16811 Bronchial Thermoplasty

Overview

Bronchial thermoplasty is a procedure used to help some adults whose severe asthma is not well controlled with usual inhalers and medicines. It is done with a thin, flexible tube called a bronchoscope, which is passed gently through your nose or mouth and down into your airways. The tube carries a small device that delivers mild heat (radiofrequency energy) to the thickened muscle in the walls of your airways. That muscle is what squeezes tight during an asthma attack. By reducing some of it, the airways cannot narrow as much, so attacks may become less frequent and less severe. It is not a cure for asthma, and you will still need your asthma medicines. It is usually done in three separate sessions, each a few weeks apart.

No, it is uncommon. Only a small number of people with asthma have severe asthma that stays poorly controlled despite good treatment, and only some of those are offered this procedure. Most people with asthma never need it.

It is considered for adults aged 18 and over with severe, persistent asthma whose symptoms and attacks continue despite taking their preventer inhalers correctly and using other asthma treatments as advised. It is not used in children. Whether it is suitable for you depends on your lung tests, your general health and your own preferences, and this is decided together with a lung specialist.

Symptoms

Common symptoms

• Wheezing or a whistling sound when breathing out
• Shortness of breath, especially with exercise, cold air or dust
• Chest tightness or a feeling of pressure in the chest
• A cough that is often worse at night or early in the morning
• Waking at night because of asthma symptoms
• Needing your reliever (rescue) inhaler more than usual
• Having to stop or avoid activities you used to manage easily
• Frequent asthma attacks that need extra treatment, such as a course of steroid tablets or a hospital visit

Symptoms in children

• Bronchial thermoplasty is not performed in children or teenagers. Children with troublesome asthma are managed with inhalers, an asthma action plan and specialist review, so speak with your child's doctor if their asthma is not well controlled.

Symptoms in older adults

• Older adults may have asthma alongside other lung or heart conditions, which can make symptoms harder to tell apart
• Breathlessness that is new or clearly getting worse should always be checked, as it can have causes other than asthma
• Fitness for the procedure is looked at carefully, including heart health and other long-term conditions
• Recovery after each session may take a little longer, so planning rest and help at home is worthwhile

Causes

Main causes

• Bronchial thermoplasty is a treatment, not an illness, so it is not 'caused' by anything. It is offered because of the underlying asthma.
• In asthma, the airways are inflamed and extra sensitive, and the ring of muscle around them tends to be thicker than usual
• When that muscle tightens, the airway narrows and air cannot move freely, which causes wheeze and breathlessness
• In some people, the airway walls also thicken and change shape over years, making attacks harder to control with inhalers alone
• Bronchial thermoplasty aims to reduce the amount of thickened muscle so the airway can open more easily

Risk factors

• Having severe asthma that stays uncontrolled despite correct inhaler technique and other treatments
• A history of frequent asthma attacks or hospital admissions
• Ongoing exposure to triggers such as tobacco smoke, dust, mould, pets or workplace fumes
• Smoking or vaping, which irritates the airways and worsens asthma control
• Being overweight, which can make breathlessness harder to manage
• Other long-term lung conditions or a history of lung infections
• Not taking preventer treatment regularly, or using an inhaler with the wrong technique

When to see a doctor

See a doctor urgently if:

• Your asthma is getting worse despite following your action plan
• You are using your reliever inhaler much more often, or it is running out faster than expected
• You have had a recent asthma attack and are not back to your usual self
• You are waking at night with symptoms several times a week
• After bronchial thermoplasty: fever, worsening chest pain, coughing up blood, or breathlessness that is not improving

Book a routine appointment if:

• You would like to know whether your asthma is as well controlled as it could be
• You are unsure whether you are using your inhaler correctly
• You want to discuss whether specialist referral or a procedure such as bronchial thermoplasty might be an option for you
• Your symptoms are affecting work, sleep, exercise or your mood
• You need your asthma action plan reviewed or updated

Diagnosis

There is no single test for bronchial thermoplasty. Instead, a lung specialist builds a picture of how severe and how well controlled your asthma is. This means going through your symptoms, your medicines and how often you use them, your inhaler technique, and any attacks or hospital visits. You will usually have breathing tests, and sometimes scans or allergy tests, to confirm the diagnosis of asthma, rule out other conditions and check how well your lungs work. Only when standard treatments have been tried properly and your asthma is still troublesome will a specialist discuss whether a procedure like this could help.

