Controlling severe asthma can be a challenge for physicians. Bronchial Thermoplasty (BT) is a device-based therapy, delivering controlled thermal energy to the airways during a series of three bronchoscopic procedures, performed at three-week intervals. Each session requires approximately 30-45 minutes.
There have been five studies looking at efficacy, three of which were randomized. There was evidence of slightly improved quality of life (based upon Asthma Quality of Life Questionnaire scores), improved asthma control, and fewer exacerbations. There was evidence of reduced airway hyperresponsiveness. Overall, the beneficial effects seemed to last about five years. Unfortunately, there are adverse effects, including asthma attacks and bleeding.
BT delivers controlled thermal energy (65°C) to airways between three and 10 mm in diameter. Potential mechanisms of action include reduction of airway smooth muscle, stiffening of the bronchial walls, and decrease secretions of inflammatory mediators. The precise mechanism or mechanisms of action is not well understood.
Bronchial Thermoplasty is indicated for cases of severe asthma inadequately controlled or uncontrolled despite maximal medical therapy. There are contraindications and relative contraindications. BT has been approved by the FDA and is being offered in select medical centers.
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