What Is Bronchial Thermoplasty?

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Bronchial thermoplasty (BT) is an interventional asthma procedure in which a tube called a bronchoscope is inserted into a person's mouth or nose and threaded through the bronchi (airways) to the lungs. Once in place, the tube is enlarged, which in turn widens the airways, allowing for a freer flow of air to the lungs. Bronchial thermoplasty is performed in three sessions, each treating one-third of the lungs at a time.

Bronchial Thermoplasty Risks

Verywell / Laura Porter

This procedure is approved to treat severe asthma in people age 18 and older. However, it's important to note that in December 2020, a panel of experts with the National Institutes of Health (NIH) issued updated recommendations for asthma management that focused in part on bronchial thermoplasty.

They determined that for most people, the risks of BT outweigh the potential benefits, stating, "In individuals aged 18 years and older with persistent asthma, the Expert Panel conditionally recommends against BT."

The panel also advised that anyone who wants to have bronchial thermoplasty should turn to a pulmonologist (a healthcare provider who specializes in respiratory diseases) who has been trained to administer BT and, if possible, that it take place as part of a clinical trial or study looking at the long-term effects of the procedure.

Purpose of Procedure

Asthma symptoms such as wheezing and shortness of breath are caused by bronchoconstriction (narrowing of the airways) and inflammation in the lungs. Bronchial thermoplasty uses thermal energy to treat the narrowing by preventing the smooth muscles in the bronchi and lungs from constricting. BT also is used to prevent bronchospasm (sudden airway narrowing) in response to asthma triggers.

You might be a candidate for bronchial thermoplasty if your asthma symptoms are severe and persistent even though you use controller medications such as inhaled corticosteroids and long-acting beta-agonists.

Because bronchial thermoplasty targets bronchoconstriction rather than inflammation, it has been suggested that people whose asthma is predominantly inflammatory may not benefit as much from the procedure as those whose asthma is primarily caused by hyperreactive bronchi.

Experts also suggest there may be other beneficial effects of bronchial thermoplasty besides reducing muscle activity, such as modifications in the lining or the nerves of the lungs.

Risks and Contraindications

Bronchial thermoplasty poses significant risks, which the NIH experts cited in the updated guidelines:

Existing health issues can raise the risk of an adverse effect, among them:

  • Asthma exacerbation in the last two weeks
  • A forced air volume (FEV1) of less than 50% or 60%
  • Life-threatening asthma
  • Respiratory infection
  • Bleeding problems

Your healthcare provider may postpone the procedure until your existing illness resolves on its own or with treatment. You also will need to wait to have this procedure if you've had an increase or decrease in your dose of oral corticosteroids for your asthma in the past 14 days.

Certain medical conditions are absolute contraindications for this procedure, among them:

  • An implantable heart device such as a pacemaker or internal defibrillator
  • An allergy to the medications used during a bronchoscopy, such as lidocaine, atropine, and benzodiazepines
  • Previous treatment with bronchial thermoplasty

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Before the Procedure

If you are considering bronchial thermoplasty, you'll undergo a thorough medical evaluation that includes tests like pulmonary function tests (PFTs), as well as an assessment of how much asthma controller and rescue medication you're using. Because inflammatory asthma may not improve with BT, you might also have blood tests to examine your level of inflammation.

If you're a candidate for bronchial thermoplasty and you decide to proceed, your practitioner will give you instructions regarding any necessary adjustments in your medications you should make first. For example, you might need to stop taking blood thinners for several days prior to BT.

Your healthcare provider may give you a prescription for prednisone or an equivalent at a dosage of 50 milligrams per day for three days before the procedure, the day of the procedure, and the day after the procedure to minimize the risk of procedure-induced inflammation.

Timing

You will most likely have your bronchial thermoplasty as an outpatient, so you can go home on the same day of the procedure. Given this is a major intervention, prepare to devote up to a full day and evening to getting to and from your appointment, checking in, the procedure itself, and recovery.

Location

You will have your procedure in a surgical suite or a procedural suite of a clinic or hospital.

What to Wear

You will likely be asked to change into a gown for your procedure. You should wear something that isn't too complicated or bulky so it can be stored easily. You'll be tired afterwards, so it may be a good idea to make sure your clothing is comfortable as well.

Food and Drink

Because you will have medical sedation for your procedure, your healthcare provider may tell you to abstain from eating or drinking after midnight the night before your appointment.

Cost and Health Insurance

The cost of bronchial thermoplasty is covered by major health insurers if prerequisites are met, though a co-pay or deductible may be required. If you have a plan, you will need to check with your insurer and/or your healthcare provider to know if you meet coverage requirements and if there will be any out-of-pocket expenses.

Your payer may require that you have experienced a certain frequency of asthma attacks and/or that you first try a certain dose of controller medications for a particular period of time before they will approve this procedure.

