For a person with severe asthma whose body does not respond to traditional medications, a doctor may recommend an FDA-approved, minimally invasive outpatient procedure called a bronchial thermoplasty (BT).
This procedure involves a medical professional applying targeted heat to your airways (bronchial tubes).
BT may help some people with asthma gain relief from long-term symptoms. But this procedure is not considered a cure. And as with any procedure, there are also side effects and risks to consider.
Learn more about BT for your asthma so that you can discuss the potential benefits and risks with your doctor before you choose to have this procedure.
Asthma is triggered by airway inflammation and swelling. When you have a flare-up of symptoms or an asthma attack, this inflammation causes your airway muscles to tighten (constrict), making it harder for you to breathe.
A healthcare professional will typically treat severe asthma with inhaled or oral corticosteroids. This type of drug helps reduce inflammation in your airways. Long-acting beta-agonists and inhaled steroids work together to help open your airways and improve airflow.
These long-term medications are not always enough to relieve symptoms of severe, persistent asthma. This is especially the case if you continue to have airway constriction, inflammation, and a buildup of mucus that makes it harder to breathe.
BT reduces “airway remodeling.” This is an ongoing structural change that asthma causes, which leads to thickened airway walls. The narrowed airways make it difficult for you to breathe.
BT decreases the amount of smooth muscle surrounding your airways by using thermal energy (heat). The procedure’s treatment goals are:
- opening your airways to allow better airflow
- reducing the number of asthma attacks you experience over time, especially severe symptoms
A 2021 review in The Lancet found that the benefits of BT lasted
Who’s a good candidate for BT?
BT is intended for people who have severe asthma. You might continue to have persistent symptoms and asthma attacks, despite taking high-dose inhaled glucocorticoids and long-acting beta-agonists.
In order to qualify for BT, you should:
- be at least 18 years old
- be a nonsmoker for at least 1 year or longer
- have a forced expiratory volume in 1 second (FEV1) greater than or equal to 60 percent (this value can be obtained by performing a simple breathing test called spirometry)
- have no history of a life threatening asthma exacerbation
- have less than three hospitalizations in the previous 12 months
- be aware of the risk of an asthma exacerbation requiring hospitalization as a result of the procedure
Risks associated with this procedure may include:
- temporary worsening of asthma symptoms, such as increased wheezing and coughing
- airway bleeding
- partial lung collapse
You may also be at an increased risk of complications from this procedure if you’ve had frequent respiratory infections (three or more) in the year leading up to the procedure.
The estimated out-of-pocket cost for BT is approximately $25,000 per treatment. Insurance coverage varies based on your plan, including factors like your annual deductible and copayments.
A few days before the procedure, a doctor may prescribe oral corticosteroids (up to
Be sure to take all medications as directed. A doctor may also advise you to stop taking certain medications and supplements prior to the procedure, especially those that have blood-thinning effects.
Asthma symptoms may temporarily flare up immediately after the procedure. You may consider refraining from activities that could increase the severity of these symptoms, including:
- work, especially manual labor
- stressful situations
A medical specialist will typically perform BT using the following steps:
- You are sedated or placed under light anesthesia.
- A pulmonologist performs a flexible bronchoscopy with a thin tube called a bronchoscope. This scope has a small camera on the end. To look inside your lungs, the pulmonologist places the bronchoscope inside your nose or mouth. Then they guide it down your throat and trachea until it reaches your airways.
- A specific catheter system (a smaller tube) goes through the working channel of the standard flexible bronchoscope. The tip of the catheter expands to contact the walls of your targeted airways.
- The pulmonologist then delivers controlled thermal energy (via radiofrequency waves) to your airway walls to reduce the presence of airway smooth muscle that narrows your air passages.
This procedure takes about an hour to complete (not including your preparation and recovery time).
You will need to have the procedure done three times, with each procedure scheduled 3 weeks apart. Your doctor will target a different part of your lungs during each treatment, including the lower and upper lobes.
BT is an outpatient procedure, so you typically can go home the same day as the procedure.
But your doctor will monitor you carefully after the procedure before you’re sent home. Make sure you arrange for someone to drive you home since the effects of the anesthesia may make it difficult or dangerous for you to drive.
For the first few hours after the procedure, you may feel numbness in your throat and mouth from the bronchoscope. Your doctor will likely advise you not to eat or drink anything until this numbness goes away.
Over the next few days, you may also experience the following
- sore throat
You’ll also need to continue taking your asthma medications as prescribed by your doctor. BT does not replace your need for all long-term medications. Instead, it helps complement these medications and improve your overall symptoms.
A doctor will be able to determine the actual effectiveness of BT 6 weeks after your final procedure.
BT can help you breathe better by using the targeted application of heat to reduce the amount of smooth muscle in your airways.
There’s no cure for asthma, so reducing your risk of asthma attacks while improving your overall quality of life is typically based on your use of medications and other long-term management strategies.
But if you have severe asthma and continue to have severe symptoms even while taking medications, BT might be an option. A doctor can help you determine whether the benefits of this procedure outweigh any risks.