Bronchial thermoplasty for severe asthma

To inform the committee, NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 14 sources, which was discussed by the committee. The evidence included 2 systematic reviews with meta‑analysis, 1 randomised controlled trial, 3 case series (2 of which were extensions of randomised trials; evidence from 1 was extracted from 2 published sources), 1 non-randomised comparative study, 1 registry and 5 case reports, and is presented in table 2 of the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The specialist advisers and the committee considered the key efficacy outcomes to be: quality of life, reduced exacerbations and hospital admissions, and improved respiratory function.

The specialist advisers and the committee considered the key safety outcomes to be: pneumothorax, bleeding, admissions to intensive care and, in the longer term, airway stenosis and lung fibrosis.

Two commentaries from patients who had experience of this procedure were received, which were discussed by the committee.

There is uncertainty about which patients may benefit from the procedure.

The committee noted that the device used in this procedure does not have a CE mark for use in people younger than 18 years.

The committee noted that there is some evidence to suggest this procedure may not be suitable for people with bronchiectasis.

The procedure should only be used for severe asthma that is not controlled despite optimal drug treatment.

The committee was informed that bronchial thermoplasty could complement the use of biological treatment in the future.