Recent Advances in Chest Medicine: Advances in Bronchial Thermoplasty

Bronchial thermoplasty (BT) is a therapeutic intervention for patients with severe persistent asthma that delivers targeted thermal energy to the airway walls with the goal of ablating the smooth muscle. Since the publication of the original pre-clinical studies, three large randomized clinical trials evaluating its impact on asthma control have been performed. These trials have shown improvements in asthma related quality of life and a reduction in asthma exacerbations following treatment with BT. However, there remains significant controversy regarding the true efficacy of BT and the interpretation of these studies, particularly the Asthma Intervention Research (AIR)-2 trial. Here, we will discuss these controversies and present the latest evidence on the use of BT in asthma, specifically the recently published 5-year longitudinal evaluation of patients. In addition, we will discuss new insights into the histopathologic changes that occur in the airways following BT as well as the feasibility of performing the procedure in very severe asthmatics. We will also discuss the ongoing translational and clinical investigations regarding the underlying mechanism of action and methods to improve patient selection for this procedure.

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