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Zikos A, Balaan M, Hobart E, Bansal S, Saeed R, Cheema T, Gentile D. Efficacy of bronchial thermoplasty in a patient panel with uncontrolled severe persistent asthma. J Asthma 2024; 61:867-875. [PMID: 38294702 DOI: 10.1080/02770903.2024.2309532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Bronchial thermoplasty (BT) is an approved procedure to manage uncontrolled severe persistent asthma. Many insurance providers are reluctant to pay for BT without proven benefit among their specific patient panel. OBJECTIVE Determine if BT is effective in a panel patient panel with uncontrolled severe persistent asthma. STUDY DESIGN AND METHODS This was an unblinded prospective study of adult subjects with uncontrolled severe persistent asthma who underwent BT. Outcomes were assessed at baseline and then 3-, 6-, 12-, 18- and 24-months post-BT. The primary metric was an improved Asthma Quality of Life Questionnaire (AQLQ) score. Other metrics included improved Asthma Control Test (ACT), peak expiratory flow rates (PEFR), spirometry, fractional excretion of nitric oxide (FeNO), number of unscheduled medical visits, and lost days of work/activity. Respiratory adverse events were assessed during the BT treatment period and at each post-BT visit. RESULTS Twenty-nine subjects completed the study; the median interquartile range (IQR) age was 47 (42-61), and the majority were female (69%), white (93%), and non-Hispanic (90%). After BT, mean (±std) AQLQ scores improved by 1.6(±1.1) at 3 months (p < 0.0001), 1.6(±1.2) at 6 months (p < 0.0001), 1.4(±1.0) at 12 months (p < 0.0001), 1.8(±1.1) at 18 months (p < 0.0001), and 1.6 (±1.5) at 24 months (p < 0.0001). There were significant improvements in ACT, PEFR, unscheduled medical visits and lost days of work and activity. Spirometry and FeNO metrics were unchanged. The average cost for subjects completing all 3 BT procedures was approximately $15,000. CONCLUSION BT is an effective adjunctive therapeutic modality in subjects with uncontrolled severe persistent asthma.
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Affiliation(s)
- Antonios Zikos
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Marvin Balaan
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Emily Hobart
- Care Analytics Department, Highmark Health, Pittsburgh, PA, USA
| | - Sandeep Bansal
- Department of Internal Medicine, The Lung Center, Penn Highlands Healthcare, Dubois, PA, USA
| | - Rihab Saeed
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Tariq Cheema
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Deborah Gentile
- Department of Health Science, Saint Francis University, Loretto, PA, USA
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2
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Hashmi MD, Khan A, Shafiq M. Bronchial thermoplasty: State of the art. Respirology 2022; 27:720-729. [PMID: 35692074 DOI: 10.1111/resp.14312] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
Since the publication of a sham-controlled, randomized trial (AIR2) and subsequent marketing approval by the US Food and Drug Administration, we have significantly advanced our understanding of bronchial thermoplasty (BT)'s scientific basis, long-term safety, clinical efficacy and cost-effectiveness. In particular, the last 2 years have witnessed multiple research publications on several of these counts. In this review, we critically appraise our evolving understanding of BT's biologic underpinnings and clinical impact, offer an evidence-based patient workflow guide for the busy pulmonologist and highlight both current challenges as well as potential solutions for the researcher and the clinician.
