@article {Svenningsen00268-2021, author = {Sarah Svenningsen and Parameswaran Nair and Rachel L Eddy and Marrissa J McIntosh and Melanie Kjarsgaard and Hui Fang Lim and David G. McCormack and Gerard Cox and Grace Parraga}, title = {Bronchial thermoplasty guided by hyperpolarised gas MRI in adults with severe asthma: a 1-year pilot randomised trial}, elocation-id = {00268-2021}, year = {2021}, doi = {10.1183/23120541.00268-2021}, publisher = {European Respiratory Society}, abstract = {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. Endpoints 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 compared to those who had standard BT (p=0.003). At 12-months, the mean improvement from baseline was similar in both groups for AQLQ score (MRI-guided n=5, 1.8 [95\% CI, 0.1 to 3.5], p=0.04; standard n=7, 0.7 [95\% CI, -0.9 to 2.3], p=0.30) (p=0.25) and ACQ-5 score (MRI-guided n=5, -1.4 [95\% CI, -2.6 to -0.2], p=0.03; standard n=7, -0.7 [95\% CI, -1.3 to 0.0], p=0.04) (p=0.17). A similar proportion of participants in both groups achieved a clinically relevant improvement in AQLQ (MRI-guided, 80\%; standard, 71\%) and ACQ-5 scores (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.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Svenningsen reports personal fees from AstraZeneca, personal fees from Novartis, grants from Cyclomedica, personal fees from Polarean, outside the submitted work.Conflict of interest: Dr. Nair reports grants and personal fees from AZ, grants from Novartis, grants and personal fees from Teva, grants from Sanofi, grants and personal fees from Roche, personal fees from Novartis, personal fees from Merck, personal fees from Equillium, grants from Foresee, outside the submitted work; .Conflict of interest: Dr. Eddy has nothing to disclose.Conflict of interest: Dr. McIntosh has nothing to disclose.Conflict of interest: Mrs Kjarsgaard has nothing to disclose.Dr. Kjarsgaard has nothing to disclose.Conflict of interest: Dr. Lim has nothing to disclose.Conflict of interest: Dr. McCormack has nothing to disclose.Conflict of interest: Dr. Cox has nothing to disclose.Conflict of interest: Dr. Parraga reports grants from Astra Zeneca plc and Novartis AG outside the submitted work.}, URL = {https://openres.ersjournals.com/content/early/2021/07/15/23120541.00268-2021}, eprint = {https://openres.ersjournals.com/content/early/2021/07/15/23120541.00268-2021.full.pdf}, journal = {ERJ Open Research} }