Bronchial Thermoplasty in Severe Asthma: Bridging Randomised and Real-World Evidence: A Systematic Review and Meta-Analysis.
Maria João Lúcio, Maria Luiza Pereira, Catarina Barata et al.
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In 30 seconds
This systematic review and meta-analysis assessed bronchial thermoplasty (BT) efficacy and safety in adults with severe uncontrolled asthma, analysing randomised controlled trials (RCTs) separately from observational studies. Across 20 studies (five RCTs and 15 observational studies), RCTs found improved asthma-related quality of life (AQLQ; MD, 0.69; 95% CI 0.30-1.09), asthma control, and morning peak expiratory flow, but not rescue medication use or symptom-free days. Hospitalisation risk increased during treatment (RR, 3.50; 95% CI, 1.26-9.68). Real-world studies also reported improvements, but were uncontrolled.
Key findings
- In RCTs, BT improved AQLQ (MD, 0.69; 95% CI 0.30-1.09) and asthma control (ACQ; MD,-0.64; 95%CI, -1.10 to -0.19).
- BT increased hospitalisation risk during treatment in RCTs (RR, 3.50; 95%CI, 1.26-9.68), with no significant excess thereafter.
- Observational studies reported reduced annualised exacerbation rates (MD, -3.79 exacerbations/patient-year; 95%CI, -6.98 to -0.61).
- Evidence for corticosteroid-sparing effects was possible but inconsistent; data on biologics and long-term safety were limited.
Why it matters
The findings suggest BT can improve quality of life and asthma control, while highlighting a short-term hospitalisation risk and uncertainty about longer-term safety and corticosteroid reduction. The distinction between randomised and uncontrolled real-world evidence is important when interpreting apparent benefits, particularly because the review does not establish BT as an alternative to biologic therapy.
What to keep in mind
Real-world findings came from uncontrolled studies, and trial benefits were mainly observed in studies without sham controls. Data on biologics and long-term safety were limited.