Endoscopic lung volume reduction (ELVR) is recognised in both national and international expert g... more Endoscopic lung volume reduction (ELVR) is recognised in both national and international expert guidelines as one of the few additive treatments to benefit patients with advanced chronic obstructive pulmonary disease (COPD) who are otherwise receiving optimal medical and supportive care. Despite these recommendations and a growing evidence base, these procedures are not widely offered across Australia and New Zealand, and general practitioner and physician awareness of this therapy can be improved. ELVR aims to mitigate the impact of hyperinflation and gas trapping on dyspnoea and exercise intolerance in COPD. Effective ELVR is of proven benefit in improving symptoms, quality of life, lung function and survival. Several endoscopic techniques to achieve ELVR have been developed, with endobronchial valve placement to collapse a single lobe being the most widely studied and commonly practised. This review describes the physiological rationale underpinning lung volume reduction, highlights the challenges of patient selection, and provides an overview of the evidence for current and investigational endoscopic interventions for COPD.
Journal of Bronchology & Interventional Pulmonology
To the Editor: Endoscopic lung volume reduction (ELVR) utilizing endobronchial valves (EBVs) is a... more To the Editor: Endoscopic lung volume reduction (ELVR) utilizing endobronchial valves (EBVs) is an evidence-based treatment for patients with advanced emphysema and is included in the current Global Initiative for Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease management.1 A crucial predictor of a beneficial response is the absence of collateral ventilation (CV); the free flow of air between the targeted and adjacent lobe(s). CV may be assessed pre-ELVR either anatomically or functionally. Anatomically, the presence of CV can be determined using a highresolution computed tomography (HRCT) by assessing the integrity of interlobar fissures and may be calculated by automated software analysis (STRATX; Pulmonx). The same software programs can additionally calculate emphysema destruction scores to help select an appropriate target lobe. Functional assessment is performed using a bronchial blocker to occlude the target lobe, with a distal catheter measuring breath by breath flow (CHARTIS; Pulmonx). Flow should diminish with time in the absence of CV.2 An European expert panel recommendation suggests that for ELVR, valves may be inserted without CHARTIS if the targeted lobe has >95% fissure completeness.2 The panel recommends against ELVR with EBVs if the targeted lobe has <80% fissure completeness. For fissures assessed to be 80% to 95% complete, CHARTIS assessment is recommended to determine the presence or absence of CV and hence the suitability for ELVR. AeriSeal (Pulmonx) is a polymer sealant, developed as a means of achieving lung volume reduction.3,4 This foam polymer (polyvinyl alcohol and glutaraldehyde) acts as a tissue glue, and obstructs peripheral airways, alveoli, and collateral channels, leading to, atelectasis and volume reduction, known as absorption atelectasis. However, early trials using up to 100mL of sealant were limited by adverse reactions including chronic obstructive pulmonary disease exacerbations and systemic flu-like illness, suggesting a dose-related acute inflammatory response. Currently, trials are ongoing evaluating varying doses and delivery methods of the biopolymer. In a prospective controlled clinical trial, approved by the Macquarie University Human Research Ethics Committee (No. MQCRG2018048), we hypothesize that a limited amount of AeriSeal could seal the defect in an incomplete fissure; converting a CV positive lobe to a CV negative lobe, when delivered to targeted airway segment(s) mapped using HRCT. Once sealed, the lobe could then be treated with endoscopic valves to achieve atelectasis. This ongoing study is recruiting patients with severe emphysema meeting standard criteria for ELVR using EBVs, with fissure integrity measured anatomically between 80% and 95%. Control subjects fulfill similar criteria but with fissure integrity > 95%. To adequately power this trial, 14 patients in each arm are required to be recruited. Here, we present our first patient treated as proof of concept. A 66-year-old male individual, former smoker of 50 pack-years with severe emphysema (forced expiratory volume in 1 s 0.98L, 31% predicted; total lung capacity 9.65L, 141% predicted; and residual volume 6.76L, 270% predicted) was referred for ELVR. The left upper lobe (LUL) was deemed to be a suitable target for EBVs based on emphysema destruction scoring and singlephoton emission computed tomography-computed tomography ventilation/perfusion scans. However, automated HRCT analysis using STRATX revealed left oblique fissure integrity of only 83.2%, indicating a high likelihood of the presence of CV. CHARTIS assessment of the LUL confirmed the presence of CV (Fig. 1). Mapping of the left oblique fissure using proprietary HRCT software indicated a region of deficiency supplied by the superior (LB4) and DOI: 10.1097/LBR.0000000000000634 This case report is the first patient enrolled in an investigator-initiated trial which is partially supported by funding from Pulmonx Australia. Disclosure: There is no conflict of interest or other disclosures. Letters to the Editor J Bronchol Intervent Pulmonol Volume 27, Number 1, January 2020
The most effective management of cough is specific therapy, which results in a greater than 90% r... more The most effective management of cough is specific therapy, which results in a greater than 90% response rate, so the cause should be thoroughly investigated. A chest x-ray should be taken early in the clinical investigation of chronic cough. The three most common causes of chronic cough when chest x-rays are normal are postnasal drip, bronchial asthma and gastro-oesophageal reflux. Chronic cough has more than one cause in 20% of patients, so therapy may need to be directed at multiple causes. Gastro-oesophageal reflux may complicate cough from any cause because a cough-reflux feedback cycle can develop. Hence, a four-week trial of an H2-receptor antagonist is indicated in patients with unexplained chronic cough where the history, physical examination, chest x-ray, lung function tests, ear/nose/throat examination and home peak flow monitoring all fail to elucidate a cause. Non-specific therapy should be reserved for when no diagnosis can be made, or when therapy is likely to be ineffective (e.g., lung malignancy).
