By Dr. Francis V. Adams
On April 27, 2010 the U.S. Food and Drug Administration approved the Alair Bronchial Thermoplasty System, the first medical device that uses radiofrequency energy to treat severe and persistent asthma in certain adults.
Bronchial thermoplasty is intended for asthmatic patients, ages 18 and older, with severe asthma that is not well controlled with inhaled corticosteroids and long-acting bronchodilators. These patients often require hospitalization and courses of oral corticosteroids to control their asthma.
In severe asthma the bronchial tubes become swollen and narrow producing shortness of breath. The muscle layer lining these air passages becomes thickened, further compromising the airway. In bronchial thermoplasty radiofrequency energy heats the lung tissue, reducing the thickness of the smooth muscle layer which improves the patient’s ability to breathe.
The device consists of a thin catheter with an electrode tip that delivers the radiofrequency energy directly to the airway and a controller. The catheter is passed through a fiberoptic instrument called a bronchoscope which is inserted either through the nose or mouth under intravenous sedation. Three separate sessions are required to treat the entire bronchial system.
The FDA based its approval of this device on a study of 297 severe asthmatics in which there was a 32% reduction in asthmatic attacks, an 84% reduction in emergency room visits and a 66% reduction in school or work days lost due to asthma. A follow-up study of the same group after two years revealed that the improvement achieved was maintained for this time period. These patients will be followed for another three years to document the long-term benefits.
Bronchial thermoplasty is currently only available at 30 medical centers in the United States. Because it is a new procedure, insurance coverage may not be available. The total cost to patients can range from $12,000 to $18,000. The procedure may cause side effects (asthma attacks, wheezing, coughing up blood) and patients undergoing bronchial thermoplasty commonly worsen immediately after the procedure due to the manipulation of the airways.
Bronchial thermoplasty is the first non-drug treatment offered for severe asthma. This new procedure provides an alternative approach to medication. The improvement noted after treatment has been documented up to two years. Anyone interested in this procedure should discuss it with their asthma specialist.
Francis V. Adams, M.D. is a pulmonologist in private practice in Manhattan and an Assistant Professor of Clinical Medicine at NYU Langone Medical Center He is the author of “The Asthma Sourcebook” and “Healing Through Empathy-An Expanded Edition”. Dr. Adams maintains a web site, www.adamsmd.com, where you can find ordering information about his books, and publishes an electronic newsletter weekly. He is also a Police Surgeon with the NYPD, a frequent contributor to the LA Times and hosts Doctor Radio on SiriusXM satellite radio every Tuesday morning from 6 to 8AM (Eastern time).