Asthma control during the year after bronchial thermoplasty

被引:449
作者
Cox, Gerard
Thomson, Neil C.
Rubin, Adalberto S.
Niven, Robert M.
Corris, Paul A.
Siersted, Hans Christian
Olivenstein, Ronald
Pavord, Ian D.
McCormack, David
Chaudhuri, Rekha
Miller, John D.
Laviolette, Michel
Busse, W.
Schellenberg, R.
Slutsky, A. S.
Nair, P.
Goodwin, S.
Currie, K.
Bourbeau, J.
Houghton, F.
Patterson, N.
Metha, S.
Howard, J.
MacBean, L.
Martel, S.
Boulet, L. -P.
Morel, L.
Trepanier, L.
Bicknell, S.
Livingston, E.
Lafferty, J.
Prys-Picard, C.
Fletcher, G.
Higgins, B.
Small, T.
Foggo, B.
Berry, M.
Shaw, D.
Sheldon, N.
Barnes, N.
Watson, D.
Cardoso, P. G.
Soares, P. R. D.
Rasmussen, F.
Christensen, H. M.
Olsen, M.
机构
[1] McMaster Univ, St Josephs Healthcare, Firestone Inst Resp Hlth, Hamilton, ON L8N 4A6, Canada
[2] Univ Glasgow, Gartnavel Gen Hosp, Glasgow, Lanark, Scotland
[3] Irmandade Santa Casa Misericordia, Porto Alegre, RS, Brazil
[4] Univ Manchester, Wythenshawe Hosp, Manchester, Lancs, England
[5] Univ Newcastle, Inst Cellular Med, Newcastle Upon Tyne, Tyne & Wear, England
[6] Odense Univ Hosp, DK-5000 Odense, Denmark
[7] Montreal Chest Inst, Montreal, PQ, Canada
[8] Glenfield Gen Hosp, Univ Hosp Leicester, Natl Hlth Serv Trust, Leicester LE3 9QP, Leics, England
[9] London Hlth Sci Ctr, London, England
[10] Univ Laval, Laval Hosp, Laval, PQ, Canada
关键词
D O I
10.1056/NEJMoa064707
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
BACKGROUND Bronchial thermoplasty is a bronchoscopic procedure to reduce the mass of airway smooth muscle and attenuate bronchoconstriction. We examined the effect of bronchial thermoplasty on the control of moderate or severe persistent asthma. METHODS We randomly assigned 112 subjects who had been treated with inhaled corticosteroids and long-acting beta(2)-adrenergic agonists (LABA) and in whom asthma control was impaired when the LABA were withdrawn to either bronchial thermoplasty or a control group. The primary outcome was the frequency of mild exacerbations, calculated during three scheduled 2-week periods of abstinence from LABA at 3, 6, and 12 months. Airflow, airway responsiveness, asthma symptoms, the number of symptom-free days, use of rescue medication, and scores on the Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) were also assessed. RESULTS The mean rate of mild exacerbations, as compared with baseline, was reduced in the bronchial-thermoplasty group but was unchanged in the control group (change in frequency per subject per week, -0.16+/-0.37 vs. 0.04+/-0.29; P=0.005). At 12 months, there were significantly greater improvements in the bronchial-thermoplasty group than in the control group in the morning peak expiratory flow (39.3+/-48.7 vs. 8.5+/-44.2 liters per minute), scores on the AQLQ (1.3+/-1.0 vs. 0.6+/-1.1) and ACQ (reduction, 1.2+/-1.0 vs. 0.5+/-1.0), the percentage of symptom-free days (40.6+/-39.7 vs. 17.0+/-37.9), and symptom scores (reduction, 1.9+/-2.1 vs. 0.7+/-2.5) while fewer puffs of rescue medication were required. Values for airway responsiveness and forced expiratory volume in 1 second did not differ significantly between the two groups. Adverse events immediately after treatment were more common in the bronchial-thermoplasty group than in the control group but were similar during the period from 6 weeks to 12 months after treatment. CONCLUSIONS Bronchial thermoplasty in subjects with moderate or severe asthma results in an improvement in asthma control.
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收藏
页码:1327 / 1337
页数:11
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