[Bronchial thermoplasty in the treatment of severe asthma].

OBJECTIVE: To assess the effectiveness and safety of bronchial thermoplasty (BT) in the treatment of severe asthma. METHODS: The safety and effectiveness of BT were studied prospectively in 6 patients with poorly controlled severe asthma on long-term inhaled high-dose glucocorticoids and long-acting beta2-agonists in the First Affiliated Hospital of Guangzhou Medical University. Outcomes assessed after BT included asthma symptoms, frequency of acute exacerbations, pulmonary function, medication adjustment, and postoperative complications at 6 and 12 months after treatment. RESULTS: The mini-AQLQ scores (6.4±0.5), the frequency of acute exacerbations [0.4(0.1-1.3) times/month], and the symptom-free days [(21.2±7.2) days/month] were significantly improved at 6 months after operation compared to those before operation [5.2±0.9, 2.0 (0.9-4.0) times/month, (14.5±3.7) days/month, respectively, P<0.05]. Data collected at the 6(th) month indicated significant improvements in the variation rate of PEF, the dose of inhaled glucocorticoids and oral glucocorticoids [(5.6±3.3)% vs. (21.1±7.8)%), (800±620) vs. (1 133±432) µg/d), 9.7 (1.3-10.0) vs. 15.0 (10-20) mg/d, P<0.05]. Outcomes mentioned above were improved as well at the 12(th) month. But the ACQ-6 scores, ACT scores, the ratio of PEF and its predicted value (%), the ratio of FVC and its predicted value (%), the ratio of FEV1 and its predicted value (%) were not changed significantly (P>0.05). The PEF values and lung function measurements remained stable throughout the study period. The most common complications were cough (24.1%), wheezing (13.8%), followed by lower respiratory infection and atelectasis during the treatment. Pneumothorax and respiratory failure occurred in 1 patient 12 h after the third procedure. CONCLUSION: Our preliminary study demonstrated promising effect of BT in the treatment of severe asthma, although there are some complications which need further observation.

Positive change in asthma control using therapeutic patient education in severe uncontrolled asthma: a one-year prospective study.

BACKGROUND: Severe asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncontrolled asthma is unclear. We evaluated whether therapeutic patient education is effective in improving asthma control and decreasing the frequency of exacerbations in severe uncontrolled asthma. METHODS: This was a prospective, observational, and self-controlled study that enrolled 40 subjects with severe uncontrolled asthma. Patients were seen at a clinic four times (on day 1 and after 3, 6, and 12 months). After baseline data collection, the subjects completed a therapeutic patient education program and were also followed-up via telephone after 1, 2, 4, 5, 7, 8, 9, 10, and 11 months to monitor asthma medication adherence and collect asthma-related information. RESULTS: Within the 1-year study period, a total of 23 exacerbations were recorded in 14 patients, seven of whom required emergency treatment and two of whom were hospitalized. Twelve months after the standardized therapeutic patient education program, pulmonary function and fractional exhaled nitric oxide levels improved significantly in all 40 patients. Moreover, the scores from three standardized asthma questionnaires and indices suggested improved quality of life in these patients with severe uncontrolled asthma. Serum levels of biomarkers reflecting asthma immune responses did not change between baseline and the 1-year follow-up time point. CONCLUSIONS: Therapeutic patient education is effective in improving asthma control and decreasing exacerbations in patients with severe uncontrolled asthma.

Asthma Phenotypes Defined From Parameters Obtained During Recovery From a Hospital-Treated Exacerbation.

