What Is Bronchial Thermoplasty?
Bronchial thermoplasty is a medical procedure designed to treat severe asthma in adults who do not respond adequately to standard medications such as inhaled corticosteroids and bronchodilators. The procedure involves applying controlled thermal energy to the airway walls, which reduces the amount of smooth muscle in the bronchi. This helps decrease the airways’ ability to constrict during an asthma attack, leading to fewer symptoms, reduced exacerbations, and improved quality of life. Bronchial thermoplasty is typically performed in specialized healthcare centers and is considered when other treatment options have failed to provide sufficient relief.
Understanding Bronchial Thermoplasty
Bronchial thermoplasty targets the underlying mechanisms of asthma by reducing the thickened airway smooth muscle that contributes to narrowing during inflammation or bronchospasm. In severe asthma, the smooth muscle in the airways becomes overdeveloped and hyperresponsive, which can cause frequent attacks, coughing, wheezing, and shortness of breath. By applying thermal energy through a bronchoscope, bronchial thermoplasty effectively diminishes the muscle mass, improving airflow and reducing the frequency and severity of asthma symptoms.
How the Procedure Works
The bronchial thermoplasty procedure is performed using a thin, flexible tube called a bronchoscope, which is inserted into the patient’s airways through the mouth or nose. The bronchoscope is equipped with a catheter that delivers radiofrequency energy to the airway walls in a controlled manner. The heat reduces excess smooth muscle without damaging surrounding tissues, allowing the airways to remain open more easily. The procedure is usually divided into multiple sessions, typically three treatments spaced three weeks apart, targeting different areas of the lungs during each session.
Step-by-Step Process
- PreparationPatients are given a short-acting sedative or general anesthesia to ensure comfort during the procedure.
- Bronchoscope InsertionA bronchoscope is carefully inserted into the airways to visualize the target areas.
- Application of Thermal EnergyRadiofrequency energy is delivered to the smooth muscle lining specific segments of the bronchi.
- RecoveryPatients are monitored for a few hours after each session for potential side effects and to ensure stability before going home.
Indications for Bronchial Thermoplasty
Bronchial thermoplasty is primarily indicated for adults with severe, persistent asthma who have not achieved adequate control with standard therapy. Candidates typically exhibit the following characteristics
- Frequent asthma attacks despite maximal use of inhaled corticosteroids and long-acting bronchodilators
- Severe symptoms that affect daily activities and quality of life
- High risk of hospitalization or emergency room visits due to asthma exacerbations
- Nonresponsive to other advanced treatments, such as biologic therapies
Benefits of Bronchial Thermoplasty
Bronchial thermoplasty offers several advantages for patients with severe asthma who struggle with conventional treatments. The main benefits include
Reduction in Asthma Attacks
Clinical studies have shown that patients undergoing bronchial thermoplasty experience fewer severe asthma exacerbations. By reducing the smooth muscle in the airways, the procedure decreases the likelihood of airway constriction during triggers such as allergens, exercise, or respiratory infections.
Improved Quality of Life
Many patients report better overall quality of life after bronchial thermoplasty, including increased ability to perform daily activities, reduced fatigue, and less reliance on rescue medications. Improved control of asthma symptoms allows for greater participation in work, exercise, and social activities.
Decreased Use of Medications
Following bronchial thermoplasty, some patients may require lower doses of inhaled corticosteroids and other medications. This reduction can minimize potential side effects associated with long-term steroid use, such as weight gain, bone density loss, and increased risk of infections.
Risks and Considerations
Although bronchial thermoplasty is generally safe, it carries certain risks that must be considered before undergoing the procedure. Short-term side effects may include
- Coughing, wheezing, or shortness of breath immediately after the procedure
- Temporary worsening of asthma symptoms for a few days
- Chest discomfort or irritation in the treated airways
Rare complications may include airway infection, prolonged hospitalization, or damage to the airways. Patients are carefully screened and monitored by a pulmonologist to ensure that the benefits outweigh the risks. It is also important to continue standard asthma medications before and after the procedure until advised otherwise by a healthcare provider.
Preparation and Recovery
Preparation for bronchial thermoplasty involves a thorough evaluation of the patient’s medical history, lung function, and asthma severity. Doctors may perform imaging studies, lung function tests, and laboratory evaluations to determine suitability for the procedure. Patients are typically instructed to continue their asthma medications and follow specific pre-procedure guidelines to reduce the risk of complications.
Recovery from each treatment session usually involves monitoring in a hospital or outpatient setting for several hours. Most patients can return home the same day, although they may experience temporary discomfort, coughing, or wheezing. Gradual improvement in symptoms is observed over weeks to months, with long-term benefits assessed through follow-up appointments and lung function testing.
Long-Term Effectiveness
Research indicates that the benefits of bronchial thermoplasty are durable, with many patients experiencing sustained reduction in asthma exacerbations and improved quality of life for several years following the procedure. Continuous monitoring and routine asthma care remain essential to maintain optimal lung function and prevent flare-ups. The procedure does not cure asthma but offers a significant improvement in symptom control for patients with severe, treatment-resistant disease.
Bronchial thermoplasty is an innovative, non-drug treatment option for adults with severe asthma that is not adequately controlled by conventional medications. By reducing excess smooth muscle in the airways, the procedure improves airflow, reduces asthma attacks, and enhances quality of life. While it carries potential risks, careful patient selection, preparation, and post-procedure monitoring help ensure safety and effectiveness. For patients struggling with severe asthma, bronchial thermoplasty offers a valuable therapeutic approach that complements standard medical management, providing lasting benefits and improved respiratory health.