Procedure helps asthma patients

Lee Trimmer had struggled with the effects of asthma for pretty much her entire life. It began worsening about 10 years ago, “and exponentially so”  the last few, she says.

That is until early last year, when she underwent a new procedure called bronchial thermoplasty. “It’s not a cure for asthma, but it’s as close as they’ve ever come,” says Trimmer, 44, a neonatal intensive care nurse at Lovelace Women’s Hospital. “I’m more than a year out, and it’s changed my life and for the better.”

Asthma is a chronic or long-term disease in which the smooth muscle in the walls of the airways become thick. When an allergen or an irritant triggers an asthmatic attack, that thick, smooth muscle contracts and the airway narrows, making breathing difficult.

Lee Trimmer, left, takes a brisk walk with her boyfriend, Dwayne Colbensen, at Phil Chacon Park. Trimmer, who suffered with asthma her entire life, is now breathing easier and is more active thanks to a new procedure called bronchial thermoplasty.
(Dean Hanson/Journal)

This artist rendering shows the Alair electrode array expanded and delivering heat to shrink the thickened smooth muscle in the wall of the airway during bronchial thermoplasty. (COURTESY of BOSTON SCIENTIFIC)

According to the Centers for Disease Control and Prevention, more than 26 million Americans have asthma, 7 million of them children; and more than 3,400 people die each year in the U.S. from asthma.

Jeffrey Dorf, a pulmonologist with Chest Medicine of New Mexico, is the only doctor in New Mexico trained to perform the procedure using the Alair system made by Boston Scientific, according to a company marketing representative. The equipment was purchased by Lovelace Women’s Hospital, where Dorf performs the procedure.

Because people can outgrow asthma, bronchial thermoplasty is not recommended for anyone younger than age 18, Dorf says. “You try medications first to avoid exposing someone to a medical procedure.”

Bronchial thermoplasty may be indicated for people with “severe and persistent asthma who have failed to respond to routine medications and have a poor quality of life,” Dorf says.

Before bronchial thermoplasty, which was approved by the federal Food and Drug Administration in April 2010, asthma could only be treated with medications and inhalers.

Trimmer tried a host of medications over the course of her life, but her asthma flare-ups were only getting worse.

“It felt like somebody was sitting on my chest. I couldn’t breathe, and as the oxygen levels in my blood got low, the skin around my lips turned blue. I’d wind up going to the emergency room two to six times each year and had one to three hospitalizations each year.”

At the peak of her asthmatic debilitation, she was on heavy steroids, like Prednisone, for extended periods of time. She’d also have to use oxygen at night and sometimes be tethered to an oxygen tank for 24 hours at a time.

When that happened I couldn’t work,” Trimmer says. “You can’t work in an intensive care unit when you’re on oxygen, so my asthma pretty much affected my whole life.”

Her asthma triggers were both genetic and environmental, she says. Her mother has asthma and Trimmer’s two children had asthma when they were young but outgrew it by age 10. Trimmer’s asthma would flare up after exposure to chemicals in floor wax and cleaning agents, while seasonal triggers included spring dust storms and winter cold.
The leading edge of the Alair catheter with its expandable electrode array tip uses radio frequency waves to heat up and shrink thickened muscle tissue in the airway walls. (COURTESY of BOSTON SCIENTIFIC)

“Trimmer learned of bronchial thermoplasty from Dorf, who happened to be her pulmonologist. “I went online and saw all the data and got excited,” she says.

The procedure is broken down into three sessions – right lower lung, left lower lung, and both upper lobes. With each session, the patient is put under conscious sedation or general anesthesia, depending on the individual, Dorf says. The sessions are spaced from three weeks to a month apart and follow the same protocol.

A standard bronchoscope is inserted into the mouth or nose, through which the Alair device, essentially a small, flexible tube, is advanced into the airway, explains Dorf. A wire that protrudes from the tube contains an expandable electrode array at the tip. When opened, the four arms of the array come in contact against the airway wall. Radio frequency pulses then heat the tip of the array to about 150 degrees, which shrinks the amount of smooth muscle in the airway wall, minimizing the amount of muscle constriction and airway narrowing that occurs during an asthma attack.

The electrode array continues delivering pulsating heat along the airway as the Alair device is slowly backed out.

Nearly 1,500 patients in the United States have had the procedure, says Dorf. About 800 of them were studied post procedure “and the overwhelming number of them have benefitted greatly in terms of improved breathing and fewer and less severe asthma attacks.”

Among his own patients, some feel a big difference in breathing capacity within a couple of weeks, and nearly all feel the benefits in three to six months. A downside to the procedure is “in about 8 percent of cases the procedure itself precipitates an asthma attack,” Dorf says.

Choosing to have bronchial thermoplasty was an easy decision for Trimmer. “I was maxed out on all my medications and there just wasn’t anything else that could be done for me. It was an avenue of last resort.”

Within two weeks of the first session, Trimmer says she noticed her right lung was breathing easier, a personal indication that continuing with the remainder of the sessions was the right thing to do.

Today, Trimmer says, she is breathing more effortlessly, which gives her more energy to do other things. “Now when the wind is blowing I can go to the grocery store or dinner and don’t have to stay home. I don’t feel near as tired when I get off work and can do more things with my kids like ride bikes or go to the park. In the past year, Trimmer says she has not had a single visit to the ER for her asthma, and this past winter was the first one in “I just started going back to the gym. I haven’t done that in years. I can get on a treadmill for 30 minutes and it’s moderately easy. I recently finished a 5K Run for the Zoo. It was the first one I’d ever done, and afterwards I felt great and didn’t have any problems.”

Trimmer says she’s happy to share information about bronchial thermoplasty with fellow asthma sufferers as way to give them some good news and hope.

“There was no pain, no discomfort, it’s available now for people like me and it can completely change your life.”

To see this story in print, click here for page 1 and here for page 2.

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