Asthmatics Benefit from Warmed Bronchi

Robert W. Griffith, MD

The use of radiofrequency heat, when applied in the right way, can improve severe persistent asthma. The technique is described in an article in the New England Journal of Medicine. It's called bronchial thermoplasty, and it's given through a standard bronchoscope, sending radio waves to the airway walls. The tissues are heated to about 65 degrees Celsius (149 degrees Fahrenheit), which is hot enough to reduce the amount of muscles lining the bronchi, but is low enough to avoid actual tissue destruction.

Over 100 adults aged about 40 with severe persistent asthma were assigned to medical therapy plus bronchial thermoplasty, or medical therapy alone, for 3 sessions of thermoplasty. Effectiveness was measured by estimating the exacerbations occurring when long-acting beta-agonists (e.g. Salmeterol®) were withdrawn for a scheduled 2-week period; this was done three times, at 3, 6, and 12 months after the thermoplasty.

Compared with baseline, the frequency of asthma exacerbations dropped significantly in the thermoplasty group, compared with the controls (medication alone). And after one year, the thermoplasty patients had a significant increase in their morning peak expiratory flow rate, an important respiratory measure in asthma. FEV-1 , however, remained unchanged. Thermoplasty improved asthma quality-of-life scores and effected more symptom-free days.

The experts believe thermoplasty will require more work before it can become a regular form of therapy for severe asthmatics. It's expensive, means three separate bronchoscopies (carrying a slight risk), and produces short-term side effects. Nevertheless, it represents a real advance in a seriously debilitating condition.

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