Bronchial thermoplasty - a new surgical treatment for asthma


Until recently, the main focus of attention in treating asthma has been on controlling airway inflammation by modifying the patient's immune response. Now, an entirely new approach has been tested which promises renewed hope for some asthma sufferers and a new direction for improved treatments in the future.

The typical symptoms of asthma - wheezing, shortness of breath and a tight chest - are caused when the muscle around the walls of the airways tightens in response to an allergen, making the airway narrower.

The new technique, called bronchial thermoplasty, involves inserting a tube, via the patient's nose or mouth, carrying radio wave-emitting wires that heat up the targeted muscle tissue and burn it away. This opens up the airway to allow more air to pass through and enables the patient to breathe more easily.

A new international study published in the March 2007 issue of the New England Journal of Medicine has shown that bronchial thermoplasty can help sufferers with moderate to severe asthma to control their condition for up to 12 months.

The study, which was carried out in 11 centres, including UK hospitals in Newcastle, Manchester, Leicester and Glasgow, as well as others in Canada, Brazil and Denmark, monitored 112 people with moderate to severe asthma aged 18 to 65 over the course of one year.

Whilst all continued to have access to their usual medications, half the group were also given the bronchial thermoplasty treatment, which involved three treatment sessions of one hour each over a nine-week period.

Following the new treatment, the bronchial thermoplasty group needed to use their inhalers and relievers less, and had better overall control of their asthma, than those who only had access to medication.
Those who had the new treatment also had an average of 86 more days without asthma symptoms during the year.

Bronchial thermoplasty may be an option for chronic asthmatics who continue to have symptoms despite use of current drug therapies. It may also have a role as a routine emergency procedure for patients who are hospitalised during a severe attack, but the technique is not without risk and is therefore unlikely, in its present form, to be appropriate for the majority of patients.

In time, other methods could be developed that have similar effects but are less invasive. For example, drugs could be developed that paralyse the excess muscle or destroy it chemically. At least the door to such developments has now been opened and researchers are
continuing their work with a larger, controlled trial, which includes a group that will receive a placebo treatment.

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First Published in June 2007

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