Objective To investigate the clinical efficacy and safety of bronchial thermoplasty (BT) in treating chronic obstructive pulmonary disease (COPD) patients. Methods Clinical data of 57 COPD patients were randomized into control (n = 29, conventional inhalation drug) or observation group (n = 28, convention inhalation drug plus BT). Primary outcomes were differences in clinical symptom changes, pulmonary function-related indicators, 6-min walk test (6MWT), COPD assessment test (CAT) score, Modified Medical Research Council (mMRC) and acute exacerbation incidence from baseline to average of 3 and 12 months. Safety was assessed by adverse events. Results FVC, FEV1 and FEV1% predicted value in both groups improved to varying degrees post-treatment compared with those pre-treatment (P < 0.05), except for FEV1/FVC. Observation group showed greater increase amplitudes of FEV1 (Ftime × between groups = 21.713, P < 0.001) and FEV1% predicted value (Ftime × between groups = 31.216, P < 0.001) than control groups, with no significant difference in FVC variation trend (Ftime × between groups = 1.705, P = 0.193). mMRC, 6MWT and CAT scores of both groups post-treatment improved to varying degrees (Ps < 0.05), but the improving amplitudes of mMRC (Ftime × between groups=3.947, P = 0.025), 6MWT (Ftime × between groups༝16.988, P < 0.001) and CAT score (Ftime × between groups༝16.741, P < 0.001) in observation group were greater than control groups. According to COPD acute exacerbation risk assessment, the proportion of high-risk COPD patients with acute exacerbation in control and observation groups at 1 year post-treatment (100% vs 65%, 100% vs 28.6%), inpatient proportion (100% vs 62.1%; 100% vs 28.6%), COPD acute exacerbation number [3.0 (2.50, 5.0) vs 1.0 (1.0, 2.50); 3.0(3.0, 4.0) vs 0 (0, 1.0)] and hospitalization number [2.0 (2.0, 3.0) vs 1.0 (0, 2.0); 2.0 (2.0, 3.0) vs 0 (0, 1.0)] were significantly lower than those pre-treatment (P < 0.05). Besides, data of observation group were significantly lower than control group (P < 0.05). Conclusion Combined BT treatment better improves lung function and life quality of COPD patients than conventional medical treatment, and reduce the COPD exacerbation risk without serious adverse events.

Objective To investigate the relation of activation site and number with clinical response to bronchial thermoplasty (BT) in refractory asthma patients. Methods This work included 106 consecutive refractory asthma patients completing three BT sessions in our hospital from May 2016 to May 2019. Procedure details included recording delivery sites and those in BT. Asthma Control Questionnaire (ACQ) scores and spirometric measurements were recorded 1-day before treatment and 6 months post-treatment to explore the effects of BT activation number and site on clinical response. Results ACQ score (3.19±1.14 vs 1.26±0.63), forced expiratory volume in 1 sec (FEV1)% predicted (55.53±21.66 vs 66.19±22.50), FEV1 (1.53±0.74 vs 1.93±0.82), and forced vital capacity (FVC) (2.49±0.86 vs 2.92±0.94) significantly increased after three BT sessions compared with pre-session. Major bronchial ablation did not significantly improve BT response in asthma patients. Multivariate logistic regression identified baseline ACQ score and baseline FEV1% predicted as independent factors affecting the clinical response to BT. Correlation and regression analysis revealed a significant linear relationship between baseline ACQ and ACQ improvement, as well as a linear relationship between the third session activation number and ACQ improvement. Based on subgroup analysis of activation number, cohort C (activations ≥ 200) had better lung function, lower non-responding rate, and better long-term effectiveness than the other two cohorts. The activation number in the third BT session showed the strongest predictive ability compared with the first two sessions. Conclusion Main bronchial ablation did not markedly affect clinical response to BT. Baseline ACQ and baseline FEV1% predicted were independent factors affecting clinical response to BT. Increasing the activation number might promote the therapeutic efficacy of BT, and the activation number in the third BT session correlated with and predicted the BT response.

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