Management of recurrent haemoptysis poses a difficult clinical scenario. TISSEEL (Baxter Healthca... more Management of recurrent haemoptysis poses a difficult clinical scenario. TISSEEL (Baxter Healthcare Corporation Deerfield, IL, USA) is a fibrin sealant often used in surgery to aid control of bleeding. However, when endoscopic TISSEEL is used independently, migration, dislodgement, or even expectoration of the fibrin clot is a common complication that may lead to recurrence of haemoptysis. Here we describe two patients with recurrent haemoptysis in the context of malignancy who underwent bronchoscopy, during which they were managed with application of topical TIS-SEEL to the bleeding area, followed by deployment of an intrabronchial valve, followed by a further application of TISSEEL over the valve. The combination of TISSEEL and intrabronchial valve appeared to control haemoptysis and was resistant to expectoration or migration in these two cases. Thus, this combination may provide a safe and effective therapeutic option for the control of bronchial bleeding secondary to malignancy.
Background and objective: Bronchial thermoplasty (BT) has been consistently shown to reduce sympt... more Background and objective: Bronchial thermoplasty (BT) has been consistently shown to reduce symptoms, exacerbations and the need for reliever medication in patients with severe asthma. Paradoxically, no consistent improvement in spirometry has been demonstrated. It has been suggested that this is due to a reduction in peripheral resistance in small airways, not captured by spirometry. Therefore, in this study, we evaluate the response to BT using oscillometry. Methods: A total of 43 patients with severe asthma from two centres were evaluated at baseline, 6 weeks and 6 months post BT, using spirometry, plethysmography and oscillometry, in addition to medication usage, exacerbation frequency and the Asthma Control Questionnaire (5-item version) (ACQ-5). Results: The mean age was 58.4 AE 11.2 years, forced expiratory volume in 1 s (FEV 1) 55.5 AE 20.1% predicted, forced expiratory ratio 53.0 AE 14.5% and FEV 1 response to salbutamol was 14.0 AE 14.5%. Following BT, the group responded to treatment with an improvement in ACQ-5 from 2.9 AE 0.9 at baseline to 1.7 AE 1.1 at 6 months (P < 0.005). There was an 81% reduction in exacerbation frequency (P < 0.001) and 50% of patients were weaned completely from maintenance oral corticosteroids. No changes after treatment were observed in spirometry but the residual volume reduced from 147 AE 38% to 139 AE 39% predicted (P < 0.01). Baseline oscillometry demonstrated high levels of resistance at 5 Hz with normal resistance at 20 Hz, indicating resistance in the small airways was elevated, but no changes were observed in any oscillometry parameter after BT treatment. Conclusion: Lung impedance measured with oscillometry did not change following BT despite marked clinical improvements in patients with severe asthma.
