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Recommendations for the use of bronchial thermoplasty in the management of severe asthma

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

Abstract


There are approximately 3 million asthma suffers in South Africa, and the national death rate is ranked as one of the highest in the world. Approximately 5% have severe asthma (uncontrolled despite being adherent on maximal and optimised therapy). Such uncontrolled asthma is associated with high healthcare expenditure and may require treatment with anti-IgE and/or systemic corticosteroids, in addition to inhaler therapy and oral agents. These treatments may be costly, and those such as oral corticosteroids may have potential serious adverse events. There is therefore a need for more effective, affordable and safe therapies for asthma. A new modality of treatment, bronchial thermoplasty (BT), has recently been developed and approved for the treatment of severe asthma. BT involves delivering radio frequency-generated thermal energy to the airways, with the goal of reducing airway-specific smooth-muscle mass. Several clinical studies have confirmed that BT is effective and safe, that it improves control and quality of life in patients whose asthma remains severe despite optimal medical therapy, and that the beneficial effects are sustained for at least 5 years. We provide recommendations for the management of severe asthma, with an emphasis on the role of BT, and endorse the use of BT in patients with severe persistent asthma who remain uncontrolled despite optimal medical therapy as outlined in steps 4 and 5 of the British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN), UK National Institute of Clinical Excellence (NICE) and Global Initiative for Asthma (GINA) guidelines. We outline the context in which BT should be used, how it works and associated potential adverse events and contraindications, and also review unanswered questions and controversies.

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

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

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

Full Text

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Keywords

Asthma; Bronchial thermoplasty; Indications; South Africa

Cite this article

South African Medical Journal 2015;105(9):726-732. DOI:10.7196/SAMJnew.8207

Article History

Date submitted: 2015-09-14
Date published: 2015-09-14

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