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GENERAL PERSPECTIVE
Year : 2020  |  Volume : 37  |  Issue : 1  |  Page : 86-96

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


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

Correspondence Address:
Dr. Karan Madan
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_418_19

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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.


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