461 results on '"Asthma surgery"'
Search Results
2. Efficacy of bronchial thermoplasty in a patient panel with uncontrolled severe persistent asthma.
- Author
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Zikos A, Balaan M, Hobart E, Bansal S, Saeed R, Cheema T, and Gentile D
- Subjects
- Humans, Female, Male, Adult, Middle Aged, Prospective Studies, Treatment Outcome, Severity of Illness Index, Nitric Oxide analysis, Nitric Oxide metabolism, Spirometry, Peak Expiratory Flow Rate, Asthma therapy, Asthma surgery, Bronchial Thermoplasty methods, Quality of Life
- Abstract
Background: Bronchial thermoplasty (BT) is an approved procedure to manage uncontrolled severe persistent asthma. Many insurance providers are reluctant to pay for BT without proven benefit among their specific patient panel., Objective: Determine if BT is effective in a panel patient panel with uncontrolled severe persistent asthma., Study Design and Methods: This was an unblinded prospective study of adult subjects with uncontrolled severe persistent asthma who underwent BT. Outcomes were assessed at baseline and then 3-, 6-, 12-, 18- and 24-months post-BT. The primary metric was an improved Asthma Quality of Life Questionnaire (AQLQ) score. Other metrics included improved Asthma Control Test (ACT), peak expiratory flow rates (PEFR), spirometry, fractional excretion of nitric oxide (FeNO), number of unscheduled medical visits, and lost days of work/activity. Respiratory adverse events were assessed during the BT treatment period and at each post-BT visit., Results: Twenty-nine subjects completed the study; the median interquartile range (IQR) age was 47 (42-61), and the majority were female (69%), white (93%), and non-Hispanic (90%). After BT, mean (±std) AQLQ scores improved by 1.6(±1.1) at 3 months ( p < 0.0001), 1.6(±1.2) at 6 months ( p < 0.0001), 1.4(±1.0) at 12 months ( p < 0.0001), 1.8(±1.1) at 18 months ( p < 0.0001), and 1.6 (±1.5) at 24 months ( p < 0.0001). There were significant improvements in ACT, PEFR, unscheduled medical visits and lost days of work and activity. Spirometry and FeNO metrics were unchanged. The average cost for subjects completing all 3 BT procedures was approximately $15,000., Conclusion: BT is an effective adjunctive therapeutic modality in subjects with uncontrolled severe persistent asthma.
- Published
- 2024
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3. The effect of adenotonsillectomy on asthma symptoms in the Pediatric Adenotonsillectomy Trial for Snoring (PATS).
- Author
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Gueye-Ndiaye S, Tully M, Tsou PY, Amin R, Baldassari CM, Chervin RD, Cielo CM, George A, Hassan F, Ibrahim S, Ishman SL, Kirkham EM, Mitchell RB, Naqvi K, Prero M, Rueschman M, Tapia IE, Sendon C, Wang R, Redline S, and Ross K
- Subjects
- Humans, Child, Female, Male, Treatment Outcome, Child, Preschool, Adolescent, Tonsillectomy methods, Adenoidectomy, Snoring surgery, Asthma surgery
- Published
- 2024
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4. Predictors of persistent disease in biologic treated type 2 diffuse/eosinophilic chronic rhinosinusitis undergoing surgery.
- Author
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Png LH, Kalish L, Campbell RG, Seresirikachorn K, Albrecht T, Raji N, Choy C, Rimmer J, Earls P, Sacks R, and Harvey RJ
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Asthma drug therapy, Asthma surgery, Chronic Disease, Cross-Sectional Studies, Eosinophilia, Neutrophils, Biological Products therapeutic use, Eosinophils, Nasal Polyps surgery, Nasal Polyps drug therapy, Rhinosinusitis drug therapy, Rhinosinusitis surgery
- Abstract
Background: Biologic therapy targeting type 2 chronic rhinosinusitis with nasal polyps (CRSwNP) has greatly improved disease control but nonresponders exist in a proportion of patients in phase 3 trials and clinical practice. This study explores the serum and histologic changes in biologic treated CRSwNP that predict disease control., Methods: A cross-sectional study was performed of patients with CRSwNP on biologics for their asthma, who underwent endoscopic sinus surgery while on biologic therapy. At the 6-month postoperative assessment, patients with poorly controlled CRSwNP while on biologic therapy were compared to patients who were controlled. Blood and mucosal samples taken at the time of surgery 6 months prior were assessed to predict disease control., Results: A total of 37 patients were included (age 47.8 ± 12.4 years, 43.2% female). Those with poorly controlled disease had reduced tissue eosinophils (% >100 cells/high-powered field: 8.3% vs. 50.0%, p < 0.001) and increased serum neutrophils (5.2 ± 2.7 vs. 3.7 ± 1.1 × 10
9 cells/L, p = 0.02). Logistic regression analysis demonstrated that reduced tissue eosinophil was predictive for poorly controlled disease (OR = 0.21, 95% CI [0.05, 0.83], p = 0.03). Receiver-operating characteristic analysis showed that need for rescue systemic corticosteroid was predicted at a serum neutrophil cut-off level of 5.75 × 109 cells/L (sensitivity = 80.0%, specificity = 96.9%, AUC = 0.938, p = 0.002)., Conclusion: Low tissue eosinophils and increased serum neutrophils while on biologics predict for poor response in the biological treatment of with CRSwNP. A serum neutrophil level of ≥5.75 × 109 cells/L predicts for poor response to current biologic therapy., (© 2023 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.)- Published
- 2024
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5. Bronchial thermoplasty for severe asthmatics: a real-world clinical study from Malaysia.
- Author
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Soo CI, Mak WW, Nasaruddin MZ, Ismail R, Ban AY, and Abdul Rahaman JA
- Subjects
- Humans, Malaysia, Bronchoscopy, Bronchial Thermoplasty, Asthma surgery
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- 2024
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6. [THE EFFICACY OF BRONCHIAL THERMOPLASTY IN LONG-TERM MAINTENANCE OF ADULT PATIENTS WITH MODERATE TO SEVERE ASTHMA].
- Author
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Matsuyama T, Tanaka J, Tone K, Shimizu K, Nakano T, and Takahashi K
- Subjects
- Adult, Humans, Quality of Life, Adrenal Cortex Hormones therapeutic use, Bronchial Thermoplasty, Asthma surgery, Asthma drug therapy
- Abstract
Background and Aims: Bronchial thermoplasty (BT) is a bronchoscopic treatment for adult patients with moderate to severe asthma. A systematic review was conducted to examine the efficacy of this treatment., Methods: Randomized controlled comparing BT to a control in adult patients with moderate to severe asthma were added to the previously conducted systematic review. Literature published prior to July 2022 was selected., Results: Four trials were included in this study. BT resulted in significant improvement in quality of life. However, no significant difference in asthma control was observed. Moreover, the incidence of severe adverse events during the treatment period was increased by BT. Furthermore, BT did not improve lung function, increase withdrawal from oral corticosteroids, reduce frequency of rescue medication usage, or increase the number of symptom-free days., Conclusion: From a risk-benefit perspective, there is insufficient evidence to support a recommendation of BT in adult patients with moderate to severe asthma.
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- 2024
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7. Editorial Commentary: Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted after Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps.
- Author
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Luo X, Huang XK, Zhang YN, and Yang QT
- Subjects
- Humans, Absorbable Implants, Stents, Nasal Polyps complications, Nasal Polyps surgery, Rhinosinusitis, Asthma surgery
- Published
- 2023
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8. S100A alarmins and thymic stromal lymphopoietin (TSLP) regulation in severe asthma following bronchial thermoplasty.
- Author
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Gagnon PA, Klein M, De Vos J, Biardel S, Côté A, Godbout K, Laviolette M, Laprise C, Assou S, and Chakir J
- Subjects
- Humans, Thymic Stromal Lymphopoietin, Alarmins, Toll-Like Receptor 4, Cytokines metabolism, Bronchial Thermoplasty, Asthma genetics, Asthma surgery, Asthma metabolism
- Abstract
Rationale: Severe asthma affects a small proportion of asthmatics but represents a significant healthcare challenge. Bronchial thermoplasty (BT) is an interventional treatment approach preconized for uncontrolled severe asthma after considering biologics therapy. It was showed that BT long-lastingly improves asthma control. These improvements seem to be related to the ability of BT to reduce airway smooth muscle remodeling, reduce the number of nerve fibers and to modulate bronchial epithelium integrity and behavior. Current evidence suggest that BT downregulates epithelial mucins expression, cytokine production and metabolic profile. Despite these observations, biological mechanisms explaining asthma control improvement post-BT are still not well understood., Objectives: To assess whether BT affects gene signatures in bronchial epithelial cells (BECs)., Methods: In this study we evaluated the transcriptome of cultured bronchial epithelial cells (BECs) of severe asthmatics obtained pre- and post-BT treatment using microarrays. We further validated gene and protein expressions in BECs and in bronchial biopsies with immunohistochemistry pre- and post-BT treatment., Measurements and Main Results: Transcriptomics analysis revealed that a large portion of differentially expressed genes (DEG) was involved in anti-viral response, anti-microbial response and pathogen induced cytokine storm signaling pathway. S100A gene family stood out as five members of this family where consistently downregulated post-BT. Further validation revealed that S100A7, S100A8, S100A9 and their receptor (RAGE, TLR4, CD36) expressions were highly enriched in severe asthmatic BECs. Further, these S100A family members were downregulated at the gene and protein levels in BECs and in bronchial biopsies of severe asthmatics post-BT. TLR4 and CD36 protein expression were also reduced in BECs post-BT. Thymic stromal lymphopoietin (TSLP) and human β-defensin 2 (hBD2) were significantly decreased while no significant change was observed in IL-25 and IL-33., Conclusions: These data suggest that BT might improve asthma control by downregulating epithelial derived S100A family expression and related downstream signaling pathways., (© 2023. The Author(s).)
- Published
- 2023
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9. Long-term Follow-up of Pediatric Chronic Rhinosinusitis After Surgical Treatment.
- Author
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Makary CA, Bonnici M, Jones G, Sullivan P, Stokes C, and Ramadan HH
- Subjects
- Adult, Humans, Child, Follow-Up Studies, Quality of Life, Cross-Sectional Studies, Endoscopy, Chronic Disease, Treatment Outcome, Rhinitis surgery, Sinusitis diagnosis, Sinusitis surgery, Rhinitis, Allergic diagnosis, Rhinitis, Allergic surgery, Asthma surgery
- Abstract
Objective: To study the long-term outcomes of pediatric chronic rhinosinusitis (CRS) after surgical treatment., Methods: Cross-sectional survey of patients who were treated surgically for CRS as children more than 10 years ago. Survey included SNOT-22 questionnaire, additional functional endoscopic sinus surgery (FESS) since last treatment, status of allergic rhinitis and asthma, and availability of any CT scan sinus/face for review., Results: About 332 patients were contacted by phone or email. Seventy-three patients filled the survey (22.5% response rate). Current age was 26 years (±+/-4.7, 15.3-37.8 years). Age at initial treatment was 6.8 years (+/-3.1, 1.7-14.7 years). Fifty-two patients (71.2%) had FESS and adenoidectomy, and 21 patients (28.8%) had adenoidectomy only. Follow-up since surgical treatment was 19.3 years (+/-4.1). SNOT-22 score was 34.5 (+/-22.2). None of the patients had any additional FESS for the duration of the follow-up, and only 3 patients had septoplasty and inferior turbinoplasty as adults. Twenty-four patients had CT scan sinuses/face available for review. Scans were obtained at an average of 14 years after surgical intervention (+/-5.2). CT LM score was 0.9 (+/-1.9), compared to 9.3 at time of their surgery (+/-5.9) ( P < .0001). Currently 45.8% and 36.9% of patients have asthma and AR, compared to 35.6% and 40.6% respectively as kids ( P = .897 and P = .167)., Conclusion: Children who had surgery for CRS do not seem to have CRS as adults. However, patients continue to have active allergic rhinitis that may affect their quality of life.
