Bronchial Thermoplasty Case Study
Patient Background
Age: 72 years old
Sex: Male
Symptoms: Shortness of breath, cough with sputum, lightheadedness, significantly decreased mobility
Personal History: Diabetic, high blood pressure
Indications for Procedure
> Diagnosed with severe asthma
> Minimal relief from inhaled corticosteroids
> Minimal relief from bronchodilators
Bronchial Thermoplasty Procedure
Bronchial Thermoplasty is an FDA approved procedure indicated for patients with severe persistent asthma in patients 18 years or older whose asthma is not well controlled with inhaled corticosteroids and long-acting beta agonist and have frequent flare-ups or inflammatory disease.
The outpatient procedure was scheduled in three sets, three weeks apart with each procedure lasting 30 to 45 minutes.
During the procedure, a bronchoscope is placed into the airway through the mouth or nose. The AlairTM Catheter has an expandable, electrode that delivers radiofrequency energy directly to the airways of the lungs for 10 seconds to heat the tissue in a controlled manner in order to reduce airway smooth muscle thickness.
Each session treats a different part of the lung to ensure safety. When the treatment is complete, patients return to their regular asthma-treating physician to continue managing the condition.
Outcomes
After the first treatment, patient noticed his breathing improved by about 50 percent. By the third procedure, the patient experienced normal breathing. Six months after treatment, the patient is increasing ambulation gradually and able to walk much further than he was ever able to do.
Bronchial Thermoplasty Research
Bronchial Thermoplasty is clinically proven to reduce asthma attacks for at least 5 years. New data presented at the 2013 meeting of the American Thoracic Society demonstrates the five-year safety profile for this procedure. Importantly, in one controlled trial in which Bronchial Thermoplasty was compared to sham treatment (bronchoscopy but no activation of the Bronchial Thermoplasty catheter), patients who received Bronchial Thermoplasty demonstrated clear, significant improvement in asthma symptoms and in quality of life.1
At 1-year (compared to sham), patients with severe asthma who were treated with Bronchial Thermoplasty experienced:
- 32% decrease in severe asthma attacks1
- 84% reduction in emergency room visits for respiratory-related symptoms1
- 66% fewer days lost from work, school and daily activities due to asthma1
- 79% of patients who were treated with Bronchial Thermoplasty reported a significant improvement in their asthma-related quality of life1
At 5-year follow up, patients who were treated with Bronchial Thermoplasty experienced:
- 44% decrease in patients having severe exacerbations, compared with 12 months prior to BT treatment.2
- Reduction in percentage of patients experiencing exacerbations2
- 78% decrease in the percentage of patients experiencing ER visits for respiratory symptoms, compared with 12 months prior to BT treatment2
References:
- Castro M, et al, for the AIR2 Trial Study Group. Am J Respir Crit Care Med. 2010;181:116-124.
- Wechsler M et al. J Allergy Clin Immunol. 2013 Dec;132(6):1295-302.
Conclusion
For most severe asthmatics Bronchial Thermoplasty is a final step after they have failed to respond to other advanced therapies and who generally are dependent on or frequent user of oral corticosteroids (prednisone). The quality of life improvement in a substantial number of patients after Bronchial Thermoplasty is remarkable. Many are able to discontinue oral corticosteroids, avoiding the long-term complications of oral prednisone therapy. The substantial reduction in the number of emergency room visits, urgent care encounters and hospitalizations for asthma further improve quality of life.
As with other procedures, patient selection in Bronchial Thermoplasty is extremely important; both to ensure appropriateness of the procedure and to ensure that health care resources are not wasted.
Allergy Sleep & Lung Care is one of the leading centers in the Southwest Florida providing Bronchial Thermoplasty with significant success in helping patients with severe, steroid-resistant asthma.
Our clinic is dedicated to evaluating patients with severe asthma in a thorough and comprehensive manner. We work diligently to exclude other conditions that might mimic asthma and ensure that patients are and have been adherent to prescribed therapy, so that we can select those who are on clinical grounds best suited for Bronchial Thermoplasty.