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Indications for the use of bronchial thermoplasty in severe asthma

Keertan Dheda, Coenraad F N Koegelenberg, Aliasgar Esmail, Elvis Irusen, Michael Wechsler, Rob M Niven, Kian Fan Chung, Eric D Bateman

Abstract


Approximately 5% of the ~3 million asthmatics in South Africa have severe asthma that is associated with substantial morbidity, cost, absenteeism, preventable mortality, and the requirement for costly chronic medication that may be associated with significant adverse events. There is an unmet need for alternative safer and more effective interventions for severe asthma. A recently introduced option, bronchial thermoplasty (BT), imparts radiofrequency-generated heat energy to the airways to cause regression of airway smooth muscle. The effectiveness of this technique has been confirmed in randomised control trials and is now endorsed by several international guidelines, including the Global Initiative for Asthma (GINA) guideline, the British Asthma Guideline, and the UK National Institute of Clinical Excellence (NICE) guideline. We recommend BT as a potential therapeutic intervention for severe uncontrolled asthma, provided that it is performed by an experienced pulmonologist at an accredited centre and done within the broader context of appropriate management of the disease by doctors experienced in treating difficult-to-control asthma.

Authors' affiliations

Keertan Dheda, Lung Infection and Immunity Unit and Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

Coenraad F N Koegelenberg, Pulmonology and Critical Care, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa

Aliasgar Esmail, Lung Infection and Immunity Unit and Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

Elvis Irusen, Division of Pulmonology, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa

Michael Wechsler, Asthma Institute, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA

Rob M Niven, University Hospital of South Manchester NHS Foundation Trust, University of Manchester, UK

Kian Fan Chung, National Heart and Lung Institute, Imperial College London and National Institute for Health Research, UK; Royal Brompton & Harefield NHS Trust, UK

Eric D Bateman, UCT Lung Institute, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Division of Pulmonology, University of cape Town and Groote Schuur Hospital, Cape Town, South Africa

Full Text

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Keywords

Asthma; Bronchial thermoplasty; Indications; South Africa

Cite this article

South African Medical Journal 2015;105(10):808-809. DOI:10.7196/SAMJnew.8208

Article History

Date submitted: 2015-09-18
Date published: 2015-09-18

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