- Published
- 2023
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10. Patient profiling to predict response to bronchial thermoplasty in patients with severe asthma.
- Author
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Ano S, Kikuchi N, Matsuyama M, and Hizawa N
- Subjects
- Humans, Bronchial Thermoplasty methods, Asthma genetics, Asthma surgery
- Abstract
Bronchial thermoplasty is the only device-based nonpharmacological treatment approach for severe asthma. Current guidelines are cautious in recommending bronchial thermoplasty because of unknown patient response prediction. Recent research on bronchial thermoplasty includes up-to-date, state-of-the-art, and recent-advances reviews. However, these reviews provide a broad and general discussion on equipment, technique, patient selection, and patient management, with little evaluation of the predictors of a beneficial response. Predicting an optimal response to bronchial thermoplasty in patients with severe asthma remains elusive. The lack of reliable predictive markers means that bronchial thermoplasty remains a last-line treatment and makes profiling for predicting the response or efficacy a topic of study. Genetic changes are associated with airway remodeling. A gap in the literature exists regarding patient profiling to predict the response to bronchial thermoplasty in patients with severe asthma. Therefore, recently published omics data and genetic associations regarding the response to bronchial thermoplasty therapy should be reviewed. We present an up-to-date review of recent publications profiling the response to bronchial thermoplasty in patients with severe asthma., Competing Interests: Conflict of Interest The authors have no conflicts of interest., (Copyright © 2023 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)
- Published
- 2023
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11. Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps.
- Author
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Huang A, Li T, Li MS, Huang ZX, Wang DH, Cheng L, Zhou B, Wang H, and Liu Z
- Subjects
- Humans, Absorbable Implants, Treatment Outcome, Steroids therapeutic use, Stents, Nasal Polyps complications, Nasal Polyps surgery, Sinusitis complications, Sinusitis surgery, Asthma complications, Asthma surgery
- Abstract
Objective: To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)., Methods: We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP. Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation: sex, serum eosinophil levels, history of prior surgery, endoscopic scores, and comorbid conditions (asthma and allergic rhinitis). The primary outcome was the rate of post-operative intervention on day 30, and the secondary outcome was the rate of polypoid tissue formation (grades 2-3) on days 14, 30, and 90., Results: A total of 151 patients with CRSwNP were included in the post-hoc analysis. Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30, with an odds ratio of 23.71 (95% CI, 2.81, 200.16; P=0.004) for the need for post-operative intervention and 19 (95% CI, 2.20, 164.16; P=0.003) for moderate-to-severe polypoid tissue formation. In addition, the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30. Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation., Conclusion: Comorbid asthma, but not blood eosinophil level, impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP., (© 2023. The Author(s).)
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- 2023
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12. Bronchial thermoplasty attenuates bronchodilator responsiveness.
- Author
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Henry C, Biardel S, Boucher M, Godbout K, Chakir J, Côté A, Laviolette M, and Bossé Y
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- Humans, Bronchodilator Agents pharmacology, Bronchodilator Agents therapeutic use, Albuterol pharmacology, Albuterol therapeutic use, Adrenal Cortex Hormones, Forced Expiratory Volume, Bronchial Thermoplasty, Asthma drug therapy, Asthma surgery, Asthma diagnosis
- Abstract
Introduction: Bronchial thermoplasty is an effective intervention to improve respiratory symptoms and to reduce the rate of exacerbations in uncontrolled severe asthma. A reduction in airway smooth muscle is arguably the most widely discussed mechanisms accounting for these clinical benefits. Yet, this smooth muscle reduction should also translate into an impaired response to bronchodilator drugs. This study was designed to address this question., Methods: Eight patients with clinical indication for thermoplasty were studied. They were uncontrolled severe asthmatics despite optimal environmental control, treatment of comorbidities, and the use of high-dose inhaled corticosteroids and long-acting β
2 -agonists. Lung function measured by spirometry and respiratory mechanics measured by oscillometry were examined pre- and post-bronchodilator (salbutamol, 400 μg), both before and at least 1 year after thermoplasty., Results: Consistent with previous studies, thermoplasty yielded no benefits in terms of baseline lung function and respiratory mechanics, despite improving symptoms based on two asthma questionnaires (ACQ-5 and ACT-5). The response to salbutamol was also not affected by thermoplasty based on spirometric readouts, including forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), and FEV1 /FVC ratio. However, a significant interaction was observed between thermoplasty and salbutamol for two oscillometric readouts, namely reactance at 5 Hz (Xrs5 ) and reactance area (Ax), showing an attenuated response to salbutamol after thermoplasty., Conclusions: Thermoplasty attenuates the response to a bronchodilator. We argue that this result is a physiological proof of therapeutic efficacy, consistent with the well-described effect of thermoplasty in reducing the amount of airway smooth muscle., Competing Interests: Declaration of competing interest YB's laboratory received funds from Boston Scientific Inc (25800$) to conduct this project. AC is funded partially by GlaxoSmithKline, and has received consulting fees and honoraria for lectures from AstraZeneca, Sanofi, GlaxoSmithKline, Regeneron and Valeo pharma. CH, SB, MB, KG, JC and ML declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)- Published
- 2023
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13. Effect of bronchial thermoplasty on static and dynamic lung compliance and resistance in patients with severe persistent asthma.
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Baydur A, Barbers R, and May D
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- Humans, Lung Compliance, Lung surgery, Lung physiology, Spirometry, Bronchial Thermoplasty methods, Asthma surgery, Asthma diagnosis
- Abstract
Rationale: Bronchial thermoplasty (BT) reduces severity and frequency of bronchoconstriction and symptoms in severe, persistent asthmatics although it is usually not associated with change in spirometric variables. Other than spirometry. there are almost no data on changes in lung mechanics following BT., Objective: To assess lung static and dynamic lung compliance (Cst,L and Cdyn,L, respectively) and static and dynamic lung resistance (Rst,L and Rdyn,L, respectively) before and after BT in severe asthmatics using the esophageal balloon technique., Methods: Rdyn,L and Cdyn,L were measured at respiratory frequencies up to 145 breaths/min, using the esophageal balloon technique in 7 patients immediately before and 12-50 weeks after completing a series of 3 BT sessions., Results: All patients experienced improved symptoms within a few weeks following completion of BT. Pre-BT, all patients exhibited frequency dependency of lung compliance, with mean Cdyn,L decreasing to 63% of Cst,L at maximum respiratory rates. Post-BT, Cst,L did not change significantly from pre-thermoplasty values, while Cdyn,L diminished to 62%% of Cst,L. In 4 of 7 patients, post-BT values of Cdyn,L were consistently higher than pre-BT over the range of respiratory rates. R
L in 4 of 7 patients during quiet breathing and at higher respiratory frequencies decreased following BT., Conclusions: Patients with severe persistent asthma exhibit increased resting lung resistance and frequency dependence of compliance, the magnitudes of which are ameliorated in some patients following bronchial thermoplasty and associated with variable change in frequency dependence of lung resistance. These findings are related to asthma severity and may be related to the heterogeneous and variable nature of airway smooth muscle modeling and its response to BT., Competing Interests: Declaration of competing interest None, (Copyright © 2023. Published by Elsevier Ltd.)- Published
- 2023
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14. Comparing bronchial thermoplasty with biologicals for severe asthma: Systematic review and network meta-analysis.
- Author
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Fong KY, Zhao JJ, Syn NL, Nair P, Chan YH, and Lee P
- Subjects
- Humans, Network Meta-Analysis, Adrenal Cortex Hormones therapeutic use, Bronchial Thermoplasty, Biological Products therapeutic use, Asthma drug therapy, Asthma surgery
- Abstract
Background: Bronchial thermoplasty (BT) has shown favorable safety and efficacy in several randomized controlled trials (RCTs), but has not been directly compared to biological therapies., Methods: Electronic literature searches were performed on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, to retrieve RCTs of BT or FDA-approved biologicals against controls in patients with severe asthma. Six outcomes were analyzed: Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ), the number of patients experiencing ≥1 asthma exacerbation, annualized exacerbation rate ratio (AERR), oral corticosteroid dose reduction (OCDR), and morning peak expiratory flow rate (amPEF). Random-effects, Frequentist network meta-analysis (NMA) were performed, and therapies were ranked using P-scores., Results: Twenty-nine RCTs (15,547 patients) were included. Fewer patients treated with BT experienced ≥1 asthma exacerbation (risk ratio [RR] = 0.66, 95%CI = 0.45-0.98) compared to control. AERR of BT versus control was non-significant, but significant improvements in ACQ score (mean difference [MD] -0.41, 95%CI -0.63 to -0.20), AQLQ score (MD = 0.54, 95%CI = 0.30-0.77), amPEF and OCDR were found. No significant differences between BT and biologics were seen across indirect comparisons of all studies., Conclusions: Despite the lack of head-to-head comparative trials, this NMA suggests that BT is non-inferior to biologicals in terms of quality-of-life scores, and represents a promising alternative for patients with severe asthma., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Parameswaran Nair reports a relationship with AZ that includes: consulting or advisory and funding grants. Parameswaran Nair reports a relationship with Novartis that includes: consulting or advisory and funding grants. Parameswaran Nair reports a relationship with Teva Pharmaceuticals USA Inc that includes: consulting or advisory and funding grants. Parameswaran Nair reports a relationship with Sanofi-Aventis US LLC that includes: funding grants. Parameswaran Nair reports a relationship with Roche that includes: consulting or advisory and funding grants. Parameswaran Nair reports a relationship with Merck that includes: consulting or advisory. Parameswaran Nair reports a relationship with Equilium that includes: consulting or advisory. Parameswaran Nair reports a relationship with Foresee Pharmaceuticals Co., Ltd. that includes: consulting or advisory., (Copyright © 2023. Published by Elsevier Ltd.)
- Published
- 2023
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15. The beneficial effects of an adenotonsillectomy upon upper respiratory tract infections, asthma and rhinitis in children: a national database study in Korea.
- Author
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Bae MR, Han KD, Park SH, and Chung YS
- Subjects
- Humans, Child, Male, Female, Adenoidectomy, Republic of Korea epidemiology, Rhinitis surgery, Rhinitis complications, Respiratory Tract Infections drug therapy, Respiratory Tract Infections surgery, Respiratory Tract Infections complications, Asthma drug therapy, Asthma surgery, Asthma complications
- Abstract
Background: Adenotonsillectomy is the most commonly performed surgery in children., Aims: To evaluate the effects of pediatric adenotonsillectomy on health care utilization., Methods: From 2006 to 2017, age/sex-matched adenotonsillectomy participants ( n = 243.396) and controls ( n = 730.188) were selected (62% of male and 38% of female. 47% age≦ 6, 16% 7-9years, 8% 10-12years, 29% 13-18years). The changes in outpatient visits, hospitalization days, and drug prescriptions due to a URI, asthma, and rhinitis before and after the surgery date (from 13 months to 1 month) were compared., Results: Outpatient visits decreased more in the surgery group than the control group (mean change, 3.24 ± 8.61 d and 1.16 ± 6.57 d for URI, 2.07 ± 8.63 d and 0.51 ± 6.47 d for rhinitis, and 0.72 ± 4.81 d and 0.42 ± 3.91 d for asthma, p < .001 for all). Hospitalizations also showed greater decreases in the surgery group (mean change, 0.31 ± 2.96 d and 0.04 ± 1.70 d for URI, 0.13 ± 2.40 d and 0.02 ± 1.48 d for rhinitis, 0.11 ± 2.32 d and 0.04 ± 1.83 d for asthma, p < .001 for all). The prescription of antihistamines, leukotriene modulators, oral antibiotics, oral steroids, and expectorants, cough suppressants and oral bronchodilators was also decreased after surgery., Conclusions: The adenotonsillectomy group showed a greater decrease in post-operative outpatients visits, hospital days and drug prescriptions associated with URI, rhinitis and asthma than the control group.
- Published
- 2023
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16. Efficacy of laparoscopic fundoplication in patients with chronic cough and gastro-oesophageal reflux.
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Frankel A, Ong HS, Smithers BM, Nathanson LK, and Gotley DC
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- Humans, Chronic Disease, Heartburn surgery, Heartburn complications, Asthma complications, Asthma surgery, Cough etiology, Cough surgery, Fundoplication adverse effects, Gastroesophageal Reflux complications, Gastroesophageal Reflux surgery, Laparoscopy adverse effects
- Abstract
Background: The outcome of anti-reflux surgery in patients with suspected gastro-oesophageal reflux-induced cough is frequently uncertain. The aims of this study were to assess the efficacy of laparoscopic fundoplication for controlling cough in patients with chronic cough without asthma, who have pathologic gastro-oesophageal reflux, and to identify predictors of response., Methods: From a prospective database of 1598 patients who have undergone laparoscopic fundoplication, 66 (4%) with proven gastro-oesophageal reflux disease (GORD) and chronic cough without asthma were studied. All patients underwent gastroscopy and 24-h pH monitoring before operation. Heartburn and regurgitation were assessed using a modified DeMeester score. Severity of cough before and after surgery was self-assessed by the patient using a visual analog scale at a minimum of 12 months post-operatively (median 43 mo; range: 14-104 mo). Patients were considered to have responded to fundoplication if they had no cough or the cough had improved by 50% or more after operation., Results: Cough and heartburn/regurgitation were relieved in 61% (40/66) and 90% (44/49) of the patients, respectively. The presence of typical GORD symptoms or oesophagitis, and pH study variables did not predict the response of the cough to fundoplication., Conclusion: Refinement in the aetiological diagnosis of chronic cough due to GORD is necessary for improved outcome. Patients diagnosed with GORD-related chronic cough need to be counseled regarding their expectations from anti-reflux surgery., (© 2022. The Author(s).)
- Published
- 2023
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17. Bronchial Thermoplasty Attenuates Cough Reflex Sensitivity in Severe Asthma : A Single-Center Retrospective Study with 2-year Follow-up.
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Hara J, Yamamura K, Sakai T, Takeda Y, Kobayashi T, Ohkura N, Watanabe S, Tambo Y, Kimura H, Abo M, Kasahara K, and Yano S
- Subjects
- Humans, Retrospective Studies, Follow-Up Studies, Cough, Quality of Life, Reflex, Bronchial Thermoplasty, Asthma surgery
- Abstract
Despite the relatively short follow-up period in our previous study, we had reported that increased cough reflex sensitivity (CRS) may predict the efficacy of bronchial thermoplasty (BT) for treating asthma. Herein, we examined whether CRS predicts the efficacy of BT 2 years after the final BT treatment. We also investigated the influence of BT on CRS. We reviewed 10 patients 2 years after their final BT treatment. CRS, asthma-related symptoms, asthma exacerbations, and cough-related quality of life were assessed at baseline and 2 years after BT. Five patients responded positively to BT (BT responders) and their asthma control improved. No significant difference in CRS at baseline was detected between the BT responders and nonresponders. In contrast, BT responders exhibited significant improvements in CRS 2 years after BT. CRS at baseline could not predict the BT efficacy after 2 years. This is the first report demonstrating BT desensitized CRS in consecutive case series. J. Med. Invest. 70 : 271-275, February, 2023.
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- 2023
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18. A comparison of central compartment atopic disease and lateral dominant nasal polyps.
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Shih LC, Hsieh BH, Ma JH, Huang SS, Tsou YA, Lin CD, Huang KH, and Tai CJ
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- Humans, Case-Control Studies, Endoscopy methods, Chronic Disease, Nasal Polyps surgery, Nasal Polyps diagnosis, Sinusitis surgery, Sinusitis diagnosis, Rhinitis surgery, Rhinitis diagnosis, Asthma surgery, Rhinitis, Allergic surgery, Eosinophilia
- Abstract
Background: The characteristics and surgical outcomes of central compartment atopic disease (CCAD) vary by region and race. Therefore, we aimed to identify the risk factors, symptom severity, and prognosis of CCAD in the Asian population., Methods: This case-control study recruited patients diagnosed with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. Patients were classified into CCAD and lateral-dominant nasal polyp (LDNP) groups based on endoscopic and computed tomography imaging findings. The demographic data, symptom severity scores, and surgical outcomes of the 2 groups were analyzed., Results: Our study included 442 patients (CCAD group: n = 51; LDNP group: n = 391). We found that CCAD was strongly related to both asthma (9.8% vs 3.5%, p = 0.04) and allergic rhinitis symptoms (43.3% vs 26.6%, p = 0.01). Higher eosinophil counts were detected in blood serum (5.8% vs 2.8%, p < 0.01) and histopathologic profiles (57.0 vs 17.3, p < 0.01) among patients with CCAD. Improvements in 22-item Sino-Nasal Outcome Test (SNOT-22) score and mucociliary clearance time (MCT) after surgical intervention revealed that the CCAD group had a better response to FESS (SNOT-22 score: -31.82 vs -22.66, p < 0.01; MCT: -233.06 vs -191.93 seconds, p = 0.03). The revision FESS rate was not different between the 2 groups., Conclusion: Polyps originating from the central compartment were found to be related to asthma and allergic rhinitis in Taiwanese patients. A higher eosinophil count was suggested in both serum and local nasal tissue from patients with CCAD. FESS serves as an effective treatment for symptom relief in patients with CCAD., (© 2022 ARS-AAOA, LLC.)
- Published
- 2022
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19. Choose Wisely: Surgical Selection of Candidates for Outpatient Anterior Cervical Surgery Based on Early Complications Among Inpatients.
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Carlson BC, Dawson JM, Beauchamp EC, Mehbod AA, Mueller B, Alcala C, Mullaney KJ, Perra JH, Pinto MR, Schwender JD, Shafa E, Transfeldt EE, and Garvey TA
- Subjects
- Adult, Humans, Cervical Vertebrae surgery, Inpatients, Outpatients, Retrospective Studies, Diskectomy adverse effects, Diskectomy methods, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Spinal Fusion adverse effects, Spinal Fusion methods, Pulmonary Disease, Chronic Obstructive complications, Asthma complications, Asthma surgery
- Abstract
Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are attractive targets for transition to the outpatient setting. We assessed the prevalence of rapid responses and major complications in the inpatient setting following 1 or 2-level ACDFs and CDAs. We evaluated factors that may place patients at greater risk for a rapid response or a postoperative complication., Methods: This was an institutional review board-approved, retrospective cohort study of adults undergoing 1 or 2-level ACDF or CDA at 1 hospital over a 2-year period (2018 and 2019). Data on patient demographic characteristics, surgical procedures, and comorbidities were collected. Rapid response events were identified by hospital floor staff and involved acute changes in a patient's clinical condition. Complications were events that were life-threatening, required an intervention, or led to delayed hospital discharge., Results: In this study, 1,040 patients were included: 888 underwent ACDF and 152 underwent CDA. Thirty-six patients (3.5%) experienced a rapid response event; 22% occurred >24 hours after extubation. Patients having a rapid response event had a significantly higher risk of developing a complication (risk ratio, 10; p < 0.01) and had a significantly longer hospital stay. Twenty-four patients (2.3%) experienced acute complications; 71% occurred >6 hours after extubation. Patients with a complication were older and more likely to be current or former smokers, have chronic obstructive pulmonary disease, have asthma, and have an American Society of Anesthesiologists (ASA) score of >2. The length of the surgical procedure was significantly longer in patients who developed a complication. All patients who developed dysphagia had a surgical procedure involving C4-C5 or more cephalad. Patients with a rapid response event or complication were more commonly undergoing revision surgical procedures., Conclusions: Rapid response and complications are uncommon following 1 or 2-level ACDFs or CDAs but portend a longer hospital stay and increased morbidity. Revision surgical procedures place patients at higher risk for rapid responses and complications. Additionally, older patients, patients with chronic obstructive pulmonary disease or asthma, patients who are current or former smokers, and patients who have an ASA score of ≥3 are at increased risk for postoperative complications., Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H155 )., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)
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- 2022
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20. Surgical management of eyelid lesions in adult-onset asthma and periocular xanthogranuloma.
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Santos MC, Kalyam P, and Couch SM
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- Adult, Eyelids pathology, Female, Granuloma diagnosis, Humans, Orbit pathology, Asthma complications, Asthma drug therapy, Asthma surgery, Soft Tissue Neoplasms, Xanthomatosis complications, Xanthomatosis surgery
- Abstract
Medical therapy is the mainstay of initial treatment for periocular xanthogranulomas. Here we depict surgical management of biopsy-proven adult-onset asthma and periocular xanthogranuloma (AAPOX). This 27-year-old female presented with seven years of progressive bilateral periorbital swelling, weight gain, and severe asthma refractory to immunosuppressive therapy including methotrexate, rituximab, and cyclophosphamide. Pre-operative and post-operative photos show excellent resolution of lesions. Orbitotomy with excision involved an upper eyelid crease incision marked at 9 mm centrally. A flap was dissected between the skin and orbicularis-involving xanthogranuloma, extended superiorly to orbital rim and laterally and medially until normal orbicularis was encountered. The xanthogranuloma was excised en-bloc. Infiltrated preaponeurotic fat and portions of the orbital lobe of the lacrimal gland were resected. After achieving hemostasis, the skin was closed with 6-0 polypropylene suture. Surgical pathology was consistent with the diagnosis of AAPOX.
