a person standing between lungs with the bronchi showing

Bronchial Thermoplasty

Six years ago my severe asthma was completely out of control. The 5 daily asthma medications and frequent ER visits and hospitalizations were taking their toll on my body. My bones are brittle from the years of chronic daily oral prednisone use.

My asthma doctor (who is also a longtime friend and mentor of mine) was attending a national asthma conference and he called between lectures and asked if I had ever heard of bronchial thermoplasty before. I said yes, but I didn’t think I was a candidate for it. He said I most definitely was and he would be speaking to my pulmonologist about it because I fit the profile to have the procedures. That phone call changed my life and I had the procedures done two months later.

Bronchial thermoplasty for severe asthma

Bronchial thermoplasty (BT) is a minimally invasive procedure that reduces the smooth muscle inside of the lungs that those with severe asthma have an excess of. With the smooth muscle reduced, it means that there is not as much to constrict during an asthma flare-up. The aim of BT is to reduce the number of severe asthma exacerbations that lead to emergency room visits and hospitalizations. Following successful clinical trials, the procedures were FDA approved in 2010.1

What to expect

BT is done over a course of three procedures completed, at minimum, 3 weeks apart. First, the right lower lobe of the lung is treated, then the left lower lobe, and the third procedure targets both upper lobes. The right middle lobe is not treated.1

The procedures are done via bronchoscopy where a catheter of sorts is inserted through the bronchoscope that delivers radiofrequency energy to the airway walls which reduces the smooth muscle. It doesn’t create scar tissue as nothing is actually burned. Each procedure takes about an hour or so and is usually done under general anesthesia, although they can also be done with twilight sedation.1

After the procedures, you will be monitored for a few hours and, in most cases, be sent home the same day, although you may need to stay the night in the hospital. For the first few days following a bronchial thermoplasty it is not uncommon to have worsening asthma symptoms while your lungs are healing and until the inflammation subsides.1

Realistic expectations

It is very important to have realistic expectations when it comes to BT. It is not a cure and the procedures can only be done once in your lifetime. The clinical trials were successful in showing a 32 percent reduction in asthma exacerbations, 84 percent reduction in ER visits, and a 44 percent decrease (average over 5 years) in severe exacerbations compared with 12 months prior to BT.2

Bronchial thermoplasty doesn’t work for everyone. Not everyone with asthma will qualify for the procedures as there is a very strict set of criteria that a severe asthmatic must meet in order to qualify for the procedures.3 It can also take several months to really start feeling the benefits of BT.

My bronchial thermoplasty experience

I had my procedures, which were each done 4 weeks apart starting in early summer 2015. My recovery took a while and I had to be off work from the hospital where I am a respiratory therapist until I was completely healed. But it was so worth it for me.

Now here I am, 6 years later and while my asthma is still (and forever will be) in the severe persistent category, I have not had a single asthma-related hospitalization since I had BT. I do still have flare-ups but a burst of prednisone usually does the trick. I still take my daily asthma medications, however, I am no longer chronically prednisone dependent. I call that a major win in my asthma book!

If you think BT might be an option for you, ask your doctor the next time you see them!

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