Bronchial Thermoplasty

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Non-drug Treatment for Severe Asthma

More than 300 million people suffer from asthma worldwide. In the United States asthma affects almost 25 million Americans, of which 10 percent have severe asthma.

(Scroll down for video transcript)

For those with severe asthma, the highest dose of standard medications may not alleviate frequent and life-threatening asthma attacks. Few treatment options are available to adequately control the disease which can have a significant impact on quality of life.

People who have asthma have more airway smooth-muscle tissue surrounding their airways than those without asthma. During an asthma attack, this excess tissue constricts the airways, making it harder to breathe. Asthma medications help open up the airways, but may not always work well in people with severe asthma.

What is Bronchial Thermoplasty?

Bronchial Thermoplasty (BT) is a procedure to reduce the smooth muscle mass of the airway. With less smooth muscle, the airways constrict less, reducing severe asthma attacks.

Delivered by the ALAIR™ System, Bronchial Thermoplasty (BT) is the first non-drug treatment option for patients with severe asthma who are 18 years and older and whose asthma is not well controlled by inhaled corticosteroids and long-acting beta-agonists. This minimally invasive outpatient procedure supplements conventional asthma drug treatments for better management of the disease.

Backed by Clinical Results

The Asthma Intervention Research 2 (AIR2) trial, a multi-center, double-blind randomized study, demonstrated that patients with severe asthma who were treated with Bronchial Thermoplasty have significant improvement at one year compared to patients who underwent bronchoscopy but did not receive the active treatment. Reductions in asthma attacks and ER visits were shown to extend through a 5-year follow-up period.

Video Transcript:

Mike: I can focus my time now on my kids instead of in a doctors office or in the emergency room.

Richard: If it wasn't for bronchial thermoplasty it would've been tough for me to continue my career.

Angel: I've been able to ride a bicycle. I've been able to cut the grass. I've been able to work on my car.

Theresa: I've been able to run around and clean up the house and look after the kids. And you're not completely exhausted.

LaRetta: And my quality of life has skyrocketed.

Narrator: These people have had a breakthrough treatment called bronchial thermoplasty, or BT. BT is a non-drug minimally-invasive outpatient procedure for severe persistent asthma in patients 18 years or older whose asthma is not well controlled with inhaled corticosteroids and long acting beta agonists. In this video you will hear stories from real patients and their doctors about how BT complemented their asthma maintenance medications by providing long-lasting asthma control, and improved these patients asthma-related quality of life.

These patients are sharing their personal experiences of their severe asthma before and after the BT treatment. Individual results may vary. Asthma is a prevalent and costly disease affecting more than 25 million Americans and consuming billions of dollars of healthcare resources each year.

Let's take a look at how asthma works. With normal breathing, the airways of the lungs are fully open as seen in this cross section of an airway. People with severe asthma have more airway smooth muscles circling their airways. This excess muscle together with the inflammation of the airways combines to make the airway walls thicker than normal. During an asthmatic attack, in response to an asthma trigger such as an allergen or irritant, the airway smooth muscle contracts leading to airway narrowing and breathing difficulties.

Theresa: There definitely is an element of panic, because you feel like you're under water. Like, you're in the deep end of a swimming pool, at the bottom of the pool and you can't get out.

Richard: Your chest gets tight. It feels like someone is literally sitting on you. Like, an elephant sitting on your chest.

Mike: For me, emergency room visits were maybe once, a couple times a month.

Angel: My daughter has been always active in sports, always playing soccer. (I was) missing activities for her. Especially, at soccer, they play at night and there was changes in temperature. I couldn't go.

Chris: I was always left out. I was always the guy who sat on the sidelines watching everybody else participate.

Narrator: Historically, medication has been the primary treatment for asthma. But, drugs can have limitations and side effects.

Mike: Treatment with my asthma was basically using my inhaler at least 10 times a day. We had one in every room.

Jenny: I had them in every purse. I had them in my desk at work. I wouldn't leave home without my inhaler.

Mike: I was gaining weight. I was between 250-300 pounds.

Narrator: Now, BT, delivered by the ALAIR System, is transforming the treatment of severe asthma with the appropriate candidates.

David Duhamel, MD: You'll be asleep, so you won't be feeling anything. And I gently glide the bronchoscope down into your lungs.

