Bronchial Thermoplasty: Another Option for Hardluck Asthma

by John Bottrell Health Professional

So you have hardluck asthma. That is, you're asthma isn't responding to conventional asthma medicines on the market. If so, there is a relatively new option available to you, and it's called bronchial thermoplasty.

It may or may not be something you'd be interested in, yet at least it's another option for you to discuss with your asthma doctor. After a study of 297 patients, the Food and Drug Administration (FDA) approved the Alair Bronchial Thermoplasty System in April of 2010.

Actually, Pat Bass wrote in his asthma blog the following results of the study:

  • Improved quality of life

  • 32 percent reduction in asthma attacks

  • 84 percent reduction in emergency room visits

  • 73 percent reduction in hospitalizations

  • 66 percent reduction in loss days from school and work

So, what is this procedure and how does it work?

The procedure is minimally invasive, and is therefore an outpatient procedure. The patient is sedated, and a bronchoscope with the Bronchothermoplasty System is inserted into the airway.

The physician then burns away extra smooth muscle from the air passages of the lungs by using radio frequency waves (a type of electromagnetic radiation). This procedure will need to be repeated three times approximately three weeks apart.

The idea here is that with less smooth muscle the airways have less ability to constrict, and this -- ideally -- reduces the frequency of asthma attacks, and improves quality of life. With less bronchial smooth muscle, the lungs stay open and are therefore less reactive to asthma triggers.

It should be noted here that this procedure does not cure asthma, it simply reduces symptoms. Yet studies show that it has reduced severity of asthma, reduced emergency room visits, improved quality of life, and reduced days lost from school or work.

What are the side effects?

As far as side effects of the procedure, Bass notes that, "While there were some increases in respiratory symptoms immediately following the procedure, they were similar to what one would expect following bronchoscopy in an asthma patient."

Of course as with any medical treatment you must weigh the risks with the advantages.

Who qualifies for this procedure?

To even be considered the asthmatics must be at least 18 years of age. The patient must also have severe and persistent asthma that does not respond to inhaled corticosteroids and long-acting bronchodilators (like Advair and Symbicort).

One question I had about the procedure
was regarding the burning away of bronchial smooth muscle. Won't this cause other complications? Yet after extensive research about bronchial smooth muscle, I learned it serves no useful purpose other than to cause asthma (I wrote about this here).

Therefore, you should't have to worry about the loss of bronchial smooth muscle.

Why does burning away bronchial smooth muscle make asthma better?

Asthma is a disease of chronic inflammation of the bronchioles causing the smooth muscles surrounding bronchioles to contract and tighten, and this ultimately narrows the air passages. This makes it so air cannot escape the lungs. This, in essence, is an asthma attack.

Inhaled corticosteroids and long acting bronchodilators usually work well to control this inflammation. Yet for a few, these medicines don't work. these are your Hardluck Asthmatics.
Bronchothermoplasty is now an option for them.

With less smooth muscle the air passages won't be able to contract and narrow, and this ultimately reduces (hopefully) your lungs ability to react to your asthma triggers.

So if your asthma is getting in the way of your life, and you are compliant with your asthma controller medicines, and your asthma is still out of control, perhaps this relatively new procedure is an option you can discuss with your physician.

John Bottrell
Meet Our Writer
John Bottrell

John Bottrell is a registered Respiratory Therapist. He wrote for HealthCentral as a health professional for Asthma and Chronic Obstructive Pulmonary Disease (COPD).