BACKGROUND: Bronchial thermoplasty (BT) has been shown to be effective in randomized controlled trials of patients with severe asthma who failed to achieve disease control with high-dose inhaled corticosteroids combined with bronchodilators. However, the effectiveness of BT in real-world clinical settings, especially among the Asian population, has not been determined.
OBJECTIVE: To evaluate the effectiveness of BT using a nationwide database.
METHODS: Using the inpatient and outpatient data from the Japanese Diagnosis Procedure Combination database, we applied a self-controlled case series design to evaluate changes in the composite outcome of hospital admissions and emergency department visits, as well as systemic corticosteroid dose, between 1 year before and after BT. We also conducted subgroup analyses based on patients' profiles.
RESULTS: Among the 561 patients with asthma who underwent BT treatment between September 2014 and March 2020, 102 patients with at least 1 outcome were analyzed. Bronchial thermoplasty was significantly associated with an improvement in the composite outcome of hospital admission and emergency department visits (incidence rate ratio 0.53; 95% CI 0.44-0.64). Systemic corticosteroid use was reduced after BT sessions (1931.5 mg [1,341.2-3,725.3 mg] to 641.3 mg [134.2-1,691.1 mg] per person-year; P < .001). Although all groups showed a significant improvement in the composite outcome in the subgroup analyses, BT tended to be less effective among people older than 65 years and those with higher body mass index (>25 kg/m(2)).
CONCLUSIONS: The present study using real-world data suggests that BT may improve asthma control; however, the effectiveness of BT can vary depending on patient baseline profiles.
|ジャーナル名||The journal of allergy and clinical immunology. In practice|
|投稿者||Akaba, Tomohiro; Jo, Taisuke; Iwagami, Masao; Hashimoto, Yohei; Matsui, Hiroki; Fushimi, Kiyohide; Tagaya, Etsuko; Yasunaga, Hideo|
|組織名||Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, Tokyo, Japan; Department of Respiratory;Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.;Electronic address: firstname.lastname@example.org.;Department of Health Services Research, Graduate School of Medicine, The;University of Tokyo, Tokyo, Japan; Department of Respiratory Medicine, Graduate;School of Medicine, The University of Tokyo, Tokyo, Japan.;Department of Health Services Research, University of Tsukuba, Ibaraki, Japan.;Health, The University of Tokyo, Tokyo, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School of Medicine, Tokyo, Japan.;Department of Respiratory Medicine, Tokyo Women's Medical University School of;Medicine, Tokyo, Japan.|