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Leroux J, Khayath N, Matau C, Marcot C, Migueres N, Barnig C, Molard A, Ochea D, Ohana M, Lefebvre F, de Blay F. Efficacy of bronchial thermoplasty in patients with severe asthma and frequent severe exacerbations: A randomized controlled study ✰. Respir Med Res 2024; 86:101109. [PMID: 38875851 DOI: 10.1016/j.resmer.2024.101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a bronchoscopic procedure for patients with severe uncontrolled asthma, but randomized controlled studies of its efficacy in severe asthma with frequent exacerbations are lacking. The current aim was to assess BT efficacy in this patient population. METHODS Thirty patients with asthma (GINA 5) who had experienced at least four severe exacerbations in the preceding year were randomized to BT (n = 15) or control groups (n = 15). All patients had four follow-up visits over the following 15 months, corresponding to 3, 6, 9, and 12 months after the last procedure for the BT group. The primary outcome was number of exacerbations at 15 months after inclusion (i.e. 12 months after bronchial thermoplasty). RESULTS All but three patients had received an asthma biologic without receiving benefit. In the year preceding enrollment, patients in the BT group had an average of five exacerbations, compared with six among controls. For patients in the BT group, oral steroid intake was 9.3 mg/d, compared with 11.0 mg/d among controls. The BT group had 1.58 fewer severe exacerbations (mean, 6.09) compared with controls (mean, 8.28) in the 12-month period after the therapy (p = 0.047). Oral steroid intake during follow-up after BT was significantly lower in the BT group (ratio vs controls: 0.61; p = 0.0002). Quality-of-life measures between inclusion and the last visit were significantly improved in the BT group, but not among controls. Few mild to moderate adverse events were reported, and all were controlled within days. CONCLUSION In patients with severe asthma and frequent severe exacerbations, BT significantly decreased the rate of severe exacerbations and oral steroid intake and led to improved quality of life during the 15 months after inclusion. BT appears to offer a therapeutic option for severe asthma with frequent exacerbations.
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Affiliation(s)
- Justine Leroux
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France.
| | - Naji Khayath
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
| | - Cezar Matau
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
| | - Christophe Marcot
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
| | - Nicolas Migueres
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
| | - Cindy Barnig
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
| | - Anita Molard
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
| | - Diana Ochea
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
| | - Mickael Ohana
- Radiology Department, Strasbourg University Hospital, France
| | | | - Frédéric de Blay
- Chest diseases department, Strasbourg University Hospital and University of Strasbourg, France
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Marques J, Duarte-Ramos F, Ferreira MB, Lima R, Lopes C, Sokolova A, Tonin FS, Loureiro CC. Optimizing the use of systemic corticosteroids in severe asthma (ROSA II project): a national Delphi consensus study. Pulmonology 2023; 29:555-563. [PMID: 37543525 DOI: 10.1016/j.pulmoe.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023] Open
Affiliation(s)
- J Marques
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Lisboa Central, EPE, Lisboa, Portugal; CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal.
| | - F Duarte-Ramos
- Department of Pharmacy, Pharmacology and Health Technologies, Faculty of Pharmacy, University of Lisboa, Lisboa, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
| | - M B Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - R Lima
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - C Lopes
- Departamento do Tórax, Hospital de Santa Maria, Lisbon, Portugal
| | - A Sokolova
- Immunology and Allergy Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - F S Tonin
- ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal; H&TRC - Health & Technology Research Center, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - C C Loureiro
- Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal; Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Henry C, Biardel S, Boucher M, Godbout K, Chakir J, Côté A, Laviolette M, Bossé Y. Bronchial thermoplasty attenuates bronchodilator responsiveness. Respir Med 2023; 217:107340. [PMID: 37422022 DOI: 10.1016/j.rmed.2023.107340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/31/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Bronchial thermoplasty is an effective intervention to improve respiratory symptoms and to reduce the rate of exacerbations in uncontrolled severe asthma. A reduction in airway smooth muscle is arguably the most widely discussed mechanisms accounting for these clinical benefits. Yet, this smooth muscle reduction should also translate into an impaired response to bronchodilator drugs. This study was designed to address this question. METHODS Eight patients with clinical indication for thermoplasty were studied. They were uncontrolled severe asthmatics despite optimal environmental control, treatment of comorbidities, and the use of high-dose inhaled corticosteroids and long-acting β2-agonists. Lung function measured by spirometry and respiratory mechanics measured by oscillometry were examined pre- and post-bronchodilator (salbutamol, 400 μg), both before and at least 1 year after thermoplasty. RESULTS Consistent with previous studies, thermoplasty yielded no benefits in terms of baseline lung function and respiratory mechanics, despite improving symptoms based on two asthma questionnaires (ACQ-5 and ACT-5). The response to salbutamol was also not affected by thermoplasty based on spirometric readouts, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. However, a significant interaction was observed between thermoplasty and salbutamol for two oscillometric readouts, namely reactance at 5 Hz (Xrs5) and reactance area (Ax), showing an attenuated response to salbutamol after thermoplasty. CONCLUSIONS Thermoplasty attenuates the response to a bronchodilator. We argue that this result is a physiological proof of therapeutic efficacy, consistent with the well-described effect of thermoplasty in reducing the amount of airway smooth muscle.
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Affiliation(s)
- Cyndi Henry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada
| | - Sabrina Biardel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada
| | - Magali Boucher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada
| | - Krystelle Godbout
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada
| | - Jamila Chakir
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada
| | - Andréanne Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada
| | - Michel Laviolette
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada
| | - Ynuk Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) - Université Laval, Québec, Canada.
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Qin Y, Wang J, Qin J, Yang N, Li S, Xu L, Han Y. Correlation Meta-Analysis of the Efficacy of Inhaled Corticosteroids in Children with Asthma Based on Smart Medical Health. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6220774. [PMID: 35463694 PMCID: PMC9020921 DOI: 10.1155/2022/6220774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Children are the reserve force for national construction, and children's health is now being paid more and more attention. In today's childhood asthma treatment, many are based on the treatment of common cough, and there is no strict division with asthma. Importantly, the efficacy of inhaled corticosteroids in the treatment of childhood asthma has been extensively studied in the medical community. However, there is no clear explanation for its specific efficacy and role. Research on childhood asthma has always been a key topic in medicine. This article aims to conduct a meta-analysis of the correlation between inhaled corticosteroids and asthma in children. This article proposes a more scientific literature screening strategy, which can achieve a higher accuracy rate for meta-analysis. It combines the intelligent medical health system in the analysis of children's asthma to assist in the analysis of curative effects. Such analysis also provides reference significance for related research. The experimental results indicate that inhaled corticosteroids have a good effect on childhood asthma. As the concentration of inhaled glucocorticoid increases, the effect will be better. Specifically, if the concentration is increased by 10%, the effect will be about 15% better, but there are corresponding side effects.
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Affiliation(s)
- Yu Qin
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Jing Wang
- Endocrine Department, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Jingmin Qin
- Neonatology, Handan Second Hospital, Handan 056001, Hebei, China
| | - Ning Yang
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Sha Li
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Lijia Xu
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Yanjun Han
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
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[Interventional bronchoscopy-an overview]. PNEUMOLOGE 2021; 18:405-418. [PMID: 34642585 PMCID: PMC8495438 DOI: 10.1007/s10405-021-00413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 12/02/2022]
Abstract
Die Bronchoskopie stellt neben der Lungenfunktion und der radiologischen Bildgebung das wichtigste Diagnostikum bei Patienten mit Atemwegs- und Lungenerkrankungen dar. Aufgrund des kombinierten Einsatzes flexibler und starrer Bronchoskope kommt sie heutzutage aber auch zunehmend als endoskopisches Therapieverfahren bei pulmonalen Erkrankungen in Frage. Bei thorakalen Tumoren kann die interventionelle Bronchoskopie sowohl in palliativer als auch kurativer Intention zum Einsatz kommen. Neben der bronchoskopischen Tumorbehandlung rückten in den letzten Jahren zunehmend die Techniken der endoskopischen Lungenvolumenreduktion in den Fokus. Darüber hinaus bieten sich Therapiemöglichkeiten für Asthma und chronische Bronchitis sowie bei Atemwegsstenosen und -fisteln.
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Menzella F, Fontana M, Galeone C, D'Amato M, Canonica GW, Ghidoni G, Capobelli S, Scelfo C, Simonazzi A, Catellani C, Ruggiero P, Facciolongo N. A Real-World Evaluation of Clinical Outcomes of Biologicals and Bronchial Thermoplasty for Severe Refractory Asthma (BIOTERM). J Asthma Allergy 2021; 14:1019-1031. [PMID: 34413654 PMCID: PMC8370487 DOI: 10.2147/jaa.s324099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background The important progress made on asthma phenotyping encouraged the development of new therapeutic strategies, such as monoclonal antibodies (mAbs) and bronchial thermoplasty (BT). The aim of this study is to compare patients diagnosed with severe refractory asthma (SRA) who are currently being treated with omalizumab, mepolizumab, benralizumab or BT and to evaluate the efficacy of these treatments over a 12-month observation period. Methods Overall, 199 consecutive patients with SRA were included. The cohort was selected referring to the eligibility criteria for all available biologics and BT. Results Among 32 patients treated with benralizumab, we found a 16.7% reduction in hospitalizations, a 66.6% reduction in exacerbations (p = 0.0001) and the greater improvement in FEV1 (+ 37.4%, p < 0.0001). Among omalizumab group (54 patients), there was a 85.7% (p = 0.012) reduction in hospitalizations and a 88.8% (p < 0.0001) reduction in exacerbations. In the mepolizumab group (83 patients), we found a 89.5% (p = 0.02) reduction in hospitalizations and a 92.1% (p < 0.0001) reduction in exacerbations. BT subgroup (30 patients) showed a 93.7% (p = 0.001) reduction in hospitalizations and a 73.5% (p < 0.0001) reduction in exacerbations. The best results in terms of OCS sparing effect were obtained by BT (- 76%, p < 0.0001) and mepolizumab (- 90.2%, p = 0.002). Omalizumab showed the highest percentage of super responder patients. Conclusion To our knowledge, this is the first study to compare all marketed mAbs with BT, ending in more comprehensive and applicable results to clinical practice. All biologics, to varying degrees, reduced hospitalizations, exacerbations, and OCS use. The starting point for patients in the BT group was worse regarding hospitalizations, exacerbations and OCS, but despite this, even this non-pharmacological option obtained positive results, comparable to biologics.
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Affiliation(s)
- Francesco Menzella
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Matteo Fontana
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Carla Galeone
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Maria D'Amato
- Department of Pulmonology, AO "Dei Colli" Federico II University, Naples, 80131, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS - Rozzano, Milan, Italy
| | - Giulia Ghidoni
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Silvia Capobelli
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Chiara Scelfo
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Anna Simonazzi
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Chiara Catellani
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Patrizia Ruggiero
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
| | - Nicola Facciolongo
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, 42123, Italy
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Thomson NC. Recent Developments In Bronchial Thermoplasty For Severe Asthma. J Asthma Allergy 2019; 12:375-387. [PMID: 31819539 PMCID: PMC6875488 DOI: 10.2147/jaa.s200912] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Neil C Thomson
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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