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Png LH, Kalish L, Campbell RG, Seresirikachorn K, Albrecht T, Raji N, Choy C, Rimmer J, Earls P, Sacks R, Harvey RJ. Predictors of persistent disease in biologic treated type 2 diffuse/eosinophilic chronic rhinosinusitis undergoing surgery. Int Forum Allergy Rhinol 2024; 14:909-918. [PMID: 37805956 DOI: 10.1002/alr.23282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/09/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Biologic therapy targeting type 2 chronic rhinosinusitis with nasal polyps (CRSwNP) has greatly improved disease control but nonresponders exist in a proportion of patients in phase 3 trials and clinical practice. This study explores the serum and histologic changes in biologic treated CRSwNP that predict disease control. METHODS A cross-sectional study was performed of patients with CRSwNP on biologics for their asthma, who underwent endoscopic sinus surgery while on biologic therapy. At the 6-month postoperative assessment, patients with poorly controlled CRSwNP while on biologic therapy were compared to patients who were controlled. Blood and mucosal samples taken at the time of surgery 6 months prior were assessed to predict disease control. RESULTS A total of 37 patients were included (age 47.8 ± 12.4 years, 43.2% female). Those with poorly controlled disease had reduced tissue eosinophils (% >100 cells/high-powered field: 8.3% vs. 50.0%, p < 0.001) and increased serum neutrophils (5.2 ± 2.7 vs. 3.7 ± 1.1 × 109 cells/L, p = 0.02). Logistic regression analysis demonstrated that reduced tissue eosinophil was predictive for poorly controlled disease (OR = 0.21, 95% CI [0.05, 0.83], p = 0.03). Receiver-operating characteristic analysis showed that need for rescue systemic corticosteroid was predicted at a serum neutrophil cut-off level of 5.75 × 109 cells/L (sensitivity = 80.0%, specificity = 96.9%, AUC = 0.938, p = 0.002). CONCLUSION Low tissue eosinophils and increased serum neutrophils while on biologics predict for poor response in the biological treatment of with CRSwNP. A serum neutrophil level of ≥5.75 × 109 cells/L predicts for poor response to current biologic therapy.
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Affiliation(s)
- Lu Hui Png
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Raewyn G Campbell
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kachorn Seresirikachorn
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Doctor of Philosophy Program in Medical Sciences (International Program), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tobias Albrecht
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Nelufer Raji
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Christine Choy
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Woolcock Institute, University of Sydney, Sydney, Australia
- Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Peter Earls
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Anatomical Pathology, St Vincent's Hospital, Darlinghurst, Australia
| | - Raymond Sacks
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Niu X, Chen Y, Zhou T, Xiao H. Endoscopic vidian and vidian-branch neurectomy for refractory allergic rhinitis: A systematic review. Int Forum Allergy Rhinol 2024; 14:679-694. [PMID: 37715589 DOI: 10.1002/alr.23259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Endoscopic vidian neurectomy is expected to provide good therapeutic relief in patients with allergic rhinitis (AR) being refractory to medication therapy or conservative surgery. However, the evidence bases for its benefit remain debatable. In this study, we conducted a systematic review and meta-analysis to clarify the therapeutic role of various forms of vidian neurectomy in refractory AR. METHOD Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct a systematic review of primary studies that reported original patient data for endoscopic vidian neurectomy (EVN) and vidian-branch neurectomy, which includes selective vidian neurectomy (SVN) and posterior nasal neurectomy (PNN). The primary outcome was patient-reported outcome measures (PROMs), including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analog Scale (VAS), to assess an improvement in nasal symptom severity and quality of patient's life. The incidence of surgical complications and other objective outcomes were considered secondary outcomes. RESULTS This review included 24 clinical studies involving 1677 patients with refractory AR, of which 510 patients in six studies had combined chronic rhinosinusitis with nasal polyps (CRSwNP) and 95 patients in one study had combined asthma. Postoperative PROMs were significantly better than preoperatively in almost all patients who underwent vidianp (RQLQ: standardized mean difference [SMD] = 2.66, 95% confidence interval [CI] = 2.40-2.92, p < 0.001; VAS: SMD = 5.15, 95% CI = 4.29-6.02, p < 0.001) or vidian-branch neurectomy (RQLQ in PNN: SMD = 3.29, 95% CI = 2.45-4.13, p < 0.001; VAS in PNN: SMD = 4.38, 95% CI = 3.41-5.34, p < 0.001), and were generally better than in the conservative treatment group. Dividing with 18 months as the cutoff point, a subgroup analysis of the follow-up period was conducted, and the results showed that both long-term and short-term postoperative patients had considerably reduced symptoms compared to the preoperative period. The two surgical procedures, SVN and PNN, attributed to vidian-branch neurectomy have extremely few complications. However, EVN is more likely to cause dry eyes and palatal numbness, with no other serious complications. In patients with AR and CRSwNP, vidian or selective vidian neurectomy combined with functional endoscopic sinus surgery (FESS) is more effective than conventional FESS (RQLQ: SMD = 2.17, 95% CI = 1.66-2.69, p < 0.001; VAS: SMD = 6.42, 95% CI = 4.78-8.06, p < 0.001). For patients who have both AR and asthma, SVN with pharyngeal branch excision is a potential treatment option. CONCLUSION EVN and vidian-branch neurectomy (including SVN and PNN) are effective treatments, but the former has a higher risk of complications. Additionally, vidian-branch neurectomy with FESS is beneficial for patients with mixed CRSwNP. SVN is a potential approach for patients with coexisting AR and asthma.
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Affiliation(s)
- Xun Niu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuzhang Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongjun Xiao
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Soo CI, Mak WW, Nasaruddin MZ, Ismail R, Ban AYL, Abdul Rahaman JA. Bronchial thermoplasty for severe asthmatics: a real-world clinical study from Malaysia. Singapore Med J 2024; 65:119-122. [PMID: 34617697 PMCID: PMC10942133 DOI: 10.11622/smedj.2021144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Chun Ian Soo
- Division of Respiratory Medicine, Department of Internal Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Woh Wei Mak
- Department of Pulmonology, Serdang Hospital, Selangor, Malaysia
| | | | - Rosmadi Ismail
- Department of Pulmonology, Serdang Hospital, Selangor, Malaysia
| | - Andrea Yu-Lin Ban
- Pulmonology Unit, Department of Internal Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Matsuyama T, Tanaka J, Tone K, Shimizu K, Nakano T, Takahashi K. [THE EFFICACY OF BRONCHIAL THERMOPLASTY IN LONG-TERM MAINTENANCE OF ADULT PATIENTS WITH MODERATE TO SEVERE ASTHMA]. Arerugi 2024; 73:40-51. [PMID: 38403700 DOI: 10.15036/arerugi.73.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIMS Bronchial thermoplasty (BT) is a bronchoscopic treatment for adult patients with moderate to severe asthma. A systematic review was conducted to examine the efficacy of this treatment. METHODS Randomized controlled comparing BT to a control in adult patients with moderate to severe asthma were added to the previously conducted systematic review. Literature published prior to July 2022 was selected. RESULTS Four trials were included in this study. BT resulted in significant improvement in quality of life. However, no significant difference in asthma control was observed. Moreover, the incidence of severe adverse events during the treatment period was increased by BT. Furthermore, BT did not improve lung function, increase withdrawal from oral corticosteroids, reduce frequency of rescue medication usage, or increase the number of symptom-free days. CONCLUSION From a risk-benefit perspective, there is insufficient evidence to support a recommendation of BT in adult patients with moderate to severe asthma.