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Affiliation(s)
- Muhammad Daniyal Hashmi
- Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan, USA
| | - Asad Khan
- Division of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Majid Shafiq
- Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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3
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Koshy K, Sha J, Bennetts K, Langton D. Safety of delivering bronchial thermoplasty in two treatment sessions. Respir Res 2021; 22:307. [PMID: 34844622 PMCID: PMC8630877 DOI: 10.1186/s12931-021-01901-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/19/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a novel endoscopic therapy for severe asthma. Traditionally it is performed in three separate treatment sessions, targeting different portions of the lung, and each requires an anaesthetic and hospital admission. Compression of treatment into 2 sessions would present a more convenient alternative for patients. In this prospective observational study, the safety of compressing BT into two treatment sessions was compared with the traditional 3 treatment approach. METHODS Sixteen patients meeting ERS/ATS criteria for severe asthma consented to participate in an accelerated treatment schedule (ABT), which treated the whole left lung followed by the right lung four weeks later. The short-term outcomes of these patients were compared with 37 patients treated with conventional BT scheduling (CBT). The outcome measures used to assess safety were (1) the requirement to remain in hospital beyond the electively planned 24-h admission and (2) the need for re-admission for any cause within of 30 days of treatment. RESULTS The total number of radiofrequency activations delivered in the ABT group was similar to CBT (187 ± 21 vs 176 ± 40, p = 0.326). With ABT, 11 in 31 admissions (37.9%) required prolonged admission due to wheezing, compared to 5.4% with CBT (p = 0.0025). The mean hospital length of stay with ABT was 1.8 ± 1.3 days, compared to 1.1 ± 0.4 days (p < 0.001). ICU monitoring was required on 5 occasions with ABT (16.1%), compared to 0.9% with CBT (p = 0.002). Subgroup analysis demonstrated that females were more likely to require prolonged admission (OR 11.6, p = 0.0025). The 30-day hospital readmission rate was similar for both groups (6.4% vs 5.4%, p = 0.67). All patients made a complete recovery after treatment with similar outcomes at the 6-month follow-up reassessment. CONCLUSION This study demonstrates that ABT results in greater short-term deterioration in lung function associated with a greater risk of prolonged hospital and ICU stay, predominantly affecting females. Therefore, in females, these risks need to be balanced against the convenience of fewer treatment sessions. In males, it may be an advantage to compress treatment.
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Affiliation(s)
- Kavya Koshy
- Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199 Australia
| | - Joy Sha
- Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199 Australia
| | - Kim Bennetts
- Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199 Australia
| | - David Langton
- Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199 Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC Australia
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4
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Abstract
Bronchial thermoplasty is an advanced therapy for severe asthma. It is a bronchoscopic procedure in which radiofrequency energy is applied to the airway wall, resulting in decreased airway smooth muscle burden. Human trials have shown that bronchial thermoplasty may reduce asthma exacerbations and improve quality of life in patients with severe uncontrolled asthma. It has been demonstrated to be a safe procedure, with most adverse events being early and mild. More studies are required to understand the precise effects of bronchial thermoplasty on the asthmatic airway and optimal parameters to appropriately select patients for this novel procedure.
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Affiliation(s)
- Anne S Mainardi
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520, USA
| | - Mario Castro
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, St Louis, MO 63110, USA
| | - Geoffrey Chupp
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520, USA.
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5
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O'Reilly A, Lane S. What is the role of bronchial thermoplasty in the management of severe asthma? Ther Adv Respir Dis 2019; 12:1753466618792410. [PMID: 30132377 PMCID: PMC6108009 DOI: 10.1177/1753466618792410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Asthma is a common chronic inflammatory condition of the airways. Conventional therapy comprises inhaled corticosteroid and bronchodilators as well as trigger avoidance and management of comorbid conditions. A small group remain symptomatic despite these strategies and novel therapies have been developed. Bronchial thermoplasty is a nonpharmacological therapy which targets airway smooth muscle to improve asthma control. Clinical trials to date have shown the efficacy and safety of bronchial thermoplasty with a persistent effect on extended follow up. Questions remain regarding the exact mechanism of action of bronchial thermoplasty, the cost effectiveness of the procedure and the ideal criteria for patient selection.
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Affiliation(s)
- Aoife O'Reilly
- Tallaght Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
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6
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Menzella F, Bertolini F, Biava M, Galeone C, Scelfo C, Caminati M. Severe refractory asthma: current treatment options and ongoing research. Drugs Context 2018; 7:212561. [PMID: 30534175 PMCID: PMC6284776 DOI: 10.7573/dic.212561] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with severe asthma have a greater risk of asthma-related symptoms, morbidities, and exacerbations. Moreover, healthcare costs of patients with severe refractory asthma are at least 80% higher than those with stable asthma, mainly because of a higher use of healthcare resources and chronic side effects of oral corticosteroids (OCS). The advent of new promising biologicals provides a unique therapeutic option that could achieve asthma control without OCS. However, the increasing number of available molecules poses a new challenge: the identification and selection of the most appropriate treatment. Thanks to a better understanding of the basic mechanisms of the disease and the use of predictive biomarkers, especially regarding the Th2-high endotype, it is now easier than before to tailor therapy and guide clinicians toward the most suitable therapeutic choice, thus reducing the number of uncontrolled patients and therapeutic failures. In this review, we will discuss the different biological options available for the treatment of severe refractory asthma, their mechanism of action, and the overlapping aspects of their usage in clinical practice. The availability of new molecules, specific for different molecular targets, is a key topic, especially when considering that the same targets are sometimes part of the same phenotype. The aim of this review is to help clarify these doubts, which may facilitate the clinical decision-making process and the achievement of the best possible outcomes.
