Bronchial Thermoplasty in Asthma: Q&A

Asthma sufferers had good news in the form of a new drug free heat treatment that promises to alleviate their symptoms faster and make breathing much easier. The procedure called bronchial thermoplasty showed promise in helping moderate to severe asthma sufferers gain control over their disease.

An international study conducted in 11 hospitals in the UK, Brazil, Canada and Denmark found bronchial thermoplasty to be more useful than asthma medications in limiting asthma symptoms and clearing up airways to make breathing easier.

The study is published in the New England Journal of Medicine (NEJM).

Below are some questions and answers on this new procedure and its implications for asthma sufferers.

What is bronchial thermoplasty?
It is an experimental treatment that has shown promise in the treatment of severe asthma. It uses radio waves or thermal energy to strip smooth muscles lining bronchial tubes.

What is the rationale behind bronchial thermoplasty?
In asthma smooth muscles of the airways contract and because they are thickened in the disease, they narrow the airways. This means that breathing is very difficult as air is unable to reach the lungs through narrowed tubes. Bronchial thermoplasty relives asthma symptoms by thinning the smooth muscles, thereby allowing easy entry of air into the bronchial tunes.

What is the procedure involved in thermoplasty?
The procedure requires light anesthesia. A flexible tube carrying a camera lens is inserted into the nose or mouth and down into the airways of the lungs. This tube called the bronchoscope, has a probe that expands the airways. It also delivers bursts of radio-frequency energy lasting for 10 seconds each. These bursts heat up the smooth muscles in the area. Consequently the muscles are burned up expanding previously contracted airways.

How often does an asthma patient need to undergo bronchial thermoplasty?
Patients need to undergo the procedure three times over about nine weeks. Each time different areas of the lungs are treated.

What are the potential benefits of bronchial thermoplasty?
In the above study 66 patients with moderate to severe asthma were treated with bronchial thermoplasty, while another 66 patients continued to take their asthma medications.

After a year, thermoplasty patients were breathing 39 liters of air per minute compared to 8.5 liters of air per minute breathed in by the medication group. Additionally the thermoplasty group had 40 days without any asthma attacks, while the medication group had only 17 symptom-free days.

What do the study authors say about the usefulness of the procedure?
Co-researcher Dr. John D. Miller, an associate professor of surgery at McMaster University in Canada said the response of asthma sufferers to bronchial thermoplasty was remarkable. "Maybe we can learn to do this in a less invasive way," Miller said. "Right now, it is a pretty stunning intervention with good results."

Are there any previous studies highlighting the benefits of bronchial thermoplasty in asthma patients?
A small study reported success with the treatment in the May 2006 issue of the American Journal of Respiratory and Critical Care Medicine. The study monitored sixteen adults who were unresponsive to current asthma treatments.

Two years after they received bronchial thermoplasty 75 percent said the treatment allowed them greater freedom in day-to-day functioning.

What do experts feel about bronchial thermoplasty?
Charles G. Irvin, director of the Vermont Lung Center of the University of Vermont and co-author of an accompanying editorial in the NEJM said the success of the treatment had put the focus on bronchial muscle rather than immunology and inflammation.

But he did admit that it might not be the best procedure. "The current procedure is not trivial," he said. "The patient must come in three times, and there is risk every time you do a bronchoscopy. But the more important thing is that this procedure improves outcome. That is exciting. It makes us rethink conventional wisdom."

However he added that further research is needed to recommend bronchial thermoplasty to the general population.

Asthma is a disease of the lungs in which airways are blocked making breathing difficult. It is estimated that 20 million Americans suffer from the disease. Currently the disease is treated with inhalers and pills. However the new heat treatment promises to relieve acute symptoms in a hassle free manner.

source:www.newslocale.org