Special and new treatments
Bronchial thermoplasty is new treatment and a possible option for some people with severe asthma who find that the usual medication doesn't control their asthma.
It has been performed overseas on a small scale for a few years, and is available in Australia in some public and private hospitals.
Asthma Australia welcomes new approaches to treat asthma. Bronchial thermoplasty is an interesting technique with some promising results. Experience with this technique is small and Asthma Australia believes there should be a registry of patients undergoing this therapy ideally with a panel of asthma experts reviewing potential subjects.
If you would like to learn what happens during the treatment and who it's for along with the pros and cons of undergoing bronchial thermoplasty then read more.
It's worth noting that there are a number of respiratory doctors that have expressed concerns about such a new procedure and the short- and long-term effects it might have.
What happens during the procedure?
A bronchoscopy is performed - that means the doctor puts a small tube down into your lungs as far as they can. It is then used to heat around half a centimetre of the walls of your airways, which affects the muscle in there and reduces its ability to contract and narrow the airway. The tube is then pulled out about half a centimetre and the heat is applied again. This continues (about 60 or 70 times) until a whole area of your lung has been treated. Each procedure takes around an hour, and they treat different areas of your lung each time. You have to have three treatments to get to as much of the lungs as they can, and these usually happen about three weeks apart. The surgery involves an overnight stay in hospital, with the procedure being performed under general anaesthetic.
What effect does it have, and for how long?
Trials have been done of this procedure, and patients have shown a reduction in severe attacks, visits to hospital, and in some cases a reduction in days off work. There is no improvement in lung function e.g. in the results of a breathing test (spirometry). The longest follow up from a study has been five years after the procedure, and the results appear to have been maintained for that time, but we don't know about the long-term effects.
Who can access the treatment?
Bronchial thermoplasty is only available following a specialist review, for people aged over 18 with severe persistent asthma that is not well controlled despite taking daily combination preventers. It's not suitable for those with a pacemaker or other implanted electronic device, or if you are unable to cope with the procedure.
Does it work for everyone?
Unfortunately, no. Trials showed that around 80% of people who had the procedure got a benefit, though interestingly, 64% of the people who had a ‘sham’ treatment (where they had the bronchoscopy but no heat applied) also had improvements. There were around 5% of people who actually had to increase their dose of inhaled corticosteroid preventer medication by 50% or more after the procedure.
Does it get rid of asthma?
No, unfortunately we still haven't found a cure for asthma. Patients who have had this procedure still need to take their asthma medications every day.
Is it safe?
In the studies that have been done, there have been no deaths as a result of the procedure. The procedure itself will tend to make your asthma a little worse temporarily, but this generally resolves within 7 days. However some people in the trials have been admitted to hospital due to an exacerbation of their asthma after the procedure.
How much does it cost?
This procedure is not currently available under Medicare, so normal private costs would apply for the hospital, the procedure, and the doctor's time. The specialist performing the procedure would be able to provide details of likely out of pocket expenses.
How do I get it?
There are a few specialists in Australia who are currently performing bronchial thermoplasty in some public and private hospitals. To see a specialist who does this treatment, you need a referral from your GP or respiratory specialist.
If you feel your asthma could be better controlled, you should talk with your own doctor about your treatment. If you are interested in this procedure they can help you balance the risks and cost against possible benefits before deciding this therapy is appropriate.