Interventional Pneumology, Ruhrlandklinik-West German Lung Center, Essen, Germany.
Department of Pulmonary Medicine, University of Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany.
Lung. 2019 Aug;197(4):493-499. doi: 10.1007/s00408-019-00240-5. Epub 2019 May 27.
Bronchial Thermoplasty (BT) is indicated in patients suffering from severe and symptomatic bronchial asthma despite maximal medical therapy. However, treatment of the right middle lobe (RML) bronchus is currently not recommended. The aim of this study was to investigate the safety and efficacy of BT if the RML bronchus is included.
BT was performed in 17 consecutive patients, quality of life and pulmonary function were characterized before and 90 days after BT completion. Furthermore, we performed a clean-up bronchoscopy following every BT. This study was approved by the IRB of the University of Essen (No. 17-7356 BO) and registered as a retrospective observational study at the German Clinical Trials Registry (No. DRKS 00011550).
The median baseline values of FEV1 and Asthma Questionnaire of Life Quality (AQLQ) were 1.33 l (0.91; 1.73) and 3.01 (2.76; 3.61), respectively, and significantly improved 90 days after treatment with FEV 1 at 1.75 l (p-value 0.002) and AQLQ 3.8 (p-value < 0.05). Also the amount of oral corticosteroid necessity decreased significantly. No severe adverse events occurred due to the procedure. Clean-up bronchoscopies-when performed-revealed significant fibrinous exudation after every BT procedure.
BT including the RML bronchus is feasible. Functionally limited patients with severe asthma could potentially profit. Due to the relevant fibrinous exudation, BT should be followed by clean-up bronchoscopy, not only after RML treatment.
支气管热成形术（BT）适用于尽管接受了最大药物治疗但仍患有严重和有症状的支气管哮喘的患者。然而，目前不建议对右中间支气管（RML）进行治疗。本研究旨在探讨如果包括 RML 支气管，BT 的安全性和有效性。
对 17 例连续患者进行 BT，在 BT 完成前后 90 天分别对生活质量和肺功能进行评估。此外，我们在每次 BT 后进行支气管镜清洗。该研究得到了埃森大学伦理委员会（编号 17-7356 BO）的批准，并在德国临床试验注册处（编号 DRKS 00011550）注册为回顾性观察性研究。
FEV1 和哮喘生活质量问卷（AQLQ）的中位基线值分别为 1.33 l（0.91；1.73）和 3.01（2.76；3.61），治疗 90 天后显著改善，FEV1 为 1.75 l（p 值<0.05），AQLQ 为 3.8（p 值<0.05）。口服皮质类固醇的需求量也显著减少。由于该程序没有发生严重的不良事件。如果进行支气管镜清洗，每次 BT 后都会发现明显的纤维蛋白渗出。
包括 RML 支气管的 BT 是可行的。功能受限的严重哮喘患者可能会从中受益。由于相关的纤维蛋白渗出，BT 后应进行支气管镜清洗，不仅在 RML 治疗后。
