Bronchial Thermoplasty

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Short presentation on Bronchial Thermoplasty
for community presentation ( NOT for health care professionals)
Edward Omron MD, MPH, FCCP
Pulmonary Medicine
Morgan Hill, CA 95037
www.docomron.com

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Bronchial Thermoplasty

  1. 1. Bronchial Thermoplasty Edward Omron MD, MPH, FCCP Pulmonary and Critical Care Medicine Saint Louise Regional Medical Center pulmonarydiseases@gmail.com
  2. 2. 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.
  3. 3. Asthma Airways
  4. 4. 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
  5. 5. Types of Asthma
  6. 6. Mainstays of TherapyInhaled Corticosteroids Remain the MAINSTAY of treatment in all asthmatic groups
  7. 7. Current Therapies• Remove asthma triggers• Short acting bronchodilators• Inhaled Corticosteroids• Long Acting Bronchodilators• Leukotriene Modifiers• Steroids• Anti IgE Modifiers• EXERCISE
  8. 8. 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
  9. 9. 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
  10. 10. Bronchial Thermoplasty Rationale Reduces Airway Smooth Muscle (ASM) Reduced Ability for Bronchoconstriction Reduced Asthma Symptoms and Exacerbations erba ba at Improved Asthma Control and Quality of Life
  11. 11. Airway Smooth Muscle Airway Smooth Muscle ySNormal Airway Asthmatic Airway
  12. 12. Bronchial Thermoplasty„ The Alair Catheter is a flexible z The Alair Radiofrequency tube with an expandable wire Controller supplies energy that is array at the tip converted to heat in the airway wall z Monopolar radiofrequency (RF) energy z Temperature controlled: 65 °C z 10 seconds z Multiple safety algorithms to ensure controlled energy delivery
  13. 13. Bronchial Thermoplasty
  14. 14. Report 3: NIH Publication No. 07-4051, Revised August 2007. Who is Appropriate for Bronchial Thermoplasty?„ FDA Indication: The Alair® Bronchial Thermoplasty System has been approved by the FDA for the treatment of severe persistent asthma in patients 18 years and older whose asthma is not well controlled with inhaled corticosteroids and long acting beta agonists.„ Adult severe, persistent asthmatics (≥ 18 years old)„ Inadequate control despite combination of inhaled corticosteroids (ICS) and a long-acting β2-agonist (LABA)„ Able to safely undergo bronchoscopy per hospital guidelines Reference the Alair Bronchial Thermoplasty System Instructions for Use for more information
  15. 15. Who is Not Appropriate for Bronchial Thermoplasty?Contraindications:„ Patients that have a pacemaker, internal defibrillator, or other implantable electronic device„ Patients that have a known sensitivity to medications required to perform bronchoscopy, including lidocaine, atropine, opioids, and benzodiazepines„ Patients that have previously been treated with thermoplasty
  16. 16. Our Patient Selection„ Adults with documented diagnosis of moderate- severe asthma„ Adherence to max doses of ICS + LABA inhalers currently on the market.„ No other explanation for bad asthma control (I have 30 cats and love to smoke for example…)„ CT imaging not demonstrating other diagnosis that needs evaluation first or explains their symptoms (ABPA, bronchiectasis, Hypersensitivity Pneumonitis, sarcoidosis, etc)„ Alpha One genotype, ANCA, IgE levels
  17. 17. Our Patient Selection„ “Why do you want to have BT” „I want to be cured of my asthma – NO! „ I want to try and do better with asthma – YES!
  18. 18. Technique„ Bronchial Thermoplasty performed in 3 bronchoscopy sessions „ Minimize risk of asthma exacerbation „ Reduces length of the bronchoscopy„ Individual sessions „ Right Lower Lobe in 1st session „ Left Lower Lobe in 2 nd session „ Right Upper Lobe and Left Upper Lobe in 3rd session„ RML is not treated, but Lingula is treated„ Each procedure is less than an hour; ~ 60+ activations
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. Resources• American Lung Association – http://www.lung.org/lung-disease/• http://www.onebreath.org/• http://www.thoracic.org/education/breathing -in-america/index.php

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