Tests that may be done

• Breathing tests (spirometry), where you blow into a machine before and sometimes after a reliever inhaler
• A test of airway inflammation, where you breathe into a machine that measures certain markers in your breath
• Allergy skin prick or blood tests, to look for triggers
• A chest X-ray or CT scan to check the lungs and rule out other problems
• Blood tests, including checking for other conditions that can cause similar symptoms
• An assessment of inhaler technique and a check of how regularly you take your preventer treatment
• A review of your symptom diary, action plan and any previous attacks or hospital stays
• A bronchoscopy (a camera test of the airways) in some cases, before or during the procedure itself

What to expect at your appointment

The assessment usually takes more than one appointment. Expect a detailed conversation about your asthma history, some breathing tests, and possibly a referral to a specialist lung clinic. If bronchial thermoplasty is being considered, your specialist will explain what the procedure involves, how well it works, what the risks are and what the alternatives are, so you can decide together. You are always free to ask for more time, a second opinion, or to say no.

Treatment

Treatment for severe asthma starts with getting the basics right: the right medicines taken the right way, avoiding triggers, and having a clear action plan. If symptoms and attacks continue after that, a specialist may consider extra options, and bronchial thermoplasty is one of them. It is done in a hospital lung unit. You are usually given sedation and a numbing spray so you stay comfortable, and the thin tube is passed through your nose or mouth into your airways. The specialist treats one section of the lung at each session, and you normally go home the same day or after a short stay. Most people have three sessions, several weeks apart.

Self-care at home

• Take your preventer inhaler every day, even when you feel well, and check your technique with your nurse or pharmacist
• Keep your reliever inhaler with you at all times and replace it before it runs out
• Follow your written asthma action plan and know what to do if symptoms get worse
• Keep a symptom diary in the weeks before and after treatment so you can see how things change
• Avoid your known triggers where possible, including tobacco smoke, damp and mould, strong fumes and dust
• If you smoke or vape, ask for help to stop — this is one of the most effective things you can do for your lungs
• Keep up with routine vaccinations as advised by your healthcare team
• Attend your follow-up appointments after each session, and tell the team about any new or worsening symptoms
• Be gentle with yourself after each session — plan lighter days and ask for help at home if you can

Medical treatments

Asthma treatment is usually stepped up gradually. Most people start with a preventer inhaler that reduces inflammation in the airways, taken regularly, plus a reliever inhaler for when symptoms flare. If control is still poor, a specialist may add other types of inhaler, tablet treatments, or injectable medicines that target the underlying inflammation in severe asthma. Courses of steroid tablets are sometimes used for short periods during a flare. Some people are offered a procedure such as bronchial thermoplasty or another specialist treatment. Your team will review your medicines regularly and stop anything that is not helping. Never start, stop or change a medicine on your own — always talk to your prescriber or pharmacist first.

When is surgery considered?

Bronchial thermoplasty is itself a procedure rather than open surgery, and it is only offered in specialist centres. It may be considered when you are an adult with severe asthma, your symptoms and attacks continue despite correctly taken treatment, your breathing tests show the expected pattern, and you and your specialist agree it is worth trying. It is not suitable if you have had a recent asthma attack or chest infection, if you have certain other lung or heart conditions, if you use a pacemaker or similar device, or if you are pregnant. Your specialist will go through your personal risks and benefits before anything is booked.

Living with this condition

Life with severe asthma takes planning, but many people find a routine that works for them. That usually means taking preventer treatment every day, keeping a reliever inhaler within reach, and knowing your early warning signs. If you have bronchial thermoplasty, you may notice a sore throat, a hoarse voice or some coughing for a few days after each session, and you may have a flare of symptoms while the airways settle. Most people are back to their usual routine within about a week, though it can vary. Improvement is often gradual and may take several months to become clear, so keep notes and bring them to your follow-up.

