Bronchial Thermoplasty Improves Ventilation Heterogeneity Measured by Functional Respiratory Imaging in Severe Asthma

Chuan T Foo; Graham M Donovan; Francis Thien; David Langton; Peter B Noble

doi:10.2147/JAA.S454951

Bronchial Thermoplasty Improves Ventilation Heterogeneity Measured by Functional Respiratory Imaging in Severe Asthma

J Asthma Allergy. 2024 Apr 22:17:399-409. doi: 10.2147/JAA.S454951. eCollection 2024.

Authors

Chuan T Foo^{1

2}, Graham M Donovan³, Francis Thien^{1

2}, David Langton^{2

4}, Peter B Noble⁵

Affiliations

¹ Department of Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia.
² Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
³ Department of Mathematics, University of Auckland, Auckland, New Zealand.
⁴ Department of Thoracic Medicine, Peninsula Health, Frankston, VIC, Australia.
⁵ School of Human Sciences, The University of Western Australia, Crawley, WA, Australia.

Abstract

Purpose: Bronchial thermoplasty (BT) is a bronchoscopic intervention for the treatment of severe asthma. Despite demonstrated symptomatic benefit, the underlying mechanisms by which this is achieved remain uncertain. We hypothesize that the effects of BT are driven by improvements in ventilation heterogeneity as assessed using functional respiratory imaging (FRI).

Patient and methods: Eighteen consecutive patients with severe asthma who underwent clinically indicated BT were recruited. Patients were assessed at baseline, 4-week after treatment of the left lung, and 12-month after treatment of the right lung. Data collected included short-acting beta-agonist (SABA) and oral prednisolone (OCS) use, asthma control questionnaire (ACQ-5) and exacerbation history. Patients also underwent lung function tests and chest computed tomography. Ventilation parameters including interquartile distance (IQD; measure of ventilation heterogeneity) were derived using FRI.

Results: 12 months after BT, significant improvements were seen in SABA and OCS use, ACQ-5, and number of OCS-requiring exacerbations. Apart from pre-bronchodilator FEV₁, no other significant changes were observed in lung function. Ventilation heterogeneity significantly improved after treatment of the left lung (0.18 ± 0.04 vs 0.20 ± 0.04, p=0.045), with treatment effect persisting up to 12 months later (0.18 ± 0.05 vs 0.20 ± 0.04, p=0.028). Ventilation heterogeneity also improved after treatment of the right lung, although this did not reach statistical significance (0.18 ± 0.05 vs 0.19 ± 0.04, p=0.06).

Conclusion: Clinical benefits after BT are accompanied by improvements in ventilation heterogeneity, advancing our understanding of its mechanism of action. Beyond BT, FRI has the potential to be expanded into other clinical applications.

Keywords: asthma; computational fluid dynamics; computed tomography; imaging; mechanism of action; pathophysiology.

Grants and funding

This work was supported by the National Australian Health and Medical Research Council (NHMRC Grant number APP1180854), for which P.N is the grant holder. C.F is the recipient of a Monash University post-graduate scholarship.