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Affiliation(s)
- Takahiro Matsuyama
- Department of Respiratory Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Jun Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine
| | - Kazuya Tone
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University
| | - Takako Nakano
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University
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Luo X, Huang XK, Zhang YN, Yang QT. Editorial Commentary: Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted after Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps. Curr Med Sci 2023; 43:1258-1259. [PMID: 38153632 DOI: 10.1007/s11596-023-2826-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Xin Luo
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Xue-Kun Huang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Ya-Na Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Qin-Tai Yang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
- Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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Gagnon PA, Klein M, De Vos J, Biardel S, Côté A, Godbout K, Laviolette M, Laprise C, Assou S, Chakir J. S100A alarmins and thymic stromal lymphopoietin (TSLP) regulation in severe asthma following bronchial thermoplasty. Respir Res 2023; 24:294. [PMID: 37996952 PMCID: PMC10668474 DOI: 10.1186/s12931-023-02604-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
RATIONALE Severe asthma affects a small proportion of asthmatics but represents a significant healthcare challenge. Bronchial thermoplasty (BT) is an interventional treatment approach preconized for uncontrolled severe asthma after considering biologics therapy. It was showed that BT long-lastingly improves asthma control. These improvements seem to be related to the ability of BT to reduce airway smooth muscle remodeling, reduce the number of nerve fibers and to modulate bronchial epithelium integrity and behavior. Current evidence suggest that BT downregulates epithelial mucins expression, cytokine production and metabolic profile. Despite these observations, biological mechanisms explaining asthma control improvement post-BT are still not well understood. OBJECTIVES To assess whether BT affects gene signatures in bronchial epithelial cells (BECs). METHODS In this study we evaluated the transcriptome of cultured bronchial epithelial cells (BECs) of severe asthmatics obtained pre- and post-BT treatment using microarrays. We further validated gene and protein expressions in BECs and in bronchial biopsies with immunohistochemistry pre- and post-BT treatment. MEASUREMENTS AND MAIN RESULTS Transcriptomics analysis revealed that a large portion of differentially expressed genes (DEG) was involved in anti-viral response, anti-microbial response and pathogen induced cytokine storm signaling pathway. S100A gene family stood out as five members of this family where consistently downregulated post-BT. Further validation revealed that S100A7, S100A8, S100A9 and their receptor (RAGE, TLR4, CD36) expressions were highly enriched in severe asthmatic BECs. Further, these S100A family members were downregulated at the gene and protein levels in BECs and in bronchial biopsies of severe asthmatics post-BT. TLR4 and CD36 protein expression were also reduced in BECs post-BT. Thymic stromal lymphopoietin (TSLP) and human β-defensin 2 (hBD2) were significantly decreased while no significant change was observed in IL-25 and IL-33. CONCLUSIONS These data suggest that BT might improve asthma control by downregulating epithelial derived S100A family expression and related downstream signaling pathways.
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Affiliation(s)
- Pierre-Alexandre Gagnon
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
| | - Martin Klein
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
| | - John De Vos
- IRMB, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Sabrina Biardel
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
| | - Andréanne Côté
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
| | - Krystelle Godbout
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
| | - Michel Laviolette
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
| | - Catherine Laprise
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi (UQAC), Saguenay, QC, Canada
| | - Said Assou
- IRMB, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Jamila Chakir
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada.
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Makary CA, Bonnici M, Jones G, Sullivan P, Stokes C, Ramadan HH. Long-term Follow-up of Pediatric Chronic Rhinosinusitis After Surgical Treatment. Ann Otol Rhinol Laryngol 2023; 132:1400-1403. [PMID: 36951071 DOI: 10.1177/00034894231161417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To study the long-term outcomes of pediatric chronic rhinosinusitis (CRS) after surgical treatment. METHODS Cross-sectional survey of patients who were treated surgically for CRS as children more than 10 years ago. Survey included SNOT-22 questionnaire, additional functional endoscopic sinus surgery (FESS) since last treatment, status of allergic rhinitis and asthma, and availability of any CT scan sinus/face for review. RESULTS About 332 patients were contacted by phone or email. Seventy-three patients filled the survey (22.5% response rate). Current age was 26 years (±+/-4.7, 15.3-37.8 years). Age at initial treatment was 6.8 years (+/-3.1, 1.7-14.7 years). Fifty-two patients (71.2%) had FESS and adenoidectomy, and 21 patients (28.8%) had adenoidectomy only. Follow-up since surgical treatment was 19.3 years (+/-4.1). SNOT-22 score was 34.5 (+/-22.2). None of the patients had any additional FESS for the duration of the follow-up, and only 3 patients had septoplasty and inferior turbinoplasty as adults. Twenty-four patients had CT scan sinuses/face available for review. Scans were obtained at an average of 14 years after surgical intervention (+/-5.2). CT LM score was 0.9 (+/-1.9), compared to 9.3 at time of their surgery (+/-5.9) (P < .0001). Currently 45.8% and 36.9% of patients have asthma and AR, compared to 35.6% and 40.6% respectively as kids (P = .897 and P = .167). CONCLUSION Children who had surgery for CRS do not seem to have CRS as adults. However, patients continue to have active allergic rhinitis that may affect their quality of life.
