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Evidence summaries

Bronchial Thermoplasty for Moderate or Severe Persistent Asthma in Adults

Bronchial thermoplasty may slightly decrease/reduce asthma exacerbations in moderate to severe asthma but it may not improve asthma control scores. Level of evidence: "C"

Comment: The quality of evidence is downgraded by study limitations (lack of blinding in 2 studies and no sham treatment in 2 studies).

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 429 subjects. In bronchial thermoplasty controlled radiofrequency-generated heat is delivered via a catheter inserted into the bronchial tree of the lungs through a flexible bronchoscope and thus reducing airway smooth muscle. Two studies compared bronchial thermoplasty vs medical management and one compared bronchial thermoplasty vs a sham intervention. There was no difference in symptom control or pulmonary function parameters but proportion of participants visiting the emergency department for respiratory symptoms were reduced (table T1). Quality of life was improved with bronchial thermoplasty, although that was not clinically significant. Two trials reported on exacerbations: One showed no significant differences in number of severe exacerbations per week. Another study showed a lower rate of severe exacerbations per participant per year in thermoplasty group compared with controls (0.48 ± 0.067 vs 0.70 ± 0.122 exacerbations per patient-year, respectively) and a significantly lower proportion of participants experiencing severe exacerbations (26% vs 40% of participants). Risk of respiratory adverse events (mostly mild or moderate) and hospitalisation for respiratory adverse events during the treatment period of thermoplasty were higher (table T1).

Bronchial thermoplasty compared with medical management or sham intervention for persistent asthma in adults

Outcomes: Follow-up: mean 12 monthsRelative effect(95% CI)Assumed risk - ControlCorresponding risk - Intervention (95% CI)No. of participants(studies) Quality of the evidence
Quality of life (AQLQ)AQLQ scores. Scale from 1 to 7 (a change of 0.5 points is considered to have clinical relevance)-Mean AQLQ ranged from5.1 to 5.7Mean AQLQ was0.28 higher(0.07 to 0.50 higher)429(3) Moderate
Asthma control (ACQ)ACQ scores. Scale from 0 to 36-Mean change in ACQ ranged from-0.55 to -0.01Mean change in ACQ was0.15 lower(0.40 lower to 0.10 higher)429(3) Moderate
Participants admitted to hospital because of respiratory adverse events (treatment period)RR 3.5 (1.26 to 9.68)2 per 1008 per 100(3 to 23)429(3) High
Participants admitted to hospital because of respiratory adverse events (post-treatment period)RR 1.12 (0.44 to 2.85)4 per 1005 per 100(2 to 12)429(3) Moderate
Use of rescue medication:Short-acting bronchodilator puffs per week-Mean use of rescue medication ranged across from-9.99 to -0.10 puffsMean use of rescue medication was0.68 lower(3.63 lower to 2.28 higher)429(3) Low

Clinical comments

Note

Date of latest search:30 January 2014

References

  • Torrego A, Solà I, Munoz AM et al. Bronchial thermoplasty for moderate or severe persistent asthma in adults. Cochrane Database Syst Rev 2014;(3):CD009910. [PubMed]

Primary/Secondary Keywords