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What is "Asthmatx?" and Bronchial Thermoplasty?

Posted Oct 30 2009 11:01pm
One of my patients asked me,"What is Asthmatx?" today.  I said its one name for people who have asthma, thinking she said "asthmatics."  No, no, she said it's device to treat asthma.  I had no idea what she was inquiring about.  Thank you to the internet for highlighting the potential for a new treatment.  So, here's the results of my latest research project.

Bronchial thermoplasty is a procedure that is being investigated to treat asthma.  Lungs have increasingly smaller tubes that deliver air to and from the alveoli, where oxygen and carbon dioxide are actively exchanged.  Those tubes are called bronchioles.  They are surrounded by rings of muscle.  When they constrict, the diameter of the airway is markedly decreased, which in turn causes great difficulty in breathing air in and out.  Normally, the bronchioles constrict and relax by less than 10%.  When this constriction is greater than 15% generally, this can be diagnostic of asthma.  Researchers have shown that when this muscle is heated using energy from radio waves, the amount of muscles is reduced, producing less symptoms.  There is less asthma. Asthmatxis the name of the company that is developing a device called the "Alair Bronchial Thermoplasty System."  Oneadvisory panel of the FDAhas voted for approval, however the FDA's overseeing panel must vote for approval.

What do I think?  Not much yet.  Of course, I don't get to play bridge with Bill Gates and Warren Buffett either.  There's very, very little data, meaning number of patients is very small, length of observation about 1 year only, the degree of improvement compared to currently approved treatments, and only a few other immunologic studies, such as have been done with corticosteroids and asthma.  This is a complex disease.  We know the immune system is involved.  It's exciting.  They are backing their way onto the market place, by aiming for severe, adults with asthma.  With time, the potential to treat many, many more patients may become realized.  This seems like treating the end result of the inflammation causing smooth muscle contraction.  Other anti-inflammatory therapies work earlier in the process.  Who's to say that since the root of the problem and the immune system have not been treated that the problem will simply recur?  New technologies sound great and I'm glad we are spending resources on this disease.  But let me and the rest of the scientific community have a little more time before this proves that it really is the Next Great Treatment.

Just little bit of midwestern skepticism from your Allergy Dude....
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