Advances in bronchoscopic management of refractory asthma

Millions of asthma patients around the world fail to achieve optimal disease control despite marked progress in pharmacotherapy. Continued symptoms in adults and children result in countless missed days of school and work that costs billions of dollars each year in productivity and healthcare expenditure. Bronchial thermoplasty (BT) is a revolutionary non-pharmacologic therapy that directly targets airway wall smooth muscle. Controlled thermal energy is delivered during a series of bronchoscopies and results in considerable reduction of airway wall smooth muscle mass. Controlled clinical trials of this technique have demonstrated decreased frequency and intensity of asthma exacerbations in patients with moderate to severe disease. Patient selection, procedural methodology, our clinical experience, and supporting evidence will be reviewed herein.