This meta-analysis assessed the efficacy and safety of a novel intervention for asthma, bronchial thermoplasty (BT), in patients with moderate-to-severe persistent asthma. An electronic literature search identified three randomized controlled trials (RCT) of BT that recruited 421 patients in total. Outcomes of interest were the Asthma Quality of Life Questionnaire (AQLQ) score, morning peak expiratory flow (PEF), tolerability and safety. Compared with standard medications and sham BT treatment, BT significantly improved AQLQ scores and PEF from baseline to the end of the trials. There were more respiratory adverse events and hospitalizations for adverse respiratory events with BT than with medications or sham treatment during the treatment period, but most events resolved, on average, within a week. This effect of BT treatment was not seen during the post-treatment period. Additional long-term RCT are required to confirm whether BT provides benefit to patients with moderate-to-severe persistent asthma.
DucharmeFMNi ChroininMGreenstoneI: Addition of long-acting β2-agonists to inhaled steroids versus higher dose inhaled steroids in adults and children with persistent asthma. Cochrane Database Syst Rev2010; 4: CD005533.
2.
NelsonHS: Advair: Combination treatment with fluticasone propionate/salmeterol in the treatment of asthma. J Allergy Clin Immunol2001; 107: 398–416.
3.
EdwardsSJvon MaltzahnRNayaIP: Budesonide/formoterol for maintenance and reliever therapy of asthma: A meta analysis of randomised controlled trials. Int J Clin Pract2010; 64: 619–627.
4.
DucharmeFMNi ChroininMGreenstoneI: Addition of long-acting β2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev2010; 5: CD005535.
5.
DanekCJLombardCMDungworthDL: Reduction in airway hyperresponsiveness to methacholine by the application of RF energy in dogs. J Appl Physiol2004; 97: 1946–1953.
6.
FernándezA Torrego: Bronchial thermoplasty in the treatment of asthma. Arch Bronconeumol2010; 46: 85–91 [in Spanish].
7.
CoxGMillerJMcWilliamsA: Bronchial thermoplasty for asthma. Am J Respir Crit Care Med2006; 173: 965–969.
8.
RubinASCardosoPF: Bronchial thermoplasty report on the first endoscopic treatment for asthma in Latin America. J Bras Pneumol2008; 34: 59–62 [in Portuguese, English abstract].
9.
CastroMRubinALavioletteM: Efficacy of bronchial thermoplasty (BT) in patients with severe asthma: The AIR2 trial. Am J Respir Crit Care Med2009; 179: A3644 [abstract].
10.
HigginsJPTGreenS (eds): Cochrane handbook for systematic reviews of interventions 4.2.6. In: The Cochrane Library, 2006, Issue 4. Chichester; John Wiley (updated September 2006).
11.
Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention: updated 2004. National Institutes of Health (NIH) publication No. 02-3659. Bethesda, MD: NIH, 2004.
12.
CoxGThomsonNCRubinAS: Asthma control during the year after bronchial thermoplasty. N Engl J Med2007; 356: 1327–1337.
13.
CastroMRubinASLavioletteM: Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: A multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med2010; 181: 116–124.
JüniPAltmanDGEggerM: Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ2001; 323: 42–46.
16.
GuyattGHSackettDLCookDJ: Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA1993; 270: 2598–2601.
17.
GuyattGHSackettDLCookDJ: Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA1994; 271: 59–63.
18.
JadadARMooreRACarrollD: Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Control Clin Trials1996; 17: 1–12.
19.
MoherDPhamBJonesA: Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?Lancet1998; 352: 609–613.
20.
SirouxVBoudierAAntoJM: Quality-of-life and asthma-severity in general population asthmatics: Results of the ECRHS II study. Allergy2008; 63: 547–554.
21.
HigginsJPThompsonSGDeeksJJ: Measuring inconsistency in meta-analyses. BMJ2003; 327: 557–560.
22.
DerSimonianRLairdN: Meta-analysis in clinical trials. Control Clin Trials1986; 7: 177–188.
23.
van HouwelingenHCArendsLRStijnenT: Advanced methods in meta-analysis: Multivariate approach and meta-regression. Stat Med2002; 21: 589–624.
24.
FollmannDElliottPSuhI: Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol1992; 45: 769–773.
25.
PavordIDCoxGThomsonNC: Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med2007; 176: 1185–1191.
Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention: Updated 2009. Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute; Geneva: World Health Organization, 2009 (available at: http://www.ginasthma.org).
28.
BaroffioMCrimiEBrusascoV: Airway smooth muscle as a model for new investigative drugs in asthma. Ther Adv Respir Dis2008; 2: 129–39.
CastroMMusaniAIMayseML: Bronchial thermoplasty: A novel technique in the treatment of severe asthma. Ther Adv Respir Dis2010; 4: 101–116.
31.
JuniperEF: The impact of patient compliance on effective asthma management. Curr Opin Pulm Med2003; 9 (suppl 1): S8–S10.
32.
BaiardiniIBraidoFBrandiS: The impact of GINA suggested drugs for the treatment of asthma on health-related quality of life: A GA2LEN review. Allergy2008; 63: 1015–1030.
33.
JuniperEFGuyattGHEpsteinRS: Evaluation of impairment of health related quality of life in asthma: Development of a questionnaire for use in clinical trials. Thorax1992; 47: 76–83.
34.
JuniperEFGuyattGHFerriePJ: Measuring quality of life in asthma. Am Rev Respir Dis1993; 147: 832–838.
