Study on the safety and efficacy of bronchial thermoplasty and omalizumab after bronchial thermoplasty in severe asthma_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SUN Lan ,  HU Qiang , SONG Benyan , ZHANG Yuling , LI Mingfeng , LIAO Xiangli

Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Panzhihua College, Panzhihua, Sichuan 617000, P.R. China;

Corresponding?author：

HU Qiang, Email: 2248961645@qq.com

Keywords：

Asthma; Severe; Bronchial thermoplasty; Omalizumab

DOI：

10.7507/1671-6205.202506089

Video：

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Objective To investigate the safety and efficacy of bronchial thermoplasty and omalizumab after bronchial thermoplasty in severe asthma.Methods Collect patients with severe asthma who underwent BT in our hospital from January 2015 to January 2025. Assess the efficacy, asthma control, and pulmonary function 1 year after surgery,divide into uncontrolled, partially controlled, and completely controlled groups based on efficacy. Allergen and total serum IgE were conducted in partially controlled and uncontrolled patients, and those suitable for treatment with omalizumab underwent a 1-year treatment.The efficacy, asthma control, quality of life, lung function, and adverse reactions of patients in the bronchial thermoplasty group (BT group) and the omalizumab after bronchial thermoplasty group(BT-omalizumab group)were evaluated. Results show that after one year of BT treatment, the ACT assessment of patients is better than before treatment (P<0.05), but more than half of patients still have poor control; The level of type 2 inflammation in the partially controlled and uncontrolled groups was higher than that in the completely controlled group (P<0.05), while there was no significant difference between the partially controlled and uncontrolled groups (P>0.05). After 1 year of BT treatment, the number of acute attacks in patients decreased, and the proportion of patients using OCS decreased, the hospitalization days shortened, and the quality of life (MiniAQLQ score) improved (all P<0.05). Compared with before BT, the FEV₁, FEV₁%, FEV₁/FVC, and PEF of patients improved after 1 year of treatment (all P<0.05), while FVC, FVC%, and MMEF% showed no significant changes (all P>0.05). Compared with BT group, BT-omalizumab group can further improve FEV₁, FEV₁%, FEV₁/FVC, and PEF (all P<0.05), while there was no significant difference in FVC, FVC%, and MMEF% between the two treatment groups (all P>0.05 ). The BT-omalizumab group can significantly shorten hospitalization days, improve asthma control and quality of life (all P<0.05); The combination group can further reduce the number of acute attacks compared to the BT group, but there is no statistical difference (P>0.05). There was no statistically significant difference in the occurrence of adverse reactions between the two groups (all P>0.05).Conclusions BT can reduce acute asthma attacks and OCS use, shorten hospitalization time, improve asthma control, quality of life and lung function. However, the effect is not ideal in patients with type 2 inflammatory phenotype. Treatment with omalizumab can more effectively control asthma, shorten hospitalization time, improve lung function, enhance quality of life, and is safer for these patients.

Citation： SUN Lan, HU Qiang, SONG Benyan, ZHANG Yuling, LI Mingfeng, LIAO Xiangli. Study on the safety and efficacy of bronchial thermoplasty and omalizumab after bronchial thermoplasty in severe asthma. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(12): 843-849. doi: 10.7507/1671-6205.202506089 Copy

