Bronchial Thermoplasty

Edward Omron MD, MPH, FCCPPulmonary and Critical Care MedicineSaint Louise Regional Medical Center

pulmonarydiseases@gmail.com

What is Asthma?

• Reversible lung disease• The airways of the lung are inflamed, swollen and

narrowed resulting in “wheezing”• Breathing problems occur in “attacks” but the

disease is continuous • Recurrent cough, chest tightness / pain, or shortness

of breath• Symptoms worsen with exercise, infection, changes

in weather, or at night.

Asthma Airways

Asthma Facts

• In 2009, 25 million Americans had asthma– Of these 13 million have had an asthma attack

• In 2007 there were 3500 deaths from asthma– 63% of these deaths occurred in women

• The prevalence of adult asthma in CA 2009 is 8%• Asthma accounts for 50 billion health care dollars

yearly

Types of Asthma

Mainstays of Therapy

Inhaled Corticosteroids Remain the MAINSTAY of treatment in all asthmatic groups

Current Therapies

• Remove asthma triggers• Short acting bronchodilators• Inhaled Corticosteroids• Long Acting Bronchodilators• Leukotriene Modifiers• Steroids• Anti IgE Modifiers• EXERCISE

Advances in Therapy

• There is no cure of asthma thus far in 2012• CONFIRM the diagnosis before any

augmentation of treatment of regimens– Rule out for example vocal cord dysfunction– Interstitial Lung Disease

• Severe persistent asthma is a great challenge to both the patient and the physician

Bronchial Thermoplasty (BT)

• Severe asthmatics have excessive smooth muscle in the airways

• BT is a non-drug procedure that reduces airway smooth muscle by applying heat to the airways– This reduces the frequency of asthma attacks

• Three outpatient procedures performed three weeks apart under sedation

• Benefits:– 32% reduction in asthma attacks– 84% reduction in ER visits– Improved asthma quality of life

Bronchial Thermoplasty

Short Term Side Effects• Mild and related to airway irritation– Coughing– Dyspnea– Wheezing

• Mean Time to onset: 1.7 days• Mean Time to resolution: 4.6 days• Only 42% of side effects required use of

medications: antibiotics, inhalers

AIR 2 Results Efficacy (288 patients)

• Severe exacerbations: 32% reduction• Emergency Department Visits: 84% reduction• Days missed from work or school: 1.3 vs 3.9 days• AQLS: BT 1.35 vs 1.16

• AJRCCM 2010: 181; 116-124

Long Term Side Effects

• Chest CT at 1 and 2 years post treatment

– No Evidence of Bronchiectasis– No Evidence of Bronchial Wall Disease– No Evidence of Lung Parenchyma Changes

Resources

• American Lung Association– http://www.lung.org/lung-disease/

• http://www.onebreath.org/• http://www.thoracic.org/education/breathing

-in-america/index.php