Asthma control during the year after bronchial thermoplasty.
BACKGROUND
Bronchial thermoplasty is a bronchoscopic procedure to reduce the mass of airway smooth muscle and attenuate bronchoconstriction. We examined the effect of bronchial thermoplasty on the control of moderate or severe persistent asthma.


METHODS
We randomly assigned 112 subjects who had been treated with inhaled corticosteroids and long-acting beta2-adrenergic agonists (LABA) and in whom asthma control was impaired when the LABA were withdrawn to either bronchial thermoplasty or a control group. The primary outcome was the frequency of mild exacerbations, calculated during three scheduled 2-week periods of abstinence from LABA at 3, 6, and 12 months. Airflow, airway responsiveness, asthma symptoms, the number of symptom-free days, use of rescue medication, and scores on the Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) were also assessed.


RESULTS
The mean rate of mild exacerbations, as compared with baseline, was reduced in the bronchial-thermoplasty group but was unchanged in the control group (change in frequency per subject per week, -0.16+/-0.37 vs. 0.04+/-0.29; P=0.005). At 12 months, there were significantly greater improvements in the bronchial-thermoplasty group than in the control group in the morning peak expiratory flow (39.3+/-48.7 vs. 8.5+/-44.2 liters per minute), scores on the AQLQ (1.3+/-1.0 vs. 0.6+/-1.1) and ACQ (reduction, 1.2+/-1.0 vs. 0.5+/-1.0), the percentage of symptom-free days (40.6+/-39.7 vs. 17.0+/-37.9), and symptom scores (reduction, 1.9+/-2.1 vs. 0.7+/-2.5) while fewer puffs of rescue medication were required. Values for airway responsiveness and forced expiratory volume in 1 second did not differ significantly between the two groups. Adverse events immediately after treatment were more common in the bronchial-thermoplasty group than in the control group but were similar during the period from 6 weeks to 12 months after treatment.


CONCLUSIONS
Bronchial thermoplasty in subjects with moderate or severe asthma results in an improvement in asthma control. (ClinicalTrials.gov number, NCT00214526 [ClinicalTrials.gov].).
Cox
Gerard
G
St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada. coxp@mcmaster.ca
Thomson
Neil C
NC
Rubin
Adalberto S
AS
Niven
Robert M
RM
Corris
Paul A
PA
Siersted
Hans Christian
HC
Olivenstein
Ronald
R
Pavord
Ian D
ID
McCormack
David
D
Chaudhuri
Rekha
R
Miller
John D
JD
Laviolette
Michel
M
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D001507:Beclomethasone / Q000627:therapeutic use; D001980:Bronchi / Q000601:surgery*; D016535:Bronchial Hyperreactivity / Q000628:therapy; D001999:Bronchoscopy; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery*; D010366:Peak Expiratory Flow Rate; D011788:Quality of Life
D000318:Adrenergic beta-Agonists; D005938:Glucocorticoids; D001507:Beclomethasone