Nerve ablation after bronchial thermoplasty and sustained improvement in severe asthma

• Published in: BMC pulmonary medicine Vol. 18; no. 1; pp. 29 - 11
• Main Authors: Facciolongo, N., Di Stefano, A., Pietrini, V., Galeone, C., Bellanova, F., Menzella, F., Scichilone, N., Piro, R., Bajocchi, G. L., Balbi, B., Agostini, L., Salsi, P. P., Formisano, D., Lusuardi, M.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.02.2018; BioMed Central; BMC
• Subjects: Adult; Aged; Analysis; Asthma; Asthma - pathology; Asthma - physiopathology; Asthma - surgery; Biopsy; Bronchi - innervation; Bronchi - pathology; Bronchial biopsies; Bronchial Thermoplasty; Bronchoscopy; Female; Forced Expiratory Volume; Humans; Immunohistochemistry; Male; Methods; Middle Aged; Nerve fibers; Nerve Fibers - pathology; Physiological aspects; Residual Volume; Respiratory Mucosa - innervation; Respiratory Mucosa - pathology; Safety and security measures; Severe asthma; Smooth muscle; Total Lung Capacity; Treatment Outcome; Vital Capacity; Bronchoscopy; Nerve fibers; Bronchial thermoplasty; Severe asthma; Bronchial biopsies
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-017-0554-8

Bronchial thermoplasty (BT) is a non-pharmacological intervention for severe asthma whose mechanism of action is not completely explained by a reduction of airway smooth muscle (ASM). In this study we analyzed the effect of BT on nerve fibers and inflammatory components in the bronchial mucosa at 1 year. Endobronchial biopsies were obtained from 12 subjects (mean age 47 ± 11.3 years, 50% male) with severe asthma. Biopsies were performed at baseline (T0) and after 1 (T1), 2 (T2) and 12 (T12) months post-BT, and studied with immunocytochemistry and microscopy methods. Clinical data including Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ) scores, exacerbations, hospitalizations, oral corticosteroids use were also collected at the same time points. A statistically significant reduction at T1, T2 and T12 of nerve fibers was observed in the submucosa and in ASM compared to T0. Among inflammatory cells, only CD68 showed significant changes at all time points. Improvement of all clinical outcomes was documented and persisted at the end of follow up. A reduction of nerve fibers in epithelium and in ASM occurs earlier and persists at one year after BT. We propose that nerve ablation may contribute to mediate the beneficial effects of BT in severe asthma. Registered on April 2, 2013 at ClinicalTrials.gov Identifier: NCT01839591 .