Endoscopic Asthma Treatment

Extensive research has increased our understanding of the mechanisms of asthma, and this has led to the development of specific new therapies. However, there are variations that exist in and between patients that contribute to suboptimal control of their asthma condition, despite compliance with prescribed medications. One recently described pathogenetic feature of asthma that we cannot yet address is the presence of increased smooth muscle in the airway wall. Bronchial thermoplasty was developed to directly reduce the amount of bronchial smooth muscle and thus to reduce the potential for airway narrowing due to bronchoconstriction. This procedure is performed during bronchoscopy using a custom-designed catheter to deliver radiofrequency energy to the airway wall. This results in the generation of heat which causes immediate inhibition of smooth muscle function and long-term reduction in smooth muscle mass. The treatment effect has been studied in patients with a range of asthma severity, and recent reports demonstrate persistence of benefit at 5 years.