Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial
Patient-specific localisation of ventilation defects using hyperpolarised gas magnetic resonance imaging (MRI) introduces the possibility of regionally targeted bronchial thermoplasty (BT) for the treatment of severe asthma. We aimed to demonstrate that BT guided by MRI to ventilation defects reduce...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2021-09-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/7/3/00268-2021.full |
| _version_ | 1818689975774871552 |
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| author | Sarah Svenningsen Parameswaran Nair Rachel L. Eddy Marrissa J. McIntosh Melanie Kjarsgaard Hui Fang Lim David G. McCormack Gerard Cox Grace Parraga |
| author_facet | Sarah Svenningsen Parameswaran Nair Rachel L. Eddy Marrissa J. McIntosh Melanie Kjarsgaard Hui Fang Lim David G. McCormack Gerard Cox Grace Parraga |
| author_sort | Sarah Svenningsen |
| collection | DOAJ |
| description | Patient-specific localisation of ventilation defects using hyperpolarised gas magnetic resonance imaging (MRI) introduces the possibility of regionally targeted bronchial thermoplasty (BT) for the treatment of severe asthma. We aimed to demonstrate that BT guided by MRI to ventilation defects reduces the number of radiofrequency activations while resulting in improved asthma quality-of-life and control scores that are non-inferior to standard BT. In a 1-year pilot randomised controlled trial, 14 patients with severe asthma who were clinically eligible to receive BT underwent hyperpolarised gas MRI to characterise ventilation defects and were randomised to MRI-guided or standard BT. End-points were improved Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ) scores, the proportion of AQLQ and ACQ responders and the number of radiofrequency activations and bronchoscopy sessions. Participants who underwent MRI-guided BT received 53% fewer radiofrequency activations than those who had standard BT (p=0.003). At 12 months, the mean improvement from baseline was similar between the MRI-guided group (n=5) and the standard group (n=7) for AQLQ score (MRI-guided: 1.8, 95% CI 0.1–3.5, p=0.04; standard: 0.7, 95% CI −0.9–2.3, p=0.30) (p=0.25) and ACQ-5 score (MRI-guided: −1.4, 95% CI −2.6– −0.2, p=0.03; standard: −0.7, 95% CI −1.3–0.0, p=0.04) (p=0.17). A similar proportion of participants in both groups achieved a clinically relevant improvement in AQLQ score (MRI-guided: 80%; standard: 71%) and ACQ-5 score (MRI-guided: 80%; standard: 57%). Hyperpolarised gas MRI-guided BT reduced the number of radiofrequency activations, and resulted in asthma quality of life and control improvements at 12 months that were non-inferior to standard BT. |
| first_indexed | 2024-12-17T12:18:39Z |
| format | Article |
| id | doaj.art-59fe0ecdbaa24a37a36aefada78a54f5 |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-12-17T12:18:39Z |
| publishDate | 2021-09-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-59fe0ecdbaa24a37a36aefada78a54f52022-12-21T21:49:05ZengEuropean Respiratory SocietyERJ Open Research2312-05412021-09-017310.1183/23120541.00268-202100268-2021Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trialSarah Svenningsen0Parameswaran Nair1Rachel L. Eddy2Marrissa J. McIntosh3Melanie Kjarsgaard4Hui Fang Lim5David G. McCormack6Gerard Cox7Grace Parraga8 Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada Robarts Research Institute, Western University, London, Canada Robarts Research Institute, Western University, London, Canada Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada Dept of Medicine, Division of Respirology, Western University, London, Canada Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada Robarts Research Institute, Western University, London, Canada Patient-specific localisation of ventilation defects using hyperpolarised gas magnetic resonance imaging (MRI) introduces the possibility of regionally targeted bronchial thermoplasty (BT) for the treatment of severe asthma. We aimed to demonstrate that BT guided by MRI to ventilation defects reduces the number of radiofrequency activations while resulting in improved asthma quality-of-life and control scores that are non-inferior to standard BT. In a 1-year pilot randomised controlled trial, 14 patients with severe asthma who were clinically eligible to receive BT underwent hyperpolarised gas MRI to characterise ventilation defects and were randomised to MRI-guided or standard BT. End-points were improved Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ) scores, the proportion of AQLQ and ACQ responders and the number of radiofrequency activations and bronchoscopy sessions. Participants who underwent MRI-guided BT received 53% fewer radiofrequency activations than those who had standard BT (p=0.003). At 12 months, the mean improvement from baseline was similar between the MRI-guided group (n=5) and the standard group (n=7) for AQLQ score (MRI-guided: 1.8, 95% CI 0.1–3.5, p=0.04; standard: 0.7, 95% CI −0.9–2.3, p=0.30) (p=0.25) and ACQ-5 score (MRI-guided: −1.4, 95% CI −2.6– −0.2, p=0.03; standard: −0.7, 95% CI −1.3–0.0, p=0.04) (p=0.17). A similar proportion of participants in both groups achieved a clinically relevant improvement in AQLQ score (MRI-guided: 80%; standard: 71%) and ACQ-5 score (MRI-guided: 80%; standard: 57%). Hyperpolarised gas MRI-guided BT reduced the number of radiofrequency activations, and resulted in asthma quality of life and control improvements at 12 months that were non-inferior to standard BT.http://openres.ersjournals.com/content/7/3/00268-2021.full |
| spellingShingle | Sarah Svenningsen Parameswaran Nair Rachel L. Eddy Marrissa J. McIntosh Melanie Kjarsgaard Hui Fang Lim David G. McCormack Gerard Cox Grace Parraga Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial ERJ Open Research |
| title | Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial |
| title_full | Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial |
| title_fullStr | Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial |
| title_full_unstemmed | Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial |
| title_short | Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial |
| title_sort | bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma a 1 year pilot randomised trial |
| url | http://openres.ersjournals.com/content/7/3/00268-2021.full |
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