In randomized controlled trials, bronchial thermoplasty (BT) has been proven to reduce symptoms i... more In randomized controlled trials, bronchial thermoplasty (BT) has been proven to reduce symptoms in severe asthma, but the mechanisms by which this is achieved are uncertain as most studies have shown no improvement in spirometry. We postulated that BT might improve lung mechanics by altering airway resistance in the small airways of the lung in ways not measured by FEV. This study aimed to evaluate changes in measures of gas trapping by body plethysmography. A prospective cohort of 32 consecutive patients with severe asthma who were listed for BT at two Australian university hospitals were evaluated at three time points, namely baseline, and then 6 weeks and 6 months post completion of all procedures. At each evaluation, medication usage, symptom scores (Asthma Control Questionnaire, ACQ-5) and exacerbation history were obtained, and lung function was evaluated by (i) spirometry (ii) gas diffusion (KCO) and (iii) static lung volumes by body plethysmography. ACQ-5 improved from 3.0 ±...
A characteristic feature of asthma is hypertrophied airway smooth muscle, responsible for broncho... more A characteristic feature of asthma is hypertrophied airway smooth muscle, responsible for bronchoconstriction. This is the target of bronchial thermoplasty (BT). It is known that with increasing time and severity some patients develop remodelled airways with fixed airflow obstruction. The question arises whether these patients will still respond to BT. Forty-nine consecutive severe asthmatic patients were prospectively evaluated at baseline and then 6 months after BT. The characteristics recorded included medication usage, exacerbation history, spirometry and the Asthma Control Questionnaire 5-Item Version score (ACQ-5). Seven patients were excluded as they did not demonstrate airflow obstruction at baseline (forced expiratory ratio (forced expiratory volume in 1 s (FEV )/forced vital capacity (FVC)) < 70%). The remaining 42 patients were divided into two cohorts based on their response to bronchodilator. Eighteen patients in whom the FEV improved by at least 12% and 200 mL follo...
Journal of bronchology & interventional pulmonology, 2018
Endoscopic lung volume reduction (ELVR) has been shown to improve lung function, quality of life,... more Endoscopic lung volume reduction (ELVR) has been shown to improve lung function, quality of life, and exercise tolerance in patients with severe heterogeneous emphysema. Our study aims to determine the effect of ELVR on gas transfer capacity corrected for alveolar volume (KCO) and investigate the relationship between KCO and ventilation and perfusion (VQ) matching. We speculate on possible mechanisms for the observed changes METHODS:: Patients with severe chronic obstructive pulmonary disease were prospectively recruited and underwent unilateral upper lobe ELVR between 2012 and 2014. Each had respiratory function test and differential VQ scans at baseline, 1-, 3-, and 12-month post-ELVR. In total, 11 patients had 3 sets of respiratory function test (at baseline, 1, and 3 mo), whereas 7 had 4 sets (at baseline, 1, 3, and 12 mo). KCO improved by 10.3 (±7.5)% at 1 month (P=NS) and 39.8 (±15.4)% at 12 months (P<0.05). VQ of the nontargeted lung increased by 12.8 (±5.6)% and 7.9 (±2.3...
Bronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe... more Bronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe asthma. The predictive factors for clinical response to BT are unknown. We examined the relationship between the number of radiofrequency activations applied and the treatment response observed. Data were collected from 24 consecutive cases treated at three Australian centres from June 2014 to March 2016. The baseline characteristics were collated along with the activations delivered. The primary response measure was change in the Asthma Control Questionnaire-5 (ACQ-5) score measured at 6 months post BT. The relationship between change in outcome parameters and the number of activations delivered was explored. All patients met the ERS/ATS definition for severe asthma. At 6 months post treatment, mean ACQ-5 improved from 3.3 ± 1.1 to 1.5 ± 1.1, p < 0.001. The minimal clinically significant improvement in ACQ-5 of ≥0.5 was observed in 21 out of 24 patients. The only significant variabl...
Bronchial thermoplasty (BT) is an approved bronchoscopic intervention for the treatment of severe... more Bronchial thermoplasty (BT) is an approved bronchoscopic intervention for the treatment of severe asthma. However, limited published experience exists outside of clinical trials regarding patient selection and outcomes achieved. To evaluate the effectiveness and safety of BT in patients with severe asthma encountered in clinical practice. This is a retrospective analysis of the first 'real world' data from Australia. The following outcomes were measured prior to, and 6 months following BT: spirometry, Asthma Control Questionnaire-5 (ACQ-5) score, reliever and preventer medication use and exacerbation history. Twenty patients were treated from June 2014 to December 2015 at three university teaching hospitals. All subjects met the European Respiratory Society/American Thoracic Society definition of severe asthma. Mean pre-bronchodilator forced expiratory volume in 1 s was 62.8 ± 16.6% predicted (range: 33-95%). All patients were being treated with high dose inhaled corticoster...