1.	Chung KF, Dixey P, Abubakar-Waziri H, et al. Characteristics, phenotypes, mechanisms and management of severe asthma. Chin Med J (Engl), 2022, 135(10): 1141-1155.
2.	Schoettler N, Strek ME. Recent Advances in Severe Asthma: From Phenotypes to Personalized Medicine. Chest, 2020, 157(3): 516-528.
3.	Menzella F, Antonicelli L, Cottini M, Imeri G, Corsi L, Di Marco F. Oscillometry in severe asthma: the state of the art and future perspectives. Expert Rev Respir Med, 2023, 17(7): 563-575.
4.	Cox G, Thomson NC, Rubin AS, et al. Asthma control during the year after bronchial thermoplasty. N Engl J Med, 2007, 356(13): 1327-1337.
5.	Castro M, Rubin AS, Laviolette M, et al. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med, 2010, 181(2): 116-124.
6.	Pavord ID, Cox G, Thomson NC, et al. Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med, 2007, 176(12): 1185-91.
7.	Akenroye AT, Segal JB, Zhou G, et al. Comparative effectiveness of omalizumab, mepolizumab, and dupilumab in asthma: A target trial emulation. J Allergy Clin Immunol, 2023, 151(5): 1269-1276.
8.	Arasi S, Mennini M, Cafarotti A, Fiocchi A. Omalizumab as monotherapy for food allergy. Curr Opin Allergy Clin Immunol, 2021, 21(3): 286-291.
9.	Global Initiative for Asthma (GINA). (2014). Global strategy for asthma management and prevention (revised 2014). Retrieved from https://www.ginasthma.org.
10.	Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113(1): 59-65.
11.	Schreiber J, Schwab Sauerbeck I, Mail?nder C. The Long-Term Effectiveness and Safety of Omalizumab on Patient- and Physician-Reported Asthma Control: A Three-Year, Real-Life Observational Study. Adv Ther, 2020, 37(1): 353-363.
12.	Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
13.	Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J, 2014, 43(2): 343-73.
14.	Busse WW. Consequences of severe asthma exacerbations. Curr Opin Allergy Clin Immunol, 2023, 23(1): 44-50.
15.	Berair R, Brightling CE. Asthma therapy and its effect on airway remodelling. Drugs, 2014, 74(12): 1345-1369.
16.	Benayoun L, Druilhe A, Dombret MC, Aubier M, Pretolani M. Airway structural alterations selectively associated with severe asthma. Am J Respir Crit Care Med, 2003, 167(10): 1360-8.
17.	Mitzner W. Airway smooth muscle: the appendix of the lung. Am J Respir Crit Care Med, 2004, 169(7): 787-790.
18.	Danek CJ, Lombard CM, Dungworth DL, et al. Reduction in airway hyperresponsiveness to methacholine by the application of RF energy in dogs. J Appl Physiol (1985), 2004, 97(5): 1946-1953.
19.	Tan LD, Yoneda KY, Louie S, Hogarth DK, Castro M. Bronchial Thermoplasty: A Decade of Experience: State of the Art. J Allergy Clin Immunol Pract, 2019, 7(1): 71-80.
20.	Miller JD, Cox G, Vincic L, Lombard CM, Loomas BE, Danek CJ. A prospective feasibility study of bronchial thermoplasty in the human airway. Chest, 2005, 127(6): 1999-2006.
21.	呂銳, 馮亦偉, 陀子能. 支氣管熱成形術在重癥哮喘治療中的臨床應用. 深圳中西醫結合雜志. 2021. 31(21): 141-144.
22.	馬越, 田稼薈, 王曉平. 支氣管熱成形術治療難治性哮喘的臨床效果及安全性分析. 中國實用醫藥, 2025, 20(14): 82-85.
23.	Pretolani M, Dombret MC, Thabut G, et al. Reduction of airway smooth muscle mass by bronchial thermoplasty in patients with severe asthma. Am J Respir Crit Care Med, 2014, 190(12): 1452-4.
24.	Gevaert P, Omachi TA, Corren J, et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. J Allergy Clin Immunol, 2020, 146(3): 595-605.
25.	李建英, 劉毅, 羅嵐, 宋思瑤, 張明強. 奧馬珠單抗治療中重度過敏性哮喘的臨床效果及安全性研究. 中國醫藥, 2022, 17(11): 1638-1642.
26.	Wood RA, Togias A, Sicherer SH, et al. Omalizumab for the Treatment of Multiple Food Allergies. N Engl J Med, 2024, 390(10): 889-899.
27.	Dantzer JA, Wood RA. Update on omalizumab in allergen immunotherapy. Curr Opin Allergy Clin Immunol, 2021, 21(6): 559-568.
28.	胡斯育, 龍發, 龍亮等. 支氣管熱成形術治療重癥哮喘與哮喘慢性阻塞性肺疾病重疊患者的臨床療效及安全性分析. 中華醫學雜志, 2021, 101(15): 1071-1076.
29.	鄭曉燕, 孫璘, 湯葳. 奧馬珠單抗對過敏性哮喘患者血清細胞因子譜的影響. 內科理論與實踐, 2023, 18(06): 388-393.

