Bronchial Thermoplasty: A Decade of Experience: State of the Art

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 7; no. 1; pp. 71 - 80
• Main Authors: Tan, Laren D., Yoneda, Ken Y., Louie, Samuel, Hogarth, D. Kyle, Castro, Mario
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2019; Elsevier Limited
• Subjects: Airway smooth muscle; Anesthesia; Asthma; Asthma - therapy; Bronchi - pathology; Bronchial thermoplasty; Bronchial Thermoplasty - methods; Bronchoconstriction; Bronchoscopy; Clinical trials; Clinical Trials as Topic; Conscious sedation; Disease Progression; Energy; FDA approval; Humans; Infections; Moderate sedation; Myocytes, Smooth Muscle - physiology; Myocytes, Smooth Muscle - radiation effects; Patients; Quality of Life; Questionnaires; Radiofrequency Ablation; Radiofrequency energy; Radiofrequency Therapy - methods; Respiratory tract; Severe asthma; Smooth muscle; Treatment Outcome; Bronchoscopy; ATS; LMA; FDA; Radiofrequency energy; ETT; ERS; Bronchial thermoplasty; AQLQ; Moderate sedation; Airway smooth muscle; MAC; Asthma; ACQ; ASA; Conscious sedation; BT; RF; LABA; ICS; FEV1; Severe asthma; ASM
• ISSN: 2213-2198; 2213-2201
• DOI: 10.1016/j.jaip.2018.08.017

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.