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Bronchial thermoplasty

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https://www.readbyqxmd.com/read/29184413/near-fatal-asthma-responsive-to-mepolizumab-after-failure-of-omalizumab-and-bronchial-thermoplasty
#1
Francesco Menzella, Carla Galeone, Mirco Lusuardi, Anna Simonazzi, Claudia Castagnetti, Patrizia Ruggiero, Nicola Facciolongo
Severe asthma affects between 5% and 10% of patients with asthma worldwide and requires best standard therapies at maximal doses, but there is a subgroup of patients refractory to all treatments. We share a case report of a 53-year-old woman with a history of severe allergic asthma that progressively worsened over the years despite the best therapy. She had been hospitalized 35 times, including nine admissions to the respiratory intensive care unit due to severe exacerbations. To rule out other possible diagnoses, several investigations were performed, such as computed tomography scan of the chest and neck, fiberoptic laryngoscopy, antineutrophil cytoplasmic antibodies, and complete blood cell count...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29149273/the-efficacy-and-safety-of-bronchial-thermoplasty-in-severe-persistent-asthma-on-extended-follow-up
#2
A O'Reilly, I Browne, D Watchorn, J J Egan, S Lane
Background: Asthma is a common condition and there remains a subset of patients who are poorly controlled on maximal therapy. Bronchial thermoplasty is a bronchoscopic therapy using radio frequency energy to reduce airway smooth muscle which has been shown to improve asthma control although further evidence regarding long term efficacy and safety is required. Aim: We aimed to demonstrate safety and efficacy of bronchial thermoplasty on extended follow up. Our initial experience with this group was previously reported in 2016 where patients were shown to have a significant improvement in Asthma Control Test (ACT) scores 1 year post treatment8...
November 15, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29103801/guiding-principles-for-use-of-newer-biologics-and-bronchial-thermoplasty-for-patients-with-severe-asthma
#3
Michael S Blaiss, Mario Castro, Bradley E Chipps, Myron Zitt, Reynold A Panettieri, Michael B Foggs
BACKGROUND: Severe asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment that is based on a patient's asthma phenotype. OBJECTIVE: To develop a consensus on the definition of severe asthma, the role of biomarkers and phenotyping severe asthma, and the use of newer biologic therapies and bronchial thermoplasty to help guide practicing clinicians...
November 2, 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/29078687/endobronchial-thermoplasty-for-asthma
#4
REVIEW
Felix Zamora, Roy Cho, Madhuri Rao, Heidi Gibson, H Erhan Dincer
Asthma is an incurable chronic disease affecting approximately 24 million people in the United States. The hallmark features of asthma are reversible airflow obstruction, airway hyperresponsiveness, airway inflammation, bronchoconstriction, and excessive mucus secretion. Clinical symptoms include episodic or persistent breathlessness, wheezing, cough, or chest tightness/pressure. Forty-five percent of asthmatics continue to have yearly exacerbations and the disease is responsible for approximately 3,600 annual deaths...
2017: Journal of visualized surgery
https://www.readbyqxmd.com/read/29076828/airway-remodeling-in-asthma-update-on-mechanisms-and-therapeutic-approaches
#5
Louis-Philippe Boulet
PURPOSE OF REVIEW: The term 'airway remodeling' reflects changes in the type, quantity, and nature of airway wall components and their organization. The purpose of this review is to look at recent publications on airway remodeling in asthma. RECENT FINDINGS: Animal models and in-vitro studies have confirmed the involvement of airway epithelium, airway smooth muscle (ASM), and extracellular matrix components in asthma-related airway remodeling. They report influences on proliferation of ASM cells, and how their orientation or morphology, in addition to the heterogeneity of ASM mass at different levels of airways could influence their effects...
January 2018: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/29033571/bronchial-thermoplasty-and-the-role-of-airway-smooth-muscle-are-we-on-the-right-direction
#6
REVIEW
Francesco Menzella, Mirco Lusuardi, Carla Galeone, Nicola Facciolongo
Asthma is characterized by inflammation of the airways that includes eosinophils, basal membrane thickening, epithelial sloughing, vascular changes, smooth muscle hypertrophy and hyperplasia, and mucous gland hyperplasia. Recently, there have been studies on the role of hypersensitivity and inflammation in asthma, but the role of bronchial smooth muscle remains unclear. Bronchial thermoplasty is an endoscopic procedure that is approved by the US Food and Drug Administration (FDA) for the treatment of severe refractory asthma, based on the local delivery of radio frequency at 65°C to the airways, with the aim of controlling bronchospasm through a reduction of airway smooth muscle (ASM)...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29033420/usefulness-of-bronchial-thermoplasty-for-patients-with-a-deteriorating-lung-function-a-report-of-two-cases
#7
Daisuke Minami, Chihiro Ando, Takamasa Nakasuka, Yoshitaka Iwamoto, Ken Sato, Keiichi Fujiwara, Takuo Shibayama, Toshirou Yonei, Toshio Sato
Bronchial thermoplasty is a novel procedure for patients with severe asthma showing a stable lung function. We herein report two cases with a deteriorating lung function. The lung function tended to improve in one case, while the other case discontinued mepolizumab medication after the procedure. Treatment was performed safely under general anesthesia in both cases. The use of bronchial thermoplasty may therefore be useful for the treatment of patients with a deteriorating lung function.
