Plain language summary
Bronchial thermoplasty for people with asthma
We reviewed the effects of bronchial thermoplasty in people with asthma.
Asthma is a chronic condition in which people experience symptoms of breathlessness, wheezing, coughing and chest tightness due to airway inflammation and airway muscle contraction. With inhaled treatments, including bronchodilators (drugs that relax airway muscle and so open up the airways) and steroids (which treat underlying inflammation in the lungs), symptoms usually can be controlled. However, for some people, asthma cannot be adequately controlled with these drugs, either because they are truly resistant or because they do not take them.
The muscle in the airways of the lungs is thicker in people with asthma than in people who do not have asthma. During asthma attacks, these muscles tighten, making it hard to breathe.
Bronchial thermoplasty is a relatively new procedure that reduces the amount of muscle bulk in the airways of the lungs. A long flexible tube, called a bronchoscope, is passed down into the lung under direct observation, and the walls of specific areas of the lungs are heated to 65 degrees Celsius. This causes some of the muscle to break up, making it harder for the muscles to tighten.
Generally, three sessions of treatment are given.
We found three trials comparing groups of adults treated with bronchial thermoplasty versus adults who received standard medical treatment or a "sham" (simulated) bronchial thermoplasty treatment.
These studies showed moderate improvement only in quality of life of patients treated with bronchial thermoplasty and in the number of asthma attacks (exacerbations) that they experienced. In addition, patients treated with this procedure had more respiratory problems than patients who received the alternative intervention during the period when they were undergoing treatment, resulting in increased risk of hospitalisation due to a respiratory symptom during this phase, but not afterward.
Quality of evidence
Confidence in the results of this review is moderate because two of the studies had no sham intervention and there were differences regarding the characteristics of patients and the comparisons performed. More studies should be conducted to determine whether the observed effect and safety of bronchial thermoplasty are durable over the long term, and to identify whether particular patients can be identified who could benefit most.
This plain language summary is current as of January 2014.
氣喘是一種慢性疾病，患者會因為氣管發炎和氣管肌肉收縮，而出現呼吸困難、喘鳴、咳嗽和胸悶等症狀。使用吸入劑治療，包括支氣管擴張劑 (可使氣管肌肉放鬆，進而打開呼吸道的藥物) 和類固醇，症狀通常可以獲得控制。不過部分患者無法利用這些藥物適當控制氣喘，無論是對藥物確實產生抗性或沒有使用藥物。
這些試驗顯示，接受支氣管熱整型術治療的患者，只有生活品質和氣喘發作 (惡化) 次數出現中度改善。此外在治療期間，接受此項程序的患者，比接受其他介入的患者發生更多呼吸道的問題，所以在這個階段患者因呼吸症狀而住院的風險增高，不過治療結束後就不再有此種現象。