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- 2022
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21. Bronchial thermoplasty: State of the art.
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Hashmi MD, Khan A, and Shafiq M
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- Bronchi surgery, Cost-Benefit Analysis, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Asthma surgery, Bronchial Thermoplasty
- Abstract
Since the publication of a sham-controlled, randomized trial (AIR2) and subsequent marketing approval by the US Food and Drug Administration, we have significantly advanced our understanding of bronchial thermoplasty (BT)'s scientific basis, long-term safety, clinical efficacy and cost-effectiveness. In particular, the last 2 years have witnessed multiple research publications on several of these counts. In this review, we critically appraise our evolving understanding of BT's biologic underpinnings and clinical impact, offer an evidence-based patient workflow guide for the busy pulmonologist and highlight both current challenges as well as potential solutions for the researcher and the clinician., (© 2022 Asian Pacific Society of Respirology.)
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- 2022
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22. Transcriptome genetic differences between responders and non-responders before bronchial thermoplasty.
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Ano S, Kikuchi N, Matsuyama M, Nakajima M, Kondo Y, Masuda M, Osawa H, Ishii Y, and Hizawa N
- Subjects
- Bronchi pathology, Bronchi surgery, Humans, Proteins, Quality of Life, RNA, Transcriptome, Asthma genetics, Asthma pathology, Asthma surgery, Bronchial Thermoplasty methods
- Abstract
Background: Bronchial thermoplasty (BT) is an endoscopic therapy used for the treatment of refractory asthma. Some predictive factors, for example the number of activations and severity of disease at baseline, have been used to determine the effectiveness of BT in treating patients with asthma. The aim of the present study was to comprehensively analyze RNA samples from the airway bronchial tissues of patients with severe asthma treated by BT, and to characterize each patient as a BT responder or non-responder., Methods: Eight patients with severe asthma scheduled to undergo BT and bronchus biopsies were recruited before the procedures were conducted. Extracted RNA samples from bronchial tissues were sequenced and differential gene expression analysis was carried out.Results/discussion: Subjects with Asthma Quality of Life Questionnaire score changes ≥0.5 for a period of 12 months were considered BT responders. Non-responders had score changes <0.5 for 12 months. Histopathology findings were similar to those reported previously, and no significant differences in the expression of α-smooth muscle actin and protein gene product 9.5 were observed between responders and non-responders. Transcriptome analysis at baseline identified 67 genes that were differentially expressed between responders and non-responders, including SLPI , MMP3 , and MUC19 , which were upregulated in responders. Although the differentially expressed gene products may have conflicting effects, genes in the airway epithelium and extracellular matrix of patients with severe asthma may determine the BT response. Our results identified possible transcriptomic changes that could be used to identify BT responders.
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- 2022
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23. Analysis of risk factors for postoperative complications in non-small cell lung cancer: comparison with the Japanese National Clinical Database risk calculator.
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Motono N, Ishikawa M, Iwai S, Yamagata A, Iijima Y, and Uramoto H
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- Humans, Japan epidemiology, Male, Pneumonectomy methods, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Asthma complications, Asthma surgery, Carcinoma, Non-Small-Cell Lung complications, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms complications, Noncommunicable Diseases
- Abstract
Background: Although the risk calculator of the National Clinical Database (RC-NCD) has been widely used to predict the occurrence of mortality and major morbidity in Japan, it has not been demonstrated whether a correlation between the calculated RC-NCD risk score and the actual occurrence of mortality and severe morbidity exists., Methods: The clinical data of 585 patients who underwent pulmonary resection for non-small cell lung cancer were collected, and the risk factors for postoperative morbidity were analyzed to verify the validity of the RC-NCD., Results: The coexistence of asthma (p = 0.02), nutrition lymphocyte ratio (p = 0.04), and pulmonary lobe (p < 0.01) were significant risk factors for postoperative morbidity in the present study, and the percent-predicted vital capacity (p < 0.01), pulmonary lobe (p = 0.03), and type of operative procedure (p = 0.01) were significant risk factors for severe postoperative morbidity. Furthermore, in patients received lobectomy, coexistence of asthma (p = 0.01) and pulmonary lobe (p < 0.01) were identified as significant risk factors for postoperative morbidity. Meanwhile, male sex (p = 0.01), high BMI (p < 0.01), low vital capacity (p = 0.04), and pulmonary lobe (p = 0.03) were identified as significant risk factors for severe postoperative morbidity., Conclusions: Given that the pulmonary lobe was a significant risk factor for postoperative morbidity in patients received pulmonary resection and for severe postoperative morbidity in patients received lobectomy, the RC-NCD for postoperative morbidity needs to be modified according to high-risk lobes., Trial Registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients., (© 2022. The Author(s).)
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- 2022
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24. Bronchial Thermoplasty in Patients With Severe Asthma at 5 Years: The Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma Study.
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Chupp G, Kline JN, Khatri SB, McEvoy C, Silvestri GA, Shifren A, Castro M, Bansal S, McClelland M, Dransfield M, Trevor J, Kahlstrom N, Simoff M, Wahidi MM, Lamb CR, Ferguson JS, Haas A, Hogarth DK, Tejedor R, Toth J, Hey J, Majid A, LaCamera P, Fitzgerald JM, Enfield K, Grubb GM, McMullen EA, Olson JL, and Laviolette M
- Subjects
- Adrenal Cortex Hormones therapeutic use, Humans, Prospective Studies, Quality of Life, Asthma drug therapy, Asthma surgery, Bronchial Thermoplasty methods
- Abstract
Background: Bronchial thermoplasty is a device-based treatment for subjects ≥ 18 years of age with severe asthma poorly controlled with inhaled corticosteroids and long-acting beta-agonists. The Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma (PAS2) study collected data on patients with severe asthma undergoing this procedure., Research Question: What are the 5-year efficacy and safety results in patients with severe asthma who have undergone bronchial thermoplasty?, Study Design and Methods: This was a prospective, open-label, observational, multicenter study conducted in the United States and Canada. Subjects 18 to 65 years of age who were taking inhaled corticosteroids ≥ 1,000 μg/d (beclomethasone or equivalent) and long-acting beta-agonists ≥ 80 μg/d (salmeterol or equivalent) were included. Severe exacerbations, hospitalization, ED visits, and medication usage were evaluated for the 12 months prior to and at years 1 through 5 posttreatment. Spirometry was evaluated at baseline and at years 1 through 5 posttreatment., Results: A total of 284 subjects were enrolled at 27 centers; 227 subjects (80%) completed 5 years of follow-up. By year 5 posttreatment, the proportion of subjects with severe exacerbations, ED visits, and hospitalizations was 42.7%, 7.9%, and 4.8%, respectively, compared with 77.8%, 29.4%, and 16.1% in the 12 months prior to treatment. The proportion of subjects on maintenance oral corticosteroids decreased from 19.4% at baseline to 9.7% at 5 years. Analyses of subgroups based on baseline clinical and biomarker characteristics revealed a statistically significant clinical improvement among all subgroups., Interpretation: Five years after treatment, subjects experienced decreases in severe exacerbations, hospitalizations, ED visits, and corticosteroid exposure. All subgroups demonstrated clinically significant improvement, suggesting that bronchial thermoplasty improves asthma control in different asthma phenotypes., Clinical Trial Registration: ClinicalTrials.gov; No.: NCT01350336; URL: www., Clinicaltrials: gov., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
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- 2022
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25. [BIOLOGICS AND BRONCHIAL THERMOPLASTY FOR THE TREATMENT OF SEVERE ASTHMA].
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Nagase H and Iikura M
- Subjects
- Humans, Bronchi surgery, Bronchial Thermoplasty, Biological Products, Asthma surgery
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- 2022
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26. A Cross-Sectional Evaluation of Outcomes of Pediatric Thyroglossal Duct Cyst Excision.
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Mattioni J, Azari S, Hoover T, Weaver D, and Chennupati SK
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- Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Male, Reoperation, Retrospective Studies, Surgical Wound Infection, Asthma surgery, Thyroglossal Cyst surgery
- Abstract
Introduction: Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cysts. They may become infected causing dysphagia or respiratory distress. Accordingly, the treatment is always surgical removal., Objectives: The objectives of this article were to examine complications following TGDC excision by surgical specialty, demographics, and comorbid conditions., Methods: A retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2014 to November 1, 2015 with a current procedure terminology code of 60,280 (excision of TGDC or sinus) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities., Results: Of the 867 cases that met inclusion criteria, the median age was 4 years. There were 448 males (52.3%) and 408 females (47.7%). Thirty-six patients (4.2%) experienced at least one 30-day complication. The most predominant complications were reoperation (19 patients, 2.2%), readmission (18 patients, 2.1%), and surgical site infection (16 patients, 1.9%). There was no statistically significant difference between complications and surgical specialty. In those experiencing a complication, there was a statistically significant difference between males (86.1%) and females (13.9%). Of patients with at least one comorbidity, 36.67% had a complication, while 17.22% did not have a complication. There was also a statistically significant difference in the percentage of patients with a past medical history of asthma between those with at least one complication (16.67%) compared to those without any complications (4.76%)., Conclusions: excision is a generally safe procedure across surgical specialties. There is a higher complication rate in males compared to females as well as those with a history of at least one medical comorbidity and those with asthma. The most common 30-day complications are reoperation, readmission, and surgical site infection., (© 2021 S. Karger AG, Basel.)
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- 2022
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27. Bronchoscopic Targeted Lung Denervation in Patients with Severe Asthma: Preliminary Findings.
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Hartman JE, Srikanthan K, Caneja C, Ten Hacken NHT, Kerstjens HAM, Shah PL, and Slebos DJ
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- Bronchoscopy methods, Denervation methods, Humans, Lung, Asthma surgery, Pulmonary Disease, Chronic Obstructive
- Abstract
Treatment options for severe asthma are limited, particularly in those patients who do not meet criteria for biologicals. Targeted lung denervation (TLD) is the bronchoscopic ablation of the peribronchial vagal nerve trunks to reduce cholinergic stimulation of airway smooth muscle and submucosal glands. This report describes the experience of the first 2 asthma patients treated with TLD worldwide. The participants were 54 and 51 years of age, and both had severe asthma (GINA 5) (FEV1: 53% and 113% of predicted; AQLQ scores: 5.3 and 4.4). Both participants were treated with TLD in a single day-case procedure under general anaesthesia. Lung function, health status, and adverse event data were collected at baseline and 12 months after TLD. No treatment-related serious adverse events were reported up to 12 months. Cough symptoms improved in both participants, and 1 participant reported a marked reduction in rescue medication use at 6 months. There were no significant changes in spirometry, lung volumes, or health status. In conclusion, TLD was performed safely in both participants, but more evidence is needed to clarify safety and efficacy of TLD in severe asthma. Therefore, further investigation of the treatment in severe asthma patients would be useful., (© 2021 The Author(s) Published by S. Karger AG, Basel.)
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- 2022
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28. Bronchial Thermoplasty Global Registry (BTGR): 2-year results.