October 16, 2017: Internal Medicine
https://www.readbyqxmd.com/read/29025885/-long-term-outcomes-of-bronchial-thermoplasty-in-subjects-with-severe-asthma-a-comparison-of-3-year-follow-up-results-from-two-prospective-multicentre-studies-geoffrey-chupp-michel-laviolette-lauren-cohn-charlene-mcevoy-sandeep-bansal-adrian-shifren-sumita
#8
https://www.readbyqxmd.com/read/29018800/asthma-endotypes-and-an-overview-of-targeted-therapy-for-asthma
#9
REVIEW
Sarah Svenningsen, Parameswaran Nair
Guidelines for the management of severe asthma do not emphasize the measurement of the inflammatory component of airway disease to indicate appropriate treatments or to monitor response to treatment. Inflammation is a central component of asthma and contributes to symptoms, physiological, and structural abnormalities. It can be assessed by a number of endotyping strategies based on "omics" technology such as proteomics, transcriptomics, and metabolomics. It can also be assessed using simple cellular responses by quantitative cytometry in sputum...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28919788/innovative-treatments-for-severe-refractory-asthma-how-to-choose-the-right-option-for-the-right-patient
#10
REVIEW
Francesco Menzella, Carla Galeone, Francesca Bertolini, Claudia Castagnetti, Nicola Facciolongo
The increasing understanding of the molecular biology and the etiopathogenetic mechanisms of asthma helps in identification of numerous phenotypes and endotypes, particularly for severe refractory asthma. For a decade, the only available biologic therapy that met the unmet needs of a specific group of patients with severe uncontrolled allergic asthma has been omalizumab. Recently, new biologic therapies with different mechanisms of action and targets have been approved for marketing, such as mepolizumab. Other promising drugs will be available in the coming years, such as reslizumab, benralizumab, dupilumab and lebrikizumab...
2017: Journal of Asthma and Allergy
https://www.readbyqxmd.com/read/28879503/asthma-phenotypes-and-endotypes-implications-for-personalised-therapy
#11
Katrina Dean, Robert Niven
Asthma is increasingly recognised as a heterogeneous group of diseases with similar clinical presentations rather than a singular disease entity. Asthma was historically categorised by clinical symptoms; however, newer methods of subgrouping, describing and categorising the disease have sub-defined asthma. These sub-definitions are intermittently called phenotypes or endotypes, but the real meanings of these words are poorly understood. Novel treatments are currently and increasingly available, partly in the monoclonal antibody environment, and also some physical therapies (bronchial thermoplasty), but additionally small molecules are not far away from clinical practice...
October 2017: BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy
https://www.readbyqxmd.com/read/28860271/how-effective-is-bronchial-thermoplasty-for-severe-asthma-in-clinical-practice
#12
EDITORIAL
Neil C Thomson, Pascal Chanez
No abstract text is available yet for this article.
August 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28860266/long-term-outcomes-of-bronchial-thermoplasty-in-subjects-with-severe-asthma-a-comparison-of-3-year-follow-up-results-from-two-prospective-multicentre-studies
#13
Geoffrey Chupp, Michel Laviolette, Lauren Cohn, Charlene McEvoy, Sandeep Bansal, Adrian Shifren, Sumita Khatri, G Mark Grubb, Edmund McMullen, Racho Strauven, Joel N Kline
Bronchial thermoplasty is an endoscopic therapy for severe asthma. The previously reported, randomised sham-controlled AIR2 (Asthma Intervention Research 2) trial showed a significant reduction in severe asthma exacerbations, emergency department visits and hospitalisations after bronchial thermoplasty. More "real-world" clinical outcome data is needed.This article compares outcomes in bronchial thermoplasty subjects with 3 years of follow-up from the ongoing, post-market PAS2 (Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma) study with those from the AIR2 trial...