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Affiliation(s)
- Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | | | - Garrett Jones
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Patrick Sullivan
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Cara Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
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Ano S, Kikuchi N, Matsuyama M, Hizawa N. Patient profiling to predict response to bronchial thermoplasty in patients with severe asthma. Respir Investig 2023; 61:675-681. [PMID: 37708632 DOI: 10.1016/j.resinv.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 09/16/2023]
Abstract
Bronchial thermoplasty is the only device-based nonpharmacological treatment approach for severe asthma. Current guidelines are cautious in recommending bronchial thermoplasty because of unknown patient response prediction. Recent research on bronchial thermoplasty includes up-to-date, state-of-the-art, and recent-advances reviews. However, these reviews provide a broad and general discussion on equipment, technique, patient selection, and patient management, with little evaluation of the predictors of a beneficial response. Predicting an optimal response to bronchial thermoplasty in patients with severe asthma remains elusive. The lack of reliable predictive markers means that bronchial thermoplasty remains a last-line treatment and makes profiling for predicting the response or efficacy a topic of study. Genetic changes are associated with airway remodeling. A gap in the literature exists regarding patient profiling to predict the response to bronchial thermoplasty in patients with severe asthma. Therefore, recently published omics data and genetic associations regarding the response to bronchial thermoplasty therapy should be reviewed. We present an up-to-date review of recent publications profiling the response to bronchial thermoplasty in patients with severe asthma.
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Affiliation(s)
- Satoshi Ano
- Department of Respiratory Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan; Department of Respiratory Medicine, National Hospital Organization Kasumigaura Medical Center, 2-7-14 Shimotakatsu, Tsuchiura, Ibaraki 300-8585, Japan.
| | - Norihiro Kikuchi
- Department of Respiratory Medicine, National Hospital Organization Kasumigaura Medical Center, 2-7-14 Shimotakatsu, Tsuchiura, Ibaraki 300-8585, Japan
| | - Masashi Matsuyama
- Department of Respiratory Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Baydur A, Barbers R, May D. Effect of bronchial thermoplasty on static and dynamic lung compliance and resistance in patients with severe persistent asthma. Respir Med 2023; 217:107341. [PMID: 37429559 DOI: 10.1016/j.rmed.2023.107341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
RATIONALE Bronchial thermoplasty (BT) reduces severity and frequency of bronchoconstriction and symptoms in severe, persistent asthmatics although it is usually not associated with change in spirometric variables. Other than spirometry. there are almost no data on changes in lung mechanics following BT. OBJECTIVE To assess lung static and dynamic lung compliance (Cst,L and Cdyn,L, respectively) and static and dynamic lung resistance (Rst,L and Rdyn,L, respectively) before and after BT in severe asthmatics using the esophageal balloon technique. METHODS Rdyn,L and Cdyn,L were measured at respiratory frequencies up to 145 breaths/min, using the esophageal balloon technique in 7 patients immediately before and 12-50 weeks after completing a series of 3 BT sessions. RESULTS All patients experienced improved symptoms within a few weeks following completion of BT. Pre-BT, all patients exhibited frequency dependency of lung compliance, with mean Cdyn,L decreasing to 63% of Cst,L at maximum respiratory rates. Post-BT, Cst,L did not change significantly from pre-thermoplasty values, while Cdyn,L diminished to 62%% of Cst,L. In 4 of 7 patients, post-BT values of Cdyn,L were consistently higher than pre-BT over the range of respiratory rates. RL in 4 of 7 patients during quiet breathing and at higher respiratory frequencies decreased following BT. CONCLUSIONS Patients with severe persistent asthma exhibit increased resting lung resistance and frequency dependence of compliance, the magnitudes of which are ameliorated in some patients following bronchial thermoplasty and associated with variable change in frequency dependence of lung resistance. These findings are related to asthma severity and may be related to the heterogeneous and variable nature of airway smooth muscle modeling and its response to BT.
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Affiliation(s)
- Ahmet Baydur
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California and Keck Medical Center, Los Angeles, CA, USA.
| | - Richard Barbers
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California and Keck Medical Center, Los Angeles, CA, USA
| | - Darren May
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California and Keck Medical Center, Los Angeles, CA, USA
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Huang A, Li T, Li MS, Huang ZX, Wang DH, Cheng L, Zhou B, Wang H, Liu Z. Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps. Curr Med Sci 2023; 43:1005-1012. [PMID: 37828371 DOI: 10.1007/s11596-023-2786-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP. Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation: sex, serum eosinophil levels, history of prior surgery, endoscopic scores, and comorbid conditions (asthma and allergic rhinitis). The primary outcome was the rate of post-operative intervention on day 30, and the secondary outcome was the rate of polypoid tissue formation (grades 2-3) on days 14, 30, and 90. RESULTS A total of 151 patients with CRSwNP were included in the post-hoc analysis. Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30, with an odds ratio of 23.71 (95% CI, 2.81, 200.16; P=0.004) for the need for post-operative intervention and 19 (95% CI, 2.20, 164.16; P=0.003) for moderate-to-severe polypoid tissue formation. In addition, the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30. Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation. CONCLUSION Comorbid asthma, but not blood eosinophil level, impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.
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Affiliation(s)
- Ao Huang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, 430030, China
| | - Tao Li
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, 430030, China
| | - Min-Shan Li
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, 430030, China
| | - Zhen-Xiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100000, China
| | - De-Hui Wang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, 200000, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100000, China.
| | - Heng Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, 430030, China.
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, 430030, China.
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Frankel A, Ong HS, Smithers BM, Nathanson LK, Gotley DC. Efficacy of laparoscopic fundoplication in patients with chronic cough and gastro-oesophageal reflux. Esophagus 2023; 20:170-177. [PMID: 36201134 PMCID: PMC9813203 DOI: 10.1007/s10388-022-00953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The outcome of anti-reflux surgery in patients with suspected gastro-oesophageal reflux-induced cough is frequently uncertain. The aims of this study were to assess the efficacy of laparoscopic fundoplication for controlling cough in patients with chronic cough without asthma, who have pathologic gastro-oesophageal reflux, and to identify predictors of response. METHODS From a prospective database of 1598 patients who have undergone laparoscopic fundoplication, 66 (4%) with proven gastro-oesophageal reflux disease (GORD) and chronic cough without asthma were studied. All patients underwent gastroscopy and 24-h pH monitoring before operation. Heartburn and regurgitation were assessed using a modified DeMeester score. Severity of cough before and after surgery was self-assessed by the patient using a visual analog scale at a minimum of 12 months post-operatively (median 43 mo; range: 14-104 mo). Patients were considered to have responded to fundoplication if they had no cough or the cough had improved by 50% or more after operation. RESULTS Cough and heartburn/regurgitation were relieved in 61% (40/66) and 90% (44/49) of the patients, respectively. The presence of typical GORD symptoms or oesophagitis, and pH study variables did not predict the response of the cough to fundoplication. CONCLUSION Refinement in the aetiological diagnosis of chronic cough due to GORD is necessary for improved outcome. Patients diagnosed with GORD-related chronic cough need to be counseled regarding their expectations from anti-reflux surgery.
