New Treatment for Severe Asthma—Bronchial Thermoplasty
Bronchial thermoplasty is a treatment for severe asthma approved by the FDA in 2010. It involvesthe delivery of controlled, therapeutic, radiofrequency energy to the airway wall, thus healing the tissues and reducing the amount of smooth muscle present. The treatment has been shown to result in acute epithelial destruction with regeneration observed in the epithelium, blood vessels, mucosa, and nerves. Airway smooth muscle has demonstrated almost no capacity for regeneration, instead being replaced by connective tissue.
By utilizing radiofrequency and damaging the smooth muscle, the tissue becomes less reactive and does not constrict. This lack of constriction lessens or eliminates the symptoms of asthma.
The procedure involves three bronchoscopy procedures that involve the introduction of a bronchoscopic device: a thin, flexible, tube-like instrument introduced through the nose or mouth into the lungs under moderate conscious sedation. At this point, a catheter delivers thermal energy into the airways at 65 degrees Celsius. This heat destroys some of the muscle tissue that causes constriction during an asthma attack, subsequently eliminating or reducing the number of severe exacerbations.
In a double-blind, randomized clinical study, adults with severe asthma who were treated with bronchial thermoplasty experienced an improved asthma-related quality of life. Results of this study showed 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
There were some associated risks immediately following the procedure. One such risk was a transient increase in the frequency and worsening of respiratory-related symptoms.
Bronchial thermoplasty was first approved by the FDA in April, 2010. It is available in various hospitals in the United States and Canada and is also being used for treatment in the United Kingdom.
- Cox G., M. D., McWilliams A., FitzGerald J.M., and Lam S. (2006). “Bronchial Thermoplasty for Asthma.” American Journal of Respiratory Critical Care Medicine 173: 965 – 969.
- Mitzner, W. (2006). “Bronchial Thermoplasty in Asthma.” Allergology International 55(3): 225 – 234.
- “Asthmatx, Inc. Alair Bronchial Thermoplasty System – P080032”. U.S. Food and Drug Administration. 2010-05-19. http://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm212594.htm.
- Nick Ravenscroft (8 June 2011). “UK doctors begin pioneering asthma treatment”. BBC News. http://www.bbc.co.uk/news/uk-13690102.
Steven Pavlak is a fulltime instructor for Independence University. He also works fulltime at a local community hospital and teaches at Youngstown State University. Recently, he was appointed by the Governor of Ohio to serve a three-year term on the Ohio Respiratory Care Board which governs the laws and licensure of the state’s licensed respiratory care practitioners.
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