Safety of delivering bronchial thermoplasty in two treatment sessions

Abstract Background Bronchial thermoplasty (BT) is a novel endoscopic therapy for severe asthma. Traditionally it is performed in three separate treatment sessions, targeting different portions of the lung, and each requires an anaesthetic and hospital admission. Compression of treatment into 2 sess...

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Autores principales:	Kavya Koshy, Joy Sha, Kim Bennetts, David Langton
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Asthma Bronchial thermoplasty Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/ad7e6ac9ddca4114be1ba0158739437a
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spelling	oai:doaj.org-article:ad7e6ac9ddca4114be1ba0158739437a2021-12-05T12:20:23ZSafety of delivering bronchial thermoplasty in two treatment sessions10.1186/s12931-021-01901-x1465-993Xhttps://doaj.org/article/ad7e6ac9ddca4114be1ba0158739437a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12931-021-01901-xhttps://doaj.org/toc/1465-993XAbstract Background Bronchial thermoplasty (BT) is a novel endoscopic therapy for severe asthma. Traditionally it is performed in three separate treatment sessions, targeting different portions of the lung, and each requires an anaesthetic and hospital admission. Compression of treatment into 2 sessions would present a more convenient alternative for patients. In this prospective observational study, the safety of compressing BT into two treatment sessions was compared with the traditional 3 treatment approach. Methods Sixteen patients meeting ERS/ATS criteria for severe asthma consented to participate in an accelerated treatment schedule (ABT), which treated the whole left lung followed by the right lung four weeks later. The short-term outcomes of these patients were compared with 37 patients treated with conventional BT scheduling (CBT). The outcome measures used to assess safety were (1) the requirement to remain in hospital beyond the electively planned 24-h admission and (2) the need for re-admission for any cause within of 30 days of treatment. Results The total number of radiofrequency activations delivered in the ABT group was similar to CBT (187 ± 21 vs 176 ± 40, p = 0.326). With ABT, 11 in 31 admissions (37.9%) required prolonged admission due to wheezing, compared to 5.4% with CBT (p = 0.0025). The mean hospital length of stay with ABT was 1.8 ± 1.3 days, compared to 1.1 ± 0.4 days (p < 0.001). ICU monitoring was required on 5 occasions with ABT (16.1%), compared to 0.9% with CBT (p = 0.002). Subgroup analysis demonstrated that females were more likely to require prolonged admission (OR 11.6, p = 0.0025). The 30-day hospital readmission rate was similar for both groups (6.4% vs 5.4%, p = 0.67). All patients made a complete recovery after treatment with similar outcomes at the 6-month follow-up reassessment. Conclusion This study demonstrates that ABT results in greater short-term deterioration in lung function associated with a greater risk of prolonged hospital and ICU stay, predominantly affecting females. Therefore, in females, these risks need to be balanced against the convenience of fewer treatment sessions. In males, it may be an advantage to compress treatment.Kavya KoshyJoy ShaKim BennettsDavid LangtonBMCarticleAsthmaBronchial thermoplastyDiseases of the respiratory systemRC705-779ENRespiratory Research, Vol 22, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Asthma Bronchial thermoplasty Diseases of the respiratory system RC705-779
spellingShingle	Asthma Bronchial thermoplasty Diseases of the respiratory system RC705-779 Kavya Koshy Joy Sha Kim Bennetts David Langton Safety of delivering bronchial thermoplasty in two treatment sessions
description	Abstract Background Bronchial thermoplasty (BT) is a novel endoscopic therapy for severe asthma. Traditionally it is performed in three separate treatment sessions, targeting different portions of the lung, and each requires an anaesthetic and hospital admission. Compression of treatment into 2 sessions would present a more convenient alternative for patients. In this prospective observational study, the safety of compressing BT into two treatment sessions was compared with the traditional 3 treatment approach. Methods Sixteen patients meeting ERS/ATS criteria for severe asthma consented to participate in an accelerated treatment schedule (ABT), which treated the whole left lung followed by the right lung four weeks later. The short-term outcomes of these patients were compared with 37 patients treated with conventional BT scheduling (CBT). The outcome measures used to assess safety were (1) the requirement to remain in hospital beyond the electively planned 24-h admission and (2) the need for re-admission for any cause within of 30 days of treatment. Results The total number of radiofrequency activations delivered in the ABT group was similar to CBT (187 ± 21 vs 176 ± 40, p = 0.326). With ABT, 11 in 31 admissions (37.9%) required prolonged admission due to wheezing, compared to 5.4% with CBT (p = 0.0025). The mean hospital length of stay with ABT was 1.8 ± 1.3 days, compared to 1.1 ± 0.4 days (p < 0.001). ICU monitoring was required on 5 occasions with ABT (16.1%), compared to 0.9% with CBT (p = 0.002). Subgroup analysis demonstrated that females were more likely to require prolonged admission (OR 11.6, p = 0.0025). The 30-day hospital readmission rate was similar for both groups (6.4% vs 5.4%, p = 0.67). All patients made a complete recovery after treatment with similar outcomes at the 6-month follow-up reassessment. Conclusion This study demonstrates that ABT results in greater short-term deterioration in lung function associated with a greater risk of prolonged hospital and ICU stay, predominantly affecting females. Therefore, in females, these risks need to be balanced against the convenience of fewer treatment sessions. In males, it may be an advantage to compress treatment.
format	article
author	Kavya Koshy Joy Sha Kim Bennetts David Langton
author_facet	Kavya Koshy Joy Sha Kim Bennetts David Langton
author_sort	Kavya Koshy
title	Safety of delivering bronchial thermoplasty in two treatment sessions
title_short	Safety of delivering bronchial thermoplasty in two treatment sessions
title_full	Safety of delivering bronchial thermoplasty in two treatment sessions
title_fullStr	Safety of delivering bronchial thermoplasty in two treatment sessions
title_full_unstemmed	Safety of delivering bronchial thermoplasty in two treatment sessions
title_sort	safety of delivering bronchial thermoplasty in two treatment sessions
publisher	BMC
publishDate	2021
url	https://doaj.org/article/ad7e6ac9ddca4114be1ba0158739437a
work_keys_str_mv	AT kavyakoshy safetyofdeliveringbronchialthermoplastyintwotreatmentsessions AT joysha safetyofdeliveringbronchialthermoplastyintwotreatmentsessions AT kimbennetts safetyofdeliveringbronchialthermoplastyintwotreatmentsessions AT davidlangton safetyofdeliveringbronchialthermoplastyintwotreatmentsessions
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Safety of delivering bronchial thermoplasty in two treatment sessions

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