Focus of the Report: This Health Technology Assessment focuses on use of bronchial thermoplasty (BT) as an adjunct treatment for severe persistent asthma that remains symptomatic despite medical management with inhaled corticosteroids (ICS) and long-acting beta2 agonists (LABAs).

Technology Description: BT is designed to reduce the smooth muscle that constricts the airway during asthma attacks. A physician inserts a bronchoscope that includes a catheter containing an expandable array of electrodes. The catheter is threaded into the airway, and an electric current is applied to the bronchial walls, generating heat to destroy the smooth muscle beneath the bronchial passages.

Controversy: BT is an approach to the treatment of severe persistent asthma that targets airway remodeling rather than modulation of airway inflammation and bronchomotor tone. BT is not effective for all patients with severe persistent asthma, and predictors of response need to be defined. The safety and effectiveness of BT relative to emerging monoclonal antibody therapies for asthma have yet to be established.

Key Questions:

  • Is bronchial thermoplasty (BT) effective in reducing the number of asthma exacerbations, controlling asthma-related symptoms, and reducing healthcare utilization in patients with severe persistent asthma?

  • How does BT compare with clinical alternatives for severe asthma?

  • Is BT safe in treating asthma exacerbations and other symptoms associated with severe asthma?

  • Have definitive patient selection criteria been identified for BT for the treatment of severe asthma?

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