Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL.
Rocky Mountain Heart and Lung Center, Kalispell, Montana.
Chest. 2016 Sep;150(3):694-704. doi: 10.1016/j.chest.2016.03.012. Epub 2016 Mar 19.
Bronchial thermoplasty (BT) is a therapeutic intervention that delivers targeted thermal energy to the airway walls with the goal of ablating the smooth muscle in patients with severe persistent asthma. Since the publication of the original preclinical studies, three large randomized clinical trials evaluating its impact on asthma control have been performed. These trials have shown improvements in asthma-related quality of life and a reduction in asthma exacerbations following treatment with BT. However, there remains significant controversy regarding the true efficacy of BT and the interpretation of these studies, particularly the Asthma Intervention Research 2 trial. In this article, we will discuss these controversies and present the latest evidence on the use of BT in asthma, specifically the 5-year longitudinal evaluation of patients. In addition, we will discuss new insights into the histopathologic changes that occur in the airways following BT, as well as the feasibility of performing the procedure in patients with very severe asthma. We also will discuss the ongoing translational and clinical investigations regarding the underlying mechanism of action and methods to improve patient selection for this procedure.
支气管热成形术（BT）是一种治疗干预手段，它将靶向热能传递到气道壁，旨在消融严重持续性哮喘患者的平滑肌。自最初的临床前研究发表以来，已经进行了三项大型随机临床试验来评估其对哮喘控制的影响。这些试验表明，BT 治疗后可改善与哮喘相关的生活质量并减少哮喘恶化。然而，关于 BT 的真正疗效以及对这些研究的解读仍存在很大争议，特别是哮喘干预研究 2 试验。在本文中，我们将讨论这些争议，并介绍 BT 在哮喘中的最新应用证据，特别是对患者进行的 5 年纵向评估。此外，我们还将讨论 BT 后气道发生的组织病理学变化的新见解，以及在极重度哮喘患者中进行该手术的可行性。我们还将讨论关于该手术作用机制的转化和临床研究，以及改善该手术患者选择的方法。
