Bronchial Thermoplasty

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Short presentation on Bronchial Thermoplasty for community presentation ( NOT for health care professionals) Edward Omron MD, MPH, FCCP Pulmonary Medicine Morgan Hill, CA 95037

Text of Bronchial Thermoplasty

  • 1.Bronchial ThermoplastyEdward Omron MD, MPH, FCCP Pulmonary and Critical Care Medicine Saint Louise Regional Medical

2. What is Asthma? Reversible lung disease The airways of the lung are inflamed, swollen andnarrowed resulting in wheezing Breathing problems occur in attacks but thedisease is continuous Recurrent cough, chest tightness / pain, or shortnessof breath Symptoms worsen with exercise, infection, changesin weather, or at night. 3. Asthma Airways 4. Asthma Facts In 2009, 25 million Americans had asthma Of these 13 million have had an asthma attack In 2007 there were 3500 deaths from asthma 63% of these deaths occurred in women The prevalence of adult asthma in CA 2009 is 8% Asthma accounts for 50 billion health care dollarsyearly 5. Types of Asthma 6. Mainstays of TherapyInhaled Corticosteroids Remain the MAINSTAY of treatment in all asthmatic groups 7. Current Therapies Remove asthma triggers Short acting bronchodilators Inhaled Corticosteroids Long Acting Bronchodilators Leukotriene Modifiers Steroids Anti IgE Modifiers EXERCISE 8. Advances in Therapy There is no cure of asthma thus far in 2012 CONFIRM the diagnosis before anyaugmentation of treatment of regimens Rule out for example vocal cord dysfunction Interstitial Lung Disease Severe persistent asthma is a great challengeto both the patient and the physician 9. Bronchial Thermoplasty (BT) Severe asthmatics have excessive smooth muscle inthe airways BT is a non-drug procedure that reduces airwaysmooth muscle by applying heat to the airways This reduces the frequency of asthma attacks Three outpatient procedures performed three weeksapart under sedation Benefits: 32% reduction in asthma attacks 84% reduction in ER visits Improved asthma quality of life 10. Bronchial ThermoplastyRationale Reduces Airway Smooth Muscle (ASM) Reduced Ability for Bronchoconstriction Reduced Asthma Symptoms andExacerbations erba baat Improved Asthma Control andQuality of Life 11. Airway Smooth MuscleAirway Smooth Muscle ySNormal AirwayAsthmatic Airway 12. Bronchial Thermoplasty The Alair Catheter is a flexible z The Alair Radiofrequencytube with an expandable wire Controller supplies energy that isarray at the tip converted to heat in the airway wallz Monopolar radiofrequency (RF) energyz Temperature controlled: 65 Cz 10 secondsz Multiple safety algorithms to ensure controlled energy delivery 13. Bronchial Thermoplasty 14. Report 3: NIH Publication No. 07-4051, Revised August 2007. Who is Appropriate forBronchial Thermoplasty? FDA Indication: The Alair Bronchial Thermoplasty Systemhas been approved by the FDA for the treatment of severepersistent asthma in patients 18 years and older whoseasthma is not well controlled with inhaled corticosteroids andlong acting beta agonists. Adult severe, persistent asthmatics ( 18 years old) Inadequate control despite combination of inhaledcorticosteroids (ICS) and a long-acting 2-agonist (LABA) Able to safely undergo bronchoscopy per hospital guidelines Reference the Alair Bronchial Thermoplasty System Instructions for Use for more information 15. Who is Not Appropriate forBronchial Thermoplasty?Contraindications: Patients that have a pacemaker, internal defibrillator,or other implantable electronic device Patients that have a known sensitivity to medicationsrequired to perform bronchoscopy, including lidocaine,atropine, opioids, and benzodiazepines Patients that have previously been treated withthermoplasty 16. Our Patient Selection Adults with documented diagnosis of moderate-severe asthma Adherence to max doses of ICS + LABA inhalerscurrently on the market. No other explanation for bad asthma control (Ihave 30 cats and love to smoke for example) CT imaging not demonstrating other diagnosisthat needs evaluation first or explains theirsymptoms (ABPA, bronchiectasis,Hypersensitivity Pneumonitis, sarcoidosis, etc) Alpha One genotype, ANCA, IgE levels 17. Our Patient Selection Why do you want to have BTIwant to be cured of my asthma NO! I want to try and do better with asthma YES! 18. Technique Bronchial Thermoplasty performed in 3 bronchoscopysessions Minimize risk of asthma exacerbation Reduces length of the bronchoscopy Individual sessions Right Lower Lobe in 1st session Left Lower Lobe in 2 nd session Right Upper Lobe and Left Upper Lobe in 3rd session RML is not treated, but Lingula is treated Each procedure is less than an hour; ~ 60+activations 19. Short Term Side Effects Mild and related to airway irritation Coughing Dyspnea Wheezing Mean Time to onset: 1.7 days Mean Time to resolution: 4.6 days Only 42% of side effects required use ofmedications: antibiotics, inhalers 20. AIR 2 Results Efficacy (288 patients) Severe exacerbations: 32% reduction Emergency Department Visits: 84% reduction Days missed from work or school: 1.3 vs 3.9 days AQLS: BT 1.35 vs 1.16 AJRCCM 2010: 181; 116-124 21. Long Term Side Effects Chest CT at 1 and 2 years post treatment No Evidence of Bronchiectasis No Evidence of Bronchial Wall Disease No Evidence of Lung Parenchyma Changes 22. Resources American Lung Association