If you are paying for the procedure yourself, you can expect it to run between $7,500 to $15,000. Costs may vary and there may be additional fees for associated pulmonary testing or anesthesia.

What to Bring

You should bring a form of identification, your health insurance card, and a method of payment. Be sure to bring your asthma medications with you, including your inhalers.

You will need to have someone with you to drive you home, as you are likely to be groggy after your procedure. You can bring that person with you or arrange for them to pick you up when you're through.

During the Procedure

You will have to sign in when you arrive for your appointment and fill out consent forms for your procedure. Several individuals may be part of your medical team, including the healthcare provider, an assistant or nurse, a nurse anesthetist, and an anesthesiologist.

The practitioner who regularly monitors and helps you manage your asthma might not be the one who performs your procedure. Your bronchial thermoplasty will be performed by a surgeon or pulmonologist who has special training in this procedure. Because this type of intervention requires specialized training, you will likely have the same team performing each of your three sessions.

Pre-Procedure

You may be asked to change into a gown and to lie down comfortably. You will have your blood pressure, breathing rate, and temperature checked before your procedure. You might have a pulse oximeter placed on your finger to monitor your oxygen level. And you will have an intravenous catheter placed so your healthcars can administer medication and draw blood as needed.

You may receive a bronchodilator like albuterol and/or glycopyrrolate 30 minutes before the procedure either intravenously (IV, in a vein), intramuscularly (IM), or by nebulizer inhaler.

Bronchial thermoplasty is usually performed under moderate sedation, so you will receive sedating medication through your IV. You won't be given medication to completely put you to sleep (general anesthesia) the way you would with major surgery.

Throughout the Procedure

When it's time to begin, you will be wheeled to the surgical or procedural suite in a bed or wheelchair.

You will be sleepy or you might fall asleep during your procedure. Your healthcare provider will insert a bronchoscope into your mouth or nose and advance it down into your lungs.

The specialized bronchoscope that's designed for this procedure has an expandable thermal tip that is carefully positioned to expand and deliver thermal energy to the targeted airways.

You shouldn't be able to feel any part of the procedure, but you may hear the medical team talking as you are having your bronchial thermoplasty.

Post-Procedure

Once your bronchial thermoplasty is complete, the bronchoscope will be removed. Your medical team will check on you and may wake you up if you are asleep. You will likely be taken to a recovery area where you can rest until you feel ready to fully wake up.

As you continue to recover, you might have your vital signs—such as blood pressure, pulse, respiratory rate—checked periodically.

If you have any complications, such as trouble breathing, declining oxygen levels, or any other medical issues, you will be urgently evaluated. You may experience worsening asthma symptoms for the first day after your treatment, and you may need to stay in the hospital for observation and management as you recover.

Once you're stable and breathing comfortably, you will be discharged to go home, where you should take it easy for the rest of the day. If any serious complications occur, however, you may have to stay in the hospital for further monitoring and treatment.

After the Procedure

Once you go home, you should be comfortable, even if you are a bit groggy. If you feel like you need to rest for a couple of days, do that. But if it takes longer for you to feel like yourself again, be sure to call your healthcare provider.

Managing Side Effects

Your throat, nose, or mouth may be sore for a few days after the procedure due to the insertion of the bronchoscope. You can ask your healthcare provider about medication to help relieve this at home.

If you develop shortness of breath, chest pain, chest tightness, confusion, severe fatigue, or you cough up blood, get medical help immediately. These are signs of potentially serious complications.

Outcomes

A bronchial thermoplasty may result in an improved quality of life. You can have a reduction in asthma attacks and a decreased need for rescue medication.

Research shows an improvement in mini-AQLQ score (a measurement of asthma-related quality of life) from a baseline of 3.6 ± 0.3 before therapy to 5.6 ± 0.3 one year after the final procedure, as well as a decrease in the use of asthma medication one year after the last of the three treatment sessions.

You may miss fewer days of work or school due to your asthma. And you may have fewer asthma-associated emergency room visits and hospitalizations.

However, you might need to continue to take some asthma medication, and it can take months after your procedure before you and your healthcare provider find the right medications and doses for you.

Follow-Up

A complete bronchial thermoplasty treatment includes three separate sessions that each treat a different area of the lung. These sessions are scheduled at least three weeks apart.

Between each session, your practitioner will follow up with you one day, two days, and seven days after your treatment.

After the full treatment regimen is complete, repeat treatments are not done.

A Word From Verywell

Bronchial thermoplasty may be beneficial for some people with severe asthma, although positive long-term outcomes are not guaranteed. For that reason, it's important to carefully review the potential risks of BT with your healthcare provider to be absolutely sure it makes sense to undergo the procedure. Ask them about the pros and cons and if there are other treatment options that may be more appropriate for you. This way, whether or not you decide to have bronchial thermoplasty, you can move forward feeling confident in your decision.

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