Bronchial thermoplasty for severe asthma: Systematic review and meta-analysis of benefits and harms

Background: The efficacy and safety of bronchial thermoplasty (BT) for severe asthma remains unclear. Objective: We systematically synthesized the efficacy and safety of BT in patients with severe asthma. Methods: As part of the upcoming American Academy of Allergy, Asthma lower better]), asthma-related quality of life (Asthma Quality of Life Questionnaire range, 1-7; higher better), severe asthma exacerbations, and harms, stratified by procedural, postprocedural, and overall. The GRADE approach informed certainty-of-evidence ratings (PROSPERO: CRD42023408565). Results: Six trials randomized 573 adults. Procedurally, BT likely increases severe exacerbations (incidence rate ratio IRR 2.95; 95% CI, 1.20-7.25; risk difference RD 0.08 more events per patient-year; moderate certainty) and serious respiratory adverse events (IRR 5.98; 95% CI, 1.07-33.29; RD 0.18 more events per patient-year; moderate certainty). Postprocedurally, BT may reduce severe exacerbations (IRR 0.67; 95% CI, 0.50-0.89; RD 0.67 fewer events per patient-year; low certainty). Overall, BT may improve asthma control (mean difference -0.37; 95% CI, -0.67 to -0.07; RD for 0.5-point decrease: 15.9% more; low certainty), asthma-related quality of life (mean difference 0.55; 95% CI, 0.28-0.82; RD for 0.5-point increase: 19.1% more; low certainty), and severe exacerbations (IRR 0.81; 95% CI, 0.68-0.97; RD 0.11 fewer events per patient-year; low certainty). Conclusion: Among adults with severe asthma, BT may improve asthma control and asthma-related quality of life and may reduce overall severe exacerbations, but it likely increases procedural severe exacerbations and serious respiratory harms.