Advances in respiratory medicine
Bronchial Thermoplasty in Severe Asthma: Bridging Randomised and Real-World Evidence: A Systematic Review and Meta-Analysis
By Lúcio MJ, Pereira ML, Barata C and 2 others.
Abstract
Introduction
Bronchial thermoplasty (BT) reduces airway smooth muscle and may benefit severe asthma, but its role alongside biologics remains unclear. We assessed randomised and real-world evidence on efficacy and safety.
Methods
We searched PubMed, Scopus, and Cochrane Library for RCTs and observational studies of BT in adults with severe uncontrolled asthma, analysing them separately.
Results
Twenty studies were included (five RCTs, 15 observational). In RCTs, BT improved asthma-related quality of life (AQLQ;MD, 0.69; 95% CI 0.30-1.09), asthma control (ACQ; MD,-0.64; 95%CI, -1.10 to -0.19), and morning peak expiratory flow (MD, 20.62 L/min; 95% CI, 4.92-36.32), but did not improve rescue medication use or symptom-free-days. BT increased the risk of hospitalisation during the treatment period (RR, 3.50; 95%CI, 1.26-9.68), with no significant excess thereafter. Real-world studies showed improvements in AQLQ (MD,1.38; 95%CI, 0.97-1.80), ACQ (MD,-1.24; 95%CI, -1.86 to -0.62), and annualised exacerbation rates (MD, -3.79 exacerbations/patient-year; 95%CI, -6.98 to -0.61). Evidence suggested a possible, inconsistent corticosteroid-sparing effect; data on biologics and long-term safety were limited.