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Bronchoscopy for refractory asthma.

We read with interest the article in CHEST (March 2012) by Good et al 1 on the application of bronchoscopy to improve the management of patients with refractory asthma. In this study, patients with refractory asthma underwent bronchoscopy with the aim of (1) obtaining data to defi ne the refractory asthma phenotypes and (2) individualizing therapy based on bronchoscop ically defi ned refractory asthma phenotype. Outcomes measured included changes in Asthma Control Test scores and FEV 1 . The study reported signifi cant improvements in these outcomes for four out of the fi ve bronchoscopically defi ned phenotypes at 12 to 60 weeks postprocedure. These fi ndings are interesting because they enhance the possibility of personalized care for patients with refractory asthma and extend the clinical usefulness of bronchoscopy. However, caution is required in interpreting these data. The lack of a separate control arm and the nonrandomized design of the trial raise the following issues: