|
|
Background Bronchial thermoplasty is a bronchoscopic procedure to reduce the mass of airway smooth muscle and attenuate bronchoconstriction. We examined the effect of bronchial thermoplasty on the control of moderate or severe persistent asthma.
Methods We randomly assigned 112 subjects who had been treated with inhaled corticosteroids and long-acting
Results The mean rate of mild exacerbations, as compared with baseline, was reduced in the bronchial-thermoplasty group but was unchanged in the control group (change in frequency per subject per week, –0.16±0.37 vs. 0.04±0.29; P=0.005). At 12 months, there were significantly greater improvements in the bronchial-thermoplasty group than in the control group in the morning peak expiratory flow (39.3±48.7 vs. 8.5±44.2 liters per minute), scores on the AQLQ (1.3±1.0 vs. 0.6±1.1) and ACQ (reduction, 1.2±1.0 vs. 0.5±1.0), the percentage of symptom-free days (40.6±39.7 vs. 17.0±37.9), and symptom scores (reduction, 1.9±2.1 vs. 0.7±2.5) while fewer puffs of rescue medication were required. Values for airway responsiveness and forced expiratory volume in 1 second did not differ significantly between the two groups. Adverse events immediately after treatment were more common in the bronchial-thermoplasty group than in the control group but were similar during the period from 6 weeks to 12 months after treatment.
Conclusions Bronchial thermoplasty in subjects with moderate or severe asthma results in an improvement in asthma control. (ClinicalTrials.gov number, NCT00214526
[ClinicalTrials.gov]
.)
2-adrenergic agonists (LABA) and in whom asthma control was impaired when the LABA were withdrawn to either bronchial thermoplasty or a control group. The primary outcome was the frequency of mild exacerbations, calculated during three scheduled 2-week periods of abstinence from LABA at 3, 6, and 12 months. Airflow, airway responsiveness, asthma symptoms, the number of symptom-free days, use of rescue medication, and scores on the Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) were also assessed.
Source Information
From St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada (G.C., J.D.M.); Gartnavel General Hospital, University of Glasgow, Glasgow, United Kingdom (N.C.T., R.C.); Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil (A.S.R.); Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom (R.M.N.); Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (P.A.C.); Odense University Hospital, Odense, Denmark (H.C.S.); Montreal Chest Institute, Montreal (R.O.); Glenfield General Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom (I.D.P.); London Health Science Centre, London, ON, Canada (D.M.); and Laval Hospital, Laval University, Quebec, QC, Canada (M.L.).
Address reprint requests to Dr. Cox at the Firestone Institute for Respiratory Health, St. Joseph's Healthcare and McMaster University, 50 Charlton Ave. E., Rm. T2123, Hamilton, ON L8N 4A6, Canada, or at coxp{at}mcmaster.ca.
Related Letters:
Bronchial Thermoplasty
Macklem P. T., Medford A. R.L., Agrawal A., Cox G., Thomson N. C., Laviolette M.
Extract |
Full Text |
PDF
N Engl J Med 2007;
356:2744-2745, Jun 28, 2007.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved. |
Previous
Supplementary Video