1. Chung KF, Dixey P, Abubakar-Waziri H, et al. Characteristics, phenotypes, mechanisms and management of severe asthma. Chin Med J (Engl), 2022, 135(10): 1141-1155.
2. Schoettler N, Strek ME. Recent Advances in Severe Asthma: From Phenotypes to Personalized Medicine. Chest, 2020, 157(3): 516-528.
3. Menzella F, Antonicelli L, Cottini M, Imeri G, Corsi L, Di Marco F. Oscillometry in severe asthma: the state of the art and future perspectives. Expert Rev Respir Med, 2023, 17(7): 563-575.
4. Cox G, Thomson NC, Rubin AS, et al. Asthma control during the year after bronchial thermoplasty. N Engl J Med, 2007, 356(13): 1327-1337.
5. Castro M, Rubin AS, Laviolette M, et al. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med, 2010, 181(2): 116-124.
6. Pavord ID, Cox G, Thomson NC, et al. Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med, 2007, 176(12): 1185-91.
7. Akenroye AT, Segal JB, Zhou G, et al. Comparative effectiveness of omalizumab, mepolizumab, and dupilumab in asthma: A target trial emulation. J Allergy Clin Immunol, 2023, 151(5): 1269-1276.
8. Arasi S, Mennini M, Cafarotti A, Fiocchi A. Omalizumab as monotherapy for food allergy. Curr Opin Allergy Clin Immunol, 2021, 21(3): 286-291.
9. Global Initiative for Asthma (GINA). (2014). Global strategy for asthma management and prevention (revised 2014). Retrieved from https://www.ginasthma.org.
10. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113(1): 59-65.
11. Schreiber J, Schwab Sauerbeck I, Mail?nder C. The Long-Term Effectiveness and Safety of Omalizumab on Patient- and Physician-Reported Asthma Control: A Three-Year, Real-Life Observational Study. Adv Ther, 2020, 37(1): 353-363.
12. Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
13. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J, 2014, 43(2): 343-73.
14. Busse WW. Consequences of severe asthma exacerbations. Curr Opin Allergy Clin Immunol, 2023, 23(1): 44-50.
15. Berair R, Brightling CE. Asthma therapy and its effect on airway remodelling. Drugs, 2014, 74(12): 1345-1369.
16. Benayoun L, Druilhe A, Dombret MC, Aubier M, Pretolani M. Airway structural alterations selectively associated with severe asthma. Am J Respir Crit Care Med, 2003, 167(10): 1360-8.
17. Mitzner W. Airway smooth muscle: the appendix of the lung. Am J Respir Crit Care Med, 2004, 169(7): 787-790.
18. Danek CJ, Lombard CM, Dungworth DL, et al. Reduction in airway hyperresponsiveness to methacholine by the application of RF energy in dogs. J Appl Physiol (1985), 2004, 97(5): 1946-1953.
19. Tan LD, Yoneda KY, Louie S, Hogarth DK, Castro M. Bronchial Thermoplasty: A Decade of Experience: State of the Art. J Allergy Clin Immunol Pract, 2019, 7(1): 71-80.
20. Miller JD, Cox G, Vincic L, Lombard CM, Loomas BE, Danek CJ. A prospective feasibility study of bronchial thermoplasty in the human airway. Chest, 2005, 127(6): 1999-2006.
21. 呂銳, 馮亦偉, 陀子能. 支氣管熱成形術在重癥哮喘治療中的臨床應用. 深圳中西醫結合雜志. 2021. 31(21): 141-144.
22. 馬越, 田稼薈, 王曉平. 支氣管熱成形術治療難治性哮喘的臨床效果及安全性分析. 中國實用醫藥, 2025, 20(14): 82-85.
23. Pretolani M, Dombret MC, Thabut G, et al. Reduction of airway smooth muscle mass by bronchial thermoplasty in patients with severe asthma. Am J Respir Crit Care Med, 2014, 190(12): 1452-4.
24. Gevaert P, Omachi TA, Corren J, et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. J Allergy Clin Immunol, 2020, 146(3): 595-605.
25. 李建英, 劉毅, 羅嵐, 宋思瑤, 張明強. 奧馬珠單抗治療中重度過敏性哮喘的臨床效果及安全性研究. 中國醫藥, 2022, 17(11): 1638-1642.
26. Wood RA, Togias A, Sicherer SH, et al. Omalizumab for the Treatment of Multiple Food Allergies. N Engl J Med, 2024, 390(10): 889-899.
27. Dantzer JA, Wood RA. Update on omalizumab in allergen immunotherapy. Curr Opin Allergy Clin Immunol, 2021, 21(6): 559-568.
28. 胡斯育, 龍發, 龍亮等. 支氣管熱成形術治療重癥哮喘與哮喘慢性阻塞性肺疾病重疊患者的臨床療效及安全性分析. 中華醫學雜志, 2021, 101(15): 1071-1076.
29. 鄭曉燕, 孫璘, 湯葳. 奧馬珠單抗對過敏性哮喘患者血清細胞因子譜的影響. 內科理論與實踐, 2023, 18(06): 388-393.

Chinese Journal of Respiratory and Critical Care Medicine

Study on the safety and efficacy of bronchial thermoplasty and omalizumab after bronchial thermoplasty in severe asthma

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