Emerging understanding of the mechanism of action of Bronchial Thermoplasty in asthma

Elsevier Pharmacology & TherapeuticsAvailable online 27 July 201 In Press, Corrected Proof
Associate editor: J. Burgess

J.N.S.d'Hooghea. N.H.T.ten Hackenb. E.J.M.Weersinka. P.J.Sterka. J.T.Annemaa. P.I.Bontaa. 

Abstract

Bronchial Thermoplasty (BT) is an endoscopic treatment for moderate-to-severe asthma patients who are uncontrolled despite optimal medical therapy. Effectiveness of BT has been demonstrated in several randomized clinical trials. However, the asthma phenotype that benefits most of this treatment is unclear, partly because the mechanism of action is incompletely understood. BT was designed to reduce the amount of airway smooth muscle (ASM), but additional direct and indirect effects on airway pathophysiology are expected. This review will provide an overview of the different components of airway pathophysiology including remodeling, with the ASM as the key player. Current concepts in the understanding of BT clinical effectiveness with a focus on its impact on airway remodeling will be reviewed.

Abbreviations

ACQ asthma control questionnaire
AHR airway hyperresponsiveness
Anti-IL5 anti-interleukin 5
AQLQ asthma quality of life questionnaire
ASM airway smooth muscle
BAL bronchoalveolar lavage
BT Bronchial Thermoplasty
ECM extracellular matrix
ED emergency department
FEV1 forced expiratory volume in 1 s
GINA Global Initiative for Asthma
ICS inhaled corticosteroids
IL-4 interleukin-4
IL-5 interleukin-5
IL-6 interleukin-6
IL-13 interleukin-13
IL-17 interleukin-17
LABA long acting beta-agonist
NANC non-adrenergic, non-cholinergic
OCS oral corticosteroids
OCT optical coherence tomography
PC20 provocative concentration leading to a fall in FEV1 of 20%
RANTES Regulated on Activation Normal T Cell Expressed and Secreted
RBM reticular basement membrane
RCT randomized control trial
RF radio-frequency energy
RML right middle lobe
TGF-ß Transforming Growth Factor-Beta
TLD targeted lung denervation
TNFα tumour necrosis factor α

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