational studies have brought new insights into the mechanism of action behind Bronchial Thermoplasty. Bronchial Thermoplasty is a treatment option for severe asthmatics who are not adequately controlled on their current treatment regimen.
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Bronchial Thermoplasty: A Decade of Experience: State of the Art
The journal of allergy and clinical immunology. In practice, 2018Co-Authors: Laren Tan, D. Kyle Hogarth, Ken Y. Yoneda, Samuel Louie, Mario CastroAbstract:Bronchial Thermoplasty (BT) delivers targeted radiofrequency energy to Bronchial airway walls and results in the partial ablation of the airway smooth muscle that is responsible for bronchoconstriction. It is approved for the treatment of severe persistent asthma. Multiple, large clinical trials including a recent "real-world" study demonstrate significant improvements in asthma-related quality of life, reduction in asthma exacerbations, emergency department visits, and hospitalizations after BT that is sustained out to 5 years. In this article, we review the state of the art of BT treatment in severe persistent asthma and share a decade of BT research and clinical experience. We share our personal experience and introduce the three "I"s (identification, implementation, and intense follow-up) that we believe promote successful patient outcomes and help build a successful BT program.
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Bronchial Thermoplasty an update for the interventional pulmonologist
AME Medical Journal, 2018Co-Authors: Jose Cardenasgarcia, George Cheng, Mario CastroAbstract:Bronchial Thermoplasty (BT) for patients with severe asthma has been extensively studied in several multi-center trials supporting its short- and long-term safety and effectiveness. In this article, the authors review the rationale and mechanism of action of BT, describe the work up to correctly identify the specific patient phenotype who will benefit from BT, provide useful tips of the technical aspects of the procedure, and summarize the clinical trials that supports its effectiveness and safety.
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guiding principles for use of newer biologics and Bronchial Thermoplasty for patients with severe asthma
Annals of Allergy Asthma & Immunology, 2017Co-Authors: Michael S Blaiss, Mario Castro, Bradley E Chipps, Myron Zitt, Reynold A Panettieri, Michael B FoggsAbstract:Abstract Background Severe asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment that is based on a patient's asthma phenotype. Objective To develop a consensus on the definition of severe asthma, the role of biomarkers and phenotyping severe asthma, and the use of newer biologic therapies and Bronchial Thermoplasty to help guide practicing clinicians. Methods A roundtable meeting was convened with a panel of severe asthma experts to discuss areas in practice that are not adequately addressed by current guidelines, specifically phenotype-guided treatment. Results We describe a consensus on the definition of severe asthma, asthma phenotyping with the use of available biomarkers, and guiding principles for newer biologic therapies and Bronchial Thermoplasty. Conclusion To optimize therapy and improve outcomes such as daily symptoms, quality of life, exacerbations, and hospitalizations, a clear picture of a patient's asthma phenotype is needed to guide therapy. Determining asthma phenotypes is the foundation of precision medicine for this persistent, often difficult-to-treat disease.
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Bronchial Thermoplasty and biological therapy as targeted treatments for severe uncontrolled asthma
The Lancet Respiratory Medicine, 2016Co-Authors: Abhaya Trivedi, Mario CastroAbstract:Although a small proportion of patients with asthma have severe disease, it accounts for the majority of morbidity related to the illness. Severe asthma comprises a heterogeneous group of phenotypes. Targeted treatments for these phenotypes represent a major advancement in the management of severe asthma. Omalizumab, a monoclonal antibody to IgE, improves asthma control in patients with a predominant allergic phenotype. Monoclonal antibodies targeted to interleukin 4α and interleukin 5 have shown substantial benefit in patients with the eosinophilic asthma phenotype; so too have monoclonal antibodies targeted to interleukin 13 in patients with a type 2 allergic phenotype. Bronchial Thermoplasty, a new technique to reduce airway smooth muscle mass, improves symptoms and reduces exacerbations in patients with severe uncontrolled asthma and the chronic airflow obstruction phenotype. While awaiting comparative trials, we can now use a targeted approach with these phenotypes, guiding our treatment selection with the best evidence. This Review will focus on the latest developments in these new treatments and inform the clinician on how to select the appropriate patient for these treatments.
