Bronchial Thermoplasty: A Nonpharmacologic Therapy for Severe Asthma

Rapid weaning from mechanical ventilation and bronchial thermoplasty for near-fatal asthma: A case report

Background

The action mechanism of bronchial thermoplasty (BT) is poorly understood. Generally, patients with severe asthma who are in desperate need of treatment have relatively low baseline values. In this paper, we describe the case of an asthmatic patient who was saved by a combination of therapy and bronchial thermoplasty.

Case information

A patient with near-fatal asthma was initially treated in our hospital with conventional medication, but his condition did not improve. The patient was next subjected to invasive mechanical ventilation, which did not provide significant relief. Additionally, he was treated with BT in conjunction with mechanical ventilation, which promptly reversed his status asthmaticus and stabilized his condition.

Conclusion

Patients with near-fatal asthma who do not react effectively to aggressive therapy may benefit from BT.

Advanced Diagnostic and Therapeutic Bronchoscopy: Technology and Reimbursement

Advanced interventional pulmonary procedures of the airways, pleural space, and mediastinum continue to evolve and be refined. Health care, finance, and clinical professionals are challenged by both the indications and related coding complexities. As the scope of interventional pulmonary procedures expands with advanced technique and medical innovation, program planning and ongoing collaboration among clinicians, finance executives, and reimbursement experts are key elements for success. We describe advanced bronchoscopic procedures, appropriate Current Procedural Terminology coding, valuations, and necessary modifiers to fill the knowledge gap between basic and advanced procedural coding. Our approach is to balance the description of procedures with the associated coding in a way that is of use to the proceduralist, the coding specialist, and other nonclinical professionals.

Focal bronchial dilatations after thermoplasty for severe asthma

Bronchial thermoplasty (BT) is a non-pharmacological alternative treatment for severe asthma [1, 2]. BT consists of applying radiofrequency energy to the airways that are distal to the lobar bronchi and >3 mm, to reduce airway smooth muscle mass and bronchial hyperreactivity. However, concerns have been raised about long-term safety, especially risk of bronchial stenosis or bronchiectasis. Indeed, morphological changes in bronchial tubes, such as bronchiectasis or widening of the airways, have been occasionally described during follow-up [3–7]. However, bronchial changes have not been systematically assessed by computed tomography (CT), especially in large prospective cohorts [2, 3, 8, 9].

Focal bronchial dilatations develop after bronchial thermoplasty (BT) in 58% of patients with severe asthma.This suggests a need for systematic evaluation by CT scan after BT, with specific focus on bronchial dilatation development.https://bit.ly/2AYuhMj

Competence in bronchial thermoplasty

Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a device called Alair™ Catheter (Boston Scientific, Natick, MA, USA). The Alair™ system is the first device that works by delivering radiofrequency or thermal energy to selectively reduce the amount of airway smooth muscle (ASM) in bronchi. Literature showed significant improvement in clinical outcomes such as symptom control, severe exacerbation rate, hospitalization, quality of life, and number of working or school days lost for asthma. Besides smooth muscle effects changes in inflammatory pattern after BT have been documented. Bronchial thermoplasty requires an experienced physician who had a proficiency training in bronchoscopy and had rigor, dexterity and a thorough knowledge of the airway anatomy. Furthermore, right selection of severe asthma patient is crucial in order to have best response after BT. This article reviews BT device description and how to perform the procedure. Criteria for right selection and management of patient before and after BT will be discussed.

Recent advances in bronchoscopy

Bronchoscopy is a very common tool for diagnosis and therapeutic purposes in dealing with diseases of the lungs and the airways. Thankfully, a multitude of new technologies have made it more accessible for the use of physicians. This article is a review of the indication of bronchoscopy as it is being used today for a variety of chest pathologies.