ObjectiveTo 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. Resultsshow 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.
