Bronchial thermoplasty in severe asthma in Australia

Background Bronchial thermoplasty is an approved bronchoscopic intervention for the treatment of severe asthma. However, limited published experience exists outside of clinical trials regarding patient selection and outcomes achieved. Aims To evaluate the effectiveness and safety of bronchial thermoplasty in patients with severe asthma encountered in clinical practice. Methods This is a retrospective analysis of the first ‘real world’ data from Australia. The following outcomes were measured prior to, and 6 months following bronchial thermoplasty: Spirometry, Asthma Control Questionnaire-5 (ACQ-5) score, reliever and preventer medication use, and exacerbation history. Results Twenty patients were treated from June 2014 to December 2015 at three university teaching hospitals. All subjects met the ERS/ATS definition of severe asthma. Mean pre-bronchodilator FEV1 was 62.8 ± 16.6% predicted (range: 33-95%). All patients were being treated with high dose inhaled corticosteroids, long-acting beta2 agonists, and long-acting muscarinic antagonists. Ten patients (50%) were taking maintenance oral prednisolone. Most subjects also required at least one of montelukast (65%), omalizumab (30%), and methotrexate (20%). ACQ-5 improved from 3.6 ± 1.1 at baseline to 1.6 ± 1.2 at 6 months, p < 0.001. Short-acting reliever use decreased from a median of 8.0 to 0.25 puffs/day, p < 0.001, and exacerbations requiring corticosteroids also significantly reduced. Five of 10 patients completely discontinued maintenance oral corticosteroids. Ten patients with a baseline FEV1 of <60% predicted significantly improved from 49.2 ± 9.6% to 61.8 ± 17.6%, p < 0.05. Only two procedures required hospitalisation beyond the planned overnight admission. Conclusion Bronchial thermoplasty is a safe procedure which can achieve clinical improvement in those with uncontrolled symptoms and severe airflow obstruction.