Endoscopic lung volume reduction (ELVR) is recognised in both national and international expert g... more Endoscopic lung volume reduction (ELVR) is recognised in both national and international expert guidelines as one of the few additive treatments to benefit patients with advanced chronic obstructive pulmonary disease (COPD) who are otherwise receiving optimal medical and supportive care. Despite these recommendations and a growing evidence base, these procedures are not widely offered across Australia and New Zealand, and general practitioner and physician awareness of this therapy can be improved. ELVR aims to mitigate the impact of hyperinflation and gas trapping on dyspnoea and exercise intolerance in COPD. Effective ELVR is of proven benefit in improving symptoms, quality of life, lung function and survival. Several endoscopic techniques to achieve ELVR have been developed, with endobronchial valve placement to collapse a single lobe being the most widely studied and commonly practised. This review describes the physiological rationale underpinning lung volume reduction, highlights the challenges of patient selection, and provides an overview of the evidence for current and investigational endoscopic interventions for COPD.
Journal of Bronchology & Interventional Pulmonology
To the Editor: Endoscopic lung volume reduction (ELVR) utilizing endobronchial valves (EBVs) is a... more To the Editor: Endoscopic lung volume reduction (ELVR) utilizing endobronchial valves (EBVs) is an evidence-based treatment for patients with advanced emphysema and is included in the current Global Initiative for Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease management.1 A crucial predictor of a beneficial response is the absence of collateral ventilation (CV); the free flow of air between the targeted and adjacent lobe(s). CV may be assessed pre-ELVR either anatomically or functionally. Anatomically, the presence of CV can be determined using a highresolution computed tomography (HRCT) by assessing the integrity of interlobar fissures and may be calculated by automated software analysis (STRATX; Pulmonx). The same software programs can additionally calculate emphysema destruction scores to help select an appropriate target lobe. Functional assessment is performed using a bronchial blocker to occlude the target lobe, with a distal catheter measuring breath by breath flow (CHARTIS; Pulmonx). Flow should diminish with time in the absence of CV.2 An European expert panel recommendation suggests that for ELVR, valves may be inserted without CHARTIS if the targeted lobe has >95% fissure completeness.2 The panel recommends against ELVR with EBVs if the targeted lobe has <80% fissure completeness. For fissures assessed to be 80% to 95% complete, CHARTIS assessment is recommended to determine the presence or absence of CV and hence the suitability for ELVR. AeriSeal (Pulmonx) is a polymer sealant, developed as a means of achieving lung volume reduction.3,4 This foam polymer (polyvinyl alcohol and glutaraldehyde) acts as a tissue glue, and obstructs peripheral airways, alveoli, and collateral channels, leading to, atelectasis and volume reduction, known as absorption atelectasis. However, early trials using up to 100mL of sealant were limited by adverse reactions including chronic obstructive pulmonary disease exacerbations and systemic flu-like illness, suggesting a dose-related acute inflammatory response. Currently, trials are ongoing evaluating varying doses and delivery methods of the biopolymer. In a prospective controlled clinical trial, approved by the Macquarie University Human Research Ethics Committee (No. MQCRG2018048), we hypothesize that a limited amount of AeriSeal could seal the defect in an incomplete fissure; converting a CV positive lobe to a CV negative lobe, when delivered to targeted airway segment(s) mapped using HRCT. Once sealed, the lobe could then be treated with endoscopic valves to achieve atelectasis. This ongoing study is recruiting patients with severe emphysema meeting standard criteria for ELVR using EBVs, with fissure integrity measured anatomically between 80% and 95%. Control subjects fulfill similar criteria but with fissure integrity > 95%. To adequately power this trial, 14 patients in each arm are required to be recruited. Here, we present our first patient treated as proof of concept. A 66-year-old male individual, former smoker of 50 pack-years with severe emphysema (forced expiratory volume in 1 s 0.98L, 31% predicted; total lung capacity 9.65L, 141% predicted; and residual volume 6.76L, 270% predicted) was referred for ELVR. The left upper lobe (LUL) was deemed to be a suitable target for EBVs based on emphysema destruction scoring and singlephoton emission computed tomography-computed tomography ventilation/perfusion scans. However, automated HRCT analysis using STRATX revealed left oblique fissure integrity of only 83.2%, indicating a high likelihood of the presence of CV. CHARTIS assessment of the LUL confirmed the presence of CV (Fig. 1). Mapping of the left oblique fissure using proprietary HRCT software indicated a region of deficiency supplied by the superior (LB4) and DOI: 10.1097/LBR.0000000000000634 This case report is the first patient enrolled in an investigator-initiated trial which is partially supported by funding from Pulmonx Australia. Disclosure: There is no conflict of interest or other disclosures. Letters to the Editor J Bronchol Intervent Pulmonol Volume 27, Number 1, January 2020
The most effective management of cough is specific therapy, which results in a greater than 90% r... more The most effective management of cough is specific therapy, which results in a greater than 90% response rate, so the cause should be thoroughly investigated. A chest x-ray should be taken early in the clinical investigation of chronic cough. The three most common causes of chronic cough when chest x-rays are normal are postnasal drip, bronchial asthma and gastro-oesophageal reflux. Chronic cough has more than one cause in 20% of patients, so therapy may need to be directed at multiple causes. Gastro-oesophageal reflux may complicate cough from any cause because a cough-reflux feedback cycle can develop. Hence, a four-week trial of an H2-receptor antagonist is indicated in patients with unexplained chronic cough where the history, physical examination, chest x-ray, lung function tests, ear/nose/throat examination and home peak flow monitoring all fail to elucidate a cause. Non-specific therapy should be reserved for when no diagnosis can be made, or when therapy is likely to be ineffective (e.g., lung malignancy).