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Affiliation(s)
- Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Francesca Bertolini
- Department of Bio and Health Informatics, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark
| | - Mirella Biava
- National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Carla Galeone
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Chiara Scelfo
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Piazzale L.A. Scuro, 37134 Verona, Italy
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7
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Evidence-Based Assessment of Bronchial Thermoplasty in Asthma: Mechanisms and Outcomes. CURRENT PULMONOLOGY REPORTS 2018. [DOI: 10.1007/s13665-018-0214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Menzella F, Lusuardi M, Galeone C, Facciolongo N. Bronchial thermoplasty and the role of airway smooth muscle: are we on the right direction? Ther Clin Risk Manag 2017; 13:1213-1221. [PMID: 29033571 PMCID: PMC5614744 DOI: 10.2147/tcrm.s144604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Asthma is characterized by inflammation of the airways that includes eosinophils, basal membrane thickening, epithelial sloughing, vascular changes, smooth muscle hypertrophy and hyperplasia, and mucous gland hyperplasia. Recently, there have been studies on the role of hypersensitivity and inflammation in asthma, but the role of bronchial smooth muscle remains unclear. Bronchial thermoplasty is an endoscopic procedure that is approved by the US Food and Drug Administration (FDA) for the treatment of severe refractory asthma, based on the local delivery of radio frequency at 65°C to the airways, with the aim of controlling bronchospasm through a reduction of airway smooth muscle (ASM). Several recent studies have shown significant improvement in clinical outcomes of bronchial thermoplasty for asthma, including symptom control, reduction in exacerbation and hospitalization rates, improved quality of life, and reduction in number of working days or school days lost due to asthma. Data from these recent studies have shown reduction in ASM following bronchial thermoplasty and changes in inflammation patterns. It has also been argued that bronchial thermoplasty may have modulating effects on neuroendocrine epithelial cells, bronchial nerve endings, TRPV1 nerve receptors, and type-C unmyelinated fibers in the bronchial mucosa. This may involve interrupting the central and local reflexes responsible for the activation of bronchospasm in the presence of bronchial hyperreactivity. Several questions remain regarding the use of bronchial thermoplasty, mechanism of action, selection of appropriate patients, and long-term effects. In this review, the role of ASM in the pathogenesis of asthma and the key aspects of bronchial thermoplasty are discussed, with a focus on the potential clinical effects of this promising procedure, beyond the reduction in ASM.
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Affiliation(s)
- Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia
| | - Mirco Lusuardi
- Unit of Respiratory Rehabilitation, AUSL Reggio Emilia, S Sebastiano Hospital, Correggio, Italy
| | - Carla Galeone
- Department of Medical Specialties, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia
| | - Nicola Facciolongo
- Department of Medical Specialties, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia
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9
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Menzella F, Galeone C, Bertolini F, Castagnetti C, Facciolongo N. Innovative treatments for severe refractory asthma: how to choose the right option for the right patient? J Asthma Allergy 2017; 10:237-247. [PMID: 28919788 PMCID: PMC5587160 DOI: 10.2147/jaa.s144100] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The increasing understanding of the molecular biology and the etiopathogenetic mechanisms of asthma helps in identification of numerous phenotypes and endotypes, particularly for severe refractory asthma. For a decade, the only available biologic therapy that met the unmet needs of a specific group of patients with severe uncontrolled allergic asthma has been omalizumab. Recently, new biologic therapies with different mechanisms of action and targets have been approved for marketing, such as mepolizumab. Other promising drugs will be available in the coming years, such as reslizumab, benralizumab, dupilumab and lebrikizumab. Moreover, since 2010, bronchial thermoplasty has been successfully introduced for a limited number of patients. This is a nonpharmacologic endoscopic procedure which is considered a promising therapy, even though several aspects still need to be clarified. Despite the increasing availability of new therapies, one of the major problems of each treatment is still the identification of the most suitable patients. This sudden abundance of therapeutic options, sometimes partially overlapping with each other, increases the importance to identify new biomarkers useful to guide the clinician in selecting the most appropriate patients and treatments, without forgetting the drug-economic aspects seen in elevated direct cost of new therapies. The aim of this review is, therefore, to update the clinician on the state of the art of therapies available for refractory asthma and, above all, to give useful directions that will help understand the different choices that sometimes partially overlap and to dispel the possible doubts that still exist.
