How to: Bronchial thermoplasty in asthma

Educational aims

• To provide an overview on how to perform bronchial thermoplasty for the treatment of asthma

• To summarise the development, mode of action and evidence for the effectiveness of bronchial thermoplasty as well as its place in the management of asthma

Summary Bronchial thermoplasty, which involves the delivery of radio frequency energy to the airways, is a nonpharmacological intervention developed for the treatment of moderate-to-severe asthma. The mode of action of bronchial thermoplasty is not established, but could be due to reduction in airway smooth muscle mass induced by thermal energy. Bronchial thermoplasty results in modest improvements in asthma quality of life questionnaire scores and clinically worthwhile reductions in severe exacerbations and emergency department visits in the year post-treatment, which may persist for up to 5 years.

The procedure involves systematic, controlled heating of the airways using dedicated radiofrequency equipment during a series of three bronchoscopy sessions. Bronchial thermoplasty causes short-term increases in asthma-related morbidity, including hospital admissions. Follow-up data, to date, supports the long-term safety of the procedure. Bronchial thermoplasty is a novel treatment option for selected patients with moderate-to-severe asthma that is poorly controlled despite maximal therapy.

Key points

• Bronchial thermoplasty, which involves the delivery of radio frequency energy to the airways, is a nonpharmacological intervention developed for the treatment of patients with moderate-to-severe asthma that is poorly controlled despite maximal therapy

• Randomised controlled clinical trials of bronchial thermoplasty in patients with moderate and severe asthma have shown modest improvements in asthma quality of life and clinically worthwhile reductions in severe exacerbations and emergency department visits

• The treatment involves three bronchoscopy sessions with repeated, precise and carefully recorded activations of a radiofrequency catheter within the medium and large airways

• Bronchial thermoplasty causes short-term increases in asthma-related morbidity including increased admissions to hospital for asthma; follow-up data, to date, supports the longterm safety of the procedure