Management of recurrent haemoptysis poses a difficult clinical scenario. TISSEEL (Baxter Healthca... more Management of recurrent haemoptysis poses a difficult clinical scenario. TISSEEL (Baxter Healthcare Corporation Deerfield, IL, USA) is a fibrin sealant often used in surgery to aid control of bleeding. However, when endoscopic TISSEEL is used independently, migration, dislodgement, or even expectoration of the fibrin clot is a common complication that may lead to recurrence of haemoptysis. Here we describe two patients with recurrent haemoptysis in the context of malignancy who underwent bronchoscopy, during which they were managed with application of topical TIS-SEEL to the bleeding area, followed by deployment of an intrabronchial valve, followed by a further application of TISSEEL over the valve. The combination of TISSEEL and intrabronchial valve appeared to control haemoptysis and was resistant to expectoration or migration in these two cases. Thus, this combination may provide a safe and effective therapeutic option for the control of bronchial bleeding secondary to malignancy.
Background and objective: Bronchial thermoplasty (BT) has been consistently shown to reduce sympt... more Background and objective: Bronchial thermoplasty (BT) has been consistently shown to reduce symptoms, exacerbations and the need for reliever medication in patients with severe asthma. Paradoxically, no consistent improvement in spirometry has been demonstrated. It has been suggested that this is due to a reduction in peripheral resistance in small airways, not captured by spirometry. Therefore, in this study, we evaluate the response to BT using oscillometry. Methods: A total of 43 patients with severe asthma from two centres were evaluated at baseline, 6 weeks and 6 months post BT, using spirometry, plethysmography and oscillometry, in addition to medication usage, exacerbation frequency and the Asthma Control Questionnaire (5-item version) (ACQ-5). Results: The mean age was 58.4 AE 11.2 years, forced expiratory volume in 1 s (FEV 1) 55.5 AE 20.1% predicted, forced expiratory ratio 53.0 AE 14.5% and FEV 1 response to salbutamol was 14.0 AE 14.5%. Following BT, the group responded to treatment with an improvement in ACQ-5 from 2.9 AE 0.9 at baseline to 1.7 AE 1.1 at 6 months (P < 0.005). There was an 81% reduction in exacerbation frequency (P < 0.001) and 50% of patients were weaned completely from maintenance oral corticosteroids. No changes after treatment were observed in spirometry but the residual volume reduced from 147 AE 38% to 139 AE 39% predicted (P < 0.01). Baseline oscillometry demonstrated high levels of resistance at 5 Hz with normal resistance at 20 Hz, indicating resistance in the small airways was elevated, but no changes were observed in any oscillometry parameter after BT treatment. Conclusion: Lung impedance measured with oscillometry did not change following BT despite marked clinical improvements in patients with severe asthma.
In randomized controlled trials, bronchial thermoplasty (BT) has been proven to reduce symptoms i... more In randomized controlled trials, bronchial thermoplasty (BT) has been proven to reduce symptoms in severe asthma, but the mechanisms by which this is achieved are uncertain as most studies have shown no improvement in spirometry. We postulated that BT might improve lung mechanics by altering airway resistance in the small airways of the lung in ways not measured by FEV. This study aimed to evaluate changes in measures of gas trapping by body plethysmography. A prospective cohort of 32 consecutive patients with severe asthma who were listed for BT at two Australian university hospitals were evaluated at three time points, namely baseline, and then 6 weeks and 6 months post completion of all procedures. At each evaluation, medication usage, symptom scores (Asthma Control Questionnaire, ACQ-5) and exacerbation history were obtained, and lung function was evaluated by (i) spirometry (ii) gas diffusion (KCO) and (iii) static lung volumes by body plethysmography. ACQ-5 improved from 3.0 ±...