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Torrego A, Herth FJ, Munoz-Fernandez AM, Puente L, Facciolongo N, Bicknell S, Novali M, Gasparini S, Bonifazi M, Dheda K, Andreo F, Votruba P, Langton D, Flandes J, Fielding D, Bonta PI, Skowasch D, Schulz C, Darwiche K, McMullen E, Grubb GM, and Niven R
- Subjects
- Adolescent, Adult, Humans, Prospective Studies, Quality of Life, Registries, Treatment Outcome, Asthma drug therapy, Asthma surgery, Bronchial Thermoplasty methods
- Abstract
Objectives: Bronchial thermoplasty (BT) is a device-based treatment for subjects ≥18 years with severe asthma not well controlled with inhaled corticosteroids and long-acting beta-agonists. The Bronchial Thermoplasty Global Registry (BTGR) collected real-world data on subjects undergoing this procedure., Design: The BTGR is an all-comer, prospective, open-label, multicentre study enrolling adult subjects indicated for and treated with BT., Setting: Eighteen centres in Spain, Italy, Germany, the UK, the Netherlands, the Czech Republic, South Africa and Australia PARTICIPANTS: One hundred fifty-seven subjects aged 18 years and older who were scheduled to undergo BT treatment for asthma. Subjects diagnosed with other medical conditions which, in the investigator's opinion, made them inappropriate for BT treatment were excluded., Primary and Secondary Outcome Measures: Baseline characteristics collected included demographics, Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test (ACT), medication usage, forced expiratory volume in one second and forced vital capacity, medical history, comorbidities and 12-month baseline recall data (severe exacerbations (SE) and healthcare utilisation). SE incidence and healthcare utilisation were summarised at 1 and 2 years post-BT., Results: Subjects' baseline characteristics were representative of persons with severe asthma. A comparison of the proportion of subjects experiencing events during the 12 months prior to BT to the 2-year follow-up showed a reduction in SE (90.3% vs 56.1%, p<0.0001), emergency room visits (53.8% vs 25.5%, p<0.0001) and hospitalisations (42.9% vs 23.5 %, p=0.0019). Reductions in asthma maintenance medication dosage were also observed. AQLQ and ACT scores improved from 3.26 and 11.18 at baseline to 4.39 and 15.54 at 2 years, respectively (p<0.0001 for both AQLQ and ACT)., Conclusions: The BTGR demonstrates sustained improvement in clinical outcomes and reduction in asthma medication usage 2 years after BT in a real-world population. This is consistent with results from other BT randomised controlled trials and registries and further supports improvement in asthma control after BT., Trial Registration Number: NCT02104856., Competing Interests: Competing interests: FH received personal fees for ad board activities and lecture fees from Pulmonx, BTG, Olympus, and Uptake. AMF reports the receipt of grants from Boston Scientific during the conduct of this study. LP reports personal fees and others from AstraZeneca, grants and other fees from GlaxoSmithKline, grants and personal fees from Esteve, personal fees and other fees from Boehringer, other fees from Teva, personal fees and other fees from Novartis, other fees from Chiesi, grants from Menarini, personal fees from MSD and Boston Scientific outside the submitted work. MN reports other fees from Boston Scientific. MB reports personal fees from Roche and Boehringer-Ingelheim outside the submitted work. DF reports other fees from Boston Scientific during the conduct of the study. PIB reports grants, non-financial support, and other fees from Boston Scientific during the conduct of the study. KD reports grants from Boston Scientific outside the submitted work. GMG is a full-time employee of Boston Scientific, the sponsor of this study. RN reports grants and personal fees from Boston Scientific outside the submitted work., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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29. Safety of delivering bronchial thermoplasty in two treatment sessions.
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Koshy K, Sha J, Bennetts K, and Langton D
- Subjects
- Asthma diagnosis, Asthma physiopathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Asthma surgery, Bronchial Thermoplasty methods, Bronchoscopy methods, Forced Expiratory Flow Rates physiology, Lung physiopathology
- 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., (© 2021. The Author(s).)
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- 2021
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30. Polarization Sensitive Optical Coherence Tomography for Bronchoscopic Airway Smooth Muscle Detection in Bronchial Thermoplasty-Treated Patients With Asthma.
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Vaselli M, Wijsman PC, Willemse J, Goorsenberg AWM, Feroldi F, d'Hooghe JNS, Annema JT, de Boer JF, and Bonta PI
- Subjects
- Biopsy, Humans, Imaging, Three-Dimensional, Asthma diagnostic imaging, Asthma surgery, Bronchial Thermoplasty, Bronchoscopy, Muscle, Smooth diagnostic imaging, Muscle, Smooth surgery, Tomography, Optical Coherence methods
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- 2021
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31. Bronchial thermoplasty in asthma: an exploratory histopathological evaluation in distinct asthma endotypes/phenotypes.
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Papakonstantinou E, Koletsa T, Zhou L, Fang L, Roth M, Karakioulaki M, Savic S, Grize L, Tamm M, and Stolz D
- Subjects
- Aged, Bronchi pathology, Bronchi physiology, Female, Humans, Male, Middle Aged, Phenotype, Prospective Studies, Airway Remodeling physiology, Asthma pathology, Asthma surgery, Bronchial Thermoplasty methods, Respiratory Mucosa pathology, Respiratory Mucosa physiology
- Abstract
Background: Bronchial thermoplasty regulates structural abnormalities involved in airway narrowing in asthma. In the present study we aimed to investigate the effect of bronchial thermoplasty on histopathological bronchial structures in distinct asthma endotypes/phenotypes., Methods: Endobronchial biopsies (n = 450) were collected from 30 patients with severe uncontrolled asthma before bronchial thermoplasty and after 3 sequential bronchial thermoplasties. Patients were classified based on blood eosinophils, atopy, allergy and smoke exposure. Tissue sections were assessed for histopathological parameters and expression of heat-shock proteins and glucocorticoid receptor. Proliferating cells were determined by Ki67-staining., Results: In all patients, bronchial thermoplasty improved asthma control (p < 0.001), reduced airway smooth muscle (p = 0.014) and increased proliferative (Ki67 +) epithelial cells (p = 0.014). After bronchial thermoplasty, airway smooth muscle decreased predominantly in patients with T2 high asthma endotype. Epithelial cell proliferation was increased after bronchial thermoplasty in patients with low blood eosinophils (p = 0.016), patients with no allergy (p = 0.028) and patients without smoke exposure (p = 0.034). In all patients, bronchial thermoplasty increased the expression of glucocorticoid receptor in epithelial cells (p = 0.018) and subepithelial mesenchymal cells (p = 0.033) and the translocation of glucocorticoid receptor in the nucleus (p = 0.036). Furthermore, bronchial thermoplasty increased the expression of heat shock protein-70 (p = 0.002) and heat shock protein-90 (p = 0.001) in epithelial cells and decreased the expression of heat shock protein-70 (p = 0.009) and heat shock protein-90 (p = 0.002) in subepithelial mesenchymal cells. The effect of bronchial thermoplasty on the expression of heat shock proteins -70 and -90 was distinctive across different asthma endotypes/phenotypes., Conclusions: Bronchial thermoplasty leads to a diminishment of airway smooth muscle, to epithelial cell regeneration, increased expression and activation of glucocorticoid receptor in the airways and increased expression of heat shock proteins in the epithelium. Histopathological effects appear to be distinct in different endotypes/phenotypes indicating that the beneficial effects of bronchial thermoplasty are achieved by diverse molecular targets associated with asthma endotypes/phenotypes.
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- 2021
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32. [Bronchial thermoplasty for severe asthma].
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Héluain V, Guilleminault L, Hermant C, Plat G, Didier A, and Guibert N
- Subjects
- Ambulatory Care, Humans, Muscle, Smooth, Phenotype, Asthma surgery, Bronchial Thermoplasty
- Abstract
Bronchial thermoplasty has been developed over the past fifteen years and is the first endoscopic technique approved in the management of severe asthma. This procedure uses radiofrequency applied to the airway wall to target bronchial smooth muscle. Patients treated in randomized controlled trials have experienced significant decreases in the use of rescue medications, urgent care visits, and exacerbations rate. The lack of reliable predictive markers of response to this expensive, minimally-invasive technique currently makes it a last-line treatment option. We review the principles and supposed mechanisms of action of this treatment, the results from the main trials and clinical registry data and discuss the place of bronchial thermoplasty in the current management of severe asthma. We also discuss perspectives to better characterize the mechanisms of action and identify the responder phenotype, the main challenge of current studies., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
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- 2021
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33. Case Report: A Novel Synonymous ARPC1B Gene Mutation Causes a Syndrome of Combined Immunodeficiency, Asthma, and Allergy With Significant Intrafamilial Clinical Heterogeneity.
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Papadatou I, Marinakis N, Botsa E, Tzanoudaki M, Kanariou M, Orfanou I, Kanaka-Gantenbein C, Traeger-Synodinos J, and Spoulou V
- Subjects
- Adolescent, Asthma diagnosis, Asthma immunology, Asthma surgery, Child, Female, Genetic Predisposition to Disease, Hematopoietic Stem Cell Transplantation, Heredity, Homozygote, Humans, Hypersensitivity diagnosis, Hypersensitivity immunology, Hypersensitivity surgery, Infant, Male, Pedigree, Phenotype, Primary Immunodeficiency Diseases diagnosis, Primary Immunodeficiency Diseases immunology, Primary Immunodeficiency Diseases surgery, RNA Splicing, Syndrome, Treatment Outcome, Actin-Related Protein 2-3 Complex genetics, Asthma genetics, Hypersensitivity genetics, Mutation, Primary Immunodeficiency Diseases genetics
- Abstract
Recently, a novel syndrome of combined immune deficiency, infections, allergy, and inflammation has been attributed to mutations in the gene encoding actin-related protein 2/3 complex subunit 1B (ARPC1B), which is a key molecule driving the dynamics of the cytoskeleton. Homozygous mutations in the ARPC1B gene have been found to result in the disruption of the protein structure and cause an autosomal recessive syndrome of combined immune deficiency, impaired T-cell migration and proliferation, increased levels of immunoglobulin E (IgE) and immunoglobulin A (IgA), and thrombocytopenia. To date, only a few individuals have been diagnosed with the ARPC1B deficiency syndrome worldwide. In this case series, we report the wide spectrum of phenotype in 3 siblings of a consanguineous family from Afghanistan with a novel homozygous synonymous pathogenic variant c.783G>A, p. (Ala261Ala) of the ARPC1B gene that causes a similar syndrome but no thrombocytopenia. Targeted RNA studies demonstrated that the variant affects the splicing process of mRNA, resulting in a marked reduction of the levels of primary (normal) RNA transcript of the ARPC1B gene in the affected patients and likely premature termination from the abnormally spliced mRNA. The next generation sequencing (NGS) studies facilitated the diagnosis of this rare combined immunodeficiency and led to the decision to treat the affected patients with hematopoietic cell transplant (HCT) from an human leukocyte antigen (HLA)-matched healthy sibling., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Papadatou, Marinakis, Botsa, Tzanoudaki, Kanariou, Orfanou, Kanaka-Gantenbein, Traeger-Synodinos and Spoulou.)
