Is Bronchial Thermoplasty A Cure For Asthma?

There has been a great deal of interest, even excitement, regarding a procedure called bronchial thermoplasty, and the potential it has as a treatment for asthma. While bronchial thermoplasty shows great promise in reducing the symptoms of an asthma attack, it is not a cure for the disease. One who has undergone bronchial thermoplasty treatments can still suffer asthma attacks, as those things that trigger such an attack remain in place, but the severity of an attack may be significantly reduced.

Those who experience frequent or severe asthma attacks are probably familiar with ASM, shorthand for airway smooth muscle. When one suffers from an asthma attack, ASM constricts and contracts, narrowing or threatening to completely close the airways (bronchi). Medications and inhalers are designed to either prevent muscle contraction, or barring that, to minimize it, and at the same time minimize the amount of constriction experienced in the airways.

Thermoplasty And Ablation - Bronchial thermoplasty is somewhat based on the presumption that if muscle contraction is a problem, eliminating muscle will eliminate the problem. No muscle, no contraction. The treatment however does not involve removing the smooth muscles of the airways. Rather the muscles are treated in a manner which makes them thinner, a process called ablation. If you've heard the term ablation somewhere before, but can't remember just where, it was frequently discussed when we first started sending spacecraft into orbit, with the intention of bringing them back safely to earth. When a spacecraft hit the earth's atmosphere, the nose cone in particular becomes extremely hot, and material starts to burn of flake away. The way in which material is lost, which makes the nose cone thinner in the process, is called ablation. The atmosphere is the ablating agent.

The Procedure - In the bronchial thermoplasty procedure, radio frequency (RF) is the ablating agent. A tube, called a bronchoscope, is passed through the nose and throat, through the airway passages, and down into the lungs. A catheter is inserted through the bronchoscope, the tip of which is inflated to the point the catheter will come into contact with the bronchial walls. RF energy, directed through the catheter, heats up the muscle walls to just under 150 degrees F, a temperature sufficient to thin the muscle walls without actually having to burn tissue. Bronchial thermoplasty is basically an outpatient procedure and as such requires only mild anesthesia.

When the procedure is performed successfully, the thinner smooth airway walls will contract less freely when an asthma attack occurs, and constriction of the airways should become less of a problem. The procedure appears to be quite promising, particularly to those who suffer very severe asthmatic attacks. Bronchial thermoplasty is still in the trial stage. The long term effects from the procedure, if indeed there are any, are not yet completely known. Side effects from the procedure appear for the most part to be negligible, though those who suffer most from asthma appear to have greater side effects from the procedure than those having milder cases of asthma. The side effects experienced to appear to be short term in nature.

Summary - Before the bronchial thermoplasty procedure becomes commonplace, there are several issues which have to be overcome. The process still requires refinement, as presently the bronchial tubes that can be effectively treated are the larger ones only. Treating these airways helps of course, but there are many airways for which the procedure cannot yet be used. Expense is also a factor. The cost of the procedure needs to come down considerably before all of those who would benefit from it could afford it. Finally, the jury is still out as far as long term side effects are concerned, however it should be said that the prospect of there not being any significant side effects looks promising.




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