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Affiliation(s)
- Adam Frankel
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia.
| | - Hock Soo Ong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - B Mark Smithers
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- Mater Private Hospital, South Brisbane, QLD, Australia
| | - Les K Nathanson
- Department of Surgery, Royal Brisbane Hospital, Herston, QLD, Australia
| | - David C Gotley
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- Mater Private Hospital, South Brisbane, QLD, Australia
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Torrego A, Herth FJ, Munoz-Fernandez AM, Puente L, Facciolongo N, Bicknell S, Novali M, Gasparini S, Bonifazi M, Dheda K, Andreo F, Votruba P, Langton D, Flandes J, Fielding D, Bonta PI, Skowasch D, Schulz C, Darwiche K, McMullen E, Grubb GM, Niven R. Bronchial Thermoplasty Global Registry (BTGR): 2-year results. BMJ Open 2021; 11:e053854. [PMID: 34916324 PMCID: PMC8679080 DOI: 10.1136/bmjopen-2021-053854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Bronchial thermoplasty (BT) is a device-based treatment for subjects ≥18 years with severe asthma not well controlled with inhaled corticosteroids and long-acting beta-agonists. The Bronchial Thermoplasty Global Registry (BTGR) collected real-world data on subjects undergoing this procedure. DESIGN The BTGR is an all-comer, prospective, open-label, multicentre study enrolling adult subjects indicated for and treated with BT. SETTING Eighteen centres in Spain, Italy, Germany, the UK, the Netherlands, the Czech Republic, South Africa and Australia PARTICIPANTS: One hundred fifty-seven subjects aged 18 years and older who were scheduled to undergo BT treatment for asthma. Subjects diagnosed with other medical conditions which, in the investigator's opinion, made them inappropriate for BT treatment were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Baseline characteristics collected included demographics, Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test (ACT), medication usage, forced expiratory volume in one second and forced vital capacity, medical history, comorbidities and 12-month baseline recall data (severe exacerbations (SE) and healthcare utilisation). SE incidence and healthcare utilisation were summarised at 1 and 2 years post-BT. RESULTS Subjects' baseline characteristics were representative of persons with severe asthma. A comparison of the proportion of subjects experiencing events during the 12 months prior to BT to the 2-year follow-up showed a reduction in SE (90.3% vs 56.1%, p<0.0001), emergency room visits (53.8% vs 25.5%, p<0.0001) and hospitalisations (42.9% vs 23.5 %, p=0.0019). Reductions in asthma maintenance medication dosage were also observed. AQLQ and ACT scores improved from 3.26 and 11.18 at baseline to 4.39 and 15.54 at 2 years, respectively (p<0.0001 for both AQLQ and ACT). CONCLUSIONS The BTGR demonstrates sustained improvement in clinical outcomes and reduction in asthma medication usage 2 years after BT in a real-world population. This is consistent with results from other BT randomised controlled trials and registries and further supports improvement in asthma control after BT. TRIAL REGISTRATION NUMBER NCT02104856.
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Affiliation(s)
- Alfons Torrego
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Felix J Herth
- Thoraxklinik, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | | | - Luis Puente
- Respiratory Department, Hospital General Universitario Gregorio Marañon-Facultad de Medicina Universidad Complutense, Madrid, Spain
| | - Nicola Facciolongo
- AUSL-IRCCS Reggio Emilia Pulmonology Unit, IRCCS Reggio Emilia Pulmonology Unit, Santa Maria Nuova, Italy
| | - Stephen Bicknell
- Respiratory Department, Gartnavel General Hospital, Glasgow, Glasgow, UK
| | - Mauro Novali
- Respiratory Department, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | - Stefano Gasparini
- Respiratory Department, Università Politecnica delle Marche, Ancona, Marche, Italy
| | - Martina Bonifazi
- Respiratory Department, Università Politecnica delle Marche, Ancona, Marche, Italy
| | - Keertan Dheda
- Respiratory Department, University of Cape Town, Cape Town, South Africa
| | - Felipe Andreo
- Pulmonology Department, Hospital Universitari Germans Trias i Pujol-CIBERES, Badalona, Barcelona, Spain
| | - Praha Votruba
- Respiratory Department, Klinika Tuberkulozy a Respiracnich Onemocneni, Prague, Czech Republic
| | - David Langton
- Respiratory Department, Frankston Hospital Peninsula Health, Frankston, Victoria, Australia
| | - Javier Flandes
- Respiratory Department, Hospital Universitario Fundacion Jimenez Diaz-CIBERES IIS-FJD, Madrid, Spain
| | - David Fielding
- Respiratory Department, Royal Brisbane and Women's Hospital-Brisbane/AUS, Brisbane, Queensland, Australia
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dirk Skowasch
- Department of Cardiology and Pneumology, University of Bonn, Medizinische Klinik II, Bonn, Germany
| | - Christian Schulz
- Respiratory Department, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Kaid Darwiche
- Respiratory Department, Ruhrlandklinik-West German Lung Center, University Medicine Essen, Essen, Germany
| | | | - G Mark Grubb
- Boston Scientific Corp, Marlborough, Massachusetts, USA
| | - Robert Niven
- Respiratory Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
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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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15
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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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Abstract
Bronchial thermoplasty (BT), which delivers thermal radiofrequency to the bronchial wall, is an effective therapy for patients with severe persistent uncontrolled asthma. We herein report the case of a 47-year-old man who underwent BT for uncontrolled severe asthma. After BT, his asthma control, asthma-related quality of life, and pulmonary function improved. Furthermore, a histologic examination of transbronchial biopsy specimens revealed a decrease in goblet cell hyperplasia and the smooth muscle mass as well as in the subepithelial basement membrane thickness. BT can be effective for patients with severe uncontrolled asthma and mucus hypersecretion.
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Affiliation(s)
- Naoko Nagano
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Ayaka Ito
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Eriko Miyawaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Masao Hashimoto
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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O'Reilly A, Browne I, Watchorn D, Egan JJ, Lane S. The efficacy and safety of bronchial thermoplasty in severe persistent asthma on extended follow-up. QJM 2018; 111:155-159. [PMID: 29149273 DOI: 10.1093/qjmed/hcx221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Asthma is a common condition and there remains a subset of patients who are poorly controlled on maximal therapy. Bronchial thermoplasty (BT) is a bronchoscopic therapy using radiofrequency energy to reduce airway smooth muscle, which has been shown to improve asthma control although further evidence regarding long-term efficacy and safety is required. AIM We aimed to demonstrate safety and efficacy of BT on extended follow-up. Our initial experience with this group was previously reported in 2016, where patients were shown to have a significant improvement in asthma control test (ACT) scores 1-year post-treatment. DESIGN We carried out a retrospective observational study of seven patients who underwent BT between 2012 and 2013 in an Irish severe asthma centre. The primary endpoint was change in ACT scores from baseline to present. METHODS Seven patients underwent BT at a tertiary referral centre in Ireland. ACT scores and data on hospital admissions, exacerbations, maintenance corticosteroid requirements, rescue bronchodilator use and forced expiratory volume for 1 s (FEV1) prior to the procedure and on extended follow-up were collected. Mean follow-up was 49.42 months. RESULTS A trend towards improvement was seen in median hospitalisations (respective values for median over 12 months 3, 1 P = 0.059) and ACT scores, from 9 to 13 (P = 0.249). Mean FEV1 was 1.68 l prior to treatment and 1.46 l 4 years post-treatment (P = 0.237). There was no mortality among the group. CONCLUSIONS These data support the safety of BT and suggest extended efficacy.
