Bronchial Thermoplasty: A New Therapeutic Approach

Introduction

The respiratory condition called severe asthma is treated with the help of a surgical procedure called bronchial thermoplasty. It is the most effective surgical therapy in treating asthma compared to other treatments. Both lungs are composed of smooth muscles. Medical conditions like severe asthma occur due to the tightening of the smooth muscle. The strain in the muscles can be prevented by bronchial thermoplasty.

What Is the Purpose of Bronchial Thermoplasty?

The bronchial thermoplasty is preferred for the following purposes;

• Individuals who get uncontrolled asthmatic attacks are treated with bronchial thermoplasty. The intensity of asthma attacks is reduced after the surgical procedure.

• Patients who do not want to use inhalational steroids can opt for bronchial thermoplasty. However, oral steroids are prescribed after the surgical procedure. Bronchial thermoplasty helps to reduce the frequency of using inhalers.

• Patients with severe inflammation present in the air passages and that do not subside with other treatments are treated with bronchial thermoplasty.

• Patients who intake beta-agonists in the long term are advised to do bronchial thermoplasty.

• The ages which are suitable for bronchial thermoplasty range from 18 to 65 years. So any patient with status asthmaticus can undergo bronchial thermoplasty irrespective of age.

• The symptoms of severe asthma gradually improve for a period of five to ten years. This reduces hospital visits so that teens and middle-aged people can attend classes and work without missing any days.

How to Prepare for Bronchial Thermoplasty?

The individual should follow the preventive measures before bronchial thermoplasty. They are as follows;

• The medical professional will ask the patient to take a dose of the oral steroid called Prednisone before the procedure. This is to prevent inflammatory reactions during the surgery. It is usually prescribed for two days before the surgery and two days post-surgery. Post-surgery doses can reduce the swelling in the lungs.

• The individual who wants to undergo bronchial thermoplasty must avoid tobacco smoke. The surgery is carried on only if the individual did not smoke for the past year.

• Before the bronchial thermoplasty, the surgeon asks the patient to sign a consent form. The caretaker must inform the healthcare provider about the inhaler and rescue medications used by the patient in the past.

• Do not consume heavy meals or plenty of fluids before bronchial thermoplasty.

• The patient should lie down in the same position until the completion of surgery to avoid rupture of the air passages during intubation.

• Bronchial thermoplasty is done separately for each lobe of the lungs. Each lung contains upper and lower lobes. So there is a gap of three weeks between each bronchial thermoplasty therapy.

• After the surgery, the individual is kept under complete observation for one to two days. However, healthy individuals are discharged on an outpatient basis.

• If the condition worsens, then the individual is admitted to the emergency.

How Is the Bronchial Thermoplasty Procedure Done?

• The anesthesia is given to the patient who undergoes bronchial thermoplasty. Usually, the surgeon does conscious sedation during bronchial thermoplasty. A light dose of anesthesia relieves the pain of the patient.

• During the bronchial thermoplasty, the surgeon will push the tube gently into the lungs.

• It is passed either through the openings of the nasal cavity (nose) or the oral cavity (mouth).

• Then a special tool called a catheter is placed inside the bronchoscope. It is passed down to the lungs.

• This catheter produces heat inside the lungs. When the heat comes in contact with the smooth muscle, it loosens.

• The temperature of the catheter is controlled by a particular radio frequency. The recommended temperature for the bronchial thermoplasty procedure is around 65 degrees Celsius.

• By repeating the same process, the rigidity of the breathing muscles becomes flexible and aids in breathing. Each series lasts for about ten seconds.

• It also opens the limited air passages and assists respiratory mechanisms.

• After the treatment, there is a regeneration of the mucosa and blood vessels of the lungs. Recent research shows that this regeneration proves to be beneficial for the lungs.

What Are the Complications of Bronchial Thermoplasty?

Patients who fail to consult the surgeon post-surgery for follow-ups may result in following complications;

• In rare cases, the bacteria may contaminate the blood during surgery and cause respiratory infections. The infection might spread to the heart and provoke chest pain.

• The exacerbation of asthmatic attacks after bronchial thermoplasty may result in the presence of blood streaks while coughing.

• For some patients, bronchial thermoplasty may worsen the symptoms of asthma.

• During the procedure, the surgical instruments may irritate the tissue lining of the lungs. It lasts for one to two weeks and can eventually cause shortness of breath.

• If the temperature goes beyond the acceptable range, it might result in the decay of the lung tissue. This condition is known as necrosis.

• If there is excess deposition of fibrous tissue during regeneration, it eventually causes lung fibrosis. It is an irreversible condition.

• A patient who has had a pacemaker for cardiac issues should not undergo bronchial thermoplasty.

• The intubation during bronchial thermoplasty may result in nausea and vomiting after the procedure.

• Some patients may have a Lidocaine allergy, which is usually manifested after the bronchial thermoplasty procedure.

• If the side effects post-surgery are unnoticed for a longer period, it eventually results in lung collapse or respiratory failure.

Conclusion

Bronchial thermoplasty has a long-term risk. So after the surgical procedure, the patient requires continuous monitoring of the symptoms to avoid life-threatening conditions. The follow-up for bronchial thermoplasty is done on three consecutive days for two weeks. The shortness of breath after bronchial thermoplasty can be overcome by using an inhaler, which is the major disadvantage of this procedure. However, for some individuals, the quality of life can be enhanced using bronchial thermoplasty. Consult the surgeon immediately if there are any symptoms post-surgery. Bronchial thermoplasty is not a curative treatment for asthmatic or status asthmaticus. The success rate of bronchial thermoplasty is relatively low. A patient with severe asthma can undergo bronchial thermoplasty only once in a lifetime. Surgery for the second time can cause serious complications. To cover the cost of bronchial thermoplasty with health insurance, the patient should contact the healthcare provider.