BT in asthma

Q: A 24-year-old male is admitted to ICU with a fourth exacerbation of Asthma within the last 6 months. The patient continued to fail all therapies despite full compliance. The patient has now registered for a Bronchial Thermoplasty (BT) trial. Which of the lobes is usually NOT treated during this procedure? - select one

A) Right upper lobe

B) Righe middle lobe

C) Right lower lobe

D) Left upper lobe

E) Left lower lobe

Answer: B

BT is a measure of extreme for patients who continued to fail all conventional medical therapy for Asthma. The procedure involves applying heat via localized controlled radiofrequency waves with a bronchoscope. It aims to reduce the increased mass of airway smooth muscle associated with asthma. 

The procedure is usually completed with three consecutive bronchoscopies three weeks apart. The target tissue temperature is kept at 65˚C for the airway walls. All accessible airways distal to the mainstem bronchus that are 3 to 10 mm in diameter are treated once, except those in the right middle lobe, which are left untreated due to difficulty with access.

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References:

1. Wahidi MM, Kraft M. Bronchial thermoplasty for severe asthma. Am J Respir Crit Care Med 2012; 185:709.

2. Langton D, Wang W, Sha J, et al. Predicting the Response to Bronchial Thermoplasty. J Allergy Clin Immunol Pract 2020; 8:1253.

3. Torrego A, Solà I, Munoz AM, et al. Bronchial thermoplasty for moderate or severe persistent asthma in adults. Cochrane Database Syst Rev 2014; :CD009910.

4. Chupp G, Kline JN, Khatri SB, et al. Bronchial Thermoplasty in Patients With Severe Asthma at 5 Years: The Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma Study. Chest 2022; 161:614.