Medicine
Bronchial Thermoplasty for Severe Persistent Asthma
Quick fact
Bronchial thermoplasty reduces asthma attacks and improves quality of life in adults with severe persistent asthma, even years after the procedure, according to clinical trials.
Why this is interesting
Imagine being able to 'remodel' your airways from the inside to make asthma attacks less frequent. That's the idea behind a procedure called bronchial thermoplasty.
Read the full explanation
Understanding Bronchial Thermoplasty for Severe Persistent Asthma
Severe persistent asthma is a form of asthma that remains poorly controlled despite high-dose inhaled corticosteroids and long-acting bronchodilators. One key feature is hypertrophy and hyperplasia of airway smooth muscle, which wraps around the airways. When triggered, this muscle contracts, constricting the airways and causing wheezing and breathlessness. Bronchial thermoplasty targets this muscle directly. During the procedure, a doctor inserts a bronchoscope—a thin, flexible tube with a camera—through the mouth into the airways. A specialized catheter is passed through the bronchoscope to deliver controlled radiofrequency energy to the airway walls. The energy heats the tissue to about 65°C, reducing the amount of smooth muscle. This is performed over three sessions, each targeting different parts of the lungs. The result is less muscle available to narrow the airways, leading to fewer asthma attacks.
A deeper explanation
The mechanism of bronchial thermoplasty lies in the selective reduction of airway smooth muscle mass. Radiofrequency energy causes localized thermal injury to the smooth muscle layer, leading to cell death and subsequent reduction in muscle thickness. Over time, the airway wall becomes less reactive to triggers because there is less muscle to contract. The procedure does not cure asthma, but it modifies the structural component of the disease, reducing the severity of attacks. Clinical trials (e.g., AIR2) showed sustained benefits for at least five years, including fewer exacerbations and improved quality of life. Important considerations include patient selection—adults with severe asthma who are not optimal candidates for biologics—and potential temporary worsening of asthma symptoms during the treatment period. The procedure is not suitable for everyone, and its long-term effects on airway remodeling are still being studied.