Matthieu Thumerel, Pierre-Olivier Girodet, Patrick Berger, Roger Marthan, Jacques Jougon
Institution : Service de chirurgie thoracique, hopital Haut-lévêque, CHU Bordeaux, Pessac
Objectives : Evaluate the use of bronchial biopsy during bronchoscopy as a tool for study of airway remodeling in severe or non-severe asthmatic patients.
Methods : In two studies (Remodelasthme, NCT00896428 and Mitasthme, NCT00808730), were performed 92 bronchoscopies among patients with severe and non-severe asthma. Three biopsies per patient of spurs segmental or sub-segmental from the middle lobe were made for an analysis of 6-8 sections per biopsy of bronchial smooth muscle (BSM) area, a marker of asthmatic airway remodeling.
Results : In Mitasthme study, 30 non-severe asthmatic patients were biopsied. Only 2 bronchoscopies were unusable. Between and within-biopsies variability of BSM area were similar in “small muscle” vs “big muscle” groups (coefficient of 0.32 vs. 0.34; p = 0.45). These study have identified a phenotype called “big muscle” in non-severe asthmatic patients whose clinical characteristics are similar to severe asthma.
In Remodelasthme study, 31 patients with severe asthma were biopsied twice. Intra-observer and inter-observers reproducibility of BSM area was good. Between and within-biopsies variability of BSM area were similar in gallopamil vs. placebo groups to 2 times. The study concluded that gallopamil is able to reduce the BSM thickness in severe asthmatic patients.
Conclusion : Bronchoscopy with biopsy is a good tool for an analysis of the bronchial smooth muscle. It remains invasive and development of other markers is needed.