August 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28858897/anesthetic-considerations-for-patients-undergoing-bronchial-thermoplasty
#14
Jagroop S Saran, Melissa Kreso, Sandhya Khurana, Michael Nead, Michael Larj, Suzanne Karan
Bronchial thermoplasty (BT) is a novel, Food and Drug Administration-approved nondrug treatment for patients whose asthma remains uncontrolled despite traditional pharmacotherapy. BT involves application of controlled radiofrequency energy to reduce airway smooth muscle in large- and medium-sized airways. Although BT is often performed under general anesthesia, anesthetic management strategies for BT are poorly described. We describe the anesthetic management of 7 patients who underwent 19 BT treatments in a tertiary academic medical center...
August 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28796545/use-of-mdct-to-assess-the-results-of-bronchial-thermoplasty
#15
Matheus Zanon, Débora L Strieder, Adalberto S Rubin, Guilherme Watte, Edson Marchiori, Paulo F G Cardoso, Bruno Hochhegger
OBJECTIVE: The purpose of this study was to evaluate the use of MDCT to assess response to bronchial thermoplasty treatment for severe persistent asthma. MATERIALS AND METHODS: MDCT data from 26 patients with severe persistent asthma who underwent imaging before and after bronchial thermoplasty were analyzed retrospectively. Changes in the following parameters were assessed: total lung volume, mean lung density, airway wall thickness, CT air trapping index (attenuation < -856 HU), and expiratory-inspiratory ratio of mean lung density (E/I index)...
October 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28794646/bronchial-thermoplasty-implementing-best-practice-in-the-era-of-cost-containment
#16
Laren D Tan, Nicholas Kenyon, Ken Y Yoneda, Samuel Louie
Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine...
2017: Journal of Asthma and Allergy
https://www.readbyqxmd.com/read/28757156/emerging-understanding-of-the-mechanism-of-action-of-bronchial-thermoplasty-in-asthma
#17
REVIEW
J N S d'Hooghe, N H T Ten Hacken, E J M Weersink, P J Sterk, J T Annema, P I Bonta
Bronchial Thermoplasty (BT) is an endoscopic treatment for moderate-to-severe asthma patients who are uncontrolled despite optimal medical therapy. Effectiveness of BT has been demonstrated in several randomized clinical trials. However, the asthma phenotype that benefits most of this treatment is unclear, partly because the mechanism of action is incompletely understood. BT was designed to reduce the amount of airway smooth muscle (ASM), but additional direct and indirect effects on airway pathophysiology are expected...
July 27, 2017: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28708944/indirect-comparison-of-bronchial-thermoplasty-versus-omalizumab-for-uncontrolled-severe-asthma
#18
Robert M Niven, Michael R Simmonds, Michael J Cangelosi, Dominic P Tilden, Suzanne Cottrell, Narinder S Shargill
OBJECTIVE: Bronchial thermoplasty (BT) as an add-on therapy for uncontrolled severe asthma is an alternative to biologic therapies like omalizumab (OM). We conducted an indirect treatment comparison (ITC) to appraise comparative effectiveness of BT and OM. METHODS: A systematic literature review identified relevant randomized controlled trials. The ITC followed accepted methodology. RESULTS: The ITC comprised a sham-controlled trial of BT (AIR2) and two placebo-controlled trials of OM (INNOVATE; EXTRA)...
July 14, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28689843/nonpharmacologic-therapy-for-severe-persistent-asthma
#19
Chase Hall, Linda Nici, Shweta Sood, Richard ZuWallack, Mario Castro
The treatment of asthma largely depends on guideline-based pharmacologic therapies. However, nonpharmacologic therapies for asthma such as pulmonary rehabilitation, focused breathing techniques, and bronchial thermoplasty have an important, yet underappreciated, role. Structured pulmonary rehabilitation programs can reduce dyspnea and increase cardiopulmonary fitness. The educational component of these programs can ensure that therapies are being used appropriately, increase compliance, and decrease health care utilization...
July 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28676053/bronchial-thermoplasty-activations-predict-response
#20
David Langton, Joy Sha, Alvin Ing, David Fielding, Francis Thien, Virginia Plummer
BACKGROUND: Bronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe asthma. The predictive factors for clinical response to BT are unknown. We examined the relationship between the number of radiofrequency activations applied and the treatment response observed. METHODS: Data were collected from 24 consecutive cases treated at three Australian centres from June 2014 to March 2016. The baseline characteristics were collated along with the activations delivered...
July 4, 2017: Respiratory Research
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