Narrator: During bronchial thermoplasty, a small flexible tube is advanced into the airway through a standard flexible bronchoscope placed through the mouth or nose. No incision is required. The ALAIR device has an expandable wire electrode array at the tip. And when it is expanded, the four arms of the electrode array come in contact with and fit snugly against the airway wall. The expanded electrode array will then deliver controlled radio frequency energy for about 10 seconds to heat the airway smooth muscle. About 1/3 of the targeted lung areas are treated during a single procedure. A total of three procedures are currently needed for complete treatment.

Once the procedure is completed, the device and the bronchoscope are removed. The controlled energy delivered during bronchial thermoplasty creates mild heat within the airway wall that is designed to reduce the amount of airway smooth muscle. By reducing the amount of airway smooth muscle, the procedure reduces the ability of the airway walls to contract and narrow during an asthma attack.

David Duhamel, MD: They're very comfortable throughout the procedure and I've not had any complaints during all the procedures that I've done. I do find, though, the patients are able to wake up very quickly and go about their day and recover very nicely.

Mario Castro, MD: The typical risk associated with bronchial thermoplasty is an aggravation of a patient's asthma. This typically occurs within 24 hours after the treatment and resolves within seven days after the treatment.

Jenny: BT involved three procedures. They were all done outpatient, so I went in in the morning and I was able to go home later on in the afternoon.

Mario Castro, MD: The way we deliver this treatment is across three treatment sessions. Each treatment itself lasts about 45 minutes to an hour. Now, in each one of these treatments we're treating a different part of your lung. So, usually for the first treatment we'll treat your right lower lung. Then the second treatment will go down to your left lower lung and treat that part of your lung. And then the last treatment we'll treat both of the upper lungs at the same time.

Narrator: In the pivotal air tube clinical study in the US to evaluate the safety and effectiveness of BT, patients not only reported improved asthma quality for at least five years over patients who received a sham procedure, but also experienced other clinically-significant benefits, including: A 32% reduction in asthma attacks, an 84% reduction in emergency room visits for respiratory symptoms, and a 66% reduction in days lost from work, school, or other daily activities due to asthma.

Additionally, 79% of patients treated with BT reported a significant improvement in their asthma-related quality of life.

LaRetta: So, now I can live life and go and do those fun activities that I hadn't done before.

Theresa: What I noticed the most was the day-to-day things. I was able to jump out of bed in the morning. I had all this energy. I'm able to really chase after my kids in the park, which is something I don't think they've ever seen me do, ever. You know, as long as they've been alive.

Angel: BT procedure, it worked fantastic for me. It's been a miracle for my lungs. All I use my regular maintenance medications that I need to use that my pulmonologist recommends. But, no asthma attacks. No episodes. No hospital admissions. Nothing at all.

Richard: I was able to run more. I was able to aggressively train more. I was able to get my game back.

Chris: Now I can look back and go, "Wow." I can now do things that I never even thought about before.

Cheryl: The first time we went running after he'd had the thermoplasty treatment, he beat me. And that was a first. He'd never beat me on the running track before.

Chris: I kept waiting. You know? Running around the track. Waiting for an asthma attack. Nothing. And I felt great. Bronchial thermoplasty has allowed me to meet an entire new word of people. A running community that I would never ever, ever have met.

Jenny: My husband is doing phenomenal and now he is very physically active. It's amazing to see the difference in his asthma control. I feel like BT has changed my life all around. I've run two half marathons and I actually enjoyed it.

David Duhamel, MD: Well, I'm very excited about this technology. I really think it offers a new opportunity to greatly impact our patient's lives. I certainly would recommend this for a family member or a loved one.

Narrator: Talk with your doctor about whether BT is right for you. BT is performed during bronchoscopy, a minimally-invasive procedure that is performed by a trained physician, typically a pulmonologist. If your regular physician currently managing your asthma is an allergist, family practice physician, general practitioner, internist, or other physician he or she will be able to refer you to a pulmonologist for the procedure.

Following the completion of the BT procedure, you will return to and continue to see your regular physician to manage your asthma-related medications. For more information on BT, including it benefits and risk, visit

How it works

Bronchial Thermoplasty illustration

(Click to enlarge)

During the BT procedure, a doctor passes the Alair Catheter through a standard bronchoscope inserted through the nose or mouth. The system delivers mild heat to the airway wall in a controlled manner to reduce the amount of excess smooth muscle tissue in the airways. The procedure is performed in three outpatient sessions that treat different parts of the lung. Each session lasts about an hour and are scheduled approximately three weeks apart.