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  1. Article: Plethysmography-derived gas trapping lacks utility in predicting response to bronchial thermoplasty.

    Rajan, Ashwin / Bennetts, Kim / Langton, David

    ERJ open research

    2022  Volume 8, Issue 2

    Abstract: There is a paucity of literature on measurable baseline parameters predicting response and guiding selection for bronchial thermoplasty. This study examines whether baseline gas trapping, as assessed by plethysmography, is associated with a response to ... ...

    Abstract There is a paucity of literature on measurable baseline parameters predicting response and guiding selection for bronchial thermoplasty. This study examines whether baseline gas trapping, as assessed by plethysmography, is associated with a response to bronchial thermoplasty at 12 months. 43 consecutive patients with severe asthma (mean±sd age 57.6±13.3 years) were evaluated at baseline and 12 months post bronchial thermoplasty. Data collected at both time points included spirometry, body plethysmography and four clinical outcome measures, namely Asthma Control Questionnaire (ACQ) score, annual exacerbation frequency, maintenance oral corticosteroid requirement and short-acting β-agonist use. At baseline, participants had severe airflow obstruction (forced expiratory volume in 1 s 49.1±15.8%) with marked gas trapping (residual volume (RV) 150.3±40.8%, RV/total lung capacity (TLC) 51.3±10.5%), poor symptom control (ACQ 3.3±1.0) and frequent exacerbations (median 4, interquartile range 8). 12 months after bronchial thermoplasty, significant improvements were observed in all four clinical outcome measures. However, baseline RV and RV/TLC were not significantly associated with changes in ACQ nor any other clinical outcome measure, and changes in RV and RV/TLC did not significantly correlate with a change in any clinical outcome measure. Plethysmography-derived gas trapping does not demonstrate utility in predicting response and guiding selection for bronchial thermoplasty. An improvement in gas trapping was not associated with positive clinical outcomes, suggesting that this may not be the dominant mode of action of bronchial thermoplasty in generating clinical improvement.
    Language English
    Publishing date 2022-05-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2827830-6
    ISSN 2312-0541
    ISSN 2312-0541
    DOI 10.1183/23120541.00690-2021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Safety of delivering bronchial thermoplasty in two treatment sessions.

    Koshy, Kavya / Sha, Joy / Bennetts, Kim / Langton, David

    Respiratory research

    2021  Volume 22, Issue 1, Page(s) 307

    Abstract: Background: Bronchial thermoplasty (BT) is a novel endoscopic therapy for severe asthma. Traditionally it is performed in three separate treatment sessions, targeting different portions of the lung, and each requires an anaesthetic and hospital ... ...

    Abstract Background: Bronchial thermoplasty (BT) is a novel endoscopic therapy for severe asthma. Traditionally it is performed in three separate treatment sessions, targeting different portions of the lung, and each requires an anaesthetic and hospital admission. Compression of treatment into 2 sessions would present a more convenient alternative for patients. In this prospective observational study, the safety of compressing BT into two treatment sessions was compared with the traditional 3 treatment approach.
    Methods: Sixteen patients meeting ERS/ATS criteria for severe asthma consented to participate in an accelerated treatment schedule (ABT), which treated the whole left lung followed by the right lung four weeks later. The short-term outcomes of these patients were compared with 37 patients treated with conventional BT scheduling (CBT). The outcome measures used to assess safety were (1) the requirement to remain in hospital beyond the electively planned 24-h admission and (2) the need for re-admission for any cause within of 30 days of treatment.
    Results: The total number of radiofrequency activations delivered in the ABT group was similar to CBT (187 ± 21 vs 176 ± 40, p = 0.326). With ABT, 11 in 31 admissions (37.9%) required prolonged admission due to wheezing, compared to 5.4% with CBT (p = 0.0025). The mean hospital length of stay with ABT was 1.8 ± 1.3 days, compared to 1.1 ± 0.4 days (p < 0.001). ICU monitoring was required on 5 occasions with ABT (16.1%), compared to 0.9% with CBT (p = 0.002). Subgroup analysis demonstrated that females were more likely to require prolonged admission (OR 11.6, p = 0.0025). The 30-day hospital readmission rate was similar for both groups (6.4% vs 5.4%, p = 0.67). All patients made a complete recovery after treatment with similar outcomes at the 6-month follow-up reassessment.
    Conclusion: This study demonstrates that ABT results in greater short-term deterioration in lung function associated with a greater risk of prolonged hospital and ICU stay, predominantly affecting females. Therefore, in females, these risks need to be balanced against the convenience of fewer treatment sessions. In males, it may be an advantage to compress treatment.
    MeSH term(s) Asthma/diagnosis ; Asthma/physiopathology ; Asthma/surgery ; Bronchial Thermoplasty/methods ; Bronchoscopy/methods ; Female ; Follow-Up Studies ; Forced Expiratory Flow Rates/physiology ; Humans ; Lung/physiopathology ; Male ; Middle Aged ; Prospective Studies ; Severity of Illness Index ; Treatment Outcome
    Language English
    Publishing date 2021-11-29
    Publishing country England
    Document type Comparative Study ; Journal Article ; Observational Study
    ZDB-ID 2041675-1
    ISSN 1465-993X ; 1465-993X
    ISSN (online) 1465-993X
    ISSN 1465-993X
    DOI 10.1186/s12931-021-01901-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Bronchial thermoplasty reduces airway resistance.

