Asthma

Bronchial thermoplasty a ‘new frontier’ in severe asthma

Tuesday, 31 Jan 2017


A relatively new bronchoscopic intervention is shaping up as a ‘new frontier’ in the treatment of severe asthma.

Less than 100 patients in Australia have undergone bronchial thermoplasty in the four years since it began, and a new paper in the Internal Medicine Journal has offered “retrospective analysis of the first ‘real world’ data from Australia.”

Lead author, Associate Professor David Langton, of the Frankston Hospital’s Department of Thoracic Medicine, said the minimally invasive procedure had proven to be a safe therapy for patients at the most severe end of the disease spectrum that delivered significant results.

“Yes it is a new frontier,” he told the limbic. “The uptake has been slow but it is not yet widely available and we wanted to see at least six months of follow-up on people to get good data.”

Between them, the authors of this paper have performed 50 of the 93 procedures that have been done in Australia to date.

Professor Langton said it was important to note that this treatment, which uses heat to open the airways, was not designed for all asthma patients.

“Most patients with asthma who take their medications will be well controlled,” he said.

But a small number – he estimates about 5% – will remain symptomatic, even with proper use of medication. There are limited treatment options for these patients, including permanent oral steroids and injections of monoclonal antibodies such as Omalizumab, which can cost up to $20,000 per year.

While there have not been any detailed cost analysis of bronchial thermoplasty, Professor Langton said the upfront cost was higher but did not require any ongoing maintenance.

And he said the benefits were clear, with many patients being able to reduce corticosteroid use and others able to come off it completely.

In the analysis of real-world data 10 patients were prednisolone dependent at baseline with a median daily dose of 10mg per day (IQR 7.4-15mg).

But at six month follow-up, five patients had ceased prednisolone altogether and the median daily dose for the group of 10 patients decreased to 1.5mg per day (IQR 0-5.gmg).

Every patient was on less prednisolone than at baseline.

The treatment was also found to be well-tolerated and safe, with minimal adverse events and no increase in infection rates.

“This study demonstrates use of BT (bronchial thermoplasty) in the real clinical world as a rescue therapy for patients at the most severe end of the disease spectrum, who are poorly controlled despite maximisation of other available treatments,” the authors concluded.

“In this group of patients, BT can be delivered not only safely, but also effectively, with demonstrable improvements in clinical outcomes.”

Professor Langton told the limbic that access to bronchial thermoplasty was an issue that would need to be addressed as more respiratory physicians referred patients for treatment.

Currently there are only seven centres in Australia offering the procedure, including three in Brisbane, one in Sydney, two in Melbourne and one in Perth.

He hopes uptake will increase as more patients have good outcomes, and urged respiratory physicians to consider it as a treatment for severe patients.

“There’s a natural scepticism which is healthy scepticism I some quarters,” he said.

An added advantage of the procedure has also emerged, when Professor Langton started training his registrars.

“It’s very good for teaching skills in bronchoscopy,” he said.

He said he would like to see the establishment of a patient registry and more specialist training.

“If it becomes bigger than Ben Hur we are going to need more centres,” he said.

Professor Langton and his colleagues will be making presentations on the procedure in the next couple of months at conferences in Brisbane and Canberra.

Related story: Bronchial thermoplasty ‘a pudding worth trying’ 

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