Bronchial Thermoplasty: A New Treatment for Asthma
by Dr. Gregory R. Neagos
The Centers for Disease Control and Prevention says that rates of asthma are higher than they were 20 years ago, and rates of asthma attacks leading to hospitalization or death also remain high. Clearly, there is a need for better control of this common but treatable disease.
The national asthma guidelines recommend a stepwise approach to treatment, beginning with "as needed" treatment with a quick-relief medication, then, if needed, introducing inhaled corticosteroids and other types of medication at later steps. The majority of asthma patients, who have mild or moderate asthma, are usually able to stay well-controlled if they take their medications as prescribed and avoid their triggers. A small number of patients have severe, uncontrolled asthma in spite of high doses of medications. They have side effects from these drugs, very limited activity levels, and live in fear of the next time they are unable to catch their breath. While this is a fairly small percentage of people, due to the costs in quality of life and dollars spent in the health system, the need for new treatments for them is great.
One new treatment for severe, uncontrolled asthma in adults is bronchial thermoplasty (BT). It is an FDA-approved outpatient treatment where thermal energy (heat) is held near the airway wall for a short period of time using a thin, bendable tube called a bronchoscope. It is given in a series of three treatments, each in a different area of the lung, with three weeks of rest between. The heat takes away some of the smooth muscle that tightens during asthma so the airways won't be so narrow, causing fewer asthma symptoms and attacks, leading to a better quality of life. Only specially trained pulmonary doctors (lung specialists) can do this treatment.
During the first few weeks after the treatment, asthma can be worse and there can be other lung problems. But within six months to a year, patients usually have a better quality of life, and fewer asthma symptoms, ED visits and missed school or work days. Patients who have had BT have been followed for up to 5 years, showing stable pulmonary function tests, no clinical problems from the treatment, and no important changes on lung CTs.
While this treatment is not yet common, more health systems are starting to offer it, and more insurance plans are starting to cover it. Learn more about bronchial thermoplasty at www.BTforAsthma.com
Dr. Neagos is a staff pulmonologist with The Spectrum Health Medical Group and a Clinical Associate Professor of Medicine at the MSU College of Human Medicine in Grand Rapids.