Case report: Bronchial thermoplasty improves severe cough in asthma patient

Naveed Saleh, MD, MS, for MDLinx | April 18, 2018

A woman diagnosed with severe asthmatic cough was effectively treated using bronchial thermoplasty, according to a recent case published in the Annals of Internal Medicine.

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The patient’s cough improved after the first procedure and cough intensity, cough-related quality of life, and asthma control continued to improve 3 months following the first treatment with bronchial thermoplasty.

“Bronchial thermoplasty is a novel treatment for severe asthma that reduces the volume of airway smooth muscles and the number of airway nerves and epithelial neuroendocrine cells,” wrote the authors, led by Yoshihiro Kanemitsu, MD, PhD, Nagoya City University, Nagoya, Japan. “These reductions are associated with fewer asthma exacerbations.”

In this case report, a 35-year-old woman with a 2.5-year history of cough was diagnosed with asthma. Despite treatment with high-dose inhaled corticosteroids, long-acting ß2-agonists, leukotriene-receptor antagonists, and a one-week course of oral prednisolone (20 mg/day), the patient’s frequent, severe cough failed to improve.

Results of allergy tests were within normal limits. Cough sensitivity testing using capsaicin showed that the lowest dose of capsaicin induced seven (7) coughs.

After initial treatments failed to resolve the cough, treatment with sustained theophylline, tiotropium, and erythromycin was initiated. Cough frequency, cough-specific quality of life, asthma control, and the number of capsaicin-induced coughs were unchanged when recorded at a 6-month follow-up.

Treatment with bronchial thermoplasty was initiated. According to the case report, all visible bronchi were treated with heat energy of 65°C (149°F) for 10 seconds during 3 procedures at 3-week intervals, for a total of 138 activations.

The cough improved after the first procedure, and cough intensity, cough-related quality of life, and asthma control continued to improve 3 months following the first treatment with bronchial thermoplasty. Moreover, the number of coughs induced by capsaicin decreased.

Although the mechanism is unknown, researchers suggest that because bronchial thermoplasty ameliorated the capsaicin cough response, this procedure may change the expression of the capsaicin receptor.

“Decreasing neuronal dysfunction and altering the capsaicin receptor may thus have contributed to this patient's improvement,” the authors wrote.

They concluded: “Whatever the explanation, we believe that other clinicians should consider bronchial thermoplasty for patients with severe asthmatic cough who have not responded to more conventional therapies.”

 To read more about this study, click here

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