Bronchial Thermoplasty for Severe Asthma (AIR2 / LIBERATE)

Bronchial thermoplasty (BT) delivers radiofrequency energy to reduce airway smooth muscle mass in severe asthma. AIR2 was the pivotal sham-controlled RCT.

Multicenter sham-controlled RCT (n=288) comparing BT vs. sham bronchoscopy in severe persistent asthma not controlled on ICS/LABA.

BT improved Asthma Quality of Life Questionnaire score (primary endpoint) vs sham (1.35 vs 1.16, p=0.046). BT reduced severe exacerbations (32% reduction), ED visits (84% reduction), and days missed from work/school at 1 year. 5-year follow-up showed sustained benefit.

Bronchial thermoplasty is FDA-approved for severe persistent asthma not controlled on ICS/LABA. It is an option for carefully selected patients (no COPD, FEV1 ≥60%, no recent exacerbations). Three bronchoscopy sessions required. Long-term safety data is reassuring.

Sham-controlled but not truly blinded. Modest effect size. Patient selection is critical.