Hall C.S., Quirk J.D, Goss C.W, et al
AJRCCM Published Online: June 08, 2020
https://doi.org/10.1164/rccm.201905-1021OC
Aim: Adverse events have limited the use of bronchial thermoplasty (BT) in severe asthma. The aim was to evaluate the effectiveness and safety of using 129Xe MRI to prioritize the most involved airways for guided BT.
Methods: 30 subjects with severe asthma were imaged with volumetric CT and 129Xe MRI to quantitate segmental ventilation defects. Subjects were randomized to treatment of the six most involved airways in the first session (guided group) or a standard three-session BT (unguided). The primary outcome was the change in Asthma Quality of Life Questionnaire (AQLQ) score from baseline after the first BT for the guided group compared to after three treatments for the unguided group.
Results: There was no significant difference in quality of life after one guided compared to three unguided BTs (ΔAQLQ guided= 0.91[95% CI, 0.28 to 1.53], unguided=1.49 [95% CI, 0.84 to 2.14] P=0.201). After one BT, the guided group had a greater reduction in the percent of poorly/non-ventilated lung from baseline when compared to unguided (-17.2%, P=0.009). At one year, both AQLQ and asthma control tests (ACT) improved from baseline (ΔAQLQ=1.50±1.63 P=<0.001, ΔACT=5.61±5.24 P<0.001) and there was no significant difference between groups. Thirty-three percent experienced asthma exacerbations after one guided BT compared to 73% after three unguided BT (P=0.028).
Conclusion: Results of this pilot study suggest that similar short-term improvements with improved safety can be achieved with one BT treatment guided by 129Xe MRI when compared to standard BT.