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Interventional
Bronchial Thermoplasty
Added by Dr. Andrew · Last updated 2024-01-15
Overview
Bronchial thermoplasty (BT) is a bronchoscopic procedure that delivers controlled radiofrequency energy to the airway wall to reduce airway smooth muscle mass, decreasing bronchoconstriction in severe asthma. It is performed in three sessions over 3 weeks.
Key Points
- 1Mechanism: radiofrequency ablation reduces airway smooth muscle mass → less bronchoconstriction
- 2Indication: severe persistent asthma (Step 4–5) not controlled on high-dose ICS + LABA ± biologics
- 3Procedure: 3 sessions (right lower lobe, left lower lobe, both upper lobes) 3 weeks apart
- 4AIR2 trial: improved Asthma Quality of Life Questionnaire (AQLQ) scores, reduced severe exacerbations
- 5Patient selection: FEV1 ≥60%, no active infection, not on anticoagulation
- 6Contraindications: pacemaker/ICD, active respiratory infection, FEV1 <60%
Clinical Pearls
- Pre-procedure: prednisone 50 mg daily x3 days before each session to reduce post-procedure exacerbations
- Post-procedure: expect worsening of asthma symptoms for 1–2 weeks after each session
- Long-term data: benefit maintained at 5 years (AIR2 5-year follow-up)
- Not a replacement for biologics — consider both in severe asthma
Board High-Yield
Exam Focus- AIR2 trial: BT improved AQLQ, reduced severe exacerbations, reduced ED visits
- Three sessions: RLL → LLL → both upper lobes (3 weeks apart)
- Pre-treatment: prednisone 50 mg x3 days before each session
- FEV1 ≥60% required — not for very severe obstruction
- Mechanism: reduces airway smooth muscle mass (not anti-inflammatory)
ABIM Exam Weight
5%
Interventional Pulmonology represents approximately 5% of the PCCM certification exam.