Bronchial Thermoplasty Improves Asthma Control, Reduces ICS Need

This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.

The use of bronchial thermoplasty (BT) resulted in improvements in asthma control and reductions in the use of corticosteroid maintenance therapies during the course of 5 years in patients with asthma, according to research presented at the 2020 CHEST Annual Meeting, held virtually October 18 to 21.

The findings presented were from the prospective, open-label PAS2 study (Bronchial Thermoplasty in Severe Persistent Asthma; ClinicalTrial.gov Identifier: NCT01350336) conducted at sites in the United States and Canada. In total, 284 patients with asthma (age range, 18-65 years) from 27 centers were enrolled. All patients were taking inhaled corticosteroids (ICS; beclomethasone or equivalent; ≥1000 µg/d) and long-acting beta-agonists (LABA; salmeterol or equivalent; ≥80 µg/d).

Patients were included if they had prebronchodilator forced expiratory volume in 1 second (FEV₁) 60% or more predicted, were nonsmokers for at least 1 year (<10 pack-years for former smokers), had at least 2 days with asthma symptoms in the past 4 weeks, and an Asthma Quality of Life Questionnaire (AQLQ) score of 6.25 or less. Additional inclusion criteria included having 2 or fewer hospitalizations, 3 or fewer lower respiratory tract infections, and 3 or fewer severe exacerbations in the 12 months before BT.

Health care utilization, including severe exacerbations, hospitalization, and emergency department visits were analyzed. Spirometry values, including FEV₁ and forced vital capacity (FVC), and medication usage through 5 years after treatment were evaluated.

A total of 279 patients had at least 1 of the 3 BT procedures, whereas 271 had all 3 BT procedures. The mean age at baseline was 45.7 years, mean body mass index was 32.2, and the mean AQLQ was 4.03. Full 5-year follow-up data were available for 227 patients.

The proportion of patients with severe exacerbations at 12 months before BT and at 1, 2, 3, 4, and 5 years after BT were 78%, 50%, 47%, 47%, 44%, and 43%, respectively. The investigators found similar patterns in hospitalizations and emergency department visits for asthma.

The mean ICS dose decreased from a baseline value of 2272 µg per day to between 1910 and 2080 µg per day for years 1 through 5 after BT. Additionally, the proportion of patients at baseline who were using maintenance oral corticosteroids was 19.4%, which decreased to 8.1% to 10.7% during years 1 through 5, respectively.

From baseline to year 5, the use of omalizumab decreased from 16% to 11%, respectively. Mepolizumab and benralizumab use increased to 6.6% and 0.9%, respectively at 5 years. The FEV₁ and FVC was stable following BT treatment. Furthermore, the safety of BT persisted at 5 years.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Chupp G, Kline J, Khatri S, et al. Long-term efficacy and safety of bronchial thermoplasty: 5-year follow-up results from a large-scale prospective study. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 12.