Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Aix-Marseille Université, Clinique des bronches, allergie et sommeil/APHM, Marseille C2VN Center INSEM INRA UMR1062, Marseille, France.
Respiration. 2018;95(5):289-300. doi: 10.1159/000488291. Epub 2018 Apr 17.
Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchos-copy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile - i.e., which specific asthma phenotype benefits most - is a topic of current research.
支气管热成形术（BT）是一种针对严重哮喘患者的支气管镜治疗方法，这些患者尽管接受了最佳药物治疗，但仍有症状。在这篇“专家最佳实践”论文中，强调了 BT 的背景和实践方面。随机对照临床试验表明，BT 治疗可安全有效地减少严重恶化、改善生活质量和减少急诊就诊次数。5 年随访研究提供了 BT 治疗患者功能稳定的证据，这些患者的临床获益持续存在。全球哮喘倡议（GINA）指南指出，BT 可被视为第 5 步成人哮喘患者的治疗选择。BT 的患者选择需要介入肺科医生和严重哮喘专家之间的密切合作。将回顾 BT 的关键患者选择标准。BT 治疗分 3 次支气管镜检查进行，每次检查至少间隔 3 周，分别覆盖肺部的不同区域。患者在治疗前 3 天开始接受 50mg/天的泼尼松龙或等效药物治疗 5 天。该程序在中度至深度镇静或全身麻醉下进行。在支气管镜检查中，将带有篮筐设计的一次性导管通过器械通道插入，能量由射频（RF）发生器（AlairTM 支气管热成形系统）提供。BT 使用温度控制的 RF 能量来影响气道重塑，包括减少气道壁内过多的气道平滑肌，这已被认为是哮喘的主要特征。治疗应从（亚）段气道的最远端开始，以系统的方式进行，然后向主支气管近端移动，确保大多数气道都得到治疗。一般来说，在下叶提供 40-70 次 RF 激活，在上叶总共提供 50-100 次激活。主要的围手术期不良事件是哮喘症状加重、咳嗽和咳痰增多。偶尔，手术后会观察到肺不张。BT 的长期安全性非常好。BT 反应者的最佳特征（即哪种特定的哮喘表型获益最大）是当前研究的一个主题。
