Can the Number of Radiofrequency Activations Predict Serious Adverse Events after Bronchial Thermoplasty? A Retrospective Case-Control Study

Correlation of Activation Site and Number with the Clinical Response to Bronchial Thermoplasty

Objective

Methods

Results

Conclusion

Recent advances in bronchial thermoplasty for severe asthma: a narrative review

Background and Objective

Severe asthma refers to asthma that requires step 4 or 5 therapy recommended by Global Initiative for Asthma (GINA) to prevent it from becoming uncontrolled or remaining “uncontrolled” despite this therapy. The poor treatment effect of severe asthma has been perplexing clinicians, which reduces the quality of life (QoL) of patients with asthma, and increases the mortality of such patients, so improving the therapeutic effect of severe asthma is an urgent problem to be solved in the clinic. Bronchial thermoplasty (BT) is a new non-drug therapy for severe asthma that is difficult to control with medications. It has been approved for clinical practice in China and the United States. The article aims at providing a new treatment option for patients with severe asthma that is poorly controlled by medications, thus improving the QoL in these patients.

Methods

An extensive literature search was performed in the PubMed database, with “bronchial thermoplasty” as the key term. The full texts of all potentially relevant articles were obtained, and relevant information was extracted.

Key Content and Findings

We find that BT is suitable for patients with severe asthma poorly controlled by medications.

Conclusions

This paper reviews the mechanism of action, procedure, safety and effectiveness, adverse effects and complications, problems, and prospects of BT, with an attempt to guide the practical application of this technique.

A case report of aspergillosis accompanied by saccular bronchodilation after bronchial thermoplasty in a 19-year-old woman

BACKGROUND

Fungal infections are rarely reported as a complication of bronchial thermoplasty (BT) in patients without immunosuppressive comorbidity.

CASE PRESENTATION

A 19-year-old woman college student was admitted to our hospital owing to uncontrolled severe asthma despite using the maximum dose of steroid inhalation. She experienced asthmatic attacks more frequently while cheerleading, which is an extracurricular activity. She received BT because she wanted to continue cheerleading. After the second BT session, she developed more sputum and cough. During the third session, white secretion and saccular bronchodilation appeared in the left lower bronchus. Aspergillus fumigatus was detected in the culture of the bronchial lavage sample, and saccular bronchodilation in the affected bronchus was observed on computed tomography (CT). Five months after the start of oral itraconazole, her subjective symptoms as well as her CT findings improved. Her asthma condition improved enough for the patient to continue cheerleading without exacerbation.

CONCLUSIONS

It is necessary to consider the possibility of respiratory tract infections including fungal infections after BT. Detailed observations of the entire bronchus and sample collection for microbial culture are highly recommended.

Puzzling onsets of pneumonia sequentially after each session of bronchial thermoplasty: a case report

BACKGROUND

Bronchial thermoplasty (BT) is a novel bronchoscopic intervention for severe persistent asthma. An increase in transient respiratory adverse events associated with BT were noted over the treatment periods, however, these events appear sporadic and should not always recur in a single individual and BT-related pneumonia has rarely been reported.

CASE PRESENTATION

We present a case of uncontrolled severe asthma who developed puzzling pneumonia sequentially after each session of BT procedures. After each operation of three sequential BT procedures, she developed cough and purulent expectoration when her chest radiology showed new infiltrates right in the treatment regions. After empirical use of antibacterial agents plus physiotherapy and postural sputum drainage, her symptoms vanished and chest imaging resumed normal.

CONCLUSION

The originality of our case report is related to the recurrence of pneumonia after three sequential BT procedures. To date, similar report has not been available in the literature. We hope to prompt alerts for post-BT respiratory infections, although most of them, along with other adverse events, are mild and tractable.