Audit of bronchial thermoplasty patients who did not complete their treatment session as planned

The Manchester Severe Asthma Service had planned 37 patients for Bronchial Thermoplasty (BT), under conscious sedation to complete three therapy sessions. Of these 2 (5%) were identified at first session, as part of a routine diagnostic assessment before active therapy is commenced, as having signficant tracheo-bronchial malacia and treatment with BT was not perfomed. One (2.5%) patient had severe bronchospasm, before the onset of active therapy precluding progression to treatment. Five (14.5%) patients experienced issues with pain management during the procedures using conscious sedation, despite routine use of midazolam, alfentanyl and iv Paracetemol. All except one of these patients completed the session at which pain was reported. These 5 patients subsequently completed their therapy under a planned general anaesthetic for their remaining procedures. In total 96/111 (86%) were completed as planned under conscious sedation. Excluding those patients already identified as unsuitable at baseline procedure (no events for 2nd or 3rd treatments), conscious sedation was succesfully used in 96/106 (90.6%), 6 were perfomed (5.7%) under general anaesthetic and 4 (3.8%)procedures were abandoned pre-active treatment or incomplete. We describe the baseline characteristics of all of these patients, in order to consider if any baseline features were predictive of a failure to complete therapy as planned.