Definition & Overview
A bronchial thermoplasty is a medical procedure used for the treatment of severe asthma. It works by keeping the airway smooth muscles (ASM) from contracting or narrowing through radiofrequency ablation. This noninvasive procedure is one of the recently developed and approved treatments for asthma and is a great alternative to using corticosteroid injections, which are linked to a high incidence rate of side effects.
A bronchial thermoplasty is expected to reduce the swelling that may lead to an airway obstruction during an asthma attack. Currently, it is the first and only therapy that can help control even severe cases of asthma without the use of any kind of medication.
Who Should Undergo and Expected Results
A bronchial thermoplasty is recommended for patients suffering from chronic asthma, a complex inflammatory disorder that affects the bronchial airways. Its primary symptom is hypersensitivity of the airways, resulting in inflammation and leading to airflow obstruction. Other symptoms include frequent or uncontrollable coughing and wheezing.
Asthma is a very common disorder affecting about 1 in every 10 people, with more than half of all affected patients suffering from asthma attacks each year. About 5 to 10 percent of this number is made up of complex, hard-to-treat cases. The disease is also more prevalent among males aged 0 and 14, among females aged 15 and older, and among people who live in inner regional areas.
Studies show that the number of patients who suffer from asthma will continue to grow up to an estimated 450 million within the next 20 years. Thus, treatment options for asthma are continuously being developed.
Based on a clinical study, a bronchial thermoplasty, when used for the treatment of severe asthma, can result in:
- 32% reduction in severe attacks
- 85% reduction in asthma-related emergencies
- 66% reduction in the number of days lost from school or work due to the condition
- 79% overall improvement in patients’ quality of life
Additionally, the treatment is expected to provide five years worth of benefits, making it a long-term treatment option.
How is the Procedure Performed?
A bronchial thermoplasty is an outpatient procedure that takes pulmonologists less than an hour to perform. The treatment was developed by Alair System and was approved by the FDA in 2010. Prior to undergoing the ablation, patients are placed under moderate sedation to ensure comfort. Anesthesia is rarely, if at all, necessary.
To maximize the full benefits of the procedure, patients should undergo several treatment sessions that are spaced three weeks apart. Each session targets any of the three bronchoscopic areas, namely the lower lobe and the two lower lobes of the lungs.
During a session of bronchial thermoplasty, the patient is asked to lie down on an examination table and is sedated. The pulmonologist uses a special type of catheter or a bronchoscope, which is inserted through either the nose or the mouth all the way to the lungs, to deliver controlled amounts of thermal energy towards the airways.
After the procedure, the patient is monitored closely for a few hours before being allowed to go home.
Possible Risks and Complications
As with any other medical procedure, a bronchial thermoplasty carries some degree of risk and may cause some side effects. The most common are temporary-onset respiratory symptoms similar to an asthma attack, such as coughing, wheezing, and mild shortness of breath. These symptoms typically begin the day following the procedure but should subside gradually and eventually disappear over a period of 7 days.
Other complications may also occur, including:
- Recurrent lung atelectasis
- Lung abscess
There are also some limitations as to who can receive the treatment. Patients who recently suffered from an asthma attack or took oral steroids are required to wait at least two weeks before undergoing the procedure. Also, patients who suffer from an active respiratory infection have to wait until the infection is treated prior to seeking the procedure.
Some patients, on the other hand, are not considered as potential candidates for the said treatment. These include patients under 18 years old and those who have electronic implantable devices such as a pacemaker or defibrillator. Patients who have a heightened sensitivity to lidocaine, atropine, and benzodiazepines, which are used during the procedure, are also advised to seek other treatment options.
“Bronchial thermoplasty for severe asthma.” NICE interventional procedure guidance. Published January 2012. https://www.nice.org.uk/guidance/ipg419
Laxmanan B, Hogarth DK. (2015). “Bronchial thermoplasty in asthma: current perspectives.” J Asthma Allergy. 2015; 8: 39-49.