Lifestyle tips

• Build a simple daily routine for your inhalers — for example, linking them to brushing your teeth
• Keep your home well ventilated and tackle damp and mould early
• Use mattress and pillow covers if house dust mites are a trigger, and wash bedding regularly
• Think about pets, strong cleaning products, perfumes and outdoor pollution on high-pollution days
• Carry your reliever inhaler and a copy of your action plan, and tell people close to you what to do in an attack
• Pace activities and rest between them rather than pushing through breathlessness
• Keep a small bag ready for hospital appointments with your medicines list, test results and questions

Diet and exercise

There is no special diet that treats asthma, but eating regularly and staying a healthy weight can make breathing easier and support your general health. A balanced pattern of meals with plenty of vegetables, fruit, whole grains and protein is a good foundation. If you have food allergies or reflux, ask your doctor or a dietitian for advice. Exercise is encouraged — asthma should not stop you being active. Warm up gradually, keep your reliever inhaler with you, and choose activities you enjoy, such as walking, swimming or cycling. Cold, dry air can trigger symptoms, so a scarf over your mouth and nose in winter may help. If exercise reliably brings on symptoms, tell your team, as your treatment may need adjusting.

Mental health and emotional wellbeing

Living with severe asthma can be worrying and tiring. Breathlessness can cause anxiety, and anxiety can in turn make breathing feel harder. It is very common and completely understandable to feel low, frustrated or fearful at times, especially around procedures or hospital visits. These feelings are part of the picture, not a sign of weakness, and help is available. Talking therapies, breathing and relaxation techniques, and support from others with similar experiences can all make a difference. If you ever have thoughts of harming yourself, please reach out straight away — contact your local emergency number or a crisis support service in your country, or tell someone you trust and ask them to stay with you.

Prevention

Bronchial thermoplasty itself is not something you can prevent or avoid — it is a treatment choice. What you can do is keep your asthma as well controlled as possible, which may reduce how often you need to consider specialist procedures. That means taking preventer treatment every day, using a good inhaler technique, avoiding triggers, keeping up with check-ups, and acting early when symptoms start to worsen. If your asthma is not well controlled, ask for a review rather than assuming nothing more can be done.

Vaccines

Vaccinations can help prevent infections that trigger asthma attacks. Ask your doctor or pharmacist which routine vaccinations are recommended for you — for example, seasonal flu and COVID-19 vaccination are commonly advised for people with long-term lung conditions, and pneumococcal vaccination is offered to some people. Recommendations vary between countries and change over time, so check your local guidance.

Screening programmes

There is no national screening programme for asthma or for bronchial thermoplasty. If you have asthma, regular reviews with your doctor or nurse act as a form of monitoring — they check symptoms, inhaler technique, and how often you need reliever treatment. After bronchial thermoplasty, planned follow-up appointments and repeat breathing tests are used to see how you are doing.

Complications

If left untreated

• Poorly controlled severe asthma can lead to frequent attacks, some of which can be life-threatening
• Repeated attacks can damage the airways over time and reduce lung function
• Sleep disturbance, fatigue and reduced ability to work, study or exercise
• More hospital visits, time off work and higher treatment needs
• Anxiety and low mood related to unpredictable symptoms
• Note: bronchial thermoplasty is an optional treatment, and choosing not to have it is a valid decision. Your team will continue to help you manage asthma in other ways.

Long-term outlook

Many people with severe asthma improve over time with the right treatment and support, and for some, bronchial thermoplasty reduces the number and severity of attacks and improves quality of life. Results vary from person to person: some notice a clear difference, others less so, and it can take several months to know how much it has helped you. It is not a cure, and you will still need your asthma medicines and regular reviews. The most important thing is to keep working with your healthcare team, ask questions, and tell them how you are really doing — there is support available at every stage.

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