Chelle Pope Wilhelm, MD
, Bradley E. Chipps, MD
Abstract
Objective: To provide a review of the literature regarding bronchial thermoplasty in the treatment of asthma.
Data Sources: PubMed was searched without time limitations using the key term bronchial thermoplasty alone and in combination with the key terms asthma and treatment of asthma. Other key terms included cost-effectiveness and bronchial thermoplasty, cost-effectiveness and omalizumab, and epidemiology andasthma.
Study Selection: Qualifying articles included clinical trials performed with bronchial thermoplasty and review articles outlining the procedure of bronchial thermoplasty.
Results: Three predominant clinical trials investigated bronchial thermoplasty as a treatment of asthma, with only 1 of these being placebo-controlled with a sham procedure. Two of these clinical trials had follow-up data published 5 years after bronchial thermoplasty. The efficacy of bronchial thermoplasty is promising for patients with asthma whose symptoms are not controlled despite medical therapy; however, evidence from the 1 sham-controlled clinical trial has been met with some concerns because the long-term follow-up of the sham-treated group was not reported. This review of the literature indicates that the procedure is safe and effective at least 5 years after the procedure. The phenotype of asthma that can be expected to respond best to bronchial thermoplasty has not been determined.
Conclusion: Bronchial thermoplasty could be a safe and effective option for patients with severe asthma, particularly when symptoms are uncontrolled despite medical therapy. Further investigation should be performed to determine which phenotypes of asthma would benefit from the procedure.