Bronchial thermoplasty
Encyclopedia
Bronchial thermoplasty is a treatment for severe asthma
approved by the FDA in 2010 involving the delivery of controlled, therapeutic radiofrequency energy to the airway wall, thus heating the tissue and reducing the amount of smooth muscle present in the airway wall. This treatment has been shown to result in acute epithelial destruction with regeneration observed in the epithelium
, blood vessels, mucosa and nerves. However, airway smooth muscle
has demonstrated almost no capacity for regeneration
, instead being replaced by connective tissue
.
Under sedation, a catheter inside a bronchoscope—a thin, flexible tube-like instrument introduced through the patient’s nose or mouth, and into their lungs—delivers thermal energy into the airways. The patient is monitored after the procedure and usually returns home that day or early the next day. The catheter delivers a series of 10-second temperature controlled bursts of radio frequency
energy which heat the lining of the lungs to 65 degrees Celsius. It is this heat that destroys some of the muscle tissue which constricts during an asthma attack, reducing the number and severity of exacerbations.
32% reduction in asthma attacks
84% reduction in emergency room visits for respiratory symptoms
66% reduction in days lost from work, school, or other daily activities due to asthma symptoms
73% reduction in hospitalizations for respiratory symptoms
Reduction in asthma attacks and ER visits and hospitalizations for respiratory symptoms are maintained to at least 2 years
These benefits were observed during clinical studies where patients continued to take their standard maintenance asthma medications which included combinations of inhaled corticosteroids and long-acting bronchodilators.
Bronchial thermoplasty is now being used as a treatment in the United Kingdom.
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
approved by the FDA in 2010 involving the delivery of controlled, therapeutic radiofrequency energy to the airway wall, thus heating the tissue and reducing the amount of smooth muscle present in the airway wall. This treatment has been shown to result in acute epithelial destruction with regeneration observed in the epithelium
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
, blood vessels, mucosa and nerves. However, airway smooth muscle
Smooth muscle
Smooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by...
has demonstrated almost no capacity for regeneration
Regeneration
-In biology:* Regeneration , the ability to recreate lost or damaged tissues, organs and limbs* Bush regeneration, an ecological technique practiced in Australia-In music:* Regeneration , a 1977 album by Roy Orbison...
, instead being replaced by connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
.
The Procedure
A full course of bronchial thermoplasty treatment includes three separate bronchoscopic procedures: one for the each lower lobe of the lung and another for both upper lobes. Each outpatient procedure is performed approximately three weeks apart.Under sedation, a catheter inside a bronchoscope—a thin, flexible tube-like instrument introduced through the patient’s nose or mouth, and into their lungs—delivers thermal energy into the airways. The patient is monitored after the procedure and usually returns home that day or early the next day. The catheter delivers a series of 10-second temperature controlled bursts of radio frequency
Radio frequency
Radio frequency is a rate of oscillation in the range of about 3 kHz to 300 GHz, which corresponds to the frequency of radio waves, and the alternating currents which carry radio signals...
energy which heat the lining of the lungs to 65 degrees Celsius. It is this heat that destroys some of the muscle tissue which constricts during an asthma attack, reducing the number and severity of exacerbations.
Benefits
In a double-blind, randomized, sham-controlled clinical study of bronchial thermoplasty, adults with severe asthma that were treated with bronchial thermoplasty had improved asthma-related quality of life out to a year compared to the control (sham-treated) patients. Additionally, when compared to control patients, patients treated with bronchial thermoplasty also experienced the following significant benefits:32% reduction in asthma attacks
84% reduction in emergency room visits for respiratory symptoms
66% reduction in days lost from work, school, or other daily activities due to asthma symptoms
73% reduction in hospitalizations for respiratory symptoms
Reduction in asthma attacks and ER visits and hospitalizations for respiratory symptoms are maintained to at least 2 years
These benefits were observed during clinical studies where patients continued to take their standard maintenance asthma medications which included combinations of inhaled corticosteroids and long-acting bronchodilators.
Risks of Procedure
In the period immediately following bronchial thermoplasty, there was an expected transient increase in the frequency and worsening of respiratory-related symptomsProcedure Availability
Bronchial thermoplasty was first approved by FDA in April 2010. and is available at various Hospitals in the United States and CanadaBronchial thermoplasty is now being used as a treatment in the United Kingdom.