Bronchial thermoplasty for severe asthma: From past to present and future
Current Respiratory Medicine Reviews, cilt.17, sa.2, ss.100-107, 2021 (ESCI, Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 17 Sayı: 2
- Basım Tarihi: 2021
- Doi Numarası: 10.2174/1573398x17666210607122600
- Dergi Adı: Current Respiratory Medicine Reviews
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE
- Sayfa Sayıları: ss.100-107
- Anahtar Kelimeler: Asthma, bronchial thermoplasty, clinical effectiveness, safety, cost-effectiveness, control, quality of life
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Approximately 3-10% of all asthmatics are refractory with severe disease, although they use optimal preventive treatment. This is reflected as a disproportionate increase in the cost of health care. Thus, bronchial thermoplasty has been developed as an add-on therapy for these refractory asthmatics. Objective: This review aims to give an update on bronchial thermoplasty in severe asthma regarding pathophysiological mechanisms of action, patient selection, procedural details, history, evidence-based effectiveness, safety and cost-effectiveness, place in management, and challenges in current clinical practice. Methods: A thorough search for the eligible and recent studies and reviews on bronchial thermoplasty and asthma has been conducted in PubMed. Results: In bronchial thermoplasty, radiofrequency energy delivered to bronchial airway walls leads to ablation of the airway smooth muscles that cause bronchoconstriction. Several large trials and a real-world study confirm its safety, and effectiveness, as shown by considerable reduction in asthma exacerbations, emergency department visits and hospitalizations as well as improvement in asthma-related quality of life, maintained up to 5 years. These improvements are more significant in more severe airway obstruction. Bronchial thermoplasty is more cost-effective if hospitalization and emergency department care cost high, but the procedure costs low. Properly performed patient identification, implementation and follow-up are critical for successful and safe outcomes with the procedure. Conclusion: A 10-year research and clinical experience has proved the long-term safety, and effectiveness of bronchial thermoplasty for improving asthma control and quality of life in severe asthma. Predictors of response (e.g. biomarkers, responder endotype/phenotype) remain to be studied further and better qualified.