Origin of bronchial thermoplasty in asthma treatment

With the many challenges posed to physicians in the treatment of asthma, there was a need to come up with better, safe and more effective ways of managing this disease. Several pharmacological and non-pharmacological methods have been proposed all of which require appropriate patient selection before being implemented. It involves the use of thermal energy which lowers the thickness of the bronchial muscles, a process which involves three steps. Therefore, bronchial thermoplasty is a method that uses an electronic device to treat asthma which is believed to cause structural alterations especially in the smooth muscles of the airways in the chronic phase (Cox, p. 966). It is estimated that in the next ten years, the prevalence of asthma will shoot to about four hundred million people. Much of the advances especially in the clinical and medical area concerning asthma management has led to the development of treatment as well as disease management options