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Affiliation(s)
- A O'Reilly
- Department of Respiratory Medicine, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin 24, Ireland
| | - I Browne
- Department of Respiratory Medicine, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin 24, Ireland
| | - D Watchorn
- Department of Respiratory Medicine, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin 24, Ireland
| | - J J Egan
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - S Lane
- Department of Respiratory Medicine, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin 24, Ireland
- Department of Respiratory Medicine, Peamount Healthcare, Newcastle, Co. Dublin, Ireland
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Bronchial thermoplasty. Arerugi 2017; 66:957-8. [PMID: 28824038 DOI: 10.15036/arerugi.66.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Minami D, Ando C, Nakasuka T, Iwamoto Y, Sato K, Fujiwara K, Shibayama T, Yonei T, Sato T. Usefulness of Bronchial Thermoplasty for Patients with a Deteriorating Lung Function. Intern Med 2018; 57:75-79. [PMID: 29033420 PMCID: PMC5799061 DOI: 10.2169/internalmedicine.8965-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/08/2017] [Indexed: 11/06/2022] Open
Abstract
Bronchial thermoplasty is a novel procedure for patients with severe asthma showing a stable lung function. We herein report two cases with a deteriorating lung function. The lung function tended to improve in one case, while the other case discontinued mepolizumab medication after the procedure. Treatment was performed safely under general anesthesia in both cases. The use of bronchial thermoplasty may therefore be useful for the treatment of patients with a deteriorating lung function.
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Affiliation(s)
- Daisuke Minami
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Chihiro Ando
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Takamasa Nakasuka
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Yoshitaka Iwamoto
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Ken Sato
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Takuo Shibayama
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Toshiro Yonei
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Toshio Sato
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
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Azagami S, Mineshita M. [Bronchial thermoplasty in the treatment of asthma]. Nihon Rinsho 2016; 74:1747-1750. [PMID: 30551291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Bronchial thermoplasty(BT) is a novel therapeutic modality for adult patients with severe asthma. BT is a procedure of applying radio frequency thermal energy to the airways with the goal of ablating the airway smooth muscle and ameliorating airway hypersensitivity. BT improves asthma related quality of life and reduces the rate of asthma exacerbations compared with standard therapy. These benefits are reported to..persist for at least 5 years. BT was introduced in Japan on April 2015, and the number of treated asthma patients is increasing. In this article, we describe the methods, effectiveness, safety and the current status of BT in Japan.
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Wilhelm CP, Chipps BE. Bronchial thermoplasty: a review of the evidence. Ann Allergy Asthma Immunol 2015; 116:92-8. [PMID: 26654482 DOI: 10.1016/j.anai.2015.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/13/2015] [Accepted: 11/02/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Chelle Pope Wilhelm
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
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Bagcchi S. Adenotonsillectomy improves asthma outcomes in children. Lancet Respir Med 2015; 2:975. [PMID: 25621348 DOI: 10.1016/s2213-2600(14)70278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mayor S. Adenotonsillectomy reduces acute asthma exacerbations in children, study shows. BMJ 2014; 349:g6575. [PMID: 25378128 DOI: 10.1136/bmj.g6575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Huang Fu H. [Effects of endoscopic surgery on patients with chronic rhinosinusitis with bronchial asthma]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:1501-1504. [PMID: 25775757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the efficacy of endoscopic sinus surgery (ESS)-based multidisciplinary therapy for patients with chronic rhinosinusitis (CRS), nasal polyps and bronchial asthma. METHOD The study included 32 patients with CRS, nasal polyps and bronchial asthma who received ESS, besides surgery, who also used glucocorticoid inhalation, nasal spray and nasal irrigation perioperatively. The evaluation of the treatment was performed 3 years post after ESS. RESULT In the 32 cases treated with ESS, 19 cases were cured, 9 cases were improved, 4 cases were inefficient by the treatment. The cure rate was 87.5%. The asthma symptoms were improved in 9 patients (P < 0.01), compared to 2 before surgery. The numbers of patients with improved symptoms were increased from 2 before the surgery to 9 after the surgery. CONCLUSION As the main treatment, endoscopic si- nus surgery was effective on CRS with asthma.
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Lu Y, Gu Q, Pang C, Gao F, Liu C, Du J, Zhao J, Chen Y. [Treatment of obstructive sleep apnea-hypopnea syndrome for children refractory asthma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 49:462-467. [PMID: 25241862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to understand the effect of different treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) for refractory asthma in children. METHODS Fifty two children (32 in surgical group, 20 in conservative group) with refractory asthma and OSAHS were included in the study. All children received asthma condition assessment and polysomnography (PSG) examination before and after treatment, and were followed up for 6 months. RESULTS All children got improved in PSG values 3 months after treatment, more significant improvement was achieved in surgical group than in conservative group (P < 0.05). While compared of OSAHS treatment, there were 2 cure, 6 notable effective, 9 effective, 3 in vain cases in conservative group, 8 cure, 16 notable effective, 8 effective, 0 in vain cases in surgery group. There was significant difference between the two groups (χ² = 8.91, P = 0.031). All children got improved in asthma condition evaluation parameters and decreased the use number of short acting β2 agonists after 6 months treatment. More significant improvement was achieved in surgical group than in conservative group. The differences of all the items had statistical significance (P < 0.05). There was statistical correlation between days mutation rate of peak expiratory flow (PEF) and apnea hypopnea index (r = 0.712, P < 0.01), and between days mutation rate of PEF and lowest oxygen saturation (r = 0.726, P < 0.01). CONCLUSIONS Active treatment of OSAHS can improve asthma symptoms and reduce asthma medication effectively. The curative effect of surgical treatment is superior to conservative treatment.
