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Lung India. 2020 Jan-Feb;37(1):86-96. doi: 10.4103/lungindia.lungindia_418_19.

Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society.

Author information

1
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
2
Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India.
3
Department of Respiratory Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India.
4
Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India.
5
Department of Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India.
6
Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
7
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
8
Department of Respiratory Medicine, Sri Ramachandra University and Hospital, Chennai, Tamil Nadu, India.
9
Lung Care and Sleep Centre, Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India.
10
Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India.
11
Department of Respiratory Medicine, Fortis Hospital, Anandapur, Kolkata, West Bengal, India.
12
Department of Pulmonary Medicine, Yashoda Hospitals, Hyderabad, Telangana, India.
13
Department of Respiratory Medicine, Jaipur Golden Hospital and Rajiv Gandhi Cancer Institute, New Delhi, India.
14
Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
15
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India.
16
Department of Respiratory Medicine, Apollo Hospital, Bengaluru, Karnataka, India.
17
Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, Tamil Nadu, India.
18
Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India.
19
Department of Pulmonary Medicine, St. Johns Medical College, Bengaluru, Karnataka, India.

Abstract

Bronchial thermoplasty (BT) is an interventional bronchoscopic treatment for severe asthma. There is a need to define patient selection criteria to guide clinicians in offering the appropriate treatment options to patients with severe asthma.

METHODOLOGY:

An expert group formed this statement under the aegis of the Indian Chest Society. We performed a systematic search of the MEDLINE and EMBASE databases to extract evidence on patient selection and the technical performance of BT.

RESULTS:

The experts agreed that the appropriate selection of patients is crucial and proposed identification of the asthma phenotype, a screening algorithm, and inclusion/exclusion criteria for BT. In the presence of atypical clinical or chest radiograph features, there should be a low threshold for obtaining a thoracic computed tomography scan before BT. The patient should not have had an asthma exacerbation in the preceding two weeks from the day of the procedure. A 5-day course of glucocorticoid should be administered, beginning three days before the procedure day, and continued until the day following the procedure. General Anesthesia (total intravenous anesthesia with a neuromuscular blocker) provides ideal conditions for performing BT. A thin bronchoscope with a 2.0 mm working channel is preferable. An attempt should be made to deliver the maximum radiofrequency activations. Middle lobe treatment is not recommended. Following the procedure, overnight observation in the hospital, and a follow-up visit, a week following each treatment session, is desirable.

CONCLUSION:

This position statement provides practical guidance regarding patient selection and the technical performance of BT for severe asthma.

KEYWORDS:

Anesthesia; bronchial asthma; bronchial thermoplasty; prednisolone

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