One Bronchial Thermoplasty Treatment Beats Three For Asthma

A single bronchial thermoplasty procedure in which a hyperpolarized gas MRI is used to prioritize six airways in the lungs of patients with uncontrolled asthma is more effective than three standardized sessions of bronchial thermoplasty, new research shows.

“We got the end point we wanted and we also saw adverse events related to the procedure significantly reduced,” said Chase Hall, MD, from the Washington University School of Medicine in St. Louis.

Although patients with severe, difficult-to-treat asthma constitute only 5% to 10% of the population with asthma, they consume a disproportionate percentage of the global asthma budget and costs of pharmacology.

“Moving forward, if this gets approved, it would mean patients would need less time off work, the procedure would cost less, and patients would have fewer complications with a similar benefit,” Hall said during a late-breaking clinical trials session at the American Thoracic Society (ATS) 2019 International Conference in Dallas.

To test this new approach, the research team randomized 15 patients with uncontrolled asthma to guided bronchial thermoplasty, in which patients underwent volumetric CT and MRI with the ¹²⁹Xe contrast agent (MagniXene, Xemed).

“The patients inhale a gas that goes into their lungs and we image that gas to see where it’s going. That gives us an idea of where gas is not able to make it,” Hall explained. Segments of the lung that received the lowest amount of gas were targeted for treatment in the guided group.

The other 15 patients — randomized to unguided bronchial thermoplasty — underwent three standard treatment sessions at 3-week intervals: one for the right lower lobe, one for the left lower lobe, and one for both upper lobes.

Median age of the study participants was 45 years, 80% were women, 63% were on chronic oral corticosteroids, 43% were on omalizumab, and FEV1% predicted was 69.7. – Med Space