Robert Niven - One of the best experts on this subject based on the ideXlab platform.
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safety and effectiveness of Bronchial Thermoplasty after 10 years in patients with persistent asthma bt10 a follow up of three randomised controlled trials
The Lancet Respiratory Medicine, 2021Co-Authors: Adalberto Sperb Rubin, Robert Niven, Rekha Chaudhuri, Charlene Mcevoy, Kaharu Sumino, Jose Roberto Lapa E Silva, Salman Siddiqui, Karin Klooster, Pallav L. ShahAbstract:Summary Background Bronchial Thermoplasty is an endoscopic treatment for uncontrolled asthma. Previous randomised clinical trials have shown that Bronchial Thermoplasty reduces severe exacerbations in people with asthma. However, the long-term efficacy and safety of Bronchial Thermoplasty beyond 5 years is unknown. The BT10+ study aimed to investigate the efficacy and safety of Bronchial Thermoplasty after 10 or more years of follow-up. Methods BT10+ was an international, multicentre, follow-up study of participants who were previously enrolled in the AIR, RISA, and AIR2 trials and who had 10 or more years of follow-up since Bronchial Thermoplasty treatment. Data on patient demographics, quality of life, lung function, CT scans (AIR2 participants only), severe exacerbations, and health-care use during the previous year were collected at the BT10+ 10-year outcomes study visit. The primary effectiveness endpoint was durability of the Thermoplasty treatment effect, determined by comparing the proportion of participants who had severe exacerbations during the first and fifth years after Bronchial Thermoplasty treatment with the proportion of participants who had severe exacerbations during the 12-month period before the BT10+ visit. The primary safety endpoint was the absence of clinically significant post-treatment respiratory image changes after Bronchial Thermoplasty, defined as bronchiectasis or Bronchial stenosis as confirmed by pulmonary volumetric high-resolution CT scan at the BT10+ visit (AIR2 participants only). All analyses were done on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov , NCT03243292 . The last patient was enrolled on Dec 11, 2018. The last patient completed follow-up on Jan 10, 2019. Findings The BT10+ study enrolled 192 (45%) of the 429 participants who were enrolled in the AIR, RISA, and AIR2 trials. The BT10+ participants comprised 136 who received Bronchial Thermoplasty (52% of the 260 participants who received Bronchial Thermoplasty in the original trials), and 56 sham or control participants (33% of 169 from the original trials). 18 (32%) sham or control participants received Bronchial Thermoplasty after the previous trials concluded. The participants included in BT10+ were followed for 10·8–15·6 years (median 12·1 years) post-treatment. Baseline characteristics were similar between participants enrolled in BT10+ and those not enrolled. Participants treated with Bronchial Thermoplasty had similar proportions of severe exacerbations at the BT10+ visit (34 [25%] of 136 participants) compared with 1 year (33 [24%] of 135 participants; difference 0·6%, 95% CI −9·7 to 10·8) and 5 years (28 [22%] of 130 participants; difference 3·5%, −6·7% to 13·6) after treatment. Quality of life measurements and spirometry were similar between year 1, year 5, and the BT10+ visit. At the BT10+ study visit, pulmonary high-resolution CT scans from AIR2 participants treated with Bronchial Thermoplasty showed that 13 (13%) of 97 participants had bronchiectasis. When compared with baseline high-resolution CT scans, six (7%) of 89 participants treated with Bronchial Thermoplasty who did not have bronchiectasis at baseline had developed bronchiectasis after treatment (5 classified as mild, 1 classified as moderate). Participants treated with Bronchial Thermoplasty after the original study and participants in the sham or control group also had reductions in severe exacerbations at the BT10+ visit compared with baseline. Interpretation Our findings suggest that efficacy of Bronchial Thermoplasty is sustained for 10 years or more, with an acceptable safety profile. Therefore, Bronchial Thermoplasty is a long-acting therapeutic option for patients with asthma that remains uncontrolled despite optimised medical treatment. Funding Boston Scientific.