    Langton, David / Bennetts, Kim / Noble, Peter / Plummer, Virginia / Thien, Francis

    Respiratory research

    2020  Volume 21, Issue 1, Page(s) 76

    Abstract: Background: The mechanism for symptomatic improvement after bronchial thermoplasty (BT) is unclear, since spirometry reveals little or no change. In this study, the effects of BT on airway resistance were examined using two independent techniques.: ... ...

    Abstract Background: The mechanism for symptomatic improvement after bronchial thermoplasty (BT) is unclear, since spirometry reveals little or no change. In this study, the effects of BT on airway resistance were examined using two independent techniques.
    Methods: Eighteen consecutive patients, with severe asthma (57.6 ± 14.2 years) were evaluated by spirometry and plethysmography at three time points: (i) baseline, (ii) left lung treated but right lung untreated and (iii) 6 weeks after both lungs were treated with BT. At each assessment, total and specific airway resistance (Raw, sRaw) were measured. High resolution CT scans were undertaken at the first two assessments, and measurements of lobar volume, airway volume and airway resistance were made. The Asthma Control Questionnaire (ACQ) was administered at each assessment.
    Results: The baseline ACQ score was 3.5 ± 0.9, and improved progressively to 1.8 ± 1.2 (p < 0.01). At baseline, severe airflow obstruction was observed, FEV1 44.8 ± 13.7% predicted, together with gas trapping, and elevated Raw at 342 ± 173%predicted. Following BT, significant improvements in Raw and sRaw were observed, as well as a reduction in Residual Volume, increase in Vital Capacity and no change in FEV1. The change in Raw correlated with the change in ACQ (r = 0.56, p < 0.05). CT scans demonstrated reduced airway volume at baseline, which correlated with the increased Raw determined by plethysmography (p = - 0.536, p = < 0.05). Following BT, the airway volume increased in the treated lung, and this was accompanied by a significant reduction in CT-determined local airway resistance.
    Conclusion: Symptomatic improvement after BT is mediated by increased airway volume and reduced airway resistance.
    MeSH term(s) Adult ; Aged ; Airway Resistance/physiology ; Asthma/diagnostic imaging ; Asthma/physiopathology ; Asthma/therapy ; Bronchial Thermoplasty/methods ; Female ; Humans ; Male ; Middle Aged ; Plethysmography/methods ; Respiratory Function Tests/methods
    Language English
    Publishing date 2020-03-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041675-1
    ISSN 1465-993X ; 1465-993X
    ISSN (online) 1465-993X
    ISSN 1465-993X
    DOI 10.1186/s12931-020-1330-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Bronchial thermoplasty reduces ventilation heterogeneity measured by multiple breath nitrogen washout.

