Oğuzhan OKUTAN, Tayfun ÇALIŞKAN, Zafer KARTALOĞLU

Astım tedavisinde bronşiyal termoplasti

Omalizumab, mepolizumab ve reslizumab gibi yeni astım tedavileri, inflamatuvar fenotipe göre kullanılmaktadır fakat bu tedavileriçin uygun olmayan veya bu tedavilerle düzelmeyen birçok astım hastası vardır. Bronşiyal termoplasti (BT), 2010 yılında inhaler kortikosteroidler (İKS) ve uzun etkili bronkodilatörler ile tedaviye rağmen şiddetli astım ve kontrolsüz semptomları olan yetişkinlerintedavisinde Amerika Birleşik Devletleri Gıda ve İlaç İdaresi (FDA) tarafından onaylanmıştır. BT, aşırı hava yolu düz kas kütlesini azaltmak için daha büyük hava yollarına radyofrekans enerji iletimine dayanan minimal invaziv bronkoskopik bir girişimdir. BT’nin astımalevlenmelerini azaltmada ve şiddetli astımı olan hastalarda astım kontrolünü iyileştirmede etkili olduğu gösterilmiştir. BT, ağır refrakter astımı olan hastalarda BT sonrası 5 yıl boyunca güvenlidir. BT, standart tedavilerle düzelmeyen, allerjik olmayan, eozinofilik olmayan (TH2 olmayan) şiddetli astımı olan hastalar için öncelikli olarak tercih edilebilir. Ne yazık ki, BT’nin etki mekanizması tam olarakanlaşılamamıştır. Bu tedaviye cevap verecek hastaları nasıl belirleyeceğimiz konusundaki belirsizlik devam etmektedir. BT’nin ağırastımda yerini gösterebilecek ve yanıt verenleri belirleyebilecek birkaç çalışma devam etmektedir. BT ile diğer tedavi opsiyonlarınıkarşılaştıran çalışmalara ihtiyaç vardır. Bu derleme, BT’nin gözden geçirilmesini sağlayacaktır. BT’nin astımda kullanımındaki en sonkanıtları tartışacağız, hasta seçim kriterleri ve prosedürün uygulaması incelenecektir.

Bronchial thermoplasty for asthma treatment

New asthma therapies such as omalizumab, mepolizumab and reslizumab are used according to the inflammatory phenotype, but there are many patients with asthma which are not suitable for these therapies or do not improve with these therapies. Bronchial thermoplasty (BT) was approved by FDA for the treatmet of adults with severe asthma and uncontrolled symptoms despite treatment with inhaler corticosteroids (ICS) and long-acting bronchodilators in 2010. BT is a minimally invasive bronhoscopic intervention based on radiofrequency energy delivery to the larger airways to reduce excessive airway smooth muscle mass. BT has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe asthma. BT is safe for 5 years after BT in patients with severe refractory asthma. BT may be primarily preferred for patients with nonallergic, non-eosinophilic (nonTH2) severe asthma not improving with standart treatments. Unfortunately, the mechanism of action of BT is incompletely understood. Uncertainty remains how to identify patients who will responde to this intervention. Several studies are underway that may show the place of BT in severe asthma and identify responders. There is also a need for studies comparing BT with other treatment options. This review will provide an overwiew of BT. We will discuss the latest evidence on the use of BT in asthma, patient selection criteria and performing the procedure will be reviewed.

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