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Affiliation(s)
- Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Carla Galeone
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Claudia Castagnetti
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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10
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Menzella F, Lusuardi M, Galeone C, Facciolongo N, Zucchi L. The clinical profile of benralizumab in the management of severe eosinophilic asthma. Ther Adv Respir Dis 2016; 10:534-548. [PMID: 27612492 PMCID: PMC5933597 DOI: 10.1177/1753465816667659] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite several therapeutic choices, 10–20% of patients with severe uncontrolled
asthma do not respond to maximal best standard treatments, leading to a
healthcare expenditure of up to 80% of overall costs for asthma. Today, there
are new important therapeutic strategies, both pharmacological and
interventional, that can result in improvement of severe asthma management, such
as omalizumab, bronchial thermoplasty and other biological drugs, for example,
mepolizumab, reslizumab and benralizumab. The availability of these new
treatments and the increasing knowledge of the different asthmatic phenotypes
and endotypes makes correct patient selection increasingly complex and
important. In this article, we discuss the features of benralizumab compared
with other anti-interleukin-5 biologics and omalizumab, the identification of
appropriate patients, the safety profile and future developments.
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Affiliation(s)
- Francesco Menzella
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Mirco Lusuardi
- Unit of Respiratory Rehabilitation, AUSL Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Carla Galeone
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Luigi Zucchi
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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11
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Menzella F, Lusuardi M, Galeone C, Taddei S, Facciolongo N, Zucchi L. Mepolizumab for severe refractory eosinophilic asthma: evidence to date and clinical potential. Ther Adv Chronic Dis 2016; 7:260-277. [PMID: 27803792 DOI: 10.1177/2040622316659863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Severe asthma is characterized by major impairment of quality of life, poor symptom control and frequent exacerbations. Inflammatory, clinical and causative factors identify different phenotypes and endotypes of asthma. In the last few years, new treatment options have allowed for targeted treatments according to the different phenotypes of the disease. To accurately select a specific treatment for each asthmatic variant, the identification of appropriate biomarkers is required. Eosinophilic asthma is a distinct phenotype characterized by thickening of the basement membrane and corticosteroid responsiveness. This review reports the latest evidence on an anti-IL-5 monoclonal antibody, mepolizumab, a new and promising biological agent recently approved by the FDA specifically for the treatment of severe eosinophilic refractory asthma.
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Affiliation(s)
- Francesco Menzella
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Mirco Lusuardi
- Unit of Respiratory Rehabilitation, AUSL Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Carla Galeone
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Sofia Taddei
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Luigi Zucchi
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
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12
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Singh SK, Tiwari KK. Bronchial thermoplasty: a non-pharmacological approach. CLINICAL RESPIRATORY JOURNAL 2015; 11:13-20. [PMID: 25919949 DOI: 10.1111/crj.12315] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/12/2015] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Asthma is a chronic inflammatory disorder of the airway characterized by the episodic symptoms of breathlessness, wheezes and cough. Even with the use of maximum anti-asthmatic pharmacological treatment sometimes it remains uncontrolled. For such patients, bronchial thermoplasty is the new mode of treatment. OBJECTIVE To review published article on bronchial thermoplasty. METHODS We identified 102 English articles on PubMed, and 56 were excluded by the abstract. The remaining articles were retrieved for full-text detailed evaluation by authors, and 28 relevant articles were selected for final review. RESULTS Bronchial thermoplasty is the radiofrequency ablation of the airway smooth muscle with the help of flexible fiberoptic bronchoscope. It reduces the smooth muscle mass of the bronchial wall and decreases its contractility. CONCLUSION Bronchial thermoplasty causes improvement in the quality of life, and causes reduction in the emergency room visit and exacerbation due to asthma. Long-term safety has been established by various prospective studies.
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Affiliation(s)
- Saurabh Kumar Singh
- Department of Pulmonary Medicine, Gajra Raja Medical College, Jayarogya Group of Hospitals, Gwalior, Madhya Pradesh, India
| | - Kamlesh Kumar Tiwari
- Department of Pulmonary Medicine, Gajra Raja Medical College, Jayarogya Group of Hospitals, Gwalior, Madhya Pradesh, India
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