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european consensus meeting statement on Bronchial Thermoplasty who where how
Respiratory Medicine, 2019Co-Authors: Robert Niven, Nicola Facciolongo, Peter I Bonta, Michel Aubier, Luis Puentemaestu, Dorothy RyanAbstract:Abstract Background Bronchial Thermoplasty (BT) is a bronchoscopic treatment for severe asthma. Following research trials there remains a need to guide BT treatment in clinical practice, specifically in the fields of patient assessment, selection and positioning of BT within the range of treatment modalities, BT treatment protocols and post-BT management and follow-up. Consensus statements can bridge the gap between evidence-based medicine and real world clinical practice. Methods We performed a modified RAND consensus analysis using a baseline list of statements derived from ATS/ERS Guidelines on Severe Asthma, Cochrane review and UK commissioning guidance. A panel of 5 European BT experts, individually scored the statements and following a day of discussion, rescored a revised final list independently. Results An initial list of 132 statements, were independently scored. These were modified to 108 following group discussion. Consensus/total agreement was reached for 68 (63%) of the statements; 8 (7.4%) statements achieving total disagreement. For only 17 statements, could some form of consensus not be achieved. Conclusions The consensus document could be applied to guide BT clinical practice and used to serve as a minimum acceptable level of assessment for BT, drive the development of clinical practice protocols and help define quality indicators
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indirect comparison of Bronchial Thermoplasty versus omalizumab for uncontrolled severe asthma
Journal of Asthma, 2018Co-Authors: Robert Niven, Michael Simmonds, Michael Cangelosi, Dominic Tilden, Suzanne Cottrell, Narinder S ShargillAbstract:ABSTRACTObjective: Bronchial Thermoplasty (BT) as an add-on therapy for uncontrolled severe asthma is an alternative to biologic therapies like omalizumab (OM). We conducted an indirect treatment comparison (ITC) to appraise comparative effectiveness of BT and OM. Methods: A systematic literature review identified relevant randomized controlled trials. The ITC followed accepted methodology. Results: The ITC comprised a sham-controlled trial of BT (AIR2) and two placebo-controlled trials of OM (INNOVATE; EXTRA). Comparing the BT post-treatment period to ongoing treatment with OM, showed no significant differences in the rate ratios (RRs) for severe exacerbations (RR of BT versus OM = 0.91 [95% CI: 0.64, 1.30]; p = 0.62) or hospitalizations (RR = 0.57 [95% CI: 0.17, 1.86]; p = 0.53); emergency department visits were significantly reduced by 75% with BT (RR = 0.25 [95% CI: 0.07, 0.91]; p = 0.04); the proportions of patients with clinically meaningful response on the asthma quality-of-life questionnaire were ...
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procedural and short term safety of Bronchial Thermoplasty in clinical practice evidence from a national registry and hospital episode statistics
Journal of Asthma, 2017Co-Authors: Julie Burn, A J Sims, Kim Keltie, Hannah Patrick, Sally Welham, Liam G Heaney, Robert NivenAbstract:ABSTRACTObjective: Bronchial Thermoplasty (BT) is a novel treatment for severe asthma. Its mode of action and ideal target patient group remain poorly defined, though clinical trials provided some evidence on efficacy and safety. This study presents procedural and short-term safety evidence from routine UK clinical practice. Methods: Patient characteristics and safety outcomes (procedural complications, 30-day readmission and accident and emergency (AE 68 treated in England) were available from DAR and 203 (85 patients) from HES. 152 procedures matched (59 patients; 6 centres), and of these, 11.2% reported a pro...
