New treatment for severe asthma gets patients moving again

UAB doctors can now employ a new procedure, using thermal energy, to open constricted airways in patients whose severe asthma is not controlled by medication.

The fancy name is bronchial thermoplasty. It’s a new, FDA-approved therapy that uses thermal energy to open constricted airways and bring relief to people with severe asthma. And in Alabama it’s offered only by the University of Alabama at Birmingham.

Patients with severe asthma have a thickening of the smooth muscle that lines the airways. When that muscle contracts, it constricts the airway and makes it difficult to breathe. Medications are sufficient to keep the airway open for most people, but the 5 percent whose severe asthma is not well controlled by inhaled medications continue to be constricted.

Bain Peto is one of those. She is among the first patients to receive the treatment at UAB. She has severe asthma, first diagnosed in 1977 when she was in seventh grade. For 35 years, she endured multiple hospitalizations, shortness of breath and an inability to do anything requiring physical exertion.

“I learned to do sedentary things like play the piano,” Peto says. “I had multiple inhalers all over the house, in the car and in every bag.”

A military wife, she moves every three years and has to adjust to weather patterns and new asthma triggers in each place. “I had another attack this past year, and they put me in a hospital,” Peto says. “I said, ‘I don’t have time for this; I have an 8-year-old who needs me.’”

Peto, who now lives in North Alabama, sought help from UAB pulmonologist Mark Dransfield, M.D.

Dransfield says bronchial thermoplasty is for people who require a high dose of inhaled steroids and a long-acting beta agonist to control their significant asthma.

The procedure, developed by Asthmatx Inc., employs a specially designed catheter and electrode array to deliver a precise amount of heat energy to remove the excess smooth muscle. The treatment is performed in three outpatient procedures, typically three weeks apart.

“By decreasing the ability of the airways to constrict, this treatment should help patients with severe asthma gain substantially better control over their disease and see a marked improvement in their quality of life,” said Dransfield, associate professor in the Division of Pulmonary, Allergy and Critical Care Medicine and medical director of the UAB Lung Health Center. “It should mean up to a 40-percent reduction in adverse asthma episodes, such as missed school or work.”

UAB now is involved in an FDA study of the therapy to determine if the beneficial treatment effect extends five years post-therapy. Dransfield says long-term safety data indicates stable lung function with no structural damage. The most common side-effect is a temporary increase of respiratory-related symptoms, similar to those seen following most bronchoscopy procedures, but they usually resolve in seven days.

Peto, who recently completed the therapy, says she now has a new, more active life with her family.

“I’m definitely more physical,” she says. “Before this, my neighbors would ask me to go walk with them, and I’d have to say no. Now, I’m up and going. I’m doing things. I’ve got a little girl, and I want to help her grow up. Just keeping up with her will be great!”