title: Bronchial thermoplasty failure in severe persistent asthma: a case report.
abstract: BACKGROUND
  Bronchial thermoplasty (BT) is an emerging therapy for patients with severe persistent asthma who remain poorly controlled despite standard maximal medical therapy. Thermoplasty elicits asthma control over time by applying thermal radiofrequency energy to airways to ablate underlying smooth muscle. While this therapy is suggested to eliminate such smooth muscle permanently, no human studies have examined the possibility of treatment failure.
  
  
  METHODS
  We present a 62-year-old female with severe, refractory asthma symptoms who underwent BT without apparent complications. However, severe symptoms including multiple clinical exacerbations persisted despite BT treatment. Repeat endobronchial biopsy done six months after BT treatment demonstrated persistent smooth muscle hyperplasia in multiple airways that previously had been treated. The patient continued to have uncontrolled, refractory asthma despite multiple therapies.
  
  
  CONCLUSIONS
  This case is the first to describe a failure of BT to reduce or eliminate airway smooth muscle in a patient with severe persistent asthma. It suggests the potential for treatment failure in the management of these patients after BT and highlights the need for further study of potential BT-refractory patients.
authors: Department of Medicine, The University of Chicago, Chicago, IL Chicago, IL 60637, USA.
authors: Diana C
authors: DC
authors: Doeing
authors: Aliya N
authors: AN
authors: Husain
authors: Edward T
authors: ET
authors: Naureckas
authors: Steven R
authors: SR
authors: White
authors: Douglas K
authors: DK
authors: Hogarth
mesh_terms: D001249:Asthma / Q000601:surgery*; D001980:Bronchi / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017211:Treatment Failure
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