Bronchial thermoplasty is the first and only non-drug therapy to treat severe asthma. At the University of Chicago Medicine, our pulmonologists are experts in performing this FDA-approved procedure. Bronchial thermoplasty uses heat to reduce excess airway smooth muscle tissue, which minimizes the airway constriction that takes place during an asthma attack. We were the first center in Illinois to perform this procedure and have the most experience in the region. Patients who've had bronchial thermoplasty say they have far fewer severe asthma attacks and emergency room visits, miss fewer days of work and school and have an improved quality of life.
Asthma is a chronic inflammatory disease of the airways that is characterized by shortness of breath, wheezing, chest tightness and coughing. Asthma causes a build-up of smooth muscle tissue within your breathing passages, which reduces the flow of air to your lungs. Bronchial thermoplasty is designed to prevent the airway constriction that is a hallmark of asthma by eliminating some of the smooth muscle tissue within your airways. That means you'll have greater airflow and can breathe easier.
During the bronchial thermoplasty procedure, physicians insert a thin flexible tube into the major airways of your lungs. This is done while you are under general anesthesia. Then they pass a small catheter through the scope to deliver the energy needed to eliminate the smooth muscle.
Once the catheter is in position it is expanded to hold it snugly in place and heated, using radiofrequency energy, to about 150 degrees Fahrenheit — a little cooler than a cup of hot coffee — for ten seconds. This kills about half of the smooth muscle cells that line that segment of the airway. Then the catheter is slightly re-positioned and re-heated.
This routine is repeated about 60 times, until all the accessible airways from one lobe of the lung have been treated. The whole process takes about 30 to 45 minutes. Patients recover in the hospital for approximately two hours after the procedure and then usually go home. Treatment involves three separate procedures spaced at least three weeks apart. Treatment sessions target different lobes of the lung at each session.
UChicago Medicine played a key role in research for bronchial thermoplasty and was one of the first centers in the world and the only hospital in Illinois to participate in the Asthma Interventional Research 2 (AIR2) clinical trial of bronchial thermoplasty. The study of severe asthma demonstrated that 79 percent of those treated with bronchial thermoplasty saw a significant improvement in their asthma-related quality of life. In addition, patients treated with bronchial thermoplasty experienced:
- 32 percent fewer severe asthma attacks
- 84 percent fewer asthma-related emergency room visits
- 66 percent fewer days missed from work, school or other daily activities due to asthma symptoms
A follow-up study of the AIR2 trial reported that benefits of bronchial thermoplasty treatment are long lasting and have been shown to continue for at least five years after treatment.
Not all people with asthma are candidates for bronchial thermoplasty. Bronchial thermoplasty may be right for you if:
- You have severe, persistent asthma that is not well controlled by inhaled corticosteroids or long-acting bronchodilator medications
- You are 18 years of age or older
Bronchial thermoplasty is not appropriate for people who:
- Are under 18 years of age
- Have a pacemaker, internal defibrillator or other implantable electronic devices
- Have a known sensitivity to medications required to perform bronchoscopy, including lidocaine, atropine and benzodiazepines
- Have been previously treated with bronchial thermoplasty
Having offered the procedure for years, UChicago Medicine pulmonary physicians are experts in assessing if bronchial thermoplasty is a good option to treat your severe asthma.
Though most patients who receive bronchial thermoplasty report a significant reduction in asthma symptoms, the procedure is not a cure for asthma. Patients should continue to take asthma medications as prescribed by their physician.
The most common side effect of bronchial thermoplasty is temporary worsening of respiratory-related symptoms. This typically occurs within a day of the procedure and resolves within seven days on average with standard care. A very small percentage of patients may require hospitalization within the period immediately following treatment. Long term, there appear to be no new symptoms or problems that develop associated with bronchial thermoplasty.
Whereas most asthma management involves inhalers or pills or injections, this is a procedure. And so it's used via bronchoscope. We go down through the mouth. You're under anesthesia, so you're comfortable. It's the only thing that directly targets the muscle that wraps around the breathing tubes.
All the therapies that are geared towards asthma are trying to help stop the inflammation or keep you from having an allergic reaction or try to dilate the muscles so that the airways stay open. But this is the only one that tries to actually target the muscle and try to make it not work, essentially, so it can't constrict.
When it was first being developed, it seemed like a crazy concept to go in and literally mess with the airways of someone whose airways, by definition, have a disease, except the clinical data proved that it's safe and it's effective.
If you're the type of asthmatic where your doctor says, take this inhaler twice a day every day, and you do, and you're feeling great, you rarely need your rescue inhaler, you're never in the ER, you’re not needing prednisone, then you don't need something like bronchial thermoplasty. Keep taking your inhalers.
But there are enough patients out there that are on the best drugs we have, and yet they still can't play sports. They can't chase their kids. They can't climb up the stairs. They're in the ER again. They're on prednisone again. Or worse, they're always on prednisone. What do you do for these people? Historically, nothing. You said, well, prednisone. Good luck. That's not acceptable. It is a horrible drug. And so we have better choices, and that's where this procedure comes in.