- Design
- Systematic review and meta-analysis (5 RCTs, 15 observational)
- Population
- Adults with severe uncontrolled asthma
- Primary outcome
- Asthma quality of life, control and exacerbations
- Effect
- RCTs: AQLQ +0.69 (0.30–1.09); ACQ −0.64; hospitalisation during treatment RR 3.50 (1.26–9.68)
This meta-analysis analysed five randomised trials and 15 observational studies of bronchial thermoplasty in adults with severe uncontrolled asthma, separately.
In the randomised trials, thermoplasty improved asthma quality of life (AQLQ +0.69) and control (ACQ −0.64) and morning peak flow (+21 L/min), but not rescue inhaler use or symptom-free days. Hospitalisation was 3.5 times more likely during the treatment period (RR 3.50, 95% CI 1.26–9.68), with no clear excess afterwards. Observational studies reported larger gains, including fewer exacerbations, but had no control groups.
The authors note that the gains came mainly from trials without sham control, which matters for symptom scores. Data alongside biologics and on long-term safety were limited. The procedure is not an established alternative to biologic therapy.
- Biologic therapy, where eligible, comes before bronchial thermoplasty in severe asthma.
- Consider thermoplasty only in carefully selected patients who cannot use or have not responded to biologics.
- Warn patients of a higher chance of admission during the treatment period.
- Confirm adherence, inhaler technique and comorbidities before labelling asthma as severe and refractory.
Why it matters
It places a procedure-based option behind biologics and tempers expectations built on uncontrolled data.
Don't overread it
Benefits rest largely on unblinded trials and uncontrolled cohorts.
The statistics, in plain English
An AQLQ improvement of 0.69 is just above the 0.5 often considered the smallest change a patient notices. Without sham control, part of that may be placebo effect.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for pulmonology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free