What is bronchial thermoplasty?
Bronchial Thermoplasty (BT) is a safe outpatient bronchoscopy procedure that uses mild heat to reduce excessive smooth muscle in the airways, which helps reduce severe asthma attacks.
How does bronchial thermoplasty treat asthma?
Asthma is chronic inflammation of the airways with episodic narrowing. Symptoms include coughing, wheezing, and chest tightness, which often come on suddenly in the form of an asthma attack. Persistent inflammation can eventually cause the airway smooth muscle to thicken, which restricts air flow and makes breathing difficult. Bronchial thermoplasty is the first asthma treatment aimed at reducing the muscle thickness and mass, making room for easier airflow.
How is the procedure performed?
Bronchial thermoplasty is performed by a lung specialist, called a pulmonologist. Full treatment involves three separate outpatient procedures, each scheduled three weeks apart. The first procedure treats the airways of the right lower lobe of the lungs; the second treats the airways of the left lower lobe; and the third procedure treats the airways in both upper lobes. Doctors use a bronchoscope to work inside a patient’s lungs. This long, flexible tube has a camera on one end so that doctors can see inside the lungs. The scope is inserted through the mouth or nose; no incisions are required. Patients are under sedation throughout the procedure and should not feel any discomfort other than occasional coughing. The specialist may also decide to do the procedure under general anesthesia, in which case, the patient will be asleep during the entire procedure. A catheter is inserted through a channel in the bronchoscope, and precisely controlled thermal energy is delivered through the catheter into the airways. This “heats up” the airway smooth muscle to around 140 degrees Fahrenheit, which is enough to destroy the smooth muscle and thus take away the ability of the airways to narrow. After the procedure, patients are monitored closely and often go home the same day.
What are the benefits?
In a double-blind, randomized, sham-controlled clinical study of bronchial thermoplasty, adults with severe asthma that were treated with bronchial thermoplasty had improved asthma-related quality of life out to a year compared to the control (sham-treated) patients. Additionally, when compared to control patients, patients treated with bronchial thermoplasty also experienced the following significant benefits:
- 32% reduction in asthma attacks
- 84% reduction in emergency room visits for respiratory symptoms
- 66% reduction in days lost from work, school, or other daily activities due to asthma symptoms
- 73% reduction in hospitalizations for respiratory symptoms
These benefits were observed during clinical studies where patients continued to take their standard maintenance asthma medications which included combinations of inhaled corticosteroids and long-acting bronchodilators.
Is bronchial thermoplasty right for me?
- Patients who benefit from bronchial thermoplasty are typically:
- Adults between ages 18–65
- Non-smokers for at least a year prior to the procedure
- Severe or persistent asthma sufferers whose condition is not well-controlled by inhaled corticosteroids or long-acting bronchodilator medications.
How does bronchial thermoplasty work?
People with severe asthma have an excess of smooth muscle tissue lining their airways. During an asthma attack, this muscle constricts the airways, making breathing difficult. BT reduces the amount of excess muscle and helps minimize the narrowing of your airways during an asthma attack.
What are the benefits and risks of bronchial thermoplasty?
In a clinical trial, almost 79% of patients treated with BT reported significant improvements in their asthma-related quality of life—including a reduction in asthma attacks, ER visits and hospitalizations for respiratory symptoms, and fewer days lost from work, school, and other daily activities due to asthma. As with any procedure, there are risks, and individual results may vary. The most common side effect of BT is temporary worsening of respiratory-related symptoms (within 1 to 7 days). There is a small risk (3.4%) of these symptoms requiring hospitalization.
Am I a candidate for bronchial thermoplasty?
BT delivered by the Alair™ System is approved by the FDA for the treatment of severe asthma in patients 18 years and older whose asthma is not well controlled with inhaled corticosteroids and long-acting beta-agonists such as Advair™, Symbicort™, and Dulera™. Further evaluation with your physician or a physician trained in BT will help determine whether you are a candidate who may benefit from this procedure.
What will happen during the procedure?
To ensure safety and optimal results every step of the way, BT is typically performed under moderate sedation in three separate sessions scheduled three weeks apart. Each session lasts about an hour and focuses on a different part of the lung to ensure all of the affected areas are treated. The device is introduced into your airways through a bronchoscope that is inserted into your mouth or nose, so no incision is required. After the procedure, you will be monitored for 2 to 4 hours and discharged on the same day. The treating physician will provide you with more details on what to expect during and after the procedure.
Who performs bronchial thermoplasty?
The BT procedure is performed at Mercy Medical Center in an outpatient setting by Mercy Pulmonology Clinic's Interventional Pulmonologist, Eduardo Celis, MD, who is specially trained to perform bronchoscopy procedures and BT.
Will I be able to stop taking my asthma medications?
BT does not replace your current daily maintenance medication, but instead works with it to provide long-term stability in your asthma symptoms and lessen severe asthma attacks requiring oral steroids (prednisone). BT provides long-term stability in your asthma symptoms, improves your quality of life and lessens asthma attacks.
Is bronchial thermoplasty covered by insurance?
Coverage policies and payment vary by payer. Your BT physician/ staff will work with you to request coverage of your BT procedure.
How can I learn more about bronchial thermoplasty?
To determine if you are a candidate for bronchial thermoplasty, please contact the Mercy Pulmonology Clinic at (319) 221-8788 to schedule a consultation.