    Langton, David / Bennetts, Kim / Thien, Francis / Plummer, Virginia / Noble, Peter B

    Respiratory research

    2020  Volume 21, Issue 1, Page(s) 308

    Abstract: Background: Despite demonstrated symptomatic benefit from bronchial thermoplasty (BT), the underlying pathophysiological benefits have been uncertain. The purpose of the present study was to relate clinical benefit after BT to changes in lung physiology, ...

    Abstract Background: Despite demonstrated symptomatic benefit from bronchial thermoplasty (BT), the underlying pathophysiological benefits have been uncertain. The purpose of the present study was to relate clinical benefit after BT to changes in lung physiology, focusing on ventilation homogeneity assessed using multiple breath nitrogen washout (MBNW), and how this may be affected by changes in airway volume and resistance.
    Methods: Consecutive patients (n = 21) with severe asthma scheduled for BT, were evaluated at baseline, 6 weeks and 6 months after completion of treatment. Assessments included the Asthma Control Questionnaire (ACQ), medication usage, exacerbation frequency, spirometry, plethysmography and MBNW. Eighteen of these patients underwent detailed CT evaluation for the estimation of airway volume at baseline and then after the left lung had received BT treatment but prior to right lung treatment. Data are mean ± STDEV.
    Results: Patients responded to BT with an improvement in ACQ from 3.4 ± 0.8 at baseline to 2.0 ± 1.1 at 6 months (p < 0.001). Steroid requiring exacerbations fell from 3.1 ± 2.9 in the 6 months prior to BT to 1.4 ± 1.7 following BT (p < 0.001). Significant reductions in maintenance oral steroid dosing and short acting beta agonist use were observed. Airway volume measured by CT scanning significantly increased after treatment. The FEV1 improved from 1.34 ± 0.65 l to 1.52 ± 0.76 l (p = 0.024). The Residual Volume fell from 2.87 ± 0.89 l to 2.71 ± 0.93 l (p = 0.008) and Total Airway Resistance (Raw) from 10.58 ± 6.56 to 7.64 ± 3.74 cmH
    Conclusion: Clinical benefit after BT is accompanied by improvements in lung physiology, including normalisation of lung homogeneity that seems to be driven by airway dilation and reduced resistance.
    MeSH term(s) Adult ; Aged ; Asthma/diagnostic imaging ; Asthma/epidemiology ; Asthma/physiopathology ; Asthma/therapy ; Australia/epidemiology ; Bronchial Thermoplasty/methods ; Female ; Forced Expiratory Volume/physiology ; Humans ; Male ; Middle Aged ; Nitrogen/analysis ; Plethysmography/methods ; Respiratory Function Tests/methods ; Spirometry/methods ; Surveys and Questionnaires ; Tidal Volume/physiology ; Tomography, X-Ray Computed/methods
    Chemical Substances Nitrogen (N762921K75)
    Language English
    Publishing date 2020-11-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041675-1
    ISSN 1465-993X ; 1465-9921
    ISSN (online) 1465-993X
    ISSN 1465-9921
    DOI 10.1186/s12931-020-01575-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Bronchial thermoplasty reduces gas trapping in severe asthma.

    Langton, David / Ing, Alvin / Bennetts, Kim / Wang, Wei / Farah, Claude / Peters, Matthew / Plummer, Virginia / Thien, Francis

    BMC pulmonary medicine

    2018  Volume 18, Issue 1, Page(s) 155

    Abstract: Background: In randomized controlled trials, bronchial thermoplasty (BT) has been proven to reduce symptoms in severe asthma, but the mechanisms by which this is achieved are uncertain as most studies have shown no improvement in spirometry. We ... ...

