Bronchial Thermoplasty in Severe Asthma Patients: A Literature Review

Yosua Kevin Hermawan¹, Ida Ayu Ika Wari Utami²

¹ Department of Pulmonology and Respiratory Medicine, Wangaya General Hospital, Denpasar, Indonesia
² Department of Pulmonology and Respiratory Medicine, Wangaya General Hospital, Denpasar, Indonesia

Abstract

Severe asthma is caused by chronic inflammation in the airway. Several treatments have been proposed to treat severe asthma. Bronchial thermoplasty is part of management that has been proposed to treat severe asthma. The treatment has been mentioned in asthma guidelines released by Global Initiative for Asthma (GINA) as an interventional management option in uncontrolled severe asthma. Bronchial thermoplasty is approved for patients with the age of at least 18 years old. The treatment is focus on airway smooth muscle by delivering radiofrequency ablation using bronchoscopy. Airway remodeling is an important feature in the disease course of asthma. There are three large randomized trial that has been done for bronchial thermoplasty. The trials recorded an increase in quality of life from asthma patients that have been treated and reduce in exacerbation frequency in long term follow up. The trials also show increased in emergency departments visit and asthma exacerbation for within a certain period after the procedure. Long term follows up of the patients that has undergone the procedure show no deterioration in terms of lung function, indicating a persistent effect of the bronchial thermoplasty. Better understanding in mechanisms of the procedure in the airway and more trials about safety and efficacy is still needed.

Keywords: Bronchial Thermoplasty, Airway smooth muscle, Interventional