Reasons for unsatisfactory asthma symptom control Poor compliance Co-morbidities Additional therapeutic measures needed – immunotherapy, thermoplasty Severe refractory asthma Main features Inhaled high-dose glucocorticoids in combination with a control drug (long-acting bronchodilator, leukotriene modulator, extended-release theophylline) and still recurrent wheezing Asthma exacerbations such as wheezing. Secondary characteristics Need for inhaled short-acting bronchodilators almost daily Persistent airway obstruction, FEV1 < 80% predicted, PEF intra-day variability More than 1 emergency room visit per year for an asthma attack ≥ 3 courses of oral hormone therapy per year Previous fatal asthma attack Regression of poorly controlled asthma Recurrent hospital admissions Severe persistent airflow obstruction Acute exacerbation of severe asthma Asthma is a chronic disease based on airway inflammation, resulting in airway hyperresponsiveness Asthma is a chronic disease based on airway inflammation, resulting in airway hyperresponsiveness, bronchospasm, and increased airway secretions. Repeated asthma attacks cause airway remodeling, such as smooth muscle hypertrophy, basement membrane thickening, collagen deposition, and cupped cell hyperplasia. In refractory asthma, thickening of airway smooth muscle is one of the main features, which causes irreversible airway narrowing, leads to persistent airflow obstruction, and the thickened airway smooth muscle exacerbates bronchoconstriction when foreign substances stimulate an asthma attack. Bronchial thermoplasty is performed by temperature-controlled radiofrequency energy to reduce airway smooth muscle and reduce bronchial stenosis, thereby reducing the number of acute asthma attacks and improving the patient's quality of life. The treatment is performed bronchoscopically, delivering temperature-controlled (65°C) energy to the bronchial mucosa for 10 seconds at a time via a bendable treatment catheter. This technique does not produce permanent damage to epithelial cells. This treatment is not a substitute for existing asthma drug therapy. In foreign studies, treatment of 297 patients with severe persistent asthma who still had symptoms despite inhaling high doses of inhaled hormone + LABA resulted in a 32% reduction in severe exacerbations, 84% reduction in emergency room visits for respiratory symptoms, 73% reduction in hospitalizations for respiratory symptoms, and 66% reduction in days missed from work and school and other daily activities due to illness 1 year after treatment. Follow-up up to 5 years still guarantees an improved quality of life for patients. Safety of thermoplasty treatment: Most respiratory adverse events are concentrated in the first postoperative day, and most of them return to normal within 1 week of standard management. To date, no procedure-related deaths have been reported. Which patients are suitable for bronchial thermoplasty? Adults with severe persistent asthma (≥18 years of age) whose symptoms are not fully controlled with high-dose inhaled steroids (ICS) combined with a long-acting beta2 agonist (LABA) Contraindications to thermoplasty: Pacemaker implantation Allergy to bronchoscopically necessary medications, including lidocaine Bronchial thermoplasty should be postponed if: Acute respiratory infection Asthma exacerbation within the last 2 weeks Known bleeding disorders Patients unable to stop anticoagulants, antiplatelet drugs before the procedure In conclusion, thermoplasty is an emerging therapeutic technique for the treatment of refractory severe asthma, which has been performed in more than 400 clinical centers in 30 countries and regions, with more than 3500 patients treated, and is currently classified as the highest level of treatment in the 2014 edition of the Global Asthma Control Initiative. It has been approved for registration in China. It has been registered and approved in China. It can reduce asthma attacks and improve quality of life for patients with asthma symptoms despite the combination of high-dose inhaled glucocorticoids and more than one control drug.