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indications for the use of Bronchial Thermoplasty in severe asthma
South African Medical Journal, 2015Co-Authors: Keertan Dheda, Robert Niven, Kian Fan Chung, Michael E. Wechsler, Coenraad F N Koegelenberg, Aliasgar Esmail, Elvis M Irusen, Eric D BatemanAbstract:Approximately 5% of the ~3 million asthmatics in South Africa have severe asthma that is associated with substantial morbidity, cost, absenteeism, preventable mortality, and the requirement for costly chronic medication that may be associated with significant adverse events. There is an unmet need for alternative safer and more effective interventions for severe asthma. A recently introduced option, Bronchial Thermoplasty (BT), imparts radiofrequency-generated heat energy to the airways to cause regression of airway smooth muscle. The effectiveness of this technique has been confirmed in randomised control trials and is now endorsed by several international guidelines, including the Global Initiative for Asthma (GINA) guideline, the British Asthma Guideline, and the UK National Institute of Clinical Excellence (NICE) guideline. We recommend BT as a potential therapeutic intervention for severe uncontrolled asthma, provided that it is performed by an experienced pulmonologist at an accredited centre and done within the broader context of appropriate management of the disease by doctors experienced in treating difficult-to-control asthma.
David Langton - One of the best experts on this subject based on the ideXlab platform.
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predicting the response to Bronchial Thermoplasty
The Journal of Allergy and Clinical Immunology: In Practice, 2020Co-Authors: David Langton, Alvin J Ing, Joy Sha, Nicole Hersch, Virginia Plummer, Wei Wang, David Fielding, Francis ThienAbstract:Background Although it is established that not all patients respond to Bronchial Thermoplasty (BT), the factors that predict response/nonresponse are largely unknown. Objectives To identify baseline factors that predict clinical response. Methods The records of 77 consecutive patients entered into the Australian Bronchial Thermoplasty Registry were examined for baseline clinical characteristics, and outcomes measured at 6 and 12 months after BT, such as change in the Asthma Control Questionnaire (ACQ) score, exacerbation frequency, the requirement for short-acting beta-2 agonist (SABA) medication and oral corticosteroids, and improvement in spirometry. Results This was a cohort of patients with severe asthma: aged 57.7 ± 11.4 years, 57.1% females, 53.2% of patients taking maintenance oral steroids, 43% having been treated with an mAb, mean FEV1 of 55.8% ± 19.8% predicted. Results BT resulted in an improvement in the ACQ score from 3.2 ± 1.0 at baseline to 1.6 ± 1.1 at 6 months (P Conclusions The most severely afflicted patients had the greatest improvements in ACQ score, exacerbation frequency, and medication requirement.
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Bronchial Thermoplasty reduces airway resistance
Respiratory Research, 2020Co-Authors: David Langton, Kim Bennetts, Virginia Plummer, Peter B Noble, Francis ThienAbstract:The mechanism for symptomatic improvement after Bronchial Thermoplasty (BT) is unclear, since spirometry reveals little or no change. In this study, the effects of BT on airway resistance were examined using two independent techniques. Eighteen consecutive patients, with severe asthma (57.6 ± 14.2 years) were evaluated by spirometry and plethysmography at three time points: (i) baseline, (ii) left lung treated but right lung untreated and (iii) 6 weeks after both lungs were treated with BT. At each assessment, total and specific airway resistance (Raw, sRaw) were measured. High resolution CT scans were undertaken at the first two assessments, and measurements of lobar volume, airway volume and airway resistance were made. The Asthma Control Questionnaire (ACQ) was administered at each assessment. The baseline ACQ score was 3.5 ± 0.9, and improved progressively to 1.8 ± 1.2 (p < 0.01). At baseline, severe airflow obstruction was observed, FEV1 44.8 ± 13.7% predicted, together with gas trapping, and elevated Raw at 342 ± 173%predicted. Following BT, significant improvements in Raw and sRaw were observed, as well as a reduction in Residual Volume, increase in Vital Capacity and no change in FEV1. The change in Raw correlated with the change in ACQ (r = 0.56, p < 0.05). CT scans demonstrated reduced airway volume at baseline, which correlated with the increased Raw determined by plethysmography (p = − 0.536, p = < 0.05). Following BT, the airway volume increased in the treated lung, and this was accompanied by a significant reduction in CT-determined local airway resistance. Symptomatic improvement after BT is mediated by increased airway volume and reduced airway resistance.
