New Asthma Treatment: Bronchial Thermoplasty
For people with severe asthma, a new treatment offered by Columbia’s interventional bronchoscopy program is helping many dramatically reduce their steroid use and, in some cases, discontinue steroids completely.
“The majority of patients improve,” says William Bulman, MD, assistant professor of medicine at CUMC and director of bronchoscopy. “We’re essentially seeing the same success rates that were reached in the major clinical trials that led to FDA approval of bronchial thermoplasty in 2010 for people with severe asthma.”
Most people with asthma are able to control their symptoms with medications, but 5 percent to 10 percent have persistent symptoms and are more likely to have life-threatening asthma attacks. Few options are available for patients with severe asthma.
By applying mild heat to the smooth muscle in a patient’s airways, bronchial thermoplasty shrinks the tissue and prevents it from swelling and constricting the airway.
In the AIR2 trial, which compared bronchial thermoplasty with a sham procedure, roughly 80 percent of patients experienced an improvement in symptoms, including a 48 percent decrease in severe attacks in the five years after the procedure.
Most patients who undergo the procedure at Columbia are between the ages of 30 and 70 and have suffered for many years with severe asthma along with the side effects of taking steroids.
“It’s reassuring that we’re seeing the same results as the randomized controlled trial,” Dr. Bulman says. He is one of three doctors at Columbia who perform the procedure, along with Keith Brenner, MD, assistant professor of medicine, and Roger Maxfield, MD, professor of medicine and director of interventional bronchoscopy and endobronchial therapy.
Roughly 20 percent of patients in the trials and in the Columbia program see no improvement, with a much smaller number experiencing a flare-up of asthma symptoms that Dr. Bulman says are manageable and temporary.
Columbia is one of the few centers in the region that offer the treatment, partly because expertise in both bronchoscopy and treating severe asthma is required to produce the best results.
In addition, only a few insurers cover the treatment. Despite FDA approval, many insurance companies still consider the treatment experimental. But now that Medicare covers the procedure and more clinical research supports it, Dr. Bulman says the number of insurance companies providing coverage is increasing.
Although bronchial thermoplasty is not suitable for the typical patient with asthma, it has the potential to be profoundly beneficial for eligible individuals. “It’s really for those patients who have severe, persistent symptoms who are doing everything possible they can do,” says Dr. Bulman. “It is an interventional procedure reserved for patients who really need it.”
For more information, call the Price Family Center for Comprehensive Chest Care at 877-586-4212 or visit http://nyp.org/columbialungcare.