Advising on BHT (Butylated Hydroxytoluene)
Critical Clarification Required
The acronym "BHT" has two completely different meanings in medicine, and your guidance depends entirely on which one is being asked about.
If BHT = Bronchial Thermoplasty (for Asthma)
Most patients aged 18 years and older with persistent asthma should NOT undergo bronchial thermoplasty because the benefits are small, the risks are moderate, and long-term outcomes remain uncertain. 1
When to Consider (Rarely)
- Only for patients who place extremely low value on harms (short-term symptom worsening, unknown long-term effects) and high value on potential benefits (modest quality of life improvement, small reduction in exacerbations) 1
- Must be performed by experienced pulmonologists in centers with appropriate expertise, ideally within clinical trials or registries to track long-term safety 1
Absolute Contraindications
- FEV1 <50-60% predicted 1
- Life-threatening asthma (ICU admission, intubation, or noninvasive ventilation in past 5 years) 1
- Age <18 years (not studied) 1
Pre-Procedure Requirements
- Optimize all asthma medications first 1
- Address comorbidities 1
- Assess and optimize adherence to existing therapy 1
Risks to Discuss
- Asthma exacerbations during treatment period 1
- Hemoptysis 1
- Atelectasis 1
- Respiratory infections 1
- Bronchiectasis 1
- Pulmonary artery complications 1
- Unknown severe delayed-onset complications (fewer than 250 patients in long-term follow-up) 1
Potential Benefits
- May reduce severe asthma exacerbations compared to standard care 1
- Benefits might last 5 years or longer (limited data) 1
- Small improvement in quality of life 1
If BHT = Bioidentical Hormone Therapy (for Menopause)
Compounded bioidentical hormone therapy should NOT be recommended due to lack of FDA approval, insufficient safety data, and documented cases of serious adverse events including unexplained endometrial cancer. 2
Recommendation
- Use FDA-approved hormone therapy regimens instead of compounded BHT 2
- FDA-approved bioidentical options exist (17β-estradiol patches, gels) that are safer and evidence-based 1
Why Compounded BHT is Problematic
- No FDA oversight or quality control 2
- Lacks sufficient efficacy and safety data 2
- Case reports of endometrial cancer in otherwise healthy BHT users 2
- Media and celebrity endorsements have promoted misconceptions about risks and benefits 2
If Patient Insists on "Bioidentical" Hormones
Prescribe FDA-approved 17β-estradiol formulations (transdermal patches or vaginal gel) as first-line, NOT compounded preparations. 1
- For post-pubertal women with premature ovarian insufficiency: transdermal 17β-estradiol patches or vaginal gel 1
- Add micronized progesterone 100-200 mg daily for 12-14 days every 28 days for endometrial protection 1
- Transdermal route avoids first-pass hepatic metabolism and has better cardiovascular and bone profiles 1
Age-Specific Contraindications
- Women ≥60 years or >10 years post-menopause: Oral estrogen-containing hormone therapy carries excess stroke risk 3
- Women >80 years: Do not initiate hormone therapy; increases morbidity and mortality 3
- History of ocular migraines or migraine with aura: Hormone therapy is contraindicated due to increased stroke risk 4
Absolute Contraindications (Any Age)
- History of breast cancer 1, 3
- Coronary heart disease 3
- Previous venous thromboembolism or stroke 3
- Active liver disease 3
- Antiphospholipid syndrome 3
If BHT = Topical Antioxidant Product (Cosmetic/Wound Care)
For external use only on intact skin; do NOT use on wounds, damaged skin, or in children under 12 years without consulting a physician. 5
Directions
- Clean and dry affected area before application 5
- Apply directly to affected area, maximum 3 times daily 5
- Wash hands thoroughly after application 5
- Avoid contact with eyes and mucous membranes 5
Warnings
- Do not use with heating devices or pads 5
- Do not cover or bandage tightly 5
- If eye contact occurs, rinse with cold water and call a doctor 5
- If swallowed, call poison control 5