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Affiliation(s)
- Yingxia Lu
- Department of Otorhinolaryngology, Capital Institute of Pediatrics affiliated Children's hospital, Beijing 100020, China
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Gompelmann D, Eberhardt R, Herth FJF. Interventional pulmonology procedures: an update. Panminerva Med 2013; 55:121-129. [PMID: 23676954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Bronchoscopy is the most important tool in diagnosis of respiratory diseases, but also provides therapeutic options in various disorders. Besides hemoptysis, airway stenoses are a frequent indication for therapeutic bronchoscopy interventions. Thereby, a broad spectrum of endoscopic techniques including electrocautery, argon plasma coagulation, laser treatment, cryosurgery and stent implantation is available. In the last decade, development of new endoscopic modalities provides also treatment of patients with chronic obstructive pulmonary disease and uncontrolled asthma.
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Affiliation(s)
- D Gompelmann
- Department of Pneumology and Respiratory Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
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Kaiser P. Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy. Pediatr Pulmonol 2012; 47:311; discussion 312-4. [PMID: 21905267 DOI: 10.1002/ppul.21543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2011] [Indexed: 11/09/2022]
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Morrow T. Long-term safety data support use of bronchial thermoplasty. Manag Care 2011; 20:67-68. [PMID: 22259879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Lee JA, Rowen DW, Rose DD. Bronchial thermoplasty: a novel treatment for severe asthma requiring monitored anesthesia care. AANA J 2011; 79:480-483. [PMID: 22400414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dexmedetomidine used in monitored anesthesia care produces a safe and effective technique well documented in research. We report the successful use of dexmedetomidine for sedation during bronchial thermoplasty, a new treatment for patients with severe persistent asthma refractory to inhaled corticosteroids and long-term beta-2 agonists.
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Kheirandish-Gozal L, Dayyat EA, Eid NS, Morton RL, Gozal D. Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy. Pediatr Pulmonol 2011; 46:913-8. [PMID: 21465680 PMCID: PMC3156307 DOI: 10.1002/ppul.21451] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 12/12/2010] [Accepted: 12/13/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnographically demonstrated OSA would be more frequent among poorly controlled asthmatics (PCA), and that treatment of OSA, if present, would ameliorate the frequency of acute asthmatic exacerbations (AAE). METHODS Children with PCA were referred for an overnight sleep study, and adenotonsillectomy (tonsillectomy and adenoidectomy, T&A) was performed if OSA was present. Frequency of asthma symptoms and exacerbations were compared. RESULTS Ninety-two PCA children, ages 3-10 years, with a mean frequency of AAE of 3.4 ± 0.4/year were prospectively referred for a sleep study. OSA (i.e., AHI > 5/hrTST) was present in 58 patients (63.0%; OR: 40.9, 12.9-144.1, P < 0.000001 compared to the prevalence of OSA in a non-asthmatic population). Information at 1-year follow-up was available for 35 PCA children after T&A. The annual frequency of AAE, rescue inhaled use, and asthma symptoms in this sub-group decreased compared to no changes in the group without OSA. CONCLUSIONS The prevalence of OSA is markedly increased among PCA children and treatment of OSA appears to be associated with substantial improvements in the severity of the underlying asthmatic condition.
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Affiliation(s)
- Leila Kheirandish-Gozal
- Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois 60637-1470, USA.
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Chen FH, Xu R, Zuo KJ, Guo YB, Li ZP, Shi JB. [Efficacy of endoscopic sinus surgery-based on multidisciplinary treatment for chronic rhinosinusitis with asthma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 46:444-448. [PMID: 21924092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis (CRS) and asthma. METHODS The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale (VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma. RESULTS Twenty-three (92%) patients were followed up for 12 months. Twelve (48%) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8.12 ± 0.60, x(-) ± s), after 1 year (3.20 ± 2.19) and 3 year (3.79 ± 2.32) follow up (both P = 0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0.851). Endoscopy Lund-Kennedy score significantly improved in post-ESS after 1 year (4.35 ± 3.21) and 3 year (5.50 ± 2.64) follow up compared to pre-ESS (9.80 ± 2.10, both P = 0.000), and there was no difference between 1 year and 3 year follow up (P = 0.606). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21.96 ± 2.16, 23.61 ± 1.94 and 22.33 ± 3.47, without statistic difference (F = 2.871, P = 0.065). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05). CONCLUSIONS ESS improves CRS with asthma significantly and persistently. Asthma control level, anti-asthma drug dose and pulmonary function remain stable after ESS.
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Affiliation(s)
- Feng-hong Chen
- Otorhinolaryngology Hospital, First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China
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Gupta SS. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma. Am J Respir Crit Care Med 2011; 182:1565; author reply 1565-7. [PMID: 21159907 DOI: 10.1164/ajrccm.182.12.1565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Thomson NC, Rubin AS, Niven RM, Corris PA, Siersted HC, Olivenstein R, Pavord ID, McCormack D, Laviolette M, Shargill NS, Cox G. Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial. BMC Pulm Med 2011; 11:8. [PMID: 21314924 PMCID: PMC3045390 DOI: 10.1186/1471-2466-11-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/11/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a bronchoscopic procedure that improves asthma control by reducing excess airway smooth muscle. Treated patients have been followed out to 5 years to evaluate long-term safety of this procedure. METHODS Patients enrolled in the Asthma Intervention Research Trial were on inhaled corticosteroids ≥200 μg beclomethasone or equivalent + long-acting-beta2-agonists and demonstrated worsening of asthma on long-acting-β2-agonist withdrawal. Following initial evaluation at 1 year, subjects were invited to participate in a 4 year safety study. Adverse events (AEs) and spirometry data were used to assess long-term safety out to 5 years post-BT. RESULTS 45 of 52 treated and 24 of 49 control group subjects participated in long-term follow-up of 5 years and 3 years respectively. The rate of respiratory adverse events (AEs/subject) was stable in years 2 to 5 following BT (1.2, 1.3, 1.2, and 1.1, respectively,). There was no increase in hospitalizations or emergency room visits for respiratory symptoms in Years 2, 3, 4, and 5 compared to Year 1. The FVC and FEV1 values showed no deterioration over the 5 year period in the BT group. Similar results were obtained for the Control group. CONCLUSIONS The absence of clinical complications (based on AE reporting) and the maintenance of stable lung function (no deterioration of FVC and FEV1) over a 5-year period post-BT in this group of patients with moderate to severe asthma support the long-term safety of the procedure out to 5 years.
