Bronchial Thermoplasty for Severe Asthma Management

Bronchial thermoplasty is an innovative bronchoscopic procedure designed for patients with severe asthma who remain uncontrolled despite maximal pharmacological therapy. The treatment delivers controlled radiofrequency energy to the airway wall, selectively reducing airway smooth muscle mass and thereby diminishing the ability of the bronchi to constrict excessively. Clinical trials and observational studies have demonstrated improvements in symptom control, reductions in exacerbation frequency and oral corticosteroid requirements, and maintenance of stable lung function over multi-year follow-up. Beyond its impact on smooth muscle, bronchial thermoplasty appears to modulate extracellular matrix composition, alter epithelial cell behaviour and attenuate airway nerve fibres, suggesting a multifaceted remodelling of airway structure and function. The procedure is generally well tolerated, with transient peri-procedural respiratory events that resolve without long-term sequelae. As an adjunct to medical therapy, bronchial thermoplasty offers a non-pharmacological strategy with global significance, particularly for patients in whom biologic treatments are unavailable or ineffective.

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Bronchial Thermoplasty for Severe Asthma Management publication trend

The graph below shows the total number of articles in bronchial thermoplasty for severe asthma management across all publications each year (not limited to Nature Index journals).

Technical terms

Bronchial thermoplasty (BT): An endoscopic intervention delivering controlled thermal energy to reduce airway smooth muscle and modify airway structure.

Airway smooth muscle (ASM): Muscle tissue within bronchial walls responsible for bronchoconstriction and airway calibre regulation.

Airway remodelling: Structural changes in the bronchial wall driven by chronic inflammation, including smooth muscle hypertrophy and extracellular matrix deposition.

Extracellular matrix (ECM): A network of proteins and glycoproteins that provides structural support and influences cell behaviour within tissues.

Alarmins (e.g., S100A proteins): Endogenous molecules released by stressed or damaged cells that activate immune responses and inflammation.

Transcriptome: The complete set of RNA transcripts produced by cells, reflecting gene expression patterns under specific conditions.

References

1. Airway wall extracellular matrix changes induced by bronchial thermoplasty in severe asthma. Journal of Allergy and Clinical Immunology (2023).
2. S100A alarmins and thymic stromal lymphopoietin (TSLP) regulation in severe asthma following bronchial thermoplasty. Respiratory Research (2023).
3. Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial. BMC Pulmonary Medicine (2011).
4. Nerve ablation after bronchial thermoplasty and sustained improvement in severe asthma. BMC Pulmonary Medicine (2018).
5. Metabolic differences between bronchial epithelium from healthy individuals and patients with asthma and the effect of bronchial thermoplasty. Journal of Allergy and Clinical Immunology (2021).