What is the key question?

• There is a paucity of data regarding BT in patients with more severe obstruction, and consequently these patients are often excluded from receiving BT.

What is the bottom line?

• Patients with more severe airway obstruction were excluded from phase III trials of bronchial thermoplasty
• A number of potent biological drugs are now on the market for the treatment of severe asthma
• What is the role of bronchial thermoplasty in this patient population?
• In this retrospective analysis of the Australian BT registry of severe asthma patients, the first 70 patients consecutively enrolled for treatment were included for analysis.
• Patients were stratified according to baseline FEV1 < 50% (n=32) or ≥ 50% predicted (n=36).
• Adverse outcomes compared between the groups were defined as
  Remaining hospitalized >24 hours
  Readmission for any cause within 30 days
• The efficacy of BT was determined at 6 months.
• 56% patients were using systemic steroids for control, had poor lung function (mean prebronchodilator FEV1 57% predicted) and required systemic steroids for exacerbations on average four times in the 6 months prior to BT.
• All patients were eosinophilic at baseline.
• 87% patients reached minimally clinically important difference improvement in scores on Asthma Control Questionnaire and 59% discontinued systemic steroids at 6 months.
• There was no difference in adverse events or efficacy between lung function stratified groups; this outcome indicated that BT is safe and effective in patients with severe obstruction at baseline.
• 97% (59) patients responded and had higher eosinophil counts at baseline (422 vs. 340 cells/uL)

Why read on?

• This research provides important evidence that BT is safe in patients with severe asthma who were not included in phase III trials.
• Patients with severe eosinophilic asthma respond to BT.
• Consensus needs to be reached regarding the role of and ideal phenotype for BT in asthma.