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

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

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...

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Bibliographic Details
Main Authors: Karan Madan, Saurabh Mittal, Tejas M Suri, Avinash Jain, Anant Mohan, Vijay Hadda, Pavan Tiwari, Randeep Guleria, Deepak Talwar, Sudhir Chaudhri, Virendra Singh, Rajesh Swarnakar, Sachidanand J Bharti, Rakesh Garg, Nishkarsh Gupta, Vinod Kumar, Ritesh Agarwal, Ashutosh N Aggarwal, Irfan I Ayub, Prashant N Chhajed, Amit Dhamija, Raja Dhar, Sahajal Dhooria, Hari K Gonuguntla, Rajiv Goyal, Parvaiz A Koul, Raj Kumar, Nagarjuna Maturu, Ravindra M Mehta, Ujjwal Parakh, Vallandaramam Pattabhiraman, Narasimhan Raghupathi, Inderpaul Singh Sehgal, Arjun Srinivasan, Kavitha Venkatnarayan
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2020-01-01
Series:Lung India
Subjects:
anesthesia
bronchial asthma
bronchial thermoplasty
prednisolone
Online Access:http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=1;spage=86;epage=96;aulast=Madan
Description
Summary: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.
ISSN:0970-2113
0974-598X

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