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safety and effectiveness of Bronchial Thermoplasty when fev1 is less than 50
Chest, 2020Co-Authors: David Langton, Alvin J Ing, Joy Sha, Nicole Hersch, Virginia Plummer, David Fielding, Francis ThienAbstract:Background Randomized clinical trials of Bronchial Thermoplasty (BT) were conducted in patients with a baseline FEV1 greater than 50%. There is a paucity of data regarding BT in patients with more severe obstruction, and consequently these patients are often excluded from receiving BT. The purpose of this study was to compare safety and efficacy outcomes in a large cohort of patients with an FEV1 less than 50% with those of a cohort of less obstructed patients. Methods Consecutive patients with severe asthma were drawn from the Australian BT Registry. Patients were grouped into (1) those with a baseline prebronchodilator FEV1 % predicted Results More severely obstructed patients were no more likely to have experienced any adverse event. Significant improvements in Asthma Control Questionnaire score, exacerbation frequency, reliever medication use, and requirement for daily oral steroids were observed in both groups, and were of a similar degree. Conclusions This study demonstrates that BT can confidently be offered to patients with asthma with an FEV1 that is 30% to 50% of predicted without risk of more frequent or more severe adverse events, and with the expectation of the same degree of response as patients with better lung function.
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understanding the mechanism of Bronchial Thermoplasty using airway volume assessed by computed tomography
ERJ Open Research, 2019Co-Authors: David Langton, Peter B Noble, Frank Thien, Graham M DonovanAbstract:High-resolution CT assessment of airway volumes after Bronchial Thermoplasty (BT), together with model predictions regarding the efficacy and underlying mechanism of action of the treatment, combine to help to elucidate the underlying mechanism of BT http://bit.ly/2WPHY6y.
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Bronchial Thermoplasty increases airway volume measured by functional respiratory imaging
Respiratory Research, 2019Co-Authors: David Langton, Kim Bennetts, Virginia Plummer, G Sloan, Ceri Banks, Francis ThienAbstract:The purpose of this study was to use CT scanning with computational fluid dynamics to evaluate the mechanisms by which Bronchial Thermoplasty (BT) improves asthmatic symptoms. The study was conducted in a university teaching hospital, experienced in performing BT. Imaging studies were performed before, and after, BT of the left lung, and prior to treatment of the right lung, which therefore acted as a control. On each occasion, two high-resolution CT scans were performed, one at full inspiration (TLC) and the other at Functional Residual Capacity (FRC). The study protocol was offered to 10 patients, all of whom met the definition of severe asthma, despite high dose inhaled corticosteroids and dual long acting bronchodilators. Significant increases in airway luminal volume were observed on the treated side, compared with control, at both full inspiration (by 27%) and at FRC (by 17%). The ratio of distal airway volume to lung volume significantly increased on the treated side. The change in airway volume with inspiration from FRC increased by 48% on the treated side compared to 5% in the control lung, suggesting treatment increased airway distensibility. No effect was observed on airway wall thickness, nor air trapping. There was a trend towards correlation between the improvement in airway volume at TLC and improvement in symptoms. This study demonstrates that BT increases the luminal airway volume on the treated side compared to the control lung. We suggest that this is an important link between the airway smooth muscle atrophy demonstrated pathologically, and the improvement in symptoms observed clinically.
Michel Laviolette - One of the best experts on this subject based on the ideXlab platform.
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acute effects of Bronchial Thermoplasty a matter of concern or an indicator of possible benefit to small airways
European Respiratory Journal, 2017Co-Authors: Louisphilippe Boulet, Michel LavioletteAbstract:Acute effects of Bronchial Thermoplasty on small airways and lung parenchyma: good or bad? http://ow.ly/T6Uu309keuf
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Bronchial Thermoplasty in the treatment of severe adult asthma
Revue Des Maladies Respiratoires, 2015Co-Authors: Pascal Chanez, Michel Laviolette, Louisphilippe Boulet, Pierre Yves Brillet, Guy Joos, Renaud Louis, Thierry Rochat, Paola M Soccal, M AubierAbstract:Bronchial Thermoplasty is a recent endoscopic technique for the treatment of severe asthma. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based treatment, the evaluation procedure of risks and benefits is different that for pharmaceutical products; safety aspects, regulatory requirements, study design and the assessment of the magnitude of effects may all be different. The mechanism of action and optimal patient selection need to be assessed further in rigorous clinical and scientific studies. This technique is in harmony with the development of personalised medicine in the 21st century. It should be developed further in response to the numerous challenges and needs not yet met in the management of severe asthma.
