1 in 20 people with asthma have severe asthma

Bronchial thermoplasty

Bronchial thermoplasty can reduce the symptoms of severe asthma in some people - and reduce their risk of asthma attacks.

You may have heard about this treatment for severe asthma because there's been a lot of talk about it in asthma communities on social media. But it can be hard to work out what's true and what's not. So if you're curious about bronchial thermoplasty (BT), or your asthma specialist has suggested it might be an option for you, here's what you need to know...

What is Bronchial Thermoplasty (BT)?

BT is a treatment suitable for some adults with severe asthma. It's a hospital procedure, not a medicine. It helps to open up the lungs and make breathing easier by applying heat using radiofrequency to the inside of the airways. This is done because asthma causes the lining of the airways to become inflamed and swollen, narrowing the airways over time, and making it harder to breathe. In people with severe asthma this inflammation can eventually cause thickening of the smooth muscle tissue in the airways, which narrows them and makes it harder for air to pass through them. BT reduces the amount of this smooth muscle tissue in the airway walls, making it less likely that the airways will become narrow in the future.

See the video below for an animation of the treatment.

Who might get benefits from BT?

BT is a possible treatment option if you’re 18 or older, with severe asthma, and you’re taking all the relevant medicines for your asthma, exactly as prescribed, but are still having symptoms. Although BT can have some benefits for some people with severe asthma, we need more research to understand the long-term effects. To decide whether it's suitable for you, your asthma specialist will discuss it with you and see whether you fit the criteria and, just as importantly, find out whether you think it's the right option for you.

If BT's not suitable for you, you can discuss other treatment options with your asthma specialist to find the best way for you to keep your asthma symptoms well managed.

What kind of benefits can you expect?

It's important to remember that BT is not a cure for asthma, and that it's likely you'll have to carry on taking your asthma medicines after having this treatment. In studies, when people who've had BT were asked about how much asthma affected their life after the treatment, they reported some improvement. Research has also found people who have had BT may use their reliever inhaler (usually blue) less often. But the long-term risks and benefits of BT aren't yet fully understood as BT hasn't been around for a long time and more evidence is needed. Unfortunately, BT doesn't work for everyone.

Questions to ask your asthma consultant about BT

You should discuss BT fully with your asthma consultant if it's offered to you, to help you decide together if it's right for you. Your asthma specialist should give you written information about the treatment, including the potential risks and what to expect afterwards - as part of this discussion. Your consultant should also have a plan in place to look after you after the treatment. Here are some questions you could think about asking:

  • What does the treatment involve?
  • What are the benefits I might get?
  • How good are my chances of getting those benefits?
  • Will I still need to keep taking my other asthma medicines?
  • Could having the treatment make me feel worse?
  • Are there alternative treatment options?
  • What are the risks of the treatment?
  • Are the risks minor or serious?
  • How likely are they to happen?
  • What care will I need after the treatment?
  • What happens if something goes wrong?
  • What may happen if I decide not to have the treatment?

What does the BT procedure involve?

  • BT is done in hospital by a lung specialist called a pulmonologist. BT is carried out as an outpatient appointment. This means you'll go home the same day, as long as your specialist is happy everything's gone well.
  • You'll be conscious during the treatment, but will be sedated to keep you comfortable and relaxed. BT isn't painful because there aren't any nerve endings inside the airways.
  • If you've ever had a tiny camera passed down into your airways to look at them (a bronchoscopy), this is a very similar procedure. A very fine, flexible tube, with a tiny camera on the end (so the pulmonologist can see exactly what they're doing), is passed through your nose or mouth and down into the airways inside your lungs.
  • A special wire is then passed down through the tube into the airways. This delivers short pulses of radiofrequency heat to the walls of the airways. The heat produced - which is about the same temperature as a warm cup of tea - reduces the excess smooth muscle tissue that can constrict (narrow) your airways in severe asthma.

BT is done in three separate treatment sessions, starting with the lower lobes of each lung. Each session takes about 30 to 60 minutes. Normally, about three weeks are left between sessions. After the first session, your specialist will look at the treated airway before they decide whether or not to continue with the next treatment, but most people will have all three sessions.

Bronchial Thermoplasty for Asthma - AnMed Health

Bronchial thermoplasty uses a small catheter to deliver controlled energy to the airways to reduce excessive smooth muscle.

Video: Bronchial Thermoplasty for Asthma - AnMed Health

Bronchial thermoplasty uses a small catheter to deliver controlled energy to the airways to reduce excessive smooth muscle.
Transcript for ‘Bronchial Thermoplasty for Asthma – AnMed Health’

0:02 With normal breathing, the airways of the lungs are fully open

0:06 as in this cross-section of an airway.

0:09 For a person with asthma, the airway smooth muscle that

0:13 circles the airway may become thicker than normal.

0:16 During an asthmatic attack, in response to an asthma trigger,

0:20 such as an allergen or irritant, the airway smooth muscle may contract,

0:25 leading to airway narrowing and breathing difficulties.

0:31 During Bronchial Thermoplasty, a small flexible tube is

0:35 advanced into the airway through a standard flexible bronchoscope

0:39 placed through the mouth or nose. No incision is required.

0:44 The Alair device has an expandable wire basket at the tip and

0:49 when it is expanded, the four arms of the basket come in contact with,

0:52 and fit snugly against, the airway wall.

0:57 The expanded basket will then deliver controlled radio frequency energy

1:01 for about ten seconds to heat the airway smooth muscle.

1:05 About one third of the targeted lung areas are treated during a single session.

1:10 A total of three procedures are currently needed for complete treatment.

1:14 Once the treatment session is completed, the device and the bronchoscope are removed.

1:22 The controlled heat delivered during Bronchial Thermoplasty is designed to

1:27 reduce the amount of airway smooth muscle in the airway wall.

1:31 By reducing the amount of airway smooth muscle, the procedure may

1:34 reduce the ability of the airway walls to contract and narrow in response to

1:39 irritation, infection or inflammation.

Possible side effects of BT

Just like any other medical treatment, it's possible you could get side effects after BT. The most common one is a temporary worsening of asthma symptoms, such as wheezing, although these usually clear within a week with your usual asthma treatment. You should make sure you know what you need to do to manage any symptoms that get worse after BT, and what to do if you have any symptoms you weren't expecting. Speak to your asthma specialist so you can understand all the possible short and medium term risks of this treatment before deciding if it's right for you.

Want to know more?

If you want to find out more about BT, talk to your GP or your asthma specialist. You can also speak, in confidence, to one of our asthma nurse specialists on our Helpline on 0300 222 5800 (9am - 5pm; Mon - Fri).

Last updated April 2015

Next review due April 2018