DrWhite2Q: I read an article about a treatment for asthma that uses heat to relax the airways. How does this work – and is it available for everyone? 

Martha White, MD: This is Bronchial Thermoplasty, an outpatient procedure approved by FDA in 2010 for adults age 18 and older with fairly severe asthma. These are patients whose symptoms are not adequately controlled using the standard therapy of a combination of inhaled corticosteroids and a long-acting bronchodilator. 

People whose symptoms do not respond to normal asthma medications face serious restrictions on their activities, often finding themselves in and out of the emergency room, with frequent hospitalizations and treatment with oral corticosteroids.

This type of difficult-to-control and long-standing asthma often results in overgrowth of the muscles that surround the airways of the lungs and keep them open. This thickens the airway wall, which narrows the air space and restricts breathing. Bronchial Thermoplasty uses mild heat to reduce the size of the bronchial muscles.

During an outpatient visit, the patient is sedated with moderate or general anesthesia. Then a trained pulmonologist places a long, slender tube called a bronchoscope into the lungs to heat affected areas. There is no incision, and the tube is smaller than the airways, which lets the patient breathe. The procedure is repeated once a month for three months, treating a different section of the lungs each time.

Bronchial Thermoplasty, delivered by the Alair™ system from Boston Scientific, is an important option for these patients and their physicians to consider.

It’s not a cure, and it’s not for everyone. Ongoing clinical trials have demonstrated long-term safety of the procedure, along with lasting results up to five years. Adverse side effects include short-term worsening of asthma, including some hospitalizations.

ACAAI, Network Support Bronchial Thermoplasty

In July 2015, the American College of Allergy, Asthma & Immunology (ACAAI) announced its support for the procedure. “The scientific literature supports Bronchial Thermoplasty as a therapeutic consideration for some carefully chosen patients with severe, difficult-to-control asthma,” says allergist James Sublett, MD, ACAAI president. “In addition, ACAAI recommends that insurers provide coverage for Bronchial Thermoplasty for those adult patients who meet the stringent requirements.” 

Allergy & Asthma Network recently posted a position statement on Bronchial Thermoplasty on its website, saying that “patients have the right to receive this therapy when their physician determines it is appropriate, and we urge health insurance payers to offer coverage.”