Bronchial Thermoplasty in Patients With Severe Asthma at 5 Years

Chupp, Geoffrey; Kline, Joel N.; Khatri, Sumita; McEvoy, Charlene; Silvestri, Gerard A.; Shifren, Adrián; Castro, Mario; Bansal, Sundeep; McClelland, Marc; Trevor, Jennifer; Kahlstrom, Nick; Simoff, Michael; Wahidi, Momen M.; Lamb, Carla; Ferguson, J. Scott; Haas, Andrew R.; Hogarth, D. Kyle; Tejedor, Richard; Toth, Jennifer; Hey, Jamie; Majid, Adnan; LaCamera, Peter; FitzGerald, J. Mark; Enfield, Kyle B.; Grubb, G. Mark; McMullen, Edmund; Olson, Jennifer L.; Laviolette, Michel

doi:10.1016/j.chest.2021.10.044

Cited by 25 publications

(13 citation statements)

References 33 publications

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“…Notable clinical trials in current literature include the Asthma Intervention Research (AIR1 and AIR2), Research in Severe Asthma (RISA) trials as well as follow-up studies including the Post-FDA Approval Clinical Trial Evaluating BT in Severe Persistent Asthma (PAS2) and the Safety and effectiveness of BT after 10 years in patients with persistent asthma (BT10+) trials. These studies demonstrated improvements in asthma control after BT, including decreased numbers of asthma exacerbations, ED visits, and hospitalizations with minimal adverse effects [8 ▪ ,9 ▪ ].…”

Section: Current Evidence: Clinical Trialsmentioning

confidence: 89%

“…With restricted availability of FDA-approved biologic agents targeting TH-1 severe asthma limited to novel antithymic stromal lymphopoietin agent Tezepelumab [15], there is an unmet need for further treatment modalities to address this subset of patients. BT beneficial effects appear to extend to different asthma phenotypes, including patients with low eosinophil levels [8 ▪ ] suggesting effectiveness in both allergic and nonallergic phenotypes. This provides an alternative resource for treatment in patients with non-TH-2 severe asthma, though larger adequately powered trials are required to assess responder profile [16].…”

Section: Special Considerationsmentioning

confidence: 99%

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Bronchial thermoplasty for the treatment of severe persistent asthma

Rodriguez

Chavez²,

Benzaquen³

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewSevere asthma is associated with frequent hospital visits and impact in quality of life as well as healthcare associated costs. Limited treatment modalities exist to assist in reduction of frequent exacerbations in patients with severe asthma who are already on maximum inhaler therapy. As supporting data becomes more robust, novel treatments have gained attention such as bronchial thermoplasty and immune-directed therapies. Recent findingsBased on review of recent studies, bronchial thermoplasty poses itself as a potential intervention for severe asthma, demonstrating a decrease in asthma exacerbations with long term clinical effect and safety profile at the expense of temporary uncontrolled asthma symptoms for the first six weeks following the procedure.

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Section: Current Evidence: Clinical Trialsmentioning

confidence: 89%

Section: Special Considerationsmentioning

confidence: 99%

Bronchial thermoplasty for the treatment of severe persistent asthma

Rodriguez

Chavez²,

Benzaquen³

2022

Current Opinion in Pulmonary Medicine

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“…It is noteworthy that these differences persist for at least 6 months after treatment, indicating that BT treatment has a long-lasting impact on local cells, which is in line with the reported long-term clinical response 5 to 10 years after treatment. [34][35][36] A correlation between airway inflammation and ASM remodeling in asthma is well described. 37,38 Considering the reduction in ASM after BT and the direct impact of BT on the epithelium, we postulate that the modulation of these BT targets might well have contributed to the effect measured on local inflammatory gene expression changes in the epithelium after BT.…”

Section: Discussionmentioning

confidence: 99%

Airway Inflammation Before and After Bronchial Thermoplasty in Severe Asthma

Wijsman¹,

Goorsenberg²,

Ravi³

et al. 2022

JAA

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Background Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma, of which the working mechanism and responder profile are partly unknown. The aim of this study is to analyse whether BT alters airway inflammation by epithelial gene expression, inflammatory cell counts and cytokines, and whether this relates to treatment response. Methods In this clinical trial, 28 severe asthma patients underwent bronchoscopy before and after treatment to obtain bronchial brushes and bronchoalveolar lavage fluid (BALF) from treated and untreated airways. RNA was extracted from bronchial brushes for transcriptome analysis, and BALF cells and cytokines were analysed. Asthma quality of life questionnaires were used to distinguish responders from non-responders. We compared results before and after treatment, between treated and untreated airways, and between responders and non-responders. Results Gene expression of airway epithelium related to airway inflammation gene set was significantly downregulated in treated airways compared to untreated airways, although this did not differ for patients before and after treatment. No differences were observed in cell counts and cytokines, neither from the untreated compared to treated airways, nor before and after treatment. At baseline, compared to non-responders, the expression of genes related to glycolysis in bronchial epithelium was downregulated and both BALF and blood eosinophil counts were higher in responders. Conclusion Local differences in gene sets pertaining to epithelial inflammatory status were identified between treated and untreated airways after treatment, not resulting in changes in differential cell counts and cytokine analyses in BALF. Secondly, baseline epithelial glycolysis genes and eosinophil counts in BALF and blood were different between responders and non-responders. The observations from this study demonstrate the potential impact of BT on epithelial gene expression related to airway inflammation while also identifying a possible responder profile.

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“…Moreover, compared to each PAS2 subject's own baseline, rates of severe exacerbation, ED visits and hospitalizations were lower (by 45%, 55% and 40%, respectively) at year 3 following BT. An extended follow‐up of the PAS2 cohort demonstrated sustained reduction in these endpoints and significantly decreased proportion of subjects requiring maintenance oral corticosteroids at 5 years compared to baseline 44,45 …”

Section: Major Clinical Studiesmentioning

confidence: 94%

“…An extended follow-up of the PAS2 cohort demonstrated sustained reduction in these endpoints and significantly decreased proportion of subjects requiring maintenance oral corticosteroids at 5 years compared to baseline. 44,45…”

Section: Pas2 (Published In 2017 and In 2022)mentioning

confidence: 99%

Bronchial thermoplasty: State of the art

2022

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Since the publication of a sham‐controlled, randomized trial (AIR2) and subsequent marketing approval by the US Food and Drug Administration, we have significantly advanced our understanding of bronchial thermoplasty (BT)'s scientific basis, long‐term safety, clinical efficacy and cost‐effectiveness. In particular, the last 2 years have witnessed multiple research publications on several of these counts. In this review, we critically appraise our evolving understanding of BT's biologic underpinnings and clinical impact, offer an evidence‐based patient workflow guide for the busy pulmonologist and highlight both current challenges as well as potential solutions for the researcher and the clinician.

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Bronchial Thermoplasty in Patients With Severe Asthma at 5 Years

Cited by 25 publications

References 33 publications

Bronchial thermoplasty for the treatment of severe persistent asthma

Bronchial thermoplasty for the treatment of severe persistent asthma

Airway Inflammation Before and After Bronchial Thermoplasty in Severe Asthma

Bronchial thermoplasty: State of the art

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