Qiu Minzhi, Wei Shushan, Lai Zhengdao, Huang Peikai, Wang Zhiqiang, Zhong Changhao, Chen Yu, Zhang Xiaoxian, Lin Xiaofeng, Zeng Qingsi, Chung Kian Fan, Zhang Qingling, Xie Jiaxing, Li Shiyue
Department of Respiratory and Critical Care Medicine, Shenzhen Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China.
Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China.
Exp Ther Med. 2020 Dec;20(6):278. doi: 10.3892/etm.2020.9408. Epub 2020 Oct 27.
Bronchial thermoplasty (BT) is a treatment to reduce the airway smooth muscle mass by delivering radiofrequency thermal energy to the airways. BT is used in patients with severe asthma. The present study reported on cases of pneumothorax directly after BT and retrospectively analyzed early radiologic and bronchoscopic modifications after BT. The clinical data and radiologic and bronchoscopic findings of 12 patients with severe asthma who were subjected to BT between July 2014 and October 2017 were analyzed. A total of 33 chest radiographs were collected within 18-24 h after BT. Radiological abnormalities were observed in 32 radiographs as atelectasis (53.1%), peribronchial consolidations (84.4%), pleural effusion (18.8%), effusion in oblique fissures (3.1%), pleural thickening (6.3%) and pneumothorax (3.1%). Of note, one patient suffered pneumothorax after the third BT session and underwent chest drain insertion, followed by mechanical ventilation at the intensive care unit and multiple bronchoscopic interventions, which revealed extensive phlegm plugs. A total of six patients with worsened symptoms and lobar atelectasis also required bronchoscopic intervention, which revealed that phlegm plugs occluded the bronchus in the treated lobe. No bronchoscopic intervention was required in the remaining five patients. During 16-30 days of follow-up, 95.7% of the findings on chest radiography were resolved. To the best of our knowledge, the present study reported the first case of pneumothorax following BT. Early radiologic modifications such as atelectasis and peribronchial consolidations appear common after BT. However, whether bronchoscopic intervention is required for atelectasis following BT warrants further investigation. Of note, BT should be audited and recorded in detail to ideally contribute to a framework of clinical trials to improve risk-benefit evaluations and the selection of patients likely to benefit from treatment.
支气管热成形术（BT）是一种通过向气道输送射频热能来减少气道平滑肌质量的治疗方法。BT用于重度哮喘患者。本研究报告了BT术后直接发生气胸的病例，并回顾性分析了BT术后早期的放射学和支气管镜改变。分析了2014年7月至2017年10月期间接受BT治疗的12例重度哮喘患者的临床资料以及放射学和支气管镜检查结果。在BT术后18 - 24小时内共收集了33张胸部X光片。在32张X光片中观察到放射学异常，表现为肺不张（53.1%）、支气管周围实变（84.4%）、胸腔积液（18.8%）、斜裂积液（3.1%）、胸膜增厚（6.3%）和气胸（3.1%）。值得注意的是，一名患者在第三次BT治疗后发生气胸，接受了胸腔闭式引流，随后在重症监护病房进行机械通气并接受了多次支气管镜干预，发现有广泛的痰栓。共有6例症状加重和肺叶肺不张的患者也需要支气管镜干预，发现痰栓阻塞了治疗肺叶的支气管。其余5例患者无需支气管镜干预。在16 - 30天的随访期间，胸部X光检查结果的95.7%得到缓解。据我们所知，本研究报告了首例BT术后气胸病例。BT术后早期的放射学改变如肺不张和支气管周围实变似乎很常见。然而，BT术后肺不张是否需要支气管镜干预值得进一步研究。值得注意的是，应对BT进行详细审核和记录，以理想地为改善风险效益评估和选择可能从治疗中获益的患者的临床试验框架做出贡献。
