Guest Author - Cheryl Tidball, DO
For most asthmatics, a combination of short- and long-acting bronchodilators and inhaled steroids work well to control asthma symptoms including cough, chest tightness and wheezing. However, approximately five percent of asthmatics have a severe resistive form of the disease that does not respond well to conventional treatment. In these individuals, a currently investigational non-drug procedure called bronchial thermoplasty may be helpful in the future.
In bronchial thermoplasty, a bronchoscope is inserted by a pulmonologist into an individual’s trachea and into the bronchial tubes that lead to the lungs. Heat is applied through a special catheter attached to a radiowave generator to remove some of the smooth muscle that constricts and causes airway spasms during an asthma attack. The temperature reaches approximately 149 degrees and reduces the muscle mass but does not cause scarring or damage to the lung tissue. Studies have shown that although initially there is a slight increase in respiratory problems, six weeks after this procedure, most asthmatics are able to reduce the amount of short-acting bronchodilator needed and many could taper off oral steroids. All of the trial participants reported a significant increase in symptom-free days. The procedure lasts less than an hour and is done as an outpatient. No general sedation is needed. Approximately three treatments are needed to treat the entire lung tissue.
As with any bronchoscopic procedure, risks include an initial increase in coughing or wheezing, infection, irregular heartbeat, or bleeding. Most side effects were transient and resolved within one day to one week after the procedure. The benefits of the procedure seem to persist for at least one year and will most likely be permanent lifetime improvements. Although this procedure is helpful in significantly reducing symptoms, it does not cure asthma and maintenance medications will continue to be needed, although most likely in decreased dosages.
Although this procedure is not yet available out of the research population, these patients continue to be monitored closely and will hopefully be obtainable soon by other severe asthmatics.
