Bronchial thermoplasty: interventional therapy in asthma

Bronchial thermoplasty is a new treatment option for patients with severe bronchial asthma who remain symptomatic despite maximal medical therapy. The aim of this interventional therapy option is the reduction of smooth muscle in the central and peripheral airways in order to reduce symptomatic bronchoconstriction via the application of heat. A full treatment with bronchial thermoplasty is divided into three bronchoscopies. Randomized, controlled clinical trials have shown an increase in quality of life, a reduction in severe exacerbations, and decreases in emergency department visits as well as days lost from school or work. The trials did not show a reduction in hyperresponsiveness or improvement in forced expiratory volume in 1 s. Short-term adverse effects include an increase in exacerbation rate, an increase in respiratory infections and an increase in hospitalizations. In the 5-year follow up of the studies available there was evidence of clinical and functional stability of the treated patients. Further studies are necessary to identify an asthma phenotype that responds well to this treatment

Self-expanding Y stents in the treatment of central airway stenosis: a retrospective analysis

Background: Central airway obstruction (CAO) is a life-threatening situation. Stent insertion re-establishes patency of the central airways. Self-expanding metallic Y stents have been available since 2005, widening the spectrum of interventional bronchoscopic techniques. Methods: Retrospective analysis of all patients treated for CAO with a self-expanding metallic Y stent at the Thoraxklinik Heidelberg between May 2005 and January 2009. Results: A total of 43 patients aged 26–81 had a metallic Y stent inserted endoscopically for the treatment of CAO; 39 of these patients (90.7%) had CAO due to malignant disease, four patients (9.3%) due to benign disease. In all 43 patients, the Y stent was deployed without any complications. A longitudinal follow up was possible in 32 of the 43 patients. The stents remained in situ for an average of 107.1 days (range 1–640 days). In 29 patients with malignant CAO the stenosis was successfully overcome with a Y stent; 11 of these patients died within 6 weeks following stent insertion. On follow up the remaining 18 patients showed immediate improvement of dyspnoea. Eight out of the 18 patients (44.4%) tolerated the stent without problems, two (11.1%) required further stenting, six (33.3%) had complications such as increased secretions, cough, dyspnoea or granulation tissue formation. The stent was removed in one patient (5.6%) due to increased secretions, and in another (5.6%) as the stent was no longer required due to successful tumour-specific therapy. Conclusion: Placement of Y stents in symptomatic CAO allows for quick relief of symptoms. Severe complications are rare. Stent removal is possible after successful treatment of the primary tumour. However, the prognostic indicator for survival is the underlying malignancy

Endobronchial ultrasound:launch of an ERS structured training programme

ERS launches structured EBUS training programme http://ow.ly/br5P302vhh

Switch from IL-5 to IL-5-Receptor alpha Antibody Treatment in Severe Eosinophilic Asthma

Background: Anti-IL-5 antibodies represent an established therapy for severe eosinophilic asthma (SEA), but some patients show inadequate response. The objective of this study was to assess the effects of a switch to anti-IL-5R alpha therapy in patients with inadequate response to anti-IL-5 therapy. Methods: In this retrospective multi-centre, real-life study, we analysed all SEA patients switched from anti-IL-5 to anti-IL-5R alpha therapy due to inadequate response or intolerability. Pulmonary function tests, blood gas analyses, asthma control tests (ACT) and oral corticosteroid (OCS) usage were analysed and compared at three timepoints: baseline (BL, before anti-IL-5 therapy), timepoint 1 (T1, under anti-IL-5 therapy) and timepoint 2 (T2, under anti-IL-5R alpha therapy). Results: Of 665 patients treated with anti-IL-5 antibodies, 70 were switched to anti-IL-5R alpha and 60 were included in the analysis. Median treatment duration was 8 months [IQR 5;15] for anti-IL-5 and 5 months [IQR 4;6] for anti-IL-5R alpha therapy. FEV1 was 61% of predicted at BL [IQR 41;74], 61% [IQR 43;79] at T1 and 68% [IQR 49;87] at T2 (P-T1-(T2)=0.011). ACT score was 10 [IQR 8;13], 16 [IQR 10;19] and 19 [IQR 14;22], respectively (both p<0.001). The number of patients requiring OCS was reduced from 41 (BL) to 32 (T1) and 19 (T2) (both p<0.001). Ten patients discontinued anti-IL-5Ra therapy due to insufficient efficacy (n=7) and adverse events (n=3). Conclusion: Switching from anti-IL-5 to anti-IL-5R alpha therapy in patients with inadequate response was associated with significantly improved FEV1, asthma control and OCS reduction