Otis Rickman
Dr. Rickman is a Interventional Pulmonologist at Vanderbilt University Medical Center his clinical expertise lies primarily in interventional pulmonology and thoracic oncology. He is trained and performs the full spectrum of diagnostic, therapeutic and palliative airway procedures for patients with lung cancer or suspected lung cancer. This extends from smoking cessation counseling, early detection with endoscopic treatment all the way to palliative airway procedures to alleviate symptoms of the patient with advanced lung cancer.
Opinions expressed in this blog are mine and not necessarily those of VUMC.
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Bronchial Thermoplasty (RFA) for Severe Refractory Asthma
On the heels of the FDA approving a novel procedure (the only non drug treatment) that uses radio-frequency ablation (RFA) delivered via a b bronchoscope to treat asthma.
Asthma is an often debilitating disease characterised by dyspnea, wheezing, coughing, respiratory distress, and sometimes death. People with asthma typically have hyperresponsive and chronically inflamed airways. Chronic asthma is also characterized by extensive airway remodeling, with a thickening of airway walls, increased mucus glands and goblet cells and most hypertrophy of airway smooth muscle.
The procedure, called bronchial thermoplasty, involves the delivery of radio frequency energy to the airway wall, which heats the tissue up to about 65°C, high enough to reduce airway smooth muscle mass, but low enough to avoid tissue destruction and scarring. Airway smooth muscle hypertrophy is presumably the culprit in airway bronchoconstriction in severe asthmatics that results in difficulty breathing, coughing spasms and wheezing. The RF energy is delivered via a catheter developed by the Asthmatx Corporation that emits radio waves, similar to microwaves used to cook food.
The treatment is done during bronchoscopy. Under general or local anesthesia, the catheter containing an expandable basket is passed through the working channel of a standard bronchoscope and is positioned in all of the small- to medium-sized airways. Several airways are treated under direct vision in a half-hour procedure. Usually, three separate treatment episodes 3 weeks apart are required to treat all the accessible airways of both lungs.
In the largest sham-controlled trial in pulmonary medicine to test bronchial thermoplasty, Castro et al demonstrated that bronchial thermoplasty modestly improved asthma-specific quality of life and decreased severe exacerbations in patients with severe asthma.
The FDA approved the device for patients 18 and older who cannot adequately control their asthma with prescription medications. While roughly 20 million people in the U.S. suffer from asthma, thermoplasty would only be appropriate for about 2 million adults with severe asthma who don't get relief from existing drugs.The FDA approved the technology under the condition that Asthmatx track patients for five years to monitor their long-term health.
