Abe Sumiko, Yasuda Mina, Tobino Kazunori, Harada Sonoko, Sasano Hitoshi, Tanabe Yuki, Sandhu Yuuki, Takeshige Tomohito, Matsuno Kei, Asao Tetsuhiko, Sueyasu Takuto, Nishizawa Saori, Yoshimine Kohei, Ko Yuki, Yoshimatsu Yuki, Tsuruno Kosuke, Ide Hiromi, Takagi Haruhi, Ito Jun, Nagaoka Tetsutaro, Harada Norihiro, Takahashi Kazuhisa
Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.
Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan.
J Asthma Allergy. 2024 Apr 6;17:325-337. doi: 10.2147/JAA.S452865. eCollection 2024.
Bronchial thermoplasty (BT) improves clinical outcomes and quality of life for patients with severe asthma and has shown sustained reductions in airway narrowing and air trapping in previous CT studies. However, there is a lack of a comprehensive analysis, including CT evaluation, of clinical outcomes in Japanese patients who have undergone BT for severe asthma. This study aimed to evaluate the impact of BT in Japanese asthma patients, with a focus on the CT metric "WA at Pi10" to assess airway disease.
Twelve patients with severe persistent asthma who underwent BT were assessed using ACQ6, AQLQ, pulmonary function tests, FeNO measurement, blood sampling, and chest CT before BT and one year after the third procedure for the upper lobes.
The median age of the patient was 62.0 years, 7/12 (58.3%) were male, 4/12 (33.3%) used regular oral corticosteroids, and 8/12 (66.7%) received biologics. Median FEV% was 73.6%, and median peripheral eosinophil count was 163.8/μL. After one year of BT, ACQ6 scores improved from 2.4 to 0.8 points ( = 0.007), and AQLQ scores improved from 4.3 to 5.8 points ( < 0.001). Significant improvements were also observed in asthma exacerbations, unscheduled visits due to exacerbations, FeNO, and √WA at Pi10 ( < 0.05). The baseline mucus score on the CT findings was negatively correlated with FEV (r = -0.688, = 0.013) and with the maximum mid-expiratory flow rate (r = -0.631, = 0.028), and positively correlated with the peripheral blood eosinophil count (r = -0.719, = 0.008). Changes in √WA at Pi10 after one year were positively correlated with changes in the mucus score (r = 0.742, = 0.007).
This study has limitations, including its single-arm observational design and the small sample size. However, BT led to a symptomatic improvement in patients with severe asthma. The validated "√WA at Pi10" metric on CT effectively evaluated the therapeutic response in Japanese asthma patients after BT.
支气管热成形术（BT）可改善重度哮喘患者的临床结局和生活质量，并且在既往的CT研究中已显示其能持续减轻气道狭窄和气体潴留。然而，对于接受BT治疗的日本重度哮喘患者的临床结局，缺乏包括CT评估在内的全面分析。本研究旨在评估BT对日本哮喘患者的影响，重点关注用于评估气道疾病的CT指标“Pi10时的WA”。
对12例接受BT治疗的重度持续性哮喘患者，在BT治疗前以及上叶第三次治疗后一年，使用哮喘控制问卷6（ACQ6）、哮喘生活质量问卷（AQLQ）、肺功能测试、呼出一氧化氮（FeNO）测量、血液采样和胸部CT进行评估。
患者的中位年龄为62.0岁，7/12（58.3%）为男性，4/12（33.3%）使用常规口服糖皮质激素，8/12（66.7%）接受生物制剂治疗。FEV%中位数为73.6%，外周血嗜酸性粒细胞计数中位数为163.8/μL。BT治疗一年后，ACQ6评分从2.4分改善至0.8分（P = 0.007），AQLQ评分从4.3分改善至5.8分（P < 0.001）。在哮喘急性发作、因急性发作的非计划就诊、FeNO以及Pi10时的√WA方面也观察到显著改善（P < 0.05）。CT表现的基线黏液评分与FEV（r = -0.688，P = 0.013）和最大呼气中期流速（r = -0.631，P = 0.028）呈负相关，与外周血嗜酸性粒细胞计数呈正相关（r = -0.719，P = 0.008）。一年后Pi10时√WA的变化与黏液评分的变化呈正相关（r = 0.742，P = 0.007）。
本研究存在局限性，包括单臂观察性设计和样本量小。然而，BT使重度哮喘患者的症状得到改善。CT上经过验证的“Pi10时的√WA”指标有效评估了日本哮喘患者BT治疗后的治疗反应。