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Bronchial Thermoplasty a new therapeutic option for the treatment of severe uncontrolled asthma in adults
European Respiratory Review, 2014Co-Authors: Mariechristine Dombret, Michel Laviolette, Louisphilippe Boulet, Khuder Alagha, Pierre Yves Brillet, Guy Joos, Renaud Louis, Thierry Rochat, Paola M Soccal, M AubierAbstract:Bronchial Thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk-benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study design and effect size assessment may be unfamiliar. The mechanisms of action and optimal patient selection need to be addressed in further rigorous clinical and scientific studies. Bronchial Thermoplasty fits in perfectly with the movement to expand personalised medicine in the field of chronic airway disorders. This is a device-based complimentary asthma treatment that must be supported and developed in order to meet the unmet needs of modern severe asthma management. The mechanisms of action and the type of patients that benefit from Bronchial Thermoplasty are the most important challenges for Bronchial Thermoplasty in the future.
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safety of Bronchial Thermoplasty in patients with severe refractory asthma
Annals of Allergy Asthma & Immunology, 2013Co-Authors: Ian D Pavord, Neil C. Thomson, Robert Niven, Paul A. Corris, Kian Fan Chung, Gerard Cox, Narinder S Shargill, Brian Armstrong, Michel LavioletteAbstract:Abstract Background Patients with severe refractory asthma treated with Bronchial Thermoplasty (BT), a bronchoscopic procedure that improves asthma control by reducing excess airway smooth muscle, were followed up for 5 years to evaluate long-term safety of this procedure. Objectives To assess long-term safety of BT for 5 years. Methods Patients with asthma aged 18 to 65 years requiring high-dose inhaled corticosteroids (ICSs) (>750 μg/d of fluticasone propionate or equivalent) and long-acting β 2 -agonists (LABAs) (at least 100 μg/d of salmeterol or equivalent), with or without oral prednisone (≤30 mg/d), leukotriene modifiers, theophylline, or other asthma controller medications were enrolled in the Research in Severe Asthma (RISA) Trial. Patients had a prebronchodilator forced expiratory volume in 1 second of 50% or more of predicted, demonstrated methacholine airway hyperresponsiveness, had uncontrolled symptoms despite taking maintenance medication, abstained from smoking for 1 year or greater, and had a smoking history of less than 10 pack-years. Results Fourteen patients (of the 15 who received active treatment in the RISA Trial) participated in the long-term follow-up study for 5 years. The rate of respiratory adverse events (AEs per patient per year) was 1.4, 2.4, 1.7, and 2.4, respectively, in years 2 to 5 after BT. There was a decrease in hospitalizations and emergency department visits for respiratory symptoms in each of years 1, 2, 3, 4, and 5 compared with the year before BT treatment. Measures of lung function showed no deterioration for 5 years. Conclusion Our findings suggest that BT is safe for 5 years after BT in patients with severe refractory asthma. Trial Registration clinicaltrials.gov Identifier: NCT00401986
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Bronchial Thermoplasty: Long-term safety and effectiveness in patients with severe persistent asthma
The Journal of allergy and clinical immunology, 2013Co-Authors: Michael E. Wechsler, Neil C. Thomson, Adalberto Sperb Rubin, Michel Laviolette, Jussara Fiterman, José Roberto Lapa E Silva, Pallav L. Shah, Elie Fiss, Ronald Olivenstein, Robert NivenAbstract:Background Bronchial Thermoplasty (BT) has previously been shown to improve asthma control out to 2 years in patients with severe persistent asthma. Objective We sought to assess the effectiveness and safety of BT in asthmatic patients 5 years after therapy. Methods BT-treated subjects from the Asthma Intervention Research 2 trial (ClinicalTrials.gov NCT01350414) were evaluated annually for 5 years to assess the long-term safety of BT and the durability of its treatment effect. Outcomes assessed after BT included severe exacerbations, adverse events, health care use, spirometric