Bronchial Thermoplasty
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Transcript of Bronchial Thermoplasty
Bronchial Thermoplasty
Edward Omron MD, MPH, FCCPPulmonary and Critical Care MedicineSaint Louise Regional Medical Center
What is Asthma?
• Reversible lung disease• The airways of the lung are inflamed, swollen and
narrowed resulting in “wheezing”• Breathing problems occur in “attacks” but the
disease is continuous • Recurrent cough, chest tightness / pain, or shortness
of breath• Symptoms worsen with exercise, infection, changes
in weather, or at night.
Asthma Airways
Asthma Facts
• In 2009, 25 million Americans had asthma– Of these 13 million have had an asthma attack
• In 2007 there were 3500 deaths from asthma– 63% of these deaths occurred in women
• The prevalence of adult asthma in CA 2009 is 8%• Asthma accounts for 50 billion health care dollars
yearly
Types of Asthma
Mainstays of Therapy
Inhaled Corticosteroids Remain the MAINSTAY of treatment in all asthmatic groups
Current Therapies
• Remove asthma triggers• Short acting bronchodilators• Inhaled Corticosteroids• Long Acting Bronchodilators• Leukotriene Modifiers• Steroids• Anti IgE Modifiers• EXERCISE
Advances in Therapy
• There is no cure of asthma thus far in 2012• CONFIRM the diagnosis before any
augmentation of treatment of regimens– Rule out for example vocal cord dysfunction– Interstitial Lung Disease
• Severe persistent asthma is a great challenge to both the patient and the physician
Bronchial Thermoplasty (BT)
• Severe asthmatics have excessive smooth muscle in the airways
• BT is a non-drug procedure that reduces airway smooth muscle by applying heat to the airways– This reduces the frequency of asthma attacks
• Three outpatient procedures performed three weeks apart under sedation
• Benefits:– 32% reduction in asthma attacks– 84% reduction in ER visits– Improved asthma quality of life
Bronchial Thermoplasty
Short Term Side Effects• Mild and related to airway irritation– Coughing– Dyspnea– Wheezing
• Mean Time to onset: 1.7 days• Mean Time to resolution: 4.6 days• Only 42% of side effects required use of
medications: antibiotics, inhalers
AIR 2 Results Efficacy (288 patients)
• Severe exacerbations: 32% reduction• Emergency Department Visits: 84% reduction• Days missed from work or school: 1.3 vs 3.9 days• AQLS: BT 1.35 vs 1.16
• AJRCCM 2010: 181; 116-124
Long Term Side Effects
• Chest CT at 1 and 2 years post treatment
– No Evidence of Bronchiectasis– No Evidence of Bronchial Wall Disease– No Evidence of Lung Parenchyma Changes
Resources
• American Lung Association– http://www.lung.org/lung-disease/
• http://www.onebreath.org/• http://www.thoracic.org/education/breathing
-in-america/index.php