A characteristic feature of asthma is hypertrophied airway smooth muscle, responsible for broncho... more A characteristic feature of asthma is hypertrophied airway smooth muscle, responsible for bronchoconstriction. This is the target of bronchial thermoplasty (BT). It is known that with increasing time and severity some patients develop remodelled airways with fixed airflow obstruction. The question arises whether these patients will still respond to BT. Forty-nine consecutive severe asthmatic patients were prospectively evaluated at baseline and then 6 months after BT. The characteristics recorded included medication usage, exacerbation history, spirometry and the Asthma Control Questionnaire 5-Item Version score (ACQ-5). Seven patients were excluded as they did not demonstrate airflow obstruction at baseline (forced expiratory ratio (forced expiratory volume in 1 s (FEV )/forced vital capacity (FVC)) < 70%). The remaining 42 patients were divided into two cohorts based on their response to bronchodilator. Eighteen patients in whom the FEV improved by at least 12% and 200 mL follo...
Journal of bronchology & interventional pulmonology, 2018
Endoscopic lung volume reduction (ELVR) has been shown to improve lung function, quality of life,... more Endoscopic lung volume reduction (ELVR) has been shown to improve lung function, quality of life, and exercise tolerance in patients with severe heterogeneous emphysema. Our study aims to determine the effect of ELVR on gas transfer capacity corrected for alveolar volume (KCO) and investigate the relationship between KCO and ventilation and perfusion (VQ) matching. We speculate on possible mechanisms for the observed changes METHODS:: Patients with severe chronic obstructive pulmonary disease were prospectively recruited and underwent unilateral upper lobe ELVR between 2012 and 2014. Each had respiratory function test and differential VQ scans at baseline, 1-, 3-, and 12-month post-ELVR. In total, 11 patients had 3 sets of respiratory function test (at baseline, 1, and 3 mo), whereas 7 had 4 sets (at baseline, 1, 3, and 12 mo). KCO improved by 10.3 (±7.5)% at 1 month (P=NS) and 39.8 (±15.4)% at 12 months (P<0.05). VQ of the nontargeted lung increased by 12.8 (±5.6)% and 7.9 (±2.3...
Bronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe... more Bronchial thermoplasty (BT) is an emerging bronchoscopic intervention for the treatment of severe asthma. The predictive factors for clinical response to BT are unknown. We examined the relationship between the number of radiofrequency activations applied and the treatment response observed. Data were collected from 24 consecutive cases treated at three Australian centres from June 2014 to March 2016. The baseline characteristics were collated along with the activations delivered. The primary response measure was change in the Asthma Control Questionnaire-5 (ACQ-5) score measured at 6 months post BT. The relationship between change in outcome parameters and the number of activations delivered was explored. All patients met the ERS/ATS definition for severe asthma. At 6 months post treatment, mean ACQ-5 improved from 3.3 ± 1.1 to 1.5 ± 1.1, p < 0.001. The minimal clinically significant improvement in ACQ-5 of ≥0.5 was observed in 21 out of 24 patients. The only significant variabl...
Bronchial thermoplasty (BT) is an approved bronchoscopic intervention for the treatment of severe... more Bronchial thermoplasty (BT) is an approved bronchoscopic intervention for the treatment of severe asthma. However, limited published experience exists outside of clinical trials regarding patient selection and outcomes achieved. To evaluate the effectiveness and safety of BT in patients with severe asthma encountered in clinical practice. This is a retrospective analysis of the first 'real world' data from Australia. The following outcomes were measured prior to, and 6 months following BT: spirometry, Asthma Control Questionnaire-5 (ACQ-5) score, reliever and preventer medication use and exacerbation history. Twenty patients were treated from June 2014 to December 2015 at three university teaching hospitals. All subjects met the European Respiratory Society/American Thoracic Society definition of severe asthma. Mean pre-bronchodilator forced expiratory volume in 1 s was 62.8 ± 16.6% predicted (range: 33-95%). All patients were being treated with high dose inhaled corticoster...
Uploads
Papers by Alvin Ing