More than two million people in Texas have at some point been diagnosed with asthma. And for some of them, inhalers and medications aren’t enough to stay out of the hospital. In 2010, the FDA approved the first non-medical treatment for severe asthma that involves inserting a heated metal device into the lung to make breathing easier. About 1,000 people across the country – and dozens in Dallas – have had the procedure. Now it’s time to review.
The KERA radio story.
If you’ve ever tried to drink something through one of those little red coffee stirrers instead of a full-sized straw, you know what it’s like to breathe with asthma.
Virginia Rady, who lives in Farmers Branch with her husband, has had asthma since she was two. She’s twenty-seven, but her lungs are like those of a sixty-five year old. If something triggers her airways to twitch and close up, it could be deadly. That means avoiding everything from cats and dogs to exercise and stress.
“If I were to get really emotional, I could actually trigger an asthma attack,” Rady says. “So my parents kind of treated me like a porcelain doll. Which was frustrating but I understand why they did it, because they were scared spitless ‘she’s going to stop breathing’.”
Rady tried to go away for college – just an hour north to Sherman – but after a bad flare-up semester she moved back home. See, for people with severe asthma, an inhaler isn’t enough. Treating the disease means hospital visits, skipping school or work and taking medications like prednisone to keep the inflammation of the airways down.
While predinose helps, long-term use has serious side effects, including mood swings, weight gain, bone loss, even type II diabetes. So when Rady heard about a procedure that might help her drop the number of pills she takes, she was intrigued.
Heating Up The Airways
While inhaled drugs and other medications offer temporary relief, Dr. Gary Weinstein of Texas Health Presbyterian in Dallas, says bronchial thermoplasty attacks the problem at its very root – the muscles in the lungs themselves. The procedure – which takes three separate visits – involves sticking a catheter into the airways and delivering thermal energy that causes the cells of the smooth muscle to slough off. Less smooth muscle means less seizing up.
“We go into airways that are 3 mm or bigger and we’re heating them up, and it doesn’t get that hot, about as hot as a cup of coffee,” Weinstein says.
Weinstein has performed bronchial thermoplasty on more than two dozen patients – including Rady.
“When people undergo bronchial thermoplasty there is a significant reduction in the amount of the muscle in the wall of the bronchus. This prevents that constriction,” Weinstein explains.
Study results just published in The Journal of Allergy and Clinical Immunology show that after five years, patients with severe persistent asthma had no long-term safety issues and a significant reduction in asthma attacks, emergency room visits and days lost from work and school.
Pros and Cons
The biggest drawback to bronchial thermoplasty seems to be the immediate response to the treatment.
“It’s like shoving a stick at a hornets nest,” Virigina Rady says. “In the days afterwards you’re wheezing, it’s not pleasant.”
But for Rady and many other patients, when that asthma flare-up subsides, it’s life changing.
Rady has been waiting to have kids until she can taper off her steroids. Now that she’s lowered her meds, and is able to go outside and exercise regularly, she’s building up the stamina to keep up with a toddler.
“I’m up to 30 minutes on the elliptical and can walk a half hour after,” Rady says. “I can actually do all of that without the inhaler. And that to me is the awesome thing, not needing the drug.”
Bronchial thermoplasty isn’t a magic wand. It won’t cure severe asthma, and it can be costly – around twenty grand – though more insurers are covering it.
Still, patients and doctors are happy to have one more weapon in the fight against asthma.