Bronchial Thermoplasty

Bronchial thermoplasty is a procedure approved to treat severe asthma for some adults. It is only done when asthma symptoms cannot be controlled by other treatments. The procedure uses heat to reduce airway muscles that cause airway narrowing.1,2

What is bronchial thermoplasty?

Chronic airway inflammation causes the airway smooth muscle (ASM) to thicken. This leads to airway narrowing, difficulty breathing, and symptoms of asthma. People with asthma have too much smooth muscle.1,2

Bronchial thermoplasty uses heat to reduce the thickness of ASM. With less ASM, the airways are less sensitive and do not narrow as much during an asthma attack.1,2

During the procedure, a thin tube called a bronchoscope is inserted through your mouth or nose. The bronchoscope has a light and camera to help your doctor see inside your airways. A special device will be inserted through the bronchoscope that expands and heats the ASM.1,2

A full bronchial thermoplasty involves 3 separate procedures:1,2

  • 1 for each of the lower lobes of the lung
  • 1 for the upper part of the lung

Each procedure takes about an hour. You will be monitored after the procedure and can usually return home that day. Each procedure must be done at least 3 weeks apart.1,2

How does bronchial thermoplasty help manage asthma?

Studies have shown benefits of bronchial thermoplasty, such as:4-6

  • Better quality of life
  • Fewer days lost from work/school due to asthma symptoms
  • Fewer asthma attacks in the year after the procedure
  • Fewer visits to the emergency department in the year after the procedure
  • Lower use of quick-relief medications for up to one year

However, there are a number of remaining questions about the procedure. One question is whether bronchial thermoplasty actually improves lung function. People who had the procedure do not seem to have improvements in spirometry tests.5

Also, certain people were excluded from studies of bronchial thermoplasty. People with frequent hospitalizations or chest colds could not participate. People with very low lung function or life-threatening asthma also could not be in the study. We do not yet know if the procedure is safe and effective for these people.5

We also do not know if the procedure is safe and effective after 1 year. Follow-up studies seem to show that some people have fewer asthma attacks 5 years after the procedure. However, experts agree that we need longer-term and higher-quality studies to understand long-term effects.3,7

What are the possible side effects of bronchial thermoplasty?

Some breathing-related side effects can occur right after the procedure. These events usually occur within 1 day and go away within 7 days. An overnight hospital stay may be needed if asthma symptoms worsen. The most common side effects from bronchial thermoplasty include:1,2

  • Coughing
  • Wheezing
  • Shortness of breath

Bronchial thermoplasty also can increase the frequency of asthma attacks in the first 3 months after the procedure. The risk of hospitalization also increases during this period. After 3 months, asthma attacks and hospitalizations seem to decrease.3

These are not all the possible side effects of bronchial thermoplasty. Talk to your doctor about what to expect when taking bronchial thermoplasty. You also should call your doctor if you have any changes that concern you about bronchial thermoplasty.

Things to know about bronchial thermoplasty

You are not a good candidate for bronchial thermoplasty if you have:

  • An implantable electrical device such as a pacemaker or a defibrillator
  • A known allergic reaction to the drugs used for the procedure

Because of concerns about safety and effectiveness, experts say doctors should only do bronchial thermoplasty as part of a registry or clinical study. This will help us gather more evidence about the procedure.3

If you are interested in bronchial thermoplasty, talk to your doctor about whether it is right for you.

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Written by: Matt Zajac | Last reviewed: September 2021