title: Advances in Bronchial Thermoplasty.
abstract: Bronchial thermoplasty (BT) is a therapeutic intervention that delivers targeted thermal energy to the airway walls with the goal of ablating the smooth muscle in patients with severe persistent asthma. Since the publication of the original preclinical studies, three large randomized clinical trials evaluating its impact on asthma control have been performed. These trials have shown improvements in asthma-related quality of life and a reduction in asthma exacerbations following treatment with BT. However, there remains significant controversy regarding the true efficacy of BT and the interpretation of these studies, particularly the Asthma Intervention Research 2 trial. In this article, we will discuss these controversies and present the latest evidence on the use of BT in asthma, specifically the 5-year longitudinal evaluation of patients. In addition, we will discuss new insights into the histopathologic changes that occur in the airways following BT, as well as the feasibility of performing the procedure in patients with very severe asthma. We also will discuss the ongoing translational and clinical investigations regarding the underlying mechanism of action and methods to improve patient selection for this procedure.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL.
authors.forename: Balaji
authors.initials: B
authors.lastname: Laxmanan
authors.affiliation: Rocky Mountain Heart and Lung Center, Kalispell, Montana.
authors.forename: Katarine
authors.initials: K
authors.lastname: Egressy
authors.affiliation: Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL.
authors.forename: Septimiu D
authors.initials: SD
authors.lastname: Murgu
authors.affiliation: Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL.
authors.forename: Steven R
authors.initials: SR
authors.lastname: White
authors.affiliation: Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL. Electronic address: dhogarth@uchicago.edu.
authors.forename: D Kyle
authors.initials: DK
authors.lastname: Hogarth
mesh_terms: D055011:Ablation Techniques / Q000379:methods; D001249:Asthma / Q000473:pathology / Q000601:surgery*; D001980:Bronchi / Q000473:pathology / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D018450:Disease Progression; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D009130:Muscle, Smooth; D011788:Quality of Life; D012720:Severity of Illness Index
keywords: asthma; bronchial thermoplasty; bronchoscopy; pulmonology