Bronchial thermoplasty : a new therapeutic option for the treatment of severe, uncontrolled asthma in adults

Bronchial thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk-benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study design and effect size assessment may be unfamiliar. The mechanisms of action and optimal patient selection need to be addressed in further rigorous clinical and scientific studies. Bronchial thermoplasty fits in perfectly with the movement to expand personalised medicine in the field of chronic airway disorders. This is a device-based complimentary asthma treatment that must be supported and developed in order to meet the unmet needs of modern severe asthma management. The mechanisms of action and the type of patients that benefit from bronchial thermoplasty are the most important challenges for bronchial thermoplasty in the future

Asthmatiques allergiques sévères traités par Omalizumab (expérience de l'Hôpital Bichat)

Les patients souffrant d un asthme sévère assument la majeure partie de la mortalité, de la morbidité, des coûts liés à l asthme. Avec les progrès dans la compréhension de la physiopathologie de l asthme, les nouveaux traitements s adressent en premier lieu à ces patients. L omalizumab est un anticorps monoclonal humanisé anti-IgE qui bloque l interaction des IgE avec leur récepteur de haute affinité sur les mastocytes, et donc la réponse aux allergènes. Dans l asthme allergique modéré à sévère, les études concordent pour montrer un bénéfice d omalizumab notamment sur le contrôle des symptômes, la diminution des exacerbations et l épargne cortisonique. L étude rétrospective des dossiers de 22 patients asthmatiques sévères traités par omalizumab à l hôpital Bichat a montré qu il s agissait de patients particulièrement sévères (antécédents de réanimation ou d intubation, de recours aux soins hospitaliers, pression thérapeutique, de fonction respiratoire). Après 16 semaines de traitement par omalizumab, on a observé une amélioration significative du VEMS, passant de 1,59 à 1,77 litres et de 57,3 à 63,5% de la théorique (p < 0,02), et une diminution de la dose de corticoïdes oraux chez les patients concernés (p = 0,02). 77,3% des patients sont répondeurs au traitement au plan symptomatique. Une diminution précoce de la dose de corticoïdes oraux ne paraît pas associée à l échec du traitement. Le seul critère initial différenciant répondeurs et non - répondeurs est le taux d IgE totales sériques, plus élevé chez les répondeurs. Le bénéfice initial semble inconstant à plus long terme.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Bronchiectasis Complicating Lung Volume Reduction Coil Treatment

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Effectiveness of bronchial thermoplasty in patients with severe refractory asthma : Clinical and histopathologic correlations

Background: The effectiveness of bronchial thermoplasty (BT) has been reported in patients with severe asthma, yet its effect on different bronchial structures remains unknown. Objective: We sought to examine the effect of BT on bronchial structures and to explore the association with clinical outcome in patients with severe refractory asthma. Methods: Bronchial biopsy specimens (n = 300) were collected from 15 patients with severe uncontrolled asthma before and 3 months after BT. Immunostained sections were assessed for airway smooth muscle (ASM) area, subepithelial basement membrane thickness, nerve fibers, and epithelial neuroendocrine cells. Histopathologic findings were correlated with clinical parameters. Results: BT significantly improved asthma control and quality of life at both 3 and 12 months and decreased the numbers of severe exacerbations and the dose of oral corticosteroids. At 3 months, this clinical benefit was accompanied by a reduction in ASM area (median values before and after BT, respectively: 19.7% [25th-75th interquartile range (IQR), 15.9% to 22.4%] and 5.3% [25th-75th IQR], 3.5% to 10.1%, P < .001), subepithelial basement membrane thickening (4.4 μm [25th-75th IQR, 4.0-4.7 μm] and 3.9 μm [25th-75th IQR, 3.7-4.6 μm], P = 0.02), submucosal nerves (1.0 ‰ [25th-75th IQR, 0.7-1.3 ‰] immunoreactivity and 0.3 ‰ [25th-75th IQR, 0.1-0.5 ‰] immunoreactivity, P < .001), ASM-associated nerves (452.6 [25th-75th IQR, 196.0-811.2] immunoreactive pixels per mm2 and 62.7 [25th-75th IQR, 0.0-230.3] immunoreactive pixels per mm2, P = .02), and epithelial neuroendocrine cells (4.9/mm2 [25th-75th IQR, 0-16.4/mm2] and 0.0/mm2 [25th-75th IQR, 0-0/mm2], P = .02). Histopathologic parameters were associated based on Asthma Control Test scores, numbers of exacerbations, and visits to the emergency department (all P ≤ .02) 3 and 12 months after BT. Conclusion: BT is a treatment option in patients with severe therapy-refractory asthma that downregulates selectively structural abnormalities involved in airway narrowing and bronchial reactivity, particularly ASM, neuroendocrine epithelial cells, and bronchial nerve endings

Monitoring of asparagine depletion and anti-L-asparaginase antibodies in adult acute lymphoblastic leukemia treated in the pediatric-inspired GRAALL-2005 trial

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