title: Indications for the use of bronchial thermoplasty in severe asthma.
abstract: Approximately 5% of the ~3 million asthmatics in South Africa have severe asthma that is associated with substantial morbidity, cost, absenteeism, preventable mortality, and the requirement for costly chronic medication that may be associated with significant adverse events. There is an unmet need for alternative safer and more effective interventions for severe asthma. A recently introduced option, bronchial thermoplasty (BT), imparts radiofrequency-generated heat energy to the airways to cause regression of airway smooth muscle. The effectiveness of this technique has been confirmed in randomised control trials and is now endorsed by several international guidelines, including the Global Initiative for Asthma (GINA) guideline, the British Asthma Guideline, and the UK National Institute of Clinical Excellence (NICE) guideline. We recommend BT as a potential therapeutic intervention for severe uncontrolled asthma, provided that it is performed by an experienced pulmonologist at an accredited centre and done within the broader context of appropriate management of the disease by doctors experienced in treating difficult-to-control asthma.
authors.affiliation: Lung Infection and Immunity Unit and Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. emmab@hmpg.co.za.
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
authors.forename: Coenraad F N
authors.initials: CF
authors.lastname: Koegelenberg
authors.forename: Aliasgar
authors.initials: A
authors.lastname: Esmail
authors.forename: Elvis
authors.initials: E
authors.lastname: Irusen
authors.forename: Michael E
authors.initials: ME
authors.lastname: Wechsler
authors.forename: Rob M
authors.initials: RM
authors.lastname: Niven
authors.forename: Kian Fan
authors.initials: KF
authors.lastname: Chung
authors.forename: Eric D
authors.initials: ED
authors.lastname: Bateman
mesh_terms: D001249:Asthma / Q000601:surgery*; D001999:Bronchoscopy; D017115:Catheter Ablation; D006801:Humans; D018579:Patient Selection; D013019:South Africa