Bronchial thermoplasty is an evolutionary therapy for treating asthma, a leading chronic disease across the globe. Asthma is one of the most common chronic diseases among children which worsens with age. It is a complex inflammatory disease caused by genetic mutation or other environmental factors. In asthma, the airway muscles become hypersensitive to various allergens, triggering inflammation of the muscular wall of airway tract, and consequently narrowing the airway passage. The inflammation eventually leads to thickening of smooth muscle of airway tract, which results in restricted air flow affecting the breathing process. Treatment of asthma involves administration of various drugs such as albuterol, steroids and beta agonists through inhalers and nebulizers. However, bronchial thermoplasty is recommended in severe cases, where asthma control with these medications is less effective.
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According to World Health Organization (WHO) report published in 2017, 235 million people across the world were affected with asthma in 2015 and it accounted for 383,000 deaths globally. Incidence rate of asthma is rising among children due to increase in susceptibility to various airborne allergens and other associated risk factors. According to the United States Environmental Protection Agency (EPA), prevalence of asthma among children was 8.4% in the U.S. in 2015. According to the Centers for Disease Control and Prevention, during 2006 to 2010among the total asthma patients in the U.S., uncontrolled asthma was evident in 38% children and 50% adults. Rise in number of asthma cases drives demand for more effective treatments. This has induced the industry to develop new therapeutic devices such as bronchial thermoplasty. However, bronchial thermoplasty is an expensive procedure and requires skilled operator and well developed infrastructure. Moreover, restricted patient selection criteria for bronchial thermoplasty restrains its adoption among physicians.
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Bronchial thermoplasty is a minimally invasive procedure, which involves provision of radiofrequency energy to bronchial wall through a catheter. A bronchoscope is inserted through the nasal cavity through which a thermoplasty catheter is advanced to the therapy sight. The catheter comprises four electrodes in the shape of a basket and temperature sensors. Bronchial thermoplasty is performed in three settings separated by three weeks’ time. In each setting, different parts of the bronchi are targeted for therapy, such as left lower lobe and right lower lobe are treated in first and second sittings, while upper lobes are treated in the third sitting. The electrodes provide temperature of about 65º C for 10 seconds to 15 seconds, which reduces the chances of adverse effects. The procedure lasts for 30 minutes to 45 minutes. Bronchial thermoplasty is claimed to improve the quality of life of asthma patients and also reduces the recurrence of asthma attacks in long term studies. However, bronchial thermoplasty is recommended as an adjuvant therapy with asthma medications.
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