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Affiliation(s)
- Neil C Thomson
- Gartnavel General Hospital, University of Glasgow, Glasgow, UK
| | | | - Robert M Niven
- University Hospital of South Manchester and University of Manchester, Manchester, UK
| | - Paul A Corris
- Department of Respiratory Medicine, Freeman Hospital, Newcastle University, Newcastle, UK
| | | | | | - Ian D Pavord
- Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Gerard Cox
- St. Joseph's Healthcare, McMaster University, Hamilton, Canada
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Herrag M, AitBatahar S, Yazidi AA. Bronchial thermoplasty in developing countries: is it really worth it? Am J Respir Crit Care Med 2010; 182:719; author reply 719. [PMID: 20802171 DOI: 10.1164/ajrccm.182.5.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Liccardi G, Salzillo A, Piccolo A, De Napoli I, D'Amato G. The risk of bronchospasm in asthmatics undergoing general anaesthesia and/or intravascular administration of radiographic contrast media. physiopatology and clinical/functional evaluation. Eur Ann Allergy Clin Immunol 2010; 42:167-173. [PMID: 21192624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
It is well known that patients suffering from bronchial asthma undergoing to surgical procedures requiring general anaesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) experience a risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted on the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. The aim of this review is to underline the need for an accurate clinical and functional evaluation of asthmatics (especially those with a relevant degree of asthma severity) undergoing GA or administration of RCM. Guidelines shared by pulmonologists, allergologists, anesthesiologists and radiologists should be produced in the future for a better evaluation and management of these patients. General practitioner plays an important role in managing asthmatic patients in "Real Life". It is likely that "Real Life"--optimally controlled asthmatics could undergo GA/RCM with lower risks especially in emergency conditions when it is not possible to perform any preoperative evaluation.
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Affiliation(s)
- G Liccardi
- Department of Chest Diseases. Division of Pneumology and Allergology, "A. Cardarelli" High Speciality Hospital, Naples, Italy
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Sun PP, Tong ZH. [The application of bronchial thermoplasty in the treatment of bronchial asthma]. Zhonghua Jie He He Hu Xi Za Zhi 2010; 33:614-616. [PMID: 20979852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Ehnhage A, Olsson P, Kölbeck KG, Skedinger M, Dahlén B, Alenius M, Stjärne P. Functional endoscopic sinus surgery improved asthma symptoms as well as PEFR and olfaction in patients with nasal polyposis. Allergy 2009; 64:762-9. [PMID: 19191775 DOI: 10.1111/j.1398-9995.2008.01870.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nasal polyposis is a disease known to be associated with asthma. The management is anti-inflammatory, with topical and oral corticosteroids as the first-line treatment. The effect of surgical treatment on lower airway inflammation has not been sufficiently studied. AIM The aim of this study is to investigate the effects of functional endoscopic sinus surgery (FESS) as well as fluticasone proprionate nasal drops (FPND) 400 microg b.i.d. on nasal and lower airway parameters in asthmatics with nasal polyposis. METHODS This was a prospective 21-week study of 68 patients with asthma and nasal polyposis, on the benefits of FESS on nasal '(butanol test, subjective olfaction, peak nasal inspiratory flow, congestion, rhinorrhoea, and polyp score)', and on the lower airway parameters (dyspnea, cough, mean daily peak expiratory flow rate (PEFR), and lung function tests). It also included a randomized, double-blind, placebo-controlled 14 weeks phase on FPND. RESULTS Functional endoscopic sinus surgery significantly improved mean asthma symptom scores and daily PEFR and all nasal parameters including subjective and objective olfaction tests. This is the first study that shows the benefits of FESS on butanol tests in patients with nasal polyposis. We found no significant difference between topical treatment with FPND or placebo in the nasal or lower airway variables. CONCLUSION Functional endoscopic sinus surgery improved nasal and asthma symptoms in patients with nasal polyposis. Functional endoscopic sinus surgery could be considered early in the natural course of nasal polyposis with concomitant asthma, as well as a second-line treatment in nasal polyposis patients with a reduced sense of smell. The potential benefits of FPND 400 microg b.i.d. were probably overshadowed by FESS.
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Affiliation(s)
- A Ehnhage
- Department of Clinical Science, Intervention and Technology, Division of Otorhinolaryngology, Karolinska Institutet, Stockholm
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Shah M. Bronchial thermoplasty: a novel approach to asthma treatment. J PAK MED ASSOC 2008; 58:289. [PMID: 18655415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Mihălţan F. [The Romanian National Congress of Pneumology, Constanţa, May 29-31, 2008]. Pneumologia 2008; 57:116-117. [PMID: 19013857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Ulmeanu R. [Bronchial thermoplasty--a new therapeutic approach in asthma]. Pneumologia 2008; 57:104. [PMID: 18822877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ruxandra Ulmeanu
- Serviciul de Bronhologie, Institutul de Pneumologie Marius Nasta, Bucureşti.
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Pavord ID, Cox G, Thomson NC, Rubin AS, Corris PA, Niven RM, Chung KF, Laviolette M. Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med 2007; 176:1185-91. [PMID: 17901415 DOI: 10.1164/rccm.200704-571oc] [Citation(s) in RCA: 294] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Bronchial thermoplasty (BT) is designed to reduce airway smooth muscle and improve asthma control. OBJECTIVES This study was conducted to determine the safety and efficacy of this procedure in subjects with symptomatic, severe asthma. METHODS Adults who were symptomatic despite treatment with fluticasone or equivalent at more than 750 mug/day, a long-acting beta(2)-agonist, and other medications, which could include 30 mg or less of oral prednisolone/day, were randomized to BT or to a control group. After treatment, subjects entered a 16-week steroid stable phase (Weeks 6-22), a 14-week steroid wean phase (Weeks 22-36), and a 16-week reduced steroid phase (Weeks 36-52). MEASUREMENTS AND MAIN RESULTS BT resulted in a transient worsening of asthma symptoms. Seven hospitalizations for respiratory symptoms occurred in 4 of 15 BT subjects during the treatment period. Five hospitalizations were within 3 days of treatment. Two subjects had segmental collapse involving the most recently treated lobe; one required bronchoscopy and aspiration of a mucus plug. There were no hospitalizations during this period in the 17 control subjects. The rate of hospitalizations was similar in both groups in the post-treatment period. At 22 weeks, BT subjects had significant improvements versus control subjects in rescue medication use (-26.6 +/- 40.1 vs. -1.5 +/- 11.7 puffs/7 d, P < 0.05), prebronchodilator FEV(1)% predicted (14.9 +/- 17.4 vs. -0.94 +/- 22.3%, P = 0.04), and Asthma Control Questionnaire scores (-1.04 +/- 1.03 vs. -0.13 +/- 1.00, P = 0.02). Improvements in rescue medication use and Asthma Control Questionnaire scores remained significantly different from those of controls at 52 weeks. CONCLUSIONS BT is associated with a short-term increase in asthma-related morbidity. However, there is preliminary evidence of long-lasting improvement in asthma control. Clinical trial registered with www.clinicaltrials.gov (NCT 00214539).
