Bronchial Thermoplasty in Severe Asthma: Bridging Randomised and Real-World Evidence: A Systematic Review and Meta-Analysis.
7 affiliations
- 1Pulmonology Department, Hospital Egas Moniz, Unidade Local de Saúde Lisboa Ocidental, 1349-019 Lisboa, Portugal.
- 2Faculty of Medicine, Universidade Nove de Julho, São Paulo 01525-000, Brazil.
- 3Severe Asthma Medical Unit, Unidade Local de Saúde Santa Maria, 1649-035 Lisboa, Portugal.
- 4Instituto de Saúde Ambiental (ISAMB), Faculty of Medicine, University of Lisbon, 1649-028 Lisboa, Portugal.
- 5Department of Medicine, Medical City Hospital for Military and Security Services, P.O. Box 721, Muscat 111, Oman.
- 6Medical Center, University of Pittsburgh, Pittsburgh, PA 15213, USA.
- 7College of Medicine, Drexel University, Philadelphia, PA 19129, USA.
Abstract
Introduction: Bronchial thermoplasty (BT) reduces airway smooth muscle and may benefit severe asthma, but its role alongside biologics remains unclear. We assessed randomised and real-world evidence on efficacy and safety. Methods: We searched PubMed, Scopus, and Cochrane Library for RCTs and observational studies of BT in adults with severe uncontrolled asthma, analysing them separately. Results: Twenty studies were included (five RCTs, 15 observational). In RCTs, BT improved asthma-related quality of life (AQLQ;MD, 0.69; 95% CI 0.30-1.09), asthma control (ACQ; MD,-0.64; 95%CI, -1.10 to -0.19), and morning peak expiratory flow (MD, 20.62 L/min; 95% CI, 4.92-36.32), but did not improve rescue medication use or symptom-free-days. BT increased the risk of hospitalisation during the treatment period (RR, 3.50; 95%CI, 1.26-9.68), with no significant excess thereafter. Real-world studies showed improvements in AQLQ (MD,1.38; 95%CI, 0.97-1.80), ACQ (MD,-1.24; 95%CI, -1.86 to -0.62), and annualised exacerbation rates (MD, -3.79 exacerbations/patient-year; 95%CI, -6.98 to -0.61). Evidence suggested a possible, inconsistent corticosteroid-sparing effect; data on biologics and long-term safety were limited. Conclusions: BT improved asthma-related quality of life and control, mainly in trials without sham controls, but increased short-term hospitalisation risk. Real-world findings were similar but came from uncontrolled studies. BT is not an established alternative to biologics, but may suit carefully selected patients with severe asthma who cannot use or do not respond to them.
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BibTeX
@article{lucio2026bronchial,
title = {{Bronchial Thermoplasty in Severe Asthma: Bridging Randomised and Real-World Evidence: A Systematic Review and Meta-Analysis.}},
author = {Maria João Lúcio and Maria Luiza Pereira and Catarina Barata and Carlos Lopes and Jafar Aljazeeri},
journal = {Advances in respiratory medicine},
year = {2026},
month = oct,
doi = {10.3390/arm94050077},
url = {https://europepmc.org/article/MED/42930055},
note = {CC BY},
}
RIS
TY - JOUR
TI - Bronchial Thermoplasty in Severe Asthma: Bridging Randomised and Real-World Evidence: A Systematic Review and Meta-Analysis.
AU - Maria João Lúcio
AU - Maria Luiza Pereira
AU - Catarina Barata
AU - Carlos Lopes
AU - Jafar Aljazeeri
PY - 2026
DA - 2026/10/21
JO - Advances in respiratory medicine
DO - 10.3390/arm94050077
UR - https://europepmc.org/article/MED/42930055
AB - Introduction: Bronchial thermoplasty (BT) reduces airway smooth muscle and may benefit severe asthma, but its role alongside biologics remains unclear. We assessed randomised and real-world evidence on efficacy and safety. Methods: We searched PubMed, Scopus, and Cochrane Library for RCTs and observational studies of BT in adults with severe uncontrolled asthma, analysing them separately. Results: Twenty studies were included (five RCTs, 15 observational). In RCTs, BT improved asthma-related quality of life (AQLQ;MD, 0.69; 95% CI 0.30-1.09), asthma control (ACQ; MD,-0.64; 95%CI, -1.10 to -0.19), and morning peak expiratory flow (MD, 20.62 L/min; 95% CI, 4.92-36.32), but did not improve rescue medication use or symptom-free-days. BT increased the risk of hospitalisation during the treatment period (RR, 3.50; 95%CI, 1.26-9.68), with no significant excess thereafter. Real-world studies showed improvements in AQLQ (MD,1.38; 95%CI, 0.97-1.80), ACQ (MD,-1.24; 95%CI, -1.86 to -0.62), and annualised exacerbation rates (MD, -3.79 exacerbations/patient-year; 95%CI, -6.98 to -0.61). Evidence suggested a possible, inconsistent corticosteroid-sparing effect; data on biologics and long-term safety were limited. Conclusions: BT improved asthma-related quality of life and control, mainly in trials without sham controls, but increased short-term hospitalisation risk. Real-world findings were similar but came from uncontrolled studies. BT is not an established alternative to biologics, but may suit carefully selected patients with severe asthma who cannot use or do not respond to them.
SN - 2451-4934
SN - 2543-6031
ER -