Therapeutic Value Of Bronchial Thermoplasty In Patients With Refractory Asthma

Background:Bronchial asthma(asthma)is a common chronic inflammatory airway disease,with airway hyperresponsiveness and reversible airflow limited,late airway remodeling,there may be changes.For most patients with asthma,inhaled corticosteroids(ICS)or combination of long-acting beta2-agonists(LAB A)specification treatment can achieve good control.About 5-10%of patients,however,although after drug treatment,the symptom is still difficult to control,these belong to the refractory asthma patients,its reason is often associated with the presence of airway remodeling.This part of the increased risk in patients with disease progression,hospitalization rate and case fatality rate increased,the serious influence the quality of life,increase the burden of the family and society.Bronchial thermoplasty(BT)is internationally in recent years the most important breakthrough in the field of non-drug therapy of asthma,its principle is radiofrequency ablation by bronchoscopy probes in bronchial lumen,the external rf generator generated by heat conduction to the bronchial wall,melting proliferation of bronchial smooth muscle cells,so as to achieve therapeutic effect.Several international study of BT in the treatment of refractory asthma,according to the results of BT can effectively improve symptoms,improve patient quality of life in patients with refractory asthma,reduce drug use.In April 2010,the United States food and drug administration(FDA)approved the BT can be used in the treatment of at least 18 years of age,poor application of the ICS and LABA control for the patients with severe persistent asthma.2014 European Respiratory Society and American Thoracic Society diagnosis and treatment of the ats guidelines specify,BT can be used in the treatment of severe asthma in adults.BT in February 2014 formally approved in China can be used in the clinical treatment of severe asthma,but about the technology of treatment in patients with refractory asthma in China is still a lack of efficacy and safety data,further accumulation and clearly.Objective:Analysis of BT in the treatment of refractory asthma in clinical application safety and therapeutic effect.Methods:This study is divided into two parts,the first part:In March 2015-December 6 cases of our hospital as the research object in patients with refractory asthma.This prospective observational 6 cases after long-term high-dose oral or inhaled corticosteroids and long-acting beta 2-agonists specification still poorly controlled severe asthma patients after treatment,after treatment with BT,observed adverse reactions occurred within 3 weeks after treatment,evaluation within 1 year after treatment of asthma symptoms,severe acute asthma attacks,The Times of number of hospitalized with acute attack of asthma,pulmonary ventilation function,hormone dosage,and postoperative complications,etc.,within 1 year and 6 patients within 1 year before BT treatment of asthma symptoms,severe acute asthma attacks,The Times of number of hospitalized with acute attack of asthma,pulmonary ventilation function and hormone dosage,and so on and so forth.The second part:the January 2014-December 2016 have been reported in the journal in China some of the patients treated by BT,the tenth people's hospital of Shanghai(s)in 2 cases,first affiliated hospital of guangzhou medical university(g)and 6 cases of china-japan friendship hospital(z),12 cases;Combination of 6 patients of our hospital overall summarized analysis before and after treatment.Results:Our hospital within 1 year of 6 patients with preoperative and postoperative severe asthma patients with acute cases were 6 and 5 cases respectively,severe asthma acute onset to hospital clinic cumulative number 30 times and 6 times,respectively,for hospitalized patients with acute asthma attacks in 5 cases and 0 cases,respectively,the cumulative number of hospitalization were 12 times and zero;6 patients within 1 year after total severe acute asthma attacks,The Times of total number of hospitalized with acute asthma attackwere significantly decreased compared with preoperative one year.By comparing the preoperative and postoperative patients with 1 year asthma survey found that the patient's subjective symptoms improved,through statistical analysis(P<0.05),statistically significant;By comparing the preoperative and postoperative patients with lung function index and the usage of hormone drugs,and through the statistical analysis(P>0.05),consider not significant;About the postoperative complications,6 patients were the most common adverse reactions after 3 weeks to cough,wheezing,coughing up phlegm,most within 1 week after surgery to relieve,there was no serious adverse events occurred in 3 weeks,chest CT postoperative 1 years did not see the airway structural changes,you did not see any adverse reactions associated with BT treatment.In combination with other hospital for treatment of 20 patients with the same period were analyzed,and the 6 patients were treated in our BT,treatment effect is similar to the effect of other kinds of hospital in China.Conclusion:For hot forming treatment of refractory line bronchial asthma patients after 1 year of follow-up observation found that BT treatment can obviously improve the patient's subjective symptoms,reduce the acute attack of asthma control,the improvement of conventional drugs,but for the patients with pulmonary function index and hormonal control the influence of the dosage of the drug,show the difference between individuals;Although patients treated in our hospital short-term complications after only a few minor treatment,and control is good,does not appear serious and long term adverse reactions after treatment,but in combination with other hospital patients were analyzed at the same time,BT has some risk treatment,need to pay attention to prevent serious complications;Through the study found that the BT treatment in Chinese and Asian people also can achieve similar to European and American people.