data, and high-resolution computed tomographic scans. Results One hundred sixty-two (85.3%) of 190 BT-treated subjects from the Asthma Intervention Research 2 trial completed 5 years of follow-up. The proportion of subjects experiencing severe exacerbations and emergency department (ED) visits and the rates of events in each of years 1 to 5 remained low and were less than those observed in the 12 months before BT treatment (average 5-year reduction in proportions: 44% for exacerbations and 78% for ED visits). Respiratory adverse events and respiratory-related hospitalizations remained unchanged in years 2 through 5 compared with the first year after BT. Prebronchodilator FEV 1 values remained stable between years 1 and 5 after BT, despite a 18% reduction in average daily inhaled corticosteroid dose. High-resolution computed tomographic scans from baseline to 5 years after BT showed no structural abnormalities that could be attributed to BT. Conclusions These data demonstrate the 5-year durability of the benefits of BT with regard to both asthma control (based on maintained reduction in severe exacerbations and ED visits for respiratory symptoms) and safety. BT has become an important addition to our treatment armamentarium and should be considered for patients with severe persistent asthma who remain symptomatic despite taking inhaled corticosteroids and long-acting β 2 -agonists.
Neil C. Thomson - One of the best experts on this subject based on the ideXlab platform.
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recent developments in Bronchial Thermoplasty for severe asthma
Journal of Asthma and Allergy, 2019Co-Authors: Neil C. ThomsonAbstract:Purpose Bronchial Thermoplasty is approved in many countries worldwide as a non-pharmacological treatment for severe asthma. This review summarizes recent publications on the selection of patients with severe asthma for Bronchial Thermoplasty, predictors of a beneficial response and developments in the procedure and discusses specific issues about Bronchial Thermoplasty including effectiveness in clinical practice, mechanism of action, cost-effectiveness, and place in management. Results Bronchial Thermoplasty is a treatment option for patients with severe asthma after assessment and management of causes of difficult-to-control asthma, such as nonadherence, poor inhaler technique, comorbidities, under treatment, and other behavioral factors. Patients treated with Bronchial Thermoplasty in clinical practice have worse baseline characteristics and comparable clinical outcomes to clinical trial data. Bronchial Thermoplasty causes a reduction in airway smooth muscle mass although it is uncertain whether this effect explains its efficacy since other mechanisms of action may be relevant, such as alterations in airway epithelial, gland, and/or nerve function; improvements in small airway function; or a placebo effect. The cost-effectiveness of Bronchial Thermoplasty is greater in countries where the costs of hospitalization and emergency department are high. The place of Bronchial Thermoplasty in the management of severe asthma is not certain, although some experts propose that Bronchial Thermoplasty should be considered for patients with severe asthma associated with non-type 2 inflammation or who fail to respond favorably to biologic therapies targeting type 2 inflammation. Conclusion Bronchial Thermoplasty is a modestly effective treatment for severe asthma after assessment and management of causes of difficult-to-control asthma. Asthma morbidity increases during and shortly after treatment. Follow-up studies provide reassurance on the long-term safety of the procedure. Uncertainties remain about predictors of response, mechanism(s) of action, and place in management of severe asthma.
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Bronchial Thermoplasty as a treatment for severe asthma controversies progress and uncertainties
Expert Review of Respiratory Medicine, 2018Co-Authors: Neil C. ThomsonAbstract:ABSTRACTIntroduction: Bronchial Thermoplasty is a licensed non-pharmacological treatment for severe asthma.Area covered: This article considers evidence for the efficacy and safety of Bronchial the...
