May 5, 2010

New Asthma Treatment On The Way

People that suffer from asthma are getting a radically different treatment option by having a wire snaked inside their lungs to melt off some of the tissue that squeezes their airway shut.

The bronchial thermoplastic treatment is being released this month and offers the first method of physically altering spasm-prone airways.

"It does seem to improve your ability to live with your asthma," Dr. Michael Silver of Chicago's Rush University Medical Center, told the Associated Press. "I certainly have moved from skeptical to, it has a niche."

"It's a very novel, very innovative treatment" "” but only for the right patient, agrees Dr. William Calhoun of the University of Texas Medical Branch at Galveston, a spokesman for the American Academy of Allergy, Asthma & Immunology.

Close to 22 million Americans suffer from asthma, and medications offer good control for most patients.  However, asthma kills about 4,000 people each year and hospitalizes at least half a million.  Up to 15 percent of patients have severe disease and experience frequent attacks despite daily medication.

"It's like slow suffocation," John Rapp, 59, of Arlington, Va., who wound up in the ER four or five times a year before participating in a study of bronchial thermoplasty, told the Associated Press.

Asthmatx Inc. estimates its Alair system could target up to 2 million adults.  The Food and Drug Administration approved the treatment last week.

The treatment beams radiofrequency waves to heat up and shrink the muscle layer that constricts airways, which causes an asthma attack.

Doctors thread a flexible tube called a bronchoscope through the nose or throat and down into the airways during the half-hour outpatient procedure.  An electrode at the tip beams RF waves through the airway wall in order to reach the muscle underneath without causing a burn.

There were 288 adults at 30 medical centers tested in a company-funded study.  About two-thirds received bronchial thermoplastic.  The rest of the patients got a "sham" treatment, in which a bronchoscope reached into their airways but did not fire, working as a placebo-type control.  Both groups stayed on their daily medications.

It takes three treatments in order to reach different parts of the lungs.  The thermoplasty-treated patients reported better improvements in quality of life with fewer severe asthma attacks.

The drawback to the thermoplasty showed that it irritates airways, which can temporarily worsen asthma, cause a partially collapsed lung and the coughing up of blood.  About 8.4 percent of thermoplasty patients required hospitalization, mostly on the day of treatment.

"If you're willing to take that short-term risk, the long-term benefits are substantial in quality-of-life," concludes Dr. Mario Castro of Washington University in St. Louis, who led the study. "We've maximized everything we currently have available for these patients ... and they're still not controlled."

The FDA says that thermoplasty is not for patients currently experiencing worsening asthma or that have an infection or a bleeding disorder.

Also, Calhoun added that candidates must have realistic expectations.  The treatment does not reach smaller airways, or treat asthma's inflammatory side.

He says that typical bronchoscopes range from $2,000 to $4,000, and it is not how much an Alair-aided one will cost.  Asthmatx says the disposable catheter for each procedure costs $1,500.  Doctors will also need the wire-heating machine, which costs about $30,000.


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