Severe asthma sufferers in Snohomish County — the 5- to 10-percent of asthma patients with the deadliest form of the disease — can now get relief through a new treatment offered at Providence Regional Medical Center Everett.
Bronchial thermoplasty is a relatively new tool in the asthma-treatment arsenal, approved in 2010 by the U.S. Food and Drug Administration for patients ages 18 and older.
While most therapies target inflammation of the airways, bronchial thermoplasty targets the excess smooth muscle that builds up around asthma patients’ airways, for reasons as yet not completely understood.
During treatment, radio frequency energy is used to shrink that excess smooth muscle, reducing the airways’ ability to contract and narrow during an asthma attack, allowing the patient to breathe more normally and reducing the number of attacks.
Treatments are done on an outpatient basis in three sessions, targeting one-third of the lungs at a time as a safety precaution.
No incision is needed, as a flexible bronchoscope with a camera on the end — similar to that used in a colonoscopy but much smaller in diameter — is inserted through the nose or mouth while the patient is deeply sedated.
With the bronchoscope inserted, a tiny array of wire electrodes slides from the tip and expands to fit snugly against the airway walls.
Moved one centimeter every 10 seconds, the electrodes deliver radio frequencies which create mild thermal heat of 135 degrees Fahrenheit, about the same heat as a warm cup of coffee, said Dr. Tom Ziedalski, medical director and section chief of pulmonary and critical-care medicine for Western Washington Medical Group in Everett.
Ziedalski, trained in administering bronchial thermoplasty, and Providence, which acquired the Alair machine, are collaborating to offer the treatment to severe asthma patients in the Everett area.
Asthma is one of the top five chronic diseases in the world, along with heart disease, stroke, cancer and diabetes.
In the U.S., more than 25 million people have asthma, accounting for 13.9 million asthma attacks every year, 2.1 million emergency-room visits and 479,300 hospitalizations, and worse.
“Three-and-a-half thousand patients die of asthma every year,” Ziedalski said.
Ziedalski started treatment last month at Providence for his first Bronchial thermoplasty patient.
The session went smoothly and he and Gary Wickman, the hospital’s director of respiratory care services, said they have six more patients lined up and awaiting insurance-company approval.
The treatment is expensive, estimated to cost up to $20,000 per patient, but has the potential to save millions, if not billions, of dollars in health costs.
At least one study states that 5 to 10 percent of patients have asthma that is not easily controlled by the inhalants and other drugs prescribed for asthma.
And those cases are responsible for more than 50 percent of asthma-related costs.
Total asthma-related costs in the U.S. grew from $53 billion in 2002 to $56 billion in 2007, according to a 2011 report of the U.S. Centers for Disease Control and Prevention.
Nearly one in 12 Americans was diagnosed with asthma in 2009, with the total number increasing 4.3 million between 2001 and 2009, the report says.
Asthma attacks can be triggered by a variety of irritants and pollutants, with an estimated 75 percent to 85 percent of asthma patients also diagnosed with some sort of allergy.
For severe asthma sufferers, triggers can be as innocuous as exercise, wind and changes in temperature, so their lives become very restricted.
Five-year studies of bronchial thermoplasty indicate “a significant improvement” in the quality of life for 79 percent of patients, according to Massachusetts-based Boston Scientific, the medical-device developer of the “Alair System” used in the treatment. Side effects include a temporary worsening of asthma symptoms, with a 3.4 percent risk of hospitalization, but these generally subside in a few days.
Patients on Boston Scientific’s website describe having asthma as being like breathing through a straw 24/7 and an asthma attack as being like drowning, or like somebody putting a plastic bag over your head and suffocating you. His patients tell him “it’s like somebody’s sitting on your chest,” Ziedalski said.
While not touted as a cure for asthma — patients are told to return to their regular doctors for continued care — the treatment helps all patients to some extent, Ziedalski said.
Providence’s Wickman said the treatment is approved by Medicare and is being covered by many insurance companies on a case-by-case basis.
“Usually private insurers follow what Medicare does” he said, “but it takes a while to get there.”
He said Providence decided to buy the $60,000 Alair System about three years ago, but the purchase was delayed because of costs of recent remodeling at the hospital.
Now Providence joins the few doctors and hospitals in and around Seattle offering bronchial thermoplasty
“We’re really excited,” Wickman said. “It’s a new tool that nobody north of Seattle has.”