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Affiliation(s)
- Ian D Pavord
- Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicester LE3 9QP, United Kingdom.
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Sumi Y, Foley S, Daigle S, L'Archevêque J, Olivenstein R, Letuvé S, Malo JL, Hamid Q. Structural changes and airway remodelling in occupational asthma at a mean interval of 14 years after cessation of exposure. Clin Exp Allergy 2007; 37:1781-7. [PMID: 17900308 DOI: 10.1111/j.1365-2222.2007.02828.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Occupational asthma (OA) may cause alterations of airways with inflammation and remodelling after cessation of exposure. Although the long-term clinical, functional and induced sputum sequelae have been examined in workers removed from exposure, the long-term pathological outcomes are unknown. OBJECTIVE We aimed to investigate whether airway inflammation and remodelling were present in bronchial biopsies of subjects with prior OA but without evidence of persisting asthma at a mean interval of 14 years after cessation of exposure. METHODS Ten clinically and functionally asymptomatic subjects with a prior diagnosis of OA were recruited and underwent bronchoscopy, bronchoalveolar lavage and bronchial biopsy. Comparisons were made with biopsies from normal control subjects. Epithelial detachment, epithelial metaplasia, mucous gland and airway smooth muscle (ASM) areas as well as the distance between the epithelium and ASM were measured by image analysis. The amount of collagen present was assessed by van Gieson staining. The numbers of TGF-beta1- and eosinophil cationic protein (ECP)-positive cells were evaluated by specific immunostaining. RESULTS Statistically significant increases were found in the numbers of TGF-beta1- and ECP-positive cells and in the amount of subepithelial fibrosis present in the biopsies of subjects with prior OA compared with control biopsies. The distance between the epithelium and ASM was significantly reduced in the OA group. Increases in epithelial metaplasia, ASM mass, mucous gland numbers, collagen deposition and eosinophilia in the OA group were not statistically significant. There was no evidence of ongoing inflammation in the group with prior OA as assessed by the number of T lymphocytes present. CONCLUSION Some aspects of airway inflammation and remodelling persist in subjects with prior OA long after cessation of exposure even in the absence of clinical, sputum and functional abnormalities. These findings are relevant to the assessment of long-term sequelae in subjects with OA when reviewed after cessation of exposure.
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Affiliation(s)
- Y Sumi
- Meakins-Christie Laboratories, McGill University, Montreal, QC, Canada
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Abstract
BACKGROUND Septoplasty is a well-described surgical technique for management of nasal airway obstruction (NAO) and improved access for endoscopic sinus surgery (ESS). The advances in endoscopic techniques have facilitated endoscopic septoplasty (ES). The purpose of this study was to review the surgical technique, indications, and outcomes for ES. METHODS A retrospective review was conducted to identify patients undergoing ES between 1998 and 2005 at a tertiary care medical center. Demographic data, operative indications, adjunctive procedures, symptom outcome, and complications were recorded. RESULTS One hundred sixteen patients with a mean age of 47 years were identified. The male/female ratio was 1.2:1 and mean follow-up period was 13 months. Indications for ES included NAO (64.6%), access (34.5%), and facial pain (0.9%). The most common concomitant diagnoses included chronic rhinosinusitis (67.2%), allergic rhinitis (55.2%), sinonasal polyposis (34.5%), and turbinate hypertrophy (25.9%). Concomitant procedures performed included ESS (81.9%), turbinate reduction (44.8%), and rhinoplasty (4.3%). Among patients who underwent primary ES for NAO, 70% achieved resolution and 20% reported improvement of their nasal obstruction. Complications included transient dental pain/hypesthesia (4.3%), asymptomatic septal perforation (3.4%), synechiae formation (2.6%), epistaxis (0.9%), and septal hematoma (0.9%). Complication rates were similar for ES alone versus ES in conjunction with ESS. CONCLUSION ES represents a viable alternative to traditional headlight septoplasty with acceptable outcomes and complications. ES allows for enhanced visualization of the septal deviation with more focused flap dissection and resection of the offending cartilage and bone. Furthermore, the technique facilitates teaching endeavors through use of video monitors.
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Affiliation(s)
- Brian J Chung
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Maniscalco M, Zedda A, Faraone S, Cerbone MR, Cristiano S, Giardiello C, Sofia M. Weight loss and asthma control in severely obese asthmatic females. Respir Med 2007; 102:102-8. [PMID: 17851059 DOI: 10.1016/j.rmed.2007.07.029] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 07/20/2007] [Accepted: 07/26/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity is proposed to represent an important predisposing condition to serious respiratory disturbances including asthma. The effects of consistent weight loss on asthma control are not well known. We investigated the effect of weight reduction induced by bariatric surgery on asthma control in severely obese asthmatic patients. PATIENTS AND METHODS A consecutive series of 12 asthmatic obese females who had laparoscopic adjustable gastric banding (OB group) and 10 non-operated asthmatic obese females as control group (CG). Body mass index (BMI), Asthma Control Test (ACT), pulmonary function test (PFT), exhaled nitric oxide (NO) were evaluated at baseline and after 1 year. RESULTS Mean BMI (kg/m(2)) of OB group decreased from 45.2+/-4.7 before surgery to 34.8+/-4.2 post-operatively. After surgery the overall ACT score in OB group significantly improved from 18.7 to 22.2 (p<0.001), while it remained unchanged in CG (from 18.8 to 18.6, p=0.73). In particular, in OB group the parameters of shortness of breath and rescue medication use were significantly improved respectively from 3.2 and 3.9 before surgery to 4.2 and 4.6 after surgery (always p<0.05). Accordingly, none of the CG who did not experience any weight loss was able to obtain a full asthma control. In the OB group after the surgery PFT significantly improved as compared to CG. No significant difference in exhaled NO was found both in OB group after surgery as compared to before surgery. CONCLUSION Consistent weight loss in severely obese patients with asthma is associated to improvement in respiratory symptoms and lung function. However, the mechanisms underlying the effect of large body mass changes on asthma would require further studies.
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Affiliation(s)
- Mauro Maniscalco
- Section of Respiratory Medicine, Hospital S. Maria della Pietà Casoria, Naples, Italy.
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Agrawal A. Bronchial thermoplasty. N Engl J Med 2007; 356:2745; author reply 2745. [PMID: 17600906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Medford ARL. Bronchial thermoplasty. N Engl J Med 2007; 356:2744; author reply 2745. [PMID: 17600907 DOI: pmid/17600907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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