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Minimally Invasive Technology for Severe Asthma Sufferers

More than 24.5 million people are currently diagnosed with asthma, accounting for 1.8 million emergency department visits a year. It is estimated that approximately nine people die from the disease each day.

Amar Bukhari, M.D.

At Saint Peter’s University Hospital, adults suffering from severe asthma can be relieved of their struggle to breathe with a minimally invasive procedure called Bronchial Thermoplasty (BT). Using technology called the Alair™ System, BT reduces the amount of excess smooth-muscle tissue in the airways. When less of this tissue is present in the airways, they constrict less, breathing is easier, and there is less likelihood of an asthma attack.

“This technology makes relief possible for the many patients who live with the reality of feeling as if they are breathing through a straw or a stirrer – which is what people with an asthma attack experience – every time they take a breath,” explains Amar Bukhari, M.D., chief of the Division of Pulmonology, Critical Care and Sleep Medicine at Saint Peter’s.

Understanding asthma

Although asthma affects people of all ages, it most often starts during childhood. About seven million of the 25 million who have asthma are children. Asthma is a chronic lung disease, which means it is long-term. It inflames and narrows the airways. Asthma causes recurring periods of wheezing – a whistling sound made while taking a breath – chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

Minimally Invasive Technology for Severe Asthma Sufferers

To understand asthma, it helps to understand the role that airways play during breathing. The airways are tubes that carry air into and out of the lungs. People who have asthma have inflamed airways. This makes them swollen and very sensitive. They tend to react strongly to allergens or irritants.

When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways can also make more mucus than usual. This sticky, thick liquid further narrows the airways. This chain reaction can result in asthma symptoms. Symptoms can flare up each time the airways are inflamed.

During an asthma attack, swollen muscle constricts the airways, making it harder to breathe. The chest tightens, followed by wheezing and coughing – all of which are symptoms of an asthma attack.

Asthma medicines, which are often prescribed as inhalers, help open up the airways, but these medicines don’t always work well in people who have severe asthma. There are two categories of medicines: “controller” such as inhaled steroids and “rescue” such as brands of albuterol. Inhaled steroids can be effective for long-term treatment. Medicines referred to as short acting beta-agonists (SABAs), are considered rescue medications that are taken at the onset of an asthma attack.

In addition to medication, patients can be advised to take steps to minimize exposure to the things that trigger their asthma. A patient with allergic asthma, for example, might be advised to spend time indoors when levels of outdoor allergens are high.

When medications do not work

Bronchial thermoplasty is a treatment option for patients who have not responded well to other treatments, explains Dr. Bukhari. Patients must be 18 years and older with persistent asthma. During the procedure, a small flexible tube is inserted into the airway via the mouth or nose using a bronchoscope. The Alair™ System technology is an expandable, four-prod electrode that delivers energy in the form of radio frequency for 10 seconds. The energy reduces the amount of smooth muscle. By reducing the amount of smooth muscle in the airways, the procedure helps to prevent them from narrowing as they do during an asthma attack.

A total of three procedures are needed to complete treatment. No incision is ever required. After the three BT treatments are completed, patients are followed up by their primary care physician and/or pulmonologist.

"The effect of bronchial thermoplasty is remarkable," says Dr. Bukhari. “Statistics show that patients experience a 32 percent decrease in severe exacerbations, an 84 percent reduction in ER visits for respiratory symptoms, and a 73 percent reduction in hospitalization for respiratory symptoms.”

The procedure is not for everyone, though. Patients who have a pacemaker, internal defibrillator, or other implantable electronic devices are not good candidates. Neither are patients who have a known sensitivity to medications – including lidocaine, atropine, and benzodiazepines – which are required to perform bronchoscopy.