UMMC Leads in Bronchial Thermoplasty Treatment for Asthma

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When first-line treatments don’t control their asthma, patients with persistent or severe cases of the highly common respiratory condition can seek novel treatment at the University of Maryland Medical Center. Here, thermal energy is used to improve breathing capacity and reduce reliance on burdensome medications.

UMMC became one of the first in Maryland to offer the procedure, known as bronchial thermoplasty, after it was first approved by the Food and Drug Administration in 2011. That same year, pulmonologist Kathryn Robinett, M.D., was brought onto the UMMC faculty to augment its asthma offerings. She has since performed more than 40 bronchial thermoplasty procedures, a number also topping other centers in the state.

The first asthma treatment aimed at reducing the thickness of airway smooth muscle, which can constrict airflow, bronchial thermoplasty is steadily growing as an option for asthmatics whose condition is insufficiently controlled by first-line medications such as inhalers and often rely on long-term steroid therapy, which comes with many adverse side effects.

“First-line medications are still first-line,” says Dr. Robinett, an assistant professor in the Division of Pulmonary and Critical Care Medicine at the University of Maryland School of Medicine. “I tell patients emphatically that this procedure will not get them off inhalers. The hope is that we can get them to have fewer ER and doctor visits and to not rely as much on prednisone.”

How Bronchial Thermoplasty Works

Done on an outpatient basis in a three-part process, bronchial thermoplasty delivers thermal energy to a patient’s airway using a catheter inserted with a bronchoscope. UMMC invested about $60,000 in 2012 for bronchial thermoplasty equipment, which delivers precisely controlled thermal energy to the airway to scale back airway smooth muscle thickened by asthma-triggered chronic inflammation.

National clinical trials examining the effectiveness of bronchial thermoplasty showed a significant improvement in patients’ asthma symptoms along with a lower incidence of severe asthma flare-ups or exacerbations, which can lead to emergency room visits.

“The heat actually kills some of the smooth muscle, with the thought being that patients won’t have as many asthma exacerbations,” Dr. Robinett explains.

The three bronchial thermoplasty procedures required to complete the treatment course include one for each of the lung’s lower lobes and another for both upper lobes. Each session is performed at least three weeks apart. Patients’ asthma symptoms may initially worsen just after a procedure because “we are stirring up the lungs,” she says, but quickly rebound.

“About three weeks after their last procedure, patients start to see the benefits,” Dr. Robinett says.

Large Group Could Benefit

About 250 adults come to UMMC each year for ongoing asthma care, and many of them were referred by community pulmonologists, Dr. Robinett says. Not all referred patients qualify for the procedure, “but we’d rather see more patients than miss people who could benefit,” she notes.

About half of the estimated 11 million people in the United States with asthma don’t have control of their disease, Dr. Robinett says.  Some of those uncontrolled cases could   improve after bronchial thermoplasty. “Many patients could do better by improving their medication compliance,” she says, “but bronchial thermoplasty is something I often recommend when standard treatments aren’t working anymore.”

Dr. Robinett finds it satisfying to help patients whose asthma, before bronchial thermoplasty, had severely undercut their ability to enjoy day-to-day life. One UMMC case involving a man in his forties particularly stands out, she recalls, since he’d dealt with osteopenia and obesity stemming from 20 years of prednisone use.

“Now he’s off prednisone, losing weight and has not been hospitalized,” she says. “People on chronic steroids often have insomnia,, weight gain and osteoporosis. The risk of mortality after a hip fracture in a patient over age 65 is sometimes estimated as high as 50%. Getting a patient off of chronic prednisone is hugely gratifying for me.”

Patients can schedule an appointment or reach Dr. Robinett by calling 410-328-8141.

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