What Is Bronchial Thermoplasty?

In This Article

Bronchial thermoplasty is an interventional asthma procedure in which a bronchoscope (a long tube designed for insertion into the lungs) is placed into a person's mouth or nose and advanced to the lungs, where it's expanded in the airways. This intent is to prevent the effects of asthma from recurring by reducing recurrent airway narrowing. This involves three separate sessions, with the treatment of 1/3 of the lungs each time.

This procedure is used to treat severe asthma in individuals age 18 and older. Bronchial thermoplasty may be considered a possible option for you if you don't experience adequate symptom control with standard asthma treatments.

Purpose of Procedure

Asthma symptoms such as wheezing and shortness of breath occur due to bronchoconstriction (narrowing of the airways) and inflammation in the lungs. Bronchial thermoplasty uses thermal energy to decrease smooth muscle activity in the bronchi (airways). The treatment, therefore, prevents the smooth muscles in the lungs and the bronchi from being able to constrict.

Bronchial thermoplasty has been shown to reduce chronic asthma-associated bronchoconstriction as well as 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 despite treatment with controller medications like inhaled corticosteroids and long-acting beta-agonists. Asthma controllers are used every day to prevent asthma symptoms and asthma attacks.

Because this procedure is used to manage bronchoconstriction rather than inflammation, it has been suggested that people whose asthma is dominated by inflammatory factors might not experience the same level of benefit as those whose asthma is primarily caused by hyperreactive bronchi.

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

The outcomes of this treatment are promising, but it can cause adverse events and is reserved for treating severe asthma. If you are interested in learning more about whether bronchial thermoplasty could be beneficial for you, talk to your doctor about your options.

Risks and Contraindications

You will need to wait to have this procedure if you've had new dose of oral corticosteroids for your asthma (up or down) in the past 14 days. Bronchial thermoplasty poses some risks, and existing health issues can raise the risk of an adverse effect.

Your doctor may recommend postponing the procedure until your illness resolves either on its own or with proper treatment.

Conditions that should be treated before your procedure include:

  • Asthma exacerbation in the last two weeks
  • Respiratory infection
  • Bleeding problems

Certain medical conditions make this procedure an absolute contraindication. You would not be eligible for treatment with bronchial thermoplasty if you have:

  • 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
  • Already been treated with bronchial thermoplasty

Before the Procedure

If you are considering this intervention, your doctor will need to participate in a 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 might not improve with bronchial thermoplasty, you might also have blood tests to examine your level of inflammation.

If it's determined bronchial thermoplasty may help you and you decide to proceed, your doctor will give you instructions regarding any medication adjustments you need to make before your procedure. For example, you might need to stop taking blood thinners for several days before your procedure.

Your doctor may give you a prescription for prednisone or equivalent at a dosage of 50 mg/d for three days before the procedure, the day of 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. But this is a major intervention, so you should prepare to devote up to a full day and evening to your procedure 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.

Also, you might be tired after your procedure, so it's a good idea to wear something that will help you feel as comfortable as possible on the way home.

Food and Drink

Because you will have medical sedation for your procedure, your doctor 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 may be required. If you have a plan, you will need to check with your insurer and/or your doctor to know if you meet coverage requirements and if there will be any out-of-pocket expenses.

Your payer may require that you first try a certain dose of controller medications for a particular period of time and/or that you have experienced a certain frequency of asthma attacks 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 can comprise your medical team, including the doctor, an assistant or nurse, a nurse anesthetist, and an anesthesiologist.

The doctor 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 doctors 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 doctor 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 are stable and breathing comfortably, you will be discharged to go home. If any serious complications occur, however, you may have to stay in the hospital for further monitoring and treatment.

You should take it easy and get some rest for the day.

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 doctor.

Managing Side Effects

You might have throat, nose, or mouth discomfort or soreness for a few days after the procedure due to the insertion of the bronchoscope. You can ask your doctor about medication to help relieve this.

If you develop a fever or cough up blood, update your doctor about it as soon as possible.

Side effects can include lung inflammation, asthma exacerbation, lung collapse, lung infections, and bleeding in the lungs. These effects are potentially harmful and cannot be managed at home.

If you develop shortness of breath, chest pain, chest tightness, confusion, or severe fatigue, be sure to get medical attention immediately. These are signs of serious health issues.

Outcomes

A bronchial thermoplasty should 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 1 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 can expect to 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 doctor 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 doctor 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 is generally considered safe and it is beneficial for some people with severe asthma. Still, the long-term outcomes are not known.

If you have severe asthma and are having persistent symptoms despite treatment, you may want to explore this procedure with your doctor. Ask about the pros/cons of this and any other option you're considering in your case so you can feel more confident about the next steps.

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