People with severe, persistent asthma are affected by its associated symptoms throughout the day — every day — even though they are taking the appropriate medication, such as inhaled steroids and long-acting bronchodilators. But thanks to a new, advanced form of treatment called bronchial thermoplasty, individuals with severe, persistent asthma that is not well-controlled with medication now have a chance at long-term relief.
A clinical trial has found that 79 percent of patients treated with bronchial thermoplasty experienced significant improvement in their asthma-related quality of life. Additionally, patients treated with the procedure experienced 84 percent fewer asthma-related emergency room visits and 66 percent fewer days lost from work, school and other activities due to asthma symptoms. A five-year follow-up trial was recently published and found that the original benefits were sustained over the past five years, a report that reflects the long-term effectiveness and safety of bronchial thermoplasty.
Bronchial Thermoplasty is available for individuals with severe, persistent asthma, which is defined by an expert panel in the Guidelines for the Diagnosis and Management of Asthma, prepared in conjunction with the National Heart, Lung, and Blood Institute, as exhibiting at least one of the following signs:
• symptoms throughout the day
• nighttime awakenings at least one time per week (and oftentimes occurring every night)
• the need to control symptoms with short-acting asthma medications (inhaled or in liquid or tablet form)
• ongoing interference with normal activity
• lung function at less than 60 percent
Asthma medications are meant to help the airways open up and reduce the symptoms of asthma, but the medications don’t always work for people with severe asthma. Airways in the lungs are lined with smooth-muscle tissue, but people with asthma have an increase in the amount of smooth-muscle tissue in their airways. This makes it more difficult for their airways to relax and let air move easily in and out of their lungs. When an asthma attack occurs, the excessive muscle constricts their airways, causing severe shortness in breath and wheezing.
Bronchial thermoplasty works by reducing the amount of excess muscle tissue in the airways through the application of mild heat. The reduction of muscle tissue allows the airways to further open up, allowing people to breathe more easily.
Performed by a specially trained pulmonologist, bronchial thermoplasty is completed in three sessions that are separated from each other by three weeks. Each session is performed under general anesthesia and takes about one hour. The procedure is performed by placing a long, flexible tube — the fiberoptic bronchoscope — through the mouth, so there are no incisions. A specialized catheter is inserted through the bronchoscope into the airways and applies mild heat to reduce the airways’ muscle tissue. After each procedure, the patient is monitored for two to four hours and then discharged. Most patients are back to their normal activities the following day. Some individuals experience temporary worsening of asthma-related symptoms after the procedure, but this side effect should resolve within a few days.
It is considered a once-in-a-lifetime procedure, so after the third session, a patient will not need to undergo the procedure again. Bronchial thermoplasty does not replace asthma medication; instead, it works with medication to provide long-lasting protection against asthma symptoms. A follow-up appointment is scheduled with the pulmonologist to determine the type and amount of medication needed. Patients will then continue to see their regular lung specialist as needed.
Mount Nittany Medical Center is the only facility performing bronchial thermoplasty within a 63-mile radius of State College. To see if bronchial thermoplasty is right for you, speak with your physician to see if you should be referred.
For more information on the procedure or to see if you’re a candidate, visit mountnittany.org or btforasthma.com.
Dr. John Cox specializes in pulmonary medicine at Mount Nittany Physician Group.