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- 2021
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34. Efficacy of bronchial thermoplasty in patients with severe asthma.
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Madsen H, Henriksen DP, Backer V, Siersted HC, Bjerring N, and Ulrik CS
- Subjects
- Adrenal Cortex Hormones therapeutic use, Adult, Anti-Bacterial Agents therapeutic use, Asthma drug therapy, Bronchial Thermoplasty adverse effects, Denmark, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Prospective Studies, Quality of Life, Respiratory Function Tests, Severity of Illness Index, Asthma surgery, Bronchial Thermoplasty methods
- Abstract
Objective: To investigate the efficacy and safety of bronchial thermoplasty (BT) in clinical practice in adults with severe, refractory asthma. Methods: Prospective, single-center, open, observational study comprising patients with uncontrolled asthma (asthma control questionnaire (ACQ) >1.5) and/or frequent exacerbations despite treatment with at least high dose inhaled corticosteroids plus a second controller. Efficacy outcomes was change from baseline 4, 8, 12 and 24 months in FEV
1 , FVC and FEV1 /FVC ratio, asthma control questionnaire (ACQ) score and asthma quality of life score (mini-AQLQ). Results are presented as median with interquartile ranges (IQR). The following were recorded as adverse events: Un-scheduled health care contacts, rescue courses of oral corticosteroid (OCS) and/or antibiotics for exacerbation for exacerbations/respiratory tract infections (RTI). Results: Six-teen patients were enrolled (nine males, median age 50 years; 14 followed for 24 months). Compared to baseline, an improvement in FEV1 , FVC, FEV1 /FVC ratio, mini-AQLQ and ACQ was observed, i.e.FEV1 (IQR) 1.98 L (1.65-2.45) vs. 2.45 L (2.09-2.93) ( p = 0.006), FVC (IQR) 3.23 L (2.76-4.05) vs. 3.75 L (3.22-4.36) ( p = 0.041), FEV1 /FVC 0.60 (IQR: 0.55-0.70) vs. 0.66 (IQR: 0.63-0.71) ( p = 0.016), mini-AQLQ 4.0 (IQR: 3.2-4.9) vs. 5.6 (IQR 4.5-6.5) ( p = 0.008, and ACQ 2.9 (IQR: 2.1-3.7) versus 1.5 (IQR 1.0-2.4) ( p = 0.004). On the other hand, an increase was observed in unscheduled visits ( p = 0.005), as well as use of OCS and antibiotics ( p = 0.009 and p = 0.003, respectively). Conclusion: BT in adults with severe asthma improved ACQ, mini-AQLQ and lung function, but resulted in an increased frequency of unscheduled doctor-visits and rescue courses of OCS and antibiotics.- Published
- 2021
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35. Bronchial Thermoplasty Induced Airway Smooth Muscle Reduction and Clinical Response in Severe Asthma. The TASMA Randomized Trial.
- Author
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Goorsenberg AWM, d'Hooghe JNS, Srikanthan K, Ten Hacken NHT, Weersink EJM, Roelofs JJTH, Kemp SV, Bel EH, Shah PL, Annema JT, and Bonta PI
- Subjects
- Adolescent, Adult, Aged, Airway Remodeling, Asthma diagnosis, Asthma pathology, Asthma physiopathology, Biopsy, Bronchi pathology, Bronchoscopy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Muscle, Smooth pathology, Severity of Illness Index, Treatment Outcome, Young Adult, Asthma surgery, Bronchi surgery, Bronchial Thermoplasty, Muscle, Smooth surgery
- Abstract
Rationale: Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass reduction after BT, but appropriate control groups are lacking. Furthermore, as treatment response is variable, identifying optimal candidates for BT treatment is important. Objectives: First, to assess the effect of BT on ASM mass, and second, to identify patient characteristics that correlate with BT response. Methods: Patients with severe asthma ( n = 40) were randomized to immediate ( n = 20) or delayed ( n = 20) BT treatment. Before randomization, clinical, functional, blood, and airway biopsy data were collected. In the delayed control group, reassessment, including biopsies, was performed after 6 months of standard clinical care, followed by BT. In both groups, post-BT data including biopsies were obtained after 6 months. ASM mass (% positive desmin or α-smooth muscle actin area in the total biopsy) was calculated with automated digital analysis software. Associations between baseline characteristics and Asthma Control Questionnaire and Asthma Quality of Life Questionnaire (AQLQ) improvement were explored. Measurements and Main Results: Median ASM mass decreased by >50% in the immediate BT group ( n = 17) versus no change in the delayed control group ( n = 19) ( P = 0.0004). In the immediate group, Asthma Control Questionnaire scores improved with -0.79 (interquartile range [IQR], -1.61 to 0.02) compared with 0.09 (IQR, -0.25 to 1.17) in the delayed group ( P = 0.006). AQLQ scores improved with 0.83 (IQR, -0.15 to 1.69) versus -0.02 (IQR, -0.77 to 0.75) ( P = 0.04). Treatment response in the total group ( n = 35) was positively associated with serum IgE and eosinophils but not with baseline ASM mass. Conclusions: ASM mass significantly decreases after BT when compared with a randomized non-BT-treated control group. Treatment response was associated with serum IgE and eosinophil levels but not with ASM mass.
- Published
- 2021
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36. A case report of aspergillosis accompanied by saccular bronchodilation after bronchial thermoplasty in a 19-year-old woman.
- Author
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Sasada S, Ohmura K, Oguri T, Fujimoto Y, Murata S, Tsuchiya Y, Ishioka K, Takahashi S, Nakamura M, and Kaji M
- Subjects
- Antifungal Agents therapeutic use, Aspergillosis, Allergic Bronchopulmonary diagnosis, Aspergillosis, Allergic Bronchopulmonary drug therapy, Aspergillus fumigatus isolation & purification, Bronchoscopy, Cough etiology, Female, Humans, Itraconazole therapeutic use, Tomography, X-Ray Computed, Young Adult, Aspergillosis, Allergic Bronchopulmonary etiology, Asthma surgery, Bronchial Thermoplasty adverse effects
- Abstract
Background: Fungal infections are rarely reported as a complication of bronchial thermoplasty (BT) in patients without immunosuppressive comorbidity., Case Presentation: A 19-year-old woman college student was admitted to our hospital owing to uncontrolled severe asthma despite using the maximum dose of steroid inhalation. She experienced asthmatic attacks more frequently while cheerleading, which is an extracurricular activity. She received BT because she wanted to continue cheerleading. After the second BT session, she developed more sputum and cough. During the third session, white secretion and saccular bronchodilation appeared in the left lower bronchus. Aspergillus fumigatus was detected in the culture of the bronchial lavage sample, and saccular bronchodilation in the affected bronchus was observed on computed tomography (CT). Five months after the start of oral itraconazole, her subjective symptoms as well as her CT findings improved. Her asthma condition improved enough for the patient to continue cheerleading without exacerbation., Conclusions: It is necessary to consider the possibility of respiratory tract infections including fungal infections after BT. Detailed observations of the entire bronchus and sample collection for microbial culture are highly recommended.
- Published
- 2020
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37. Bronchial thermoplasty: Redefining its role.
- Author
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Langton D and Lee P
- Subjects
- Asthma physiopathology, Bronchi, Bronchoscopy, Humans, Asthma surgery, Bronchial Thermoplasty adverse effects, Muscle, Smooth surgery
- Abstract
In this review, we trace (i) the origins of bronchial thermoplasty, (ii) the development of a solid evidence base for efficacy and safety, (iii) the emerging understanding of the pathophysiological mechanisms of action and (iv) the place in therapy today. Future challenges are then discussed., (© 2020 Asian Pacific Society of Respirology.)
- Published
- 2020
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38. Single-Session Bronchial Thermoplasty Guided by 129 Xe Magnetic Resonance Imaging. A Pilot Randomized Controlled Clinical Trial.
- Author
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Hall CS, Quirk JD, Goss CW, Lew D, Kozlowski J, Thomen RP, Woods JC, Tustison NJ, Mugler JP 3rd, Gallagher L, Koch T, Schechtman KB, Ruset IC, Hersman FW, and Castro M
- Subjects
- Adult, Bronchial Thermoplasty adverse effects, Double-Blind Method, Female, Humans, Male, Middle Aged, Pilot Projects, Quality of Life, Severity of Illness Index, Treatment Outcome, Asthma surgery, Bronchial Thermoplasty methods, Magnetic Resonance Imaging methods, Surgery, Computer-Assisted, Xenon Isotopes therapeutic use
- Abstract
Rationale: Adverse events have limited the use of bronchial thermoplasty (BT) in severe asthma. Objectives: We sought to evaluate the effectiveness and safety of using
129 Xe magnetic resonance imaging (129 Xe MRI) to prioritize the most involved airways for guided BT. Methods: Thirty subjects with severe asthma were imaged with volumetric computed tomography and129 Xe MRI to quantitate segmental ventilation defects. Subjects were randomized to treatment of the six most involved airways in the first session (guided group) or a standard three-session BT (unguided). The primary outcome was the change in Asthma Quality of Life Questionnaire score from baseline to 12 weeks after the first BT for the guided group compared with after three treatments for the unguided group. Measurements and Main Results: There was no significant difference in quality of life after one guided compared with three unguided BTs (change in Asthma Quality of Life Questionnaire guided = 0.91 [95% confidence interval, 0.28-1.53]; unguided = 1.49 [95% confidence interval, 0.84-2.14]; P = 0.201). After one BT, the guided group had a greater reduction in the percentage of poorly and nonventilated lung from baseline when compared with unguided (-17.2%; P = 0.009). Thirty-three percent experienced asthma exacerbations after one guided BT compared with 73% after three unguided BTs ( P = 0.028). Conclusions: Results of this pilot study suggest that similar short-term improvements can be achieved with one BT treatment guided by129 Xe MRI when compared with standard three-treatment-session BT with fewer periprocedure adverse events.- Published
- 2020
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39. Puzzling onsets of pneumonia sequentially after each session of bronchial thermoplasty: a case report.
- Author
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Nong Y and Lin JT
- Subjects
- Adult, Bronchoscopy, Cough etiology, Female, Humans, Pneumonia diagnosis, Recurrence, Asthma surgery, Bronchial Thermoplasty adverse effects, Pneumonia etiology
- Abstract
Background: Bronchial thermoplasty (BT) is a novel bronchoscopic intervention for severe persistent asthma. An increase in transient respiratory adverse events associated with BT were noted over the treatment periods, however, these events appear sporadic and should not always recur in a single individual and BT-related pneumonia has rarely been reported., Case Presentation: We present a case of uncontrolled severe asthma who developed puzzling pneumonia sequentially after each session of BT procedures. After each operation of three sequential BT procedures, she developed cough and purulent expectoration when her chest radiology showed new infiltrates right in the treatment regions. After empirical use of antibacterial agents plus physiotherapy and postural sputum drainage, her symptoms vanished and chest imaging resumed normal., Conclusion: The originality of our case report is related to the recurrence of pneumonia after three sequential BT procedures. To date, similar report has not been available in the literature. We hope to prompt alerts for post-BT respiratory infections, although most of them, along with other adverse events, are mild and tractable.
- Published
- 2020
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40. [Effect of endoscopic vidian neurectomy in patients with coexisting allergic rhinitis and bronchial asthma].
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Ai JG, Qing X, Gao R, Liu HH, Xie ZZ, Li W, Wang TS, and Tan GL
- Subjects
- Adult, Climate Change, Endoscopy, Female, Humans, Male, Quality of Life, Retrospective Studies, Treatment Outcome, Asthma complications, Asthma drug therapy, Asthma surgery, Denervation methods, Rhinitis, Allergic complications, Rhinitis, Allergic drug therapy, Rhinitis, Allergic surgery
- Abstract
Objective: To evaluate the clinical significance of endoscopic vidian neurectomy (EVN) on outcomes in patients with coexisting refractory allergic rhinitis (AR) and bronchial asthma, and to analyze its influence factor. Methods: Clinical data of 109 patients with moderate to severe persistent intractable AR and bronchial asthma who were allocated to the bilateral EVN group (surgery group, 70 cases) or conservative medication group (drug group, 39 cases) from 1 May 2008 to 30 April 2013 in Department of Otorhinolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University were retrospectively analyzed, including 47 cases of male and 62 cases of female aged (32.7±6.8) years.Ninety-five patients were followed up for at least 3 years. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Visual Analog Scale (VAS), Asthma Quality of Life Questionnaire (AQLQ), Total Asthma Symptom Score (TASS), forced expiratory volume in 1 second of predicted (FEV1) and medication scores were evaluated at 6 months, 1 year and 3 years after undergoing the initial treatments in the two groups. Multiple factor analysis was used to determine the factors influencing the improvement after EVN. Results: Postoperative scores of RQLQ were significantly lower than preoperative scores during follow-up in surgery group (the preoperative score and postoperative score at 6 months, 1 year, 3 years after operation was 2.39±0.61 ( x ± s ), 0.81±0.43, 0.89±0.32, 1.06±0.24, respectively, all P< 0.001). Postoperative scores of VAS were significantly lower than preoperative scores during follow-up in surgery group (the preoperative score and postoperative score at 6 months, 1 year,3 years after operation was 7.13±1.04, 2.52±1.47, 2.70±1.42, 2.85±1.64, respectively, all P< 0.05). Scores of RQLQ and VAS in surgery group were significantly lower than those of drug group. Postoperative scores of AQLQ were significantly higher than preoperative scores during follow-up in surgery group (the preoperative score and postoperative score at 6 months, 1 year, 3 years after operation was 3.78±0.81, 4.99±0.45, 4.75±0.71, 4.62±0.64, respectively, all P< 0.05), and were significantly higher than those of drug group. The TASS and FEV1 were not significantly changed in surgery group. The postoperative medication scores for AR were gradually reduced after surgery (the preoperative score and postoperative score at 6 months, 1 year, 3 years after operation was 0.99±0.21, 0.37±0.12, 0.39±0.26, 0.45±0.11, respectively, all P< 0.05), and the postoperative medication scores for Asthma were gradually reduced after surgery too (the preoperative score and postoperative score at 6 months, 1 year, 3 years after operation was 1.27±0.31, 0.82±0.29, 0.85±0.23, 0.96±0.19, respectively, all P< 0.05), and all the postoperative medication scores were significantly lower than those of drug group. At the end of the follow-up, the improvement rates for AR and asthma were 90.6% (58/64) and 45.3% (29/64), respectively. Asthma outcomes were significantly improved by controlling rhinitis symptoms in patients whose asthma attacks were induced by "rhinitis onset" or "climate change" . Conclusion: For patients with AR and bronchial asthma, EVN can significantly control AR symptoms, and improve asthma outcomes in patients whose asthma attacks are induced by rhinitis onset and/or climate change.
- Published
- 2020
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41. Effect of endoscopic sinus surgery for chronic rhinosinusitis on the state of coexisting asthma.
- Author
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Tajiri T, Fujita S, Sokai A, Gotoh K, Nakamura Y, Kita H, and Niimi A
- Subjects
- Adult, Aged, Asthma epidemiology, Chronic Disease, Comorbidity, Female, Humans, Male, Middle Aged, Prevalence, Rhinitis epidemiology, Sinusitis epidemiology, Asthma surgery, Endoscopy, Nasal Surgical Procedures, Rhinitis surgery, Sinusitis surgery
- Published
- 2020
- Full Text
- View/download PDF
42. Complications and discomfort after research bronchoscopy in the MicroCOPD study.
- Author
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Leiten EO, Eagan TML, Martinsen EMH, Nordeide E, Husebø GR, Knudsen KS, Lehmann S, Svanes Ø, Bakke PS, and Nielsen R
- Subjects
- Aged, Alfentanil adverse effects, Analgesics, Opioid adverse effects, Asthma diagnosis, Asthma microbiology, Biopsy adverse effects, Bronchoalveolar Lavage Fluid microbiology, Case-Control Studies, Conscious Sedation adverse effects, Dyspnea etiology, Female, Fever etiology, Follow-Up Studies, Humans, Male, Microbiota, Middle Aged, Prospective Studies, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive microbiology, Risk Factors, Treatment Outcome, Asthma surgery, Bronchoscopy adverse effects, Postoperative Complications etiology, Pulmonary Disease, Chronic Obstructive surgery
- Abstract
Background: Data on discomfort and complications from research bronchoscopy in chronic obstructive pulmonary disease (COPD) and asthma is limited. We present complications and discomfort occurring within a week after bronchoscopy, and investigate personal and procedural risk factors., Methods: 239 subjects with COPD, asthma or without lung disease underwent research bronchoscopies as part of a microbiome study of the lower airways (the MicroCOPD study). Bronchoscopy was done in the supine position with oral scope insertion with the option of light conscious alfentanil sedation. Sampling consisted of protected specimen brushes, bronchoalveolar lavage, small volume lavage and for some, endobronchial biopsies. Bleeding, desaturation, cough, haemodynamic changes, dyspnoea and other events that required an unplanned intervention or early termination of bronchoscopy were prospectively recorded. Follow-up consisted of a telephone interview where subjects rated discomfort and answered questions about fever sensation and respiratory symptoms in the week following bronchoscopy., Results: An unplanned intervention or early termination of bronchoscopy was required in 25.9% of bronchoscopies. Three subjects (1.3%) experienced potentially severe complications, of which all recovered without sequelae. COPD subjects experienced more dyspnoea than controls. Sedation and lower age was associated with less unplanned intervention or premature termination. About half of the subjects (47.7%) reported fever. Discomfort was associated with postprocedural fever, dread of bronchoscopy, higher score on the COPD Assessment Test and never-smoking. In subjects undergoing more than one bronchoscopy, the first bronchoscopy was often predictive for complications and postprocedural fever in the repeated bronchoscopy., Conclusion: Research bronchoscopies were not associated with more complications or discomfort in COPD subjects. 47.7% experienced postbronchoscopy fever sensation, which was associated with discomfort., Competing Interests: Competing interests: EOL, EMHM, EN, KSK, ØS and PSB declare no competing interests. TMLE has for the last three years received lecture fees from Boehringer Ingelheim, Roche and Astra Zeneca. GRH has for the last three years received lecture fees from Novartis and Boehringer Ingelheim. RN reports grants from GlaxoSmithKline, during the conduct of the study; grants from Boehringer Ingelheim, grants and personal fees from AstraZeneca, grants from Novartis, personal fees from GlaxoSmithKline, outside the submitted work. SL has for the last three years received lecture fees from Philips, Novartis and Astra Zeneca, and advisory board fees (paid to employer) from Novartis and Astra Zeneca, all outside the submitted work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
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43. State of the Art: Interventional Pulmonology.
- Author
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Wahidi MM, Herth FJF, Chen A, Cheng G, and Yarmus L
- Subjects
- Antineoplastic Agents administration & dosage, Argon Plasma Coagulation, Asthma surgery, Biopsy, Bronchial Thermoplasty, Certification, Cryosurgery, Debridement, Electrocoagulation, Emphysema surgery, Humans, Injections, Intralesional, Laser Therapy, Lung Neoplasms therapy, Pneumonectomy, Stents, Ablation Techniques, Bronchoscopy, Endosonography, Pulmonary Medicine, Thoracoscopy, Tracheostomy
- Abstract
Interventional pulmonology (IP) has evolved over the past decade from an obscure subspecialty in pulmonary medicine to a recognized discipline offering advanced consultative and procedural services to patients with thoracic malignancy, anatomic airway disease, and pleural disease. Innovative interventions are now also available for diseases not traditionally treated procedurally, such as asthma and emphysema. The IP field has established certification examinations and training standards for IP training programs in an effort to enhance training quality and ensure competency. Validating new technology and proving its cost-effectiveness and effect on patient outcomes present the biggest challenge to IP as the health-care environment marches toward value-based health care. High-quality research is now thriving in IP and promises to elevate its practice into patient-centric evidence-based care., (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
44. Safety and Effectiveness of Bronchial Thermoplasty When FEV 1 Is Less Than 50.
- Author
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Langton D, Ing A, Fielding D, Hersch N, Sha J, Plummer V, and Thien F
- Subjects
- Administration, Inhalation, Administration, Oral, Adrenal Cortex Hormones therapeutic use, Aged, Anti-Asthmatic Agents therapeutic use, Asthma physiopathology, Australia, Bronchodilator Agents therapeutic use, Bronchoscopy, Case-Control Studies, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Registries, Severity of Illness Index, Treatment Outcome, Vital Capacity, Asthma surgery, Bronchial Thermoplasty, Length of Stay statistics & numerical data, Patient Readmission statistics & numerical data
- Abstract
Background: Randomized clinical trials of bronchial thermoplasty (BT) were conducted in patients with a baseline FEV
1 greater than 50%. There is a paucity of data regarding BT in patients with more severe obstruction, and consequently these patients are often excluded from receiving BT. The purpose of this study was to compare safety and efficacy outcomes in a large cohort of patients with an FEV1 less than 50% with those of a cohort of less obstructed patients., Methods: Consecutive patients with severe asthma were drawn from the Australian BT Registry. Patients were grouped into (1) those with a baseline prebronchodilator FEV1 % predicted < 50% (n = 32) or (2) those with an FEV1 ≥ 50% (n = 36). Adverse outcomes were defined as (1) remaining in hospital longer than the planned 24-hour admission posttreatment or (2) being readmitted to hospital for any cause within 30 days of a treatment. Efficacy outcomes were evaluated 6 months after BT., Results: More severely obstructed patients were no more likely to have experienced any adverse event. Significant improvements in Asthma Control Questionnaire score, exacerbation frequency, reliever medication use, and requirement for daily oral steroids were observed in both groups, and were of a similar degree., Conclusions: This study demonstrates that BT can confidently be offered to patients with asthma with an FEV1 that is 30% to 50% of predicted without risk of more frequent or more severe adverse events, and with the expectation of the same degree of response as patients with better lung function., (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
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- View/download PDF
45. Increased Serum Periostin Levels and Eosinophils in Nasal Polyps Are Associated with the Preventive Effect of Endoscopic Sinus Surgery for Asthma Exacerbations in Chronic Rhinosinusitis Patients.