BACKGROUND: Asthma is a heterogeneous disease with diverse clinical manifestations and inflammatory pathologies that is punctuated by exacerbations. OBJECTIVE: To describe the clinical and inflammatory characteristics of patients with asthma treated in hospital for an acute exacerbation. METHODS: Data from 320 adult patients receiving treatment for an acute exacerbation of asthma were obtained. In 218 patients with complete data, we used the Ward hierarchical clustering to obtain clusters. Pulmonary function, blood cell counts, sputum cell counts, serum IgE levels, and fractional exhaled nitric oxide were measured on hospital admission. We selected 13 variables with which we performed the Ward minimum-variance hierarchical clustering. RESULTS: Four clusters were defined. Clusters 1 (24.5%) and 3 (36.7%) were characterized by predominantly female patients with asthma with sputum neutrophilia, with cluster 1 associated with a small degree of airflow obstruction and early-onset asthma and cluster 3 with a moderate degree of reduction in FEV1. Clusters 2 (22.0%) and 4 (16.5%) were associated with high sputum eosinophilia and severe airflow obstruction. Cluster 4 was made exclusively of male smoking subjects, whereas cluster 2 was made up of predominantly female nonsmoking subjects with the worst FEV1, forced expiratory flow at 25% to 75% of forced vital capacity (% predicted), and partial pressure of oxygen in arterial blood on admission. There were no differences between clusters in terms of atopy, serum IgE, prevalence of nasal disease, dose of maintenance inhaled corticosteroids, or oral/systemic corticosteroid use and asthma exacerbations. CONCLUSIONS: The clusters during recovery from an exacerbation of asthma were distinguished by airflow obstruction and a neutrophilic, eosinophilic, or mixed inflammation. Eosinophilic inflammation was found in smoking and nonsmoking patients with asthma during an exacerbation.

Bronchiectasis after bronchial thermoplasty.

Bronchial thermoplasty (BT) is used in the treatment of severe refractory asthma. It has been found to be beneficial to long-term improvements in the rate of asthma exacerbation, quality of life questionnaire answers (AQLQ), hospitalization, and emergency room visits. Atelectasis and lung abscess as direct complication of BT, but not bronchiectasis, have been reported previously. In this study, we report bronchiectasis after BT in what we believe may be the first case, combined with optical coherence tomography (OCT) and a 3-year follow-up of chest computed tomography (CT), to evaluate a patient with severe persistent asthma. We describe a 49-year-old Chinese male who complained of recurrent wheezing lasting over 5 years. His chest CT scan was normal before BT, but one month thereafter, he presented with mild central bronchiectasis on high-resolution CT, which persisted for more than 4 years. It remains unclear why this patient developed bronchiectasis so early post-BT treatment. This case highlights the need for short-term and long-term safety data on BT.

Sputum microbiota in severe asthma patients: Relationship to eosinophilic inflammation.

BACKGROUND: Altered composition of airway microbiota has been reported in subjects suffering from asthma but its relation to eosinophilic phenotype is unclear. OBJECTIVE: To examine the relationship between sputum microbiota, asthma severity and inflammatory type in asthmatic subjects from Guangzhou, China. METHODS: Induced sputum samples were obtained from 49 non-smoking asthma patients, 25 severe and 24 non-severe, and 15 healthy subjects. Total DNA was amplified using primers specific for the V3-V5 hypervariable region of bacterial 16s rRNA and sequenced using the 454 GS FLX sequencer. Sequences were assigned to bacterial taxa by comparing them with 16s rRNA sequences in the Ribosomal Database Project. RESULTS: Sputum eosinophil counts were higher and FEV1 (% predicted) was lower in severe compared to non-severe asthmatics. There were no significant differences in operational taxonomic unit (OTU) numbers at the phylum level and in diversity scores between non-severe asthmatics and severe asthmatics, and healthy subjects. At the family level, Porphyromonadaceae was most abundant in healthy subjects whereas Pseudomonadaceae and Enterobacteriaceae were higher in severe asthmatics compared to non-severe asthmatics (p < 0.05). Actinomycetaceae was particularly abundant in eosinophilic asthma patients compared to non-eosinophilic asthma (p = 0.011). Bacteroidaceae was positively correlated with FEV1 in all subjects (r = 0.335, p < 0.01), whereas body mass index was negatively associated with the number of species observed (r = -0.3, p < 0.05). Principal component analysis confirmed the positive association of Actinomycetaceae and Enterobacteriaceae abundance with eosinophilic asthma. CONCLUSION: Patients with asthma have an altered airway microbiota, with specific bacteria associated with severe asthma and the eosinophilic inflammatory phenotype.