RT Journal Article
SR Electronic
T1 Bronchial thermoplasty guided by hyperpolarised gas magnetic resonance imaging in adults with severe asthma: a 1-year pilot randomised trial
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00268-2021
DO 10.1183/23120541.00268-2021
VO 7
IS 3
A1 Sarah Svenningsen
A1 Parameswaran Nair
A1 Rachel L. Eddy
A1 Marrissa J. McIntosh
A1 Melanie Kjarsgaard
A1 Hui Fang Lim
A1 David G. McCormack
A1 Gerard Cox
A1 Grace Parraga
YR 2021
UL http://openres.ersjournals.com/content/7/3/00268-2021.abstract
AB 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. End-points 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 than those who had standard BT (p=0.003). At 12 months, the mean improvement from baseline was similar between the MRI-guided group (n=5) and the standard group (n=7) for AQLQ score (MRI-guided: 1.8, 95% CI 0.1–3.5, p=0.04; standard: 0.7, 95% CI −0.9–2.3, p=0.30) (p=0.25) and ACQ-5 score (MRI-guided: −1.4, 95% CI −2.6– −0.2, p=0.03; standard: −0.7, 95% CI −1.3–0.0, p=0.04) (p=0.17). A similar proportion of participants in both groups achieved a clinically relevant improvement in AQLQ score (MRI-guided: 80%; standard: 71%) and ACQ-5 score (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.In adults with severe asthma, MRI-guided BT reduces the number of radiofrequency activations and bronchoscopy sessions, and results in asthma quality-of-life and control improvements at 12 months that are non-inferior to standard whole-lung BT https://bit.ly/3qWYjp4