Safety and effectiveness of bronchial thermoplasty when FEV1 less than 50

Abstract Background The randomized clinical trials of bronchial thermoplasty (BT) were conducted in patients with a baseline FEV1 greater than 50%. There is a paucity of data regarding BT in patients with more severe obstruction, and consequently these patients are often excluded from receiving BT. The purpose of this study was to compare safety and efficacy outcomes in a large cohort of patients with an FEV1 less than 50% with a cohort of less obstructed patients. Methods Consecutive patients with severe asthma were drawn from the Australian BT Registry. Patients were grouped into (i) those with a baseline prebronchodilator FEV1% predicted Results More severely obstructed patients were no more likely to have experienced any adverse event. Significant improvements in ACQ, exacerbation frequency, reliever medication use and the requirement for daily oral steroids were observed in both groups, and were of a similar degree. Conclusion This study demonstrates that BT can confidently be offered to asthmatic patients with an FEV1 30-50% predicted without risk of more frequent or more severe adverse events, and with the expectation of the same degree of response as patients with better lung function.