Increased attention is being given to the potential use of bronchial thermoplasty in the management of patients with asthma. This procedure uses radiofrequency ener- gy to reduce the mass of smooth muscle in the walls of conducting airways, thereby reducing the potential for smooth muscle-mediated bronchoconstriction. Is bronchial thermoplasty safe, and does it work? Yes, according to a study conducted in Canada by Cox and associates. Their 2-year nonrandomized prospective study included 16 patients with mild to moderate asthma. With patients under general or local anesthesia, bronchial thermoplasty was performed over 30 minutes or less during 3 bronchoscopic sessions in 13 patients and 2 sessions in 3 patients. Measurements at baseline and 12-week follow-up included daily diary recordings of peak flow, symptoms, and medication use; spirometry; and methacholine challenge. The adverse effects observed in this study were transient and typical of those associated with bronchoscopy. At 12 weeks, patients recorded significant improvements over baseline in symptom-free days and in morning and evening peak flow measurements. In addition, patients had a significant reduction in airway hyperresponsiveness, which was documented by methacholine challenge testing. At 1-year post-treatment, all patients reported satisfaction and indicated they would undergo the procedure again if required. CT scans reviewed at baseline and 1- and 2-year post-treatment follow-up showed no clinically significant findings, such as bronchiectasis, bronchial wall thickening, or parenchymal changes.
