Department of Respiratory Medicine, Fujita Health University School of Medicine, Kutsukake-cho, Toyoake, Aichi, Japan.
Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241254980. doi: 10.1177/17534666241254980.
Bronchial thermoplasty (BT) is a recently developed non-pharmacological therapy for refractory bronchial asthma. Although increasing evidence has suggested that BT is effective for various phenotypes of severe asthma, its safety and efficacy in patients with severe irreversible impaired lung function are unclear.
To assess the efficacy and safety of BT in patients with refractory asthma, including patients with a severely impaired forced expiratory volume in 1 second (FEV1).
This was a single-center, retrospective, observational cohort study.
We retrospectively reviewed the medical records of 15 patients with refractory asthma (Global Initiative for Asthma step 4 or 5), including patients with severely impaired airflow limitation (% predicted pre-bronchodilator FEV1 <60%), who had undergone BT between June 2016 and January 2022. We analyzed the efficacy (change in asthma symptoms, exacerbation rate, pulmonary function, asthma medication, and serum inflammatory chemokine/cytokines before and after BT) and complications in all patients. We compared these data between patients with severe obstructive lung dysfunction [group 1(G1)] and patients with FEV1 ⩾ 60% [group 2 (G2)].
Six patients were in G1 and nine were in G2. Clinical characteristics, T2 inflammation, and concurrent treatment were equivalent in both groups. BT significantly improved asthma-related symptoms (measured using the Asthma Control Test and Asthma Quality of Life Questionnaire scores) in both groups. FEV1 was significantly improved in G1 but not in G2. Four patients in G2, but none in G1, experienced asthma exacerbation requiring additional systemic corticosteroids (including two requiring prolonged hospitalization) after BT. Long-term responders (patients who reduced systemic or inhaled corticosteroid without newly adding biologics in a follow-up > 2 years) of BT were identified in G1 and G2 ( = 2, 33.3% and = 4, 44.4%, respectively).
BT in patients with refractory asthma and severe airflow limitation is equally safe and efficacious as that in patients with moderate airflow limitation.
支气管热成形术（BT）是一种最近开发的用于治疗难治性支气管哮喘的非药物治疗方法。尽管越来越多的证据表明 BT 对各种严重哮喘表型有效，但在严重不可逆肺功能受损的患者中的安全性和疗效尚不清楚。
评估 BT 在难治性哮喘患者中的疗效和安全性，包括严重 1 秒用力呼气容积（FEV1）受损的患者。
这是一项单中心、回顾性、观察性队列研究。
我们回顾性分析了 2016 年 6 月至 2022 年 1 月期间接受 BT 的 15 例难治性哮喘（哮喘全球倡议第 4 或 5 步）患者（包括气流受限严重的患者，支气管扩张剂前 %预计 FEV1 <60%）的病历。我们分析了所有患者的疗效（哮喘症状变化、加重率、肺功能、哮喘药物和 BT 前后血清炎症趋化因子/细胞因子）和并发症。我们比较了两组间的这些数据，一组为严重阻塞性肺功能障碍（G1），另一组为 FEV1 ⩾60%（G2）。
6 例患者在 G1，9 例患者在 G2。两组患者的临床特征、T2 炎症和同时治疗均相当。BT 显著改善了两组患者的哮喘相关症状（使用哮喘控制测试和哮喘生活质量问卷评分衡量）。G1 的 FEV1 显著改善，但 G2 没有。BT 后，G2 中有 4 例（但 G1 无）患者出现需要额外全身皮质类固醇治疗的哮喘加重（包括 2 例需要延长住院时间）。BT 的长期应答者（在随访 > 2 年期间减少全身或吸入皮质类固醇而无需新添加生物制剂的患者）在 G1 和 G2 中均有发现（ = 2，33.3%和 = 4，44.4%）。
在严重气流受限的难治性哮喘患者中，BT 的安全性和疗效与中气流受限患者相当。