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how effective is Bronchial Thermoplasty for severe asthma in clinical practice
European Respiratory Journal, 2017Co-Authors: Neil C. Thomson, Pascal ChanezAbstract:Bronchial Thermoplasty can be effective in patients who often have features of more severe asthma than in AIR2http://ow.ly/Qv5730cTIuB
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safety of Bronchial Thermoplasty in patients with severe refractory asthma
Annals of Allergy Asthma & Immunology, 2013Co-Authors: Ian D Pavord, Neil C. Thomson, Robert Niven, Paul A. Corris, Kian Fan Chung, Gerard Cox, Narinder S Shargill, Brian Armstrong, Michel LavioletteAbstract:Abstract Background Patients with severe refractory asthma treated with Bronchial Thermoplasty (BT), a bronchoscopic procedure that improves asthma control by reducing excess airway smooth muscle, were followed up for 5 years to evaluate long-term safety of this procedure. Objectives To assess long-term safety of BT for 5 years. Methods Patients with asthma aged 18 to 65 years requiring high-dose inhaled corticosteroids (ICSs) (>750 μg/d of fluticasone propionate or equivalent) and long-acting β 2 -agonists (LABAs) (at least 100 μg/d of salmeterol or equivalent), with or without oral prednisone (≤30 mg/d), leukotriene modifiers, theophylline, or other asthma controller medications were enrolled in the Research in Severe Asthma (RISA) Trial. Patients had a prebronchodilator forced expiratory volume in 1 second of 50% or more of predicted, demonstrated methacholine airway hyperresponsiveness, had uncontrolled symptoms despite taking maintenance medication, abstained from smoking for 1 year or greater, and had a smoking history of less than 10 pack-years. Results Fourteen patients (of the 15 who received active treatment in the RISA Trial) participated in the long-term follow-up study for 5 years. The rate of respiratory adverse events (AEs per patient per year) was 1.4, 2.4, 1.7, and 2.4, respectively, in years 2 to 5 after BT. There was a decrease in hospitalizations and emergency department visits for respiratory symptoms in each of years 1, 2, 3, 4, and 5 compared with the year before BT treatment. Measures of lung function showed no deterioration for 5 years. Conclusion Our findings suggest that BT is safe for 5 years after BT in patients with severe refractory asthma. Trial Registration clinicaltrials.gov Identifier: NCT00401986
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Bronchial Thermoplasty: Long-term safety and effectiveness in patients with severe persistent asthma
The Journal of allergy and clinical immunology, 2013Co-Authors: Michael E. Wechsler, Neil C. Thomson, Adalberto Sperb Rubin, Michel Laviolette, Jussara Fiterman, José Roberto Lapa E Silva, Pallav L. Shah, Elie Fiss, Ronald Olivenstein, Robert NivenAbstract:Background Bronchial Thermoplasty (BT) has previously been shown to improve asthma control out to 2 years in patients with severe persistent asthma. Objective We sought to assess the effectiveness and safety of BT in asthmatic patients 5 years after therapy. Methods BT-treated subjects from the Asthma Intervention Research 2 trial (ClinicalTrials.gov NCT01350414) were evaluated annually for 5 years to assess the long-term safety of BT and the durability of its treatment effect. Outcomes assessed after BT included severe exacerbations, adverse events, health care use, spirometric data, and high-resolution computed tomographic scans. Results One hundred sixty-two (85.3%) of 190 BT-treated subjects from the Asthma Intervention Research 2 trial completed 5 years of follow-up. The proportion of subjects experiencing severe exacerbations and emergency department (ED) visits and the rates of events in each of years 1 to 5 remained low and were less than those observed in the 12 months before BT treatment (average 5-year reduction in proportions: 44% for exacerbations and 78% for ED visits). Respiratory adverse events and respiratory-related hospitalizations remained unchanged in years 2 through 5 compared with the first year after BT. Prebronchodilator FEV 1 values remained stable between years 1 and 5 after BT, despite a 18% reduction in average daily inhaled corticosteroid dose. High-resolution computed tomographic scans from baseline to 5 years after BT showed no structural abnormalities that could be attributed to BT. Conclusions These data demonstrate the 5-year durability of the benefits of BT with regard to both asthma control (based on maintained reduction in severe exacerbations and ED visits for respiratory symptoms) and safety. BT has become an important addition to our treatment armamentarium and should be considered for patients with severe persistent asthma who remain symptomatic despite taking inhaled corticosteroids and long-acting β 2 -agonists.
