Asthma Gets its Close-up

Bronchoscopy used to visually examine and treat difficult asthma

(RxWiki News) If you can see it, you can treat it according to a new asthma study. Using a bronchoscope can be effective for hard-to-treat asthma.

A bronchoscope is a device with a camera that is inserted into the airways. Researchers can use a bronchoscope to examine the lungs or collect samples.

This could be a way to treat refractory, or hard-to-treat, asthma patients whose symptoms are not managed despite medication usage.

"Ask your family doctor about new asthma tests."

The study was led by James Good, M.D., professor of medicine at National Jewish Health. Researchers used a bronchoscope on 58 participants who had hard-to-treat asthma. Out of the 58 patients, 20 were given standard treatment for four months followed by a bronchoscopy and personalized treatment. The other 38 participants were given a bronchoscopy and personalized treatment based on the results.

A bronchoscope allows a doctor to visually examine the upper and lower airways of the lungs. Researchers can than collect samples and analyze the data. Using the data collected from the visual examination and samples, researchers can tailor treatment based on those results.

Hard-to-treat asthma was defined as sufferers who needed to use oral corticosteroids for more than half of the previous year or who continued to have symptoms despite high doses of corticosteroids.

Using bronchoscopy, researchers discovered five different ways asthma expressed itself. The five ways included asthma with acid reflux, subacute, between acute and chronic, bacterial infection, high levels of eosinophils, white blood cells, two or three of these symptoms at the same time or no specific behavior.

Identifying these asthma behaviors allowed researchers to better treat the participants. For individuals with acid reflux, researchers performed surgery or additional medical therapy in addition to asthma treatments. Antibiotics were given to individuals with bacterial infection, while participants with high levels of eosinophils were given omalizumab, which helps neutralize the allergic response cause by immunoglobulin E (IgE).

The participants were given this tailored treatment for 24 weeks. Researchers noticed improved lung function and asthma control based on a questionnaire called the Asthma Control Test (ACT). Using a breathing test to measure exhaled air, lung function improved from 58.9 percent to 74.3 percent. Based on the ACT, asthma management went from poorly controlled to minimally uncontrolled, which scores going from 11.8 to 18.5 with a maximum score of 25.

Participants who were using standard treatment for the first part of the study only improved after the targeted treatment period.

This is a positive beginning for hard-to-treat asthma sufferers. Additional tests can lead to a better understanding of how to use bronchoscopy to tailor treatment to the particular type of asthma behavior being expressed by the patient. 

No funding information was provided.

This study was published in the March edition of Chest.

Review Date: 
March 29, 2012