Bronchial thermoplasty for moderate or severe persistent asthma in adults (Review)

ABSTRACT: Background Bronchial thermoplasty is a procedure that consists of the delivery of controlled radiofrequency-generated heat via a catheter inserted into the bronchial tree of the lungs through a flexible bronchoscope. It has been suggested that bronchial thermoplasty works by reducing airway smooth muscle, thereby reducing the ability of the smooth muscle to bronchoconstrict. This treatment could then reduce asthma symptoms and exacerbations, resulting in improved asthma control and quality of life. Objectives To determine the eHicacy and safety of bronchial thermoplasty in adults with bronchial asthma. Search methods We searched the Cochrane Airways Group Specialised Register of Trials (CAGR) up to January 2014. Selection criteria We included randomised controlled clinicaltrials that compared bronchialthermoplasty versus any active control in adults with moderate or severe persistent asthma. Our primary outcomes were quality of life, asthma exacerbations and adverse events. Data collection and analysis Two review authors independently extracted data and assessed risk of bias Main results We included three trials (429 participants) with diHerences regarding their design (two trials compared bronchial thermoplasty vs medical management and the other compared bronchial thermoplasty vs a sham intervention) and participant characteristics; one of the studies included participants with more symptomatic asthma compared with the others. The pooled analysis showed improvement in quality of life at 12 months in participants who received bronchial thermoplasty that did not reach the threshold for clinical significance (3 trials, 429 participants; mean diHerence (MD) in Asthma Quality of Life Questionnaire (AQLQ) scores 0.28, 95% confidence interval (CI) 0.07 to 0.50; moderate-quality evidence). Measures of symptom control showed no significant diHerences (3 trials, 429 participants; MD in Asthma Control Questionnaire (ACQ) scores -0.15, 95% CI -0.40 to 0.10; moderate-quality evidence). The risk of bias for these outcomes was high because two of the studies did not have a sham intervention for the control group. The results from two trials showed a lower rate of exacerbation aTer 12 months of treatment for participants who underwent bronchial thermoplasty. The trial with sham intervention showed a significant reduction in the proportion of participants visiting the emergency department for respiratory symptoms, from 15.3% on sham treatment to 8.4% over 12 months following thermoplasty. The trials showed no significant improvement in pulmonary function parameters (with the exception of a greater increase in morning peak expiratory flow (PEF) in one trial). Treated participants who underwent bronchialthermoplasty had a greaterrisk of hospitalisation forrespiratory adverse events during the treatment period (3 trials, 429 participants; risk ratio 3.50, 95% CI 1.26 to 9.68; high-quality evidence), which represents an absolute increase from 2% to 8% (95% CI 3% to 23%) over the treatment period. This means that six of 100 participants treated with thermoplasty (95% CI 1 to 21) would require an additional hospitalisation over the treatment period. No significant diHerence in the risk of hospitalisation was noted at the end of the treatment period. Bronchial thermoplasty was associated with an increase in respiratory adverse events, mainly during the treatment period. Most of these events were mild or moderate, appeared in the 24-hour post-treatment period, and were resolved within a week. Authors' conclusions Bronchial thermoplasty for patients with moderate to severe asthma provides a modest clinical benefit in quality of life and lower rates of asthma exacerbation, but no significant diHerence in asthma control scores. The quality of life findings are at risk of bias, as the main benefits were seen in the two studies that did not include a sham treatment arm. This procedure increases the risk of adverse events during treatment but has a reasonable safety profile aTer completion of the bronchoscopies. The overall quality of evidence regarding this procedure is moderate. For clinical practice, it would be advisable to collect data from patients systematically in independent clinical registries. Furtherresearch should provide better understanding ofthe mechanisms of action of bronchialthermoplasty, as well as its eHect in diHerent asthma phenotypes or in patients with worse lung function

• Autores: Muñoz, Ana María; Yepes Nuñez, Juan José; Torrego, Alfons; Solà, Ivan; Roqué i Figuls, Marta; Coello, Pablo Alonso; Plaza, Vicente
• Tipo de recurso: Review article
• Fecha de publicación: 2014
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/26327
• Acceso en línea: http://hdl.handle.net/10495/26327
• Palabra clave: Adulto; Adult; Humanos; Humans; Asma; Asthma; Bronquios; Bronchi
• Rights: openAccess
• License: http://creativecommons.org/licenses/by-nc-sa/2.5/co/