    Abstract Background: In randomized controlled trials, bronchial thermoplasty (BT) has been proven to reduce symptoms in severe asthma, but the mechanisms by which this is achieved are uncertain as most studies have shown no improvement in spirometry. We postulated that BT might improve lung mechanics by altering airway resistance in the small airways of the lung in ways not measured by FEV
    Methods: A prospective cohort of 32 consecutive patients with severe asthma who were listed for BT at two Australian university hospitals were evaluated at three time points, namely baseline, and then 6 weeks and 6 months post completion of all procedures. At each evaluation, medication usage, symptom scores (Asthma Control Questionnaire, ACQ-5) and exacerbation history were obtained, and lung function was evaluated by (i) spirometry (ii) gas diffusion (KCO) and (iii) static lung volumes by body plethysmography.
    Results: ACQ-5 improved from 3.0 ± 0.8 at baseline to 1.5 ± 0.9 at 6 months (mean ± SD, p < 0.001, paired t-test). Daily salbutamol usage improved from 8.3 ± 5.6 to 3.5 ± 4.3 puffs per day (p < 0.001). Oral corticosteroid requiring exacerbations reduced from 2.5 ± 2.0 in the 6 months prior to BT, to 0.6 ± 1.3 in the 6 months after BT (p < 0.001). The mean baseline FEV
    Conclusion: Bronchial thermoplasty improves gas trapping and this effect is greatest in the most severely obstructed patients. The improvement may relate to changes in the mechanical properties of small airways that are not measured with spirometry.
    MeSH term(s) Adrenal Cortex Hormones/administration & dosage ; Aged ; Asthma/therapy ; Australia ; Bronchial Thermoplasty ; Female ; Humans ; Lung/physiopathology ; Male ; Middle Aged ; Prospective Studies ; Residual Volume ; Spirometry
    Chemical Substances Adrenal Cortex Hormones
    Language English
    Publishing date 2018-09-24
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2059871-3
    ISSN 1471-2466 ; 1471-2466
    ISSN (online) 1471-2466
    ISSN 1471-2466
    DOI 10.1186/s12890-018-0721-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Measuring the effects of bronchial thermoplasty using oscillometry.

    Langton, David / Ing, Alvin / Sha, Joy / Bennetts, Kim / Hersch, Nicole / Kwok, McKinny / Plummer, Virginia / Thien, Francis / Farah, Claude

    Respirology (Carlton, Vic.)

    2018  Volume 24, Issue 5, Page(s) 431–436

    Abstract: Background and objective: Bronchial thermoplasty (BT) has been consistently shown to reduce symptoms, exacerbations and the need for reliever medication in patients with severe asthma. Paradoxically, no consistent improvement in spirometry has been ... ...

    Abstract Background and objective: Bronchial thermoplasty (BT) has been consistently shown to reduce symptoms, exacerbations and the need for reliever medication in patients with severe asthma. Paradoxically, no consistent improvement in spirometry has been demonstrated. It has been suggested that this is due to a reduction in peripheral resistance in small airways, not captured by spirometry. Therefore, in this study, we evaluate the response to BT using oscillometry.
    Methods: A total of 43 patients with severe asthma from two centres were evaluated at baseline, 6 weeks and 6 months post BT, using spirometry, plethysmography and oscillometry, in addition to medication usage, exacerbation frequency and the Asthma Control Questionnaire (5-item version) (ACQ-5).
    Results: The mean age was 58.4 ± 11.2 years, forced expiratory volume in 1 s (FEV
    Conclusion: Lung impedance measured with oscillometry did not change following BT despite marked clinical improvements in patients with severe asthma.
    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Aged ; Airway Resistance ; Albuterol/pharmacology ; Asthma/drug therapy ; Asthma/physiopathology ; Asthma/surgery ; Bronchial Thermoplasty ; Bronchodilator Agents/pharmacology ; Disease Progression ; Female ; Forced Expiratory Volume/drug effects ; Humans ; Male ; Middle Aged ; Oscillometry ; Residual Volume ; Spirometry ; Surveys and Questionnaires
    Chemical Substances Adrenal Cortex Hormones ; Bronchodilator Agents ; Albuterol (QF8SVZ843E)
    Language English
    Publishing date 2018-11-12
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1435849-9
    ISSN 1440-1843 ; 1323-7799
    ISSN (online) 1440-1843
    ISSN 1323-7799
    DOI 10.1111/resp.13439
    Database MEDical Literature Analysis and Retrieval System OnLINE

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