Bronchial Thermoplasty for the Treatment of Asthma

Woman out of breath because of physical activity

Asthma is a common chronic lung condition affecting more than 25 million people in the United States. Symptoms can include coughing, wheezing, breathlessness, and chest tightness. Episodes of symptoms occur as a result of exercise, respiratory tract infections such as the common cold, exposure to irritants such as cold air and acid reflux, exposure to various allergens such as pollen and pet dander, as well as due to stress. In most cases, asthma is mild and can usually be controlled with medications such as Singulair or low-dose inhaled steroids, as well as with the use of inhaled short-acting bronchodilators (such as albuterol) to treat immediate symptoms.

Asthma can be severe and difficult to treat, despite the use of stronger controller medications, such as high-dose inhaled steroids and combination products such as Advair, and even with injectable therapies such as Xolair or systemic steroids such as prednisone. Severe asthma can lead to emergency room visits, hospitalizations, and an overall decrease in the quality of life for people suffering from this condition. The costs associated with severe asthma in the United States are enormous and are in the range of $50 billion dollars per year.

For these people with severe asthma, there needs to be another type of therapy for those who don’t seem to respond to medications. Bronchial thermoplasty (BT) is a non-pharmacologic therapy indicated for the treatment of severe asthma for people who don’t respond well to the usual asthma medications. BT was approved by the U.S. Food and Drug Administration in 2010 for the treatment of severe asthma in patients 18 years and older whose symptoms were not controlled despite usual asthma therapies.

Bronchial Thermoplasty Basics

BT utilizes thermal energy (heat) on the smooth muscle inside the airways of the lungs. It is this smooth muscle that is enlarged (hypertrophy) and more abundant (hyperplasia) in the lungs of severe asthmatics. The contraction of this muscle is what is responsible for asthma symptoms, and what inhaled medicines for asthma are supposed to relax (bronchodilators) and prevent further symptoms (inhaled steroids). BT is performed with the use of a special catheter that is inserted into the lung airways during bronchoscopy. The catheter is inserted into medium-sized airways in the lungs, and heat energy is released. Different areas of the lungs are treated over different days, with each treatment session lasting under an hour.

How Does Bronchial Thermoplasty Work?

It is not known exactly how BT works to treat asthma, but theories include reduced smooth muscle in the lungs, decreased muscle contraction of the smooth muscle in the lungs, and/or decreased secretion of inflammatory chemicals from the smooth muscle cells within the lungs.

Hundreds of patients have received BT treatments, with their outcomes published in various scientific studies. Most patients experience a decrease in airway reactivity in response to inhaled irritants (methacholine challenge), decrease in asthma symptoms, and reduction in asthma attacks requiring emergency room visits or hospitalizations. In some cases, the benefits of BT were present for many years after receiving the treatment.

Side Effects

Generally speaking, BT is a well-tolerated procedure with few complications. Most complications are mild and do not require any aggressive treatments. The most common complications include worsening of asthma symptoms, development of upper respiratory tract infections, discolored sputum (phlegm), and bronchial irritation. Many of these same side effects are those that occur after routine bronchoscopy. Most of these side effects resolve after a few days to weeks after BT is performed.

Determining If Bronchial Thermoplasty Is Right for You

BT should be reserved for people with severe asthma who do not respond to usual asthma medications, such as inhaled steroids, Singulair, theophylline and combination products such as Advair or Symbicort. International guidelines from 2014 for the long-term treatment of asthma place BT in the same category as Xolair or prednisone. Therefore, BT should be considered for people with severe asthma despite the use of traditional asthma therapies.


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Article Sources
  • Wilhelm CP, Chipps BE. Bronchial Thermoplasty: A Review of the Evidence. Ann Allergy Asthma Immunol. 2016;116:92-98.