What Is New In Small Airways Research
By Ves Dimov, MD
Allergist / Immunologist
Assistant Professor of Medicine and Pediatrics
University of Chicago
Bronchial thermoplasty for treatment of severe persistent asthma shows 5-year durability of the benefits for disease control and safety
This study assessed effectiveness and safety of bronchial thermoplasty (BT) in 162 asthmatic patients 5 years after therapy.
The 5-year reduction was 44% for asthma exacerbations and 78% for ED visits compared to those observed in the 12 months before BT treatment. Respiratory-related hospitalizations remained unchanged. FEV1 values remained stable between years 1 and 5 after BT, despite an 18% reduction in daily inhaled corticosteroid dose.
High-resolution computed tomographic scans after BT showed no structural abnormalities that could be attributed to BT.
These data demonstrate the 5-year durability of the benefits of BT. BT should be considered for patients with severe persistent asthma who remain symptomatic despite therapy.
Source: Wechsler ME, Laviolette M, Rubin AS, Fiteman J, Lapa e Silva JR et al. Bronchial thermoplasty: Long-term safety and effectiveness in patients with severe persistent asthma. The Journal of Allergy and Clinical Immunology 2013; Corrected proof, published online ahead of print (September)
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Wheeze phenotypes in young children: no remission is observed in atopic multiple-trigger wheeze
This French study aimed to determine if three asthma phenotypes have different courses during the preschool period as part of the prospectively followed Trousseau Asthma Program cohort:
- early viral wheeze (EVW)
- atopic multiple-trigger wheeze (MTW)
- nonatopic uncontrolled wheeze (NAUW)
At age 5, children with mild EVW became asymptomatic or remained with mild EVW. Those with atopic MTW remained with atopic MTW and those with NAUW developed severe wheeze in most cases.
These results show that remission is most frequently observed in mild EVW and that no remission is observed in atopic MTW.
Source: Just J, Saint-Pierre P, Gouvis-Echraghi R, Boutin B, Panayotopoulos V et al. Wheeze phenotypes in young children have different courses during the preschool period. Annals of Allergy Asthma and Immunology 2013; 111(4): 256-261.e1. (doi:10.1016/j.anai.2013.07.002)
Mechanisms of airway remodeling: still no available therapy to prevent or reverse it (2013 review)
Airway remodeling comprises the structural changes of airway walls, induced by repeated injury and repair processes. It occurs in patients with chronic inflammatory airway diseases such as asthma, COPD, bronchiectasis, and cystic fibrosis. Airway remodeling is one of the most intractable problems in these diseases, leading to irreversible loss of lung function.
Current therapeutics can ameliorate inflammation, but there is no available therapy to prevent or reverse airway remodeling.
Airway remodeling is often considered the result of longstanding airway inflammation, but it may be present to an equivalent degree in the airways of children with asthma, raising the necessity for early and specific therapeutic interventions.
Source: Hirota N, Martin JG. Mechanisms of airway remodeling. Chest 2013; 144(3): 1026-1032. (doi:10.1378/chest.12-3073)