Bronchial Thermoplasty: Is It Being Phased Out?

Bronchial Thermoplasty (BT) received FDA approval in 2010 as a treatment for severe asthma. Since then, it has helped many individuals improve their asthma control. Some people I know personally have experienced significant benefits from the procedure. However, there's now a rumor that this procedure might be phased out. Why would such an effective treatment be discontinued? Is there any truth to this? Let’s explore.  (1-2)

Who Qualifies for Bronchial Thermoplasty?

The lungs contain a network of airways that allow air to flow freely. In asthma, the smaller bronchial airways become chronically inflamed and overly sensitive to triggers like dust mites or infections. This inflammation causes the surrounding smooth muscles to constrict, leading to asthma symptoms like shortness of breath and wheezing.

Over time, this inflammation can cause the bronchial muscles to thicken, making the airways even more reactive. For individuals with severe asthma, this ongoing cycle leads to frequent and intense asthma attacks despite using the best treatments, such as inhaled corticosteroids and long-acting bronchodilators. (2)

What is bronchial thermoplasty?

When you go in for a bronchial thermoplasty, the procedure typically takes place as an outpatient, meaning you don’t need to stay overnight in the hospital. You'll be sedated or placed under mild anesthesia, so you're comfortably asleep during the process. While you’re sleeping, a thin, flexible tube called a bronchoscope is inserted into your airway. The bronchoscope has a camera at the tip, allowing the doctor to guide it through your bronchial tubes and deliver controlled, therapeutic heat to the smooth muscle that lines your airways. (1-3

This heat is applied in a way that reduces the amount of smooth muscle in the walls of the airways. By lessening this muscle, the airways are less likely to tighten during an asthma attack. The procedure itself is done in three separate sessions, with each session focusing on different areas of your lungs. These sessions are usually spaced a few weeks apart to give your lungs time to recover in between. (1-3)

While bronchial thermoplasty isn’t a cure for asthma, it has been shown to help reduce the frequency and severity of asthma attacks. Many patients report needing their rescue inhalers less often and experiencing fewer hospitalizations due to asthma symptoms after undergoing the procedure.  (1-3)

Is Bronchial Thermoplasty Being Phased Out?

According to a source from the Asthma and Allergy Network, the answer is both yes and no. “It wasn’t covered well by payers, and biologics were better covered,” she explained. “Guidelines made it a last resort, and doctors were reluctant. But I know several patients whose lives were changed by the procedure."She also mentioned that bronchial thermoplasty is no longer being promoted. Boston Scientific, the company behind the technology, pulled all resources in 2020 and will stop manufacturing the necessary components as of December 31, 2024.

While it's encouraging that new and possibly better options are now available, it's always a bit disheartening when a treatment—one that could make a positive difference for certain patients—gets discontinued. Every tool in the fight against asthma matters, and for some, bronchial thermoplasty was that vital option.

References.

1. Menzella, et al, "Bronchial Thermoplasty and the role of airway smooth muscle: are we on the right direction," 2017, National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614744/, accessed 9/9/2024
2. Chupp, Geoffrey Lowell, "Bronchial Thermoplasty: A Treatment In Search Of A Phenotype," Chest, 2020, March, https://journal.chestnet.org/article/S0012-3692(20)30091-X/fulltext, accessed 9/6/2024
3. "What is bronchial Thermoplasty," Cleveland Clinic, https://my.clevelandclinic.org/health/treatments/16811-bronchial-thermoplasty, accessed 9/9/2024