- Author
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Kanemitsu Y, Kurokawa R, Ono J, Fukumitsu K, Takeda N, Fukuda S, Uemura T, Tajiri T, Ohkubo H, Maeno K, Ito Y, Oguri T, Takemura M, Yap J, Nishiyama H, Masaki A, Ozawa Y, Izuhara K, Suzuki M, and Niimi A
- Subjects
- Adult, Asthma epidemiology, Asthma surgery, Chronic Disease, Comorbidity, Disease Progression, Female, Humans, Japan epidemiology, Leukocyte Count, Male, Middle Aged, Nasal Polyps epidemiology, Nasal Polyps surgery, Prospective Studies, Rhinitis epidemiology, Rhinitis surgery, Sinusitis epidemiology, Sinusitis surgery, Up-Regulation, Young Adult, Asthma diagnosis, Biomarkers blood, Cell Adhesion Molecules blood, Endoscopy, Eosinophils pathology, Nasal Polyps diagnosis, Rhinitis diagnosis, Sinusitis diagnosis
- Abstract
Background: Eosinophilic nasal polyps (NPs) are associated with the presence of asthma in chronic rhinosinusitis (CRS) patients. Serum periostin has been considered a relevant biomarker for unified airway diseases., Objective: To determine the utility of biomarkers including serum periostin that reflects reduction of exacerbations of comorbid asthma in CRS patients., Methods: We prospectively recruited 56 CRS patients who were subjected to undergo endoscopic sinus surgery (ESS) (20 with asthma) between October 2015 and December 2017 and followed them for 1 year after ESS. Blood eosinophil count, serum periostin, and fractional nitric oxide (FeNO) were measured at enrollment. How these type 2-driven biomarkers reflect comorbid asthma was determined using receiver operating characteristic (ROC) analysis. The frequency of asthma exacerbations during 1 year was counted both before and after ESS. Associations between preoperative biomarkers including eosinophils in NPs and asthma exacerbations were evaluated., Results: Blood eosinophil count, FeNO, and serum periostin levels were significantly higher in CRS patients with asthma than in those without (p < 0.01 for all) and discriminated comorbid asthma among CRS patients (p < 0.05; AUC > 0.80 for all). The increased preoperative serum periostin correlated with lower absolute number of postoperative exacerbations (ρ = -0.49, p = 0.03) and its relative reduction after ESS (ρ = 0.53, p = 0.03) in asthmatic patients. Increased eosinophils in NPs were also associated with reduced asthma exacerbations., Conclusion: Preoperative increased serum periostin and eosinophils in NPs are associated with the preventive effect of ESS for asthma exacerbations in CRS patients comorbid with asthma., (© 2020 S. Karger AG, Basel.)
- Published
- 2020
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46. The therapeutic effects of bronchial thermoplasty evaluated by cardiopulmonary exercise testing : a case series.
- Author
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Nakatsubo S, Miki K, Miki M, Kagawa H, Iwai A, Hara R, Ohara Y, Oshitani Y, Tsujino K, Yoshimura K, and Kida H
- Subjects
- Asthma physiopathology, Female, Humans, Male, Middle Aged, Asthma surgery, Bronchial Thermoplasty, Exercise Test
- Abstract
Bronchial thermoplasty (BT) had been reported to improve the symptoms of severe asthma. However, the exertional responses of BT based on the mechanisms have not been elucidated. A 57-year-old man and a 60-year-old woman underwent BT due to intractable severe asthma. We evaluated the therapeutic effects of BT using cardiopulmonary exercise testing (CPET). After BT, the exercise time during CPET substantially prolonged reducing exertional dyspnea in the former (good), but not in the latter (poor). In the good responder, the high air remaining in the lung after expiration (i.e., inspiratory tidal volume minus expiratory tidal volume) during CPET decreased after BT. In contrast, in the poor responder, the high air remaining after expiration during exercise was not obtained before BT. Further investigations are necessary to confirm that the presence or absence of the exertional wasted ventilation on CPET may be informative to evaluate the therapeutic effects of BT. J. Med. Invest. 67 : 386-390, August, 2020.
- Published
- 2020
- Full Text
- View/download PDF
47. [Interventionen beim Asthma COPD].
- Author
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Mandovra NP, Leuppi JD, Herth FJF, and Chhajed PN
- Subjects
- Bronchi surgery, Humans, Muscle, Smooth, Asthma surgery, Bronchoscopy methods, Pulmonary Disease, Chronic Obstructive surgery
- Abstract
Advanced emphysema and asthma constitute major health burden worldwide and are associated with significant morbidity and mortality. Pharmacological options are limited. Researches are being carried out aiming to modify the natural course of both the diseases. Lung volume reduction surgeries are performed in advanced emphysema but are associated with significant morbidity and prolonged hospital stay. Various minimally invasive bronchoscopic methods have been developed with the goal of achieving clinical benefits of volume reduction surgery but lower complications. Bronchial thermoplasty is a bronchoscopic method of delivering controlled heat in the airways to reduce airway smooth muscle mass, thereby reducing bronchoconstriction in patients with severe asthma who remain uncontrolled despite optimal medical therapy. Various randomised controlled trials have been performed to evaluate the safety and efficacy of various endoscopic treatments like valves, coils, use of sclerosants and targeted lung denervation for severe emphysema and bronchial thermoplasty in severe asthma. The current review summaries the clinical trial evidence available for lung volume reduction in emphysema and thermoplasty in asthma and provide guidance for optimal patient selection for various therapies available.
- Published
- 2019
- Full Text
- View/download PDF
48. Bronchial Thermoplasty Including the Middle Lobe Bronchus Significantly Improves Lung Function and Quality of Life in Patients Suffering from Severe Asthma.
- Author
-
Eisenmann S, Schütte W, Funke F, Oezkan F, Islam S, and Darwiche K
- Subjects
- Adrenal Cortex Hormones administration & dosage, Adult, Asthma diagnosis, Asthma drug therapy, Asthma physiopathology, Bronchi drug effects, Bronchi physiopathology, Bronchoscopy, Female, Forced Expiratory Volume, Germany, Humans, Male, Middle Aged, Recovery of Function, Retrospective Studies, Severity of Illness Index, Time Factors, Treatment Outcome, Asthma surgery, Bronchi surgery, Bronchial Thermoplasty adverse effects, Bronchoconstriction drug effects, Quality of Life
- Abstract
Purpose: Bronchial Thermoplasty (BT) is indicated in patients suffering from severe and symptomatic bronchial asthma despite maximal medical therapy. However, treatment of the right middle lobe (RML) bronchus is currently not recommended. The aim of this study was to investigate the safety and efficacy of BT if the RML bronchus is included., Methods: BT was performed in 17 consecutive patients, quality of life and pulmonary function were characterized before and 90 days after BT completion. Furthermore, we performed a clean-up bronchoscopy following every BT. This study was approved by the IRB of the University of Essen (No. 17-7356 BO) and registered as a retrospective observational study at the German Clinical Trials Registry (No. DRKS 00011550)., Results: The median baseline values of FEV1 and Asthma Questionnaire of Life Quality (AQLQ) were 1.33 l (0.91; 1.73) and 3.01 (2.76; 3.61), respectively, and significantly improved 90 days after treatment with FEV 1 at 1.75 l (p-value 0.002) and AQLQ 3.8 (p-value < 0.05). Also the amount of oral corticosteroid necessity decreased significantly. No severe adverse events occurred due to the procedure. Clean-up bronchoscopies-when performed-revealed significant fibrinous exudation after every BT procedure., Conclusion: BT including the RML bronchus is feasible. Functionally limited patients with severe asthma could potentially profit. Due to the relevant fibrinous exudation, BT should be followed by clean-up bronchoscopy, not only after RML treatment.
- Published
- 2019
- Full Text
- View/download PDF
49. [Clinical control status and quality of life in patients with chronic rhinosinusitis and asthma after endoscopic surgery].
- Author
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Guo JX and Yan AH
- Subjects
- Chronic Disease, Humans, Prospective Studies, Asthma surgery, Endoscopy, Quality of Life, Rhinitis surgery, Sinusitis surgery
- Abstract
Objective: The aim of this study is to investigate the clinical control status and quality of life of patients with chronic sinusitis and asthma after endoscopic surgery. Method: A prospective study of 36 patients with chronic rhinosinusitis and asthma who had endoscopic surgery. All patients underwent standardized drug therapy before operation. After evaluation by the respiratory and anesthesiologists, they were admitted to the hospital for endoscopic surgery. The patients were closely monitored during the operation, and the patients were observed and recorded. Self-control was performed to compare the observational indexes of the patients for half a year and one year after surgery. Result: ①The Asthma Control Scale (ACT) score showed that the proportion of complete control of asthma increased from 8.33% before surgery to 30.56% in the first half of the year and 27.78% in 1 year, which was significantly improved ( P <0.05). ②Asthma Quality of Life Questionnaire(AQLQ) showedthatthe indicators of postoperative quality except the response to the stimulus, limited activity, asthma symptoms, psychological status and concern for their own health are all have statistically significant ( P <0.05). ③In the first half of the year, there were 47.22%, in 1 year, 41.67% of the patients had improved asthma medication. There was no difference between the two groups ( P >0.05). ④The exhaled nitric oxide index was decreased in the first half of the year and in the first year after operation. ⑤There was no significant change in lung function indexes before and after operation ( P >0.05). Conclusion: In patients with chronic sinusitis and asthma, under the comprehensive treatment of endoscopic surgery, improving the quality of life of patients can also improve the control of asthma symptoms and medication, control the development of asthma, and have a positive effect on clinical efficacy., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)
- Published
- 2019
- Full Text
- View/download PDF
50. Bronchial Thermoplasty for Severe Asthma with Mucus Hypersecretion.
- Author
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Nagano N, Iikura M, Ito A, Miyawaki E, Hashimoto M, and Sugiyama H
- Subjects
- Asthma pathology, Asthma physiopathology, Biopsy, Bronchi pathology, Bronchoscopy methods, Forced Expiratory Volume physiology, Humans, Male, Middle Aged, Mucus metabolism, Quality of Life, Vital Capacity physiology, Asthma surgery, Bronchial Thermoplasty methods
- Abstract
Bronchial thermoplasty (BT), which delivers thermal radiofrequency to the bronchial wall, is an effective therapy for patients with severe persistent uncontrolled asthma. We herein report the case of a 47-year-old man who underwent BT for uncontrolled severe asthma. After BT, his asthma control, asthma-related quality of life, and pulmonary function improved. Furthermore, a histologic examination of transbronchial biopsy specimens revealed a decrease in goblet cell hyperplasia and the smooth muscle mass as well as in the subepithelial basement membrane thickness. BT can be effective for patients with severe uncontrolled asthma and mucus hypersecretion.
- Published
- 2019
- Full Text
- View/download PDF
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