Abstract

Bronchial thermoplasty arose as a promising technique to reduce exacerbation rate in severe asthmatics. It delivers a thermic form of energy to the bronchi through radiofrequency and is supposed to reduce the airway smooth muscle component. Reports on its effectiveness in real life are very few. Here we report the clinical evolution in 10 severe asthmatics who underwent three sessions of thermoplasty 3 weeks apart and were followed-up for one year after the last procedure in our asthma clinic.

Mean age was 48 years, mean pre and post bronchodilation FEV1 were 57% and 69% predicted respectively. Despite fixed high dose ICS/LABA combination and oral corticoids for three patients, asthma remained uncontrolled with an ACQ averaging 3.6 and an exacerbation rate of 2.9/patient/y prior to thermoplasty. Median blood eosinophil count, total serum IgE and FeNO were low reaching 99/µl, 43 Ku/L and 15 ppb respectively, indicating a current non T2 pattern. Thermoplasty was well tolerated with no serious side effect.  After one year we observed an improvement in pre and post FEV1 % predicted from 57% to 67% and from 69% to 80% respectively together with a reduction in exacerbation rate from 2.9 to 2.2/patient/y. Patient perspective outcomes such as ACQ, ACT and AQLQ remained fairly stable over the year just as the average dose of ICS while average dose of OCS was reduced from 9,3 to 6,2 mg/d.

We conclude that thermoplasty can be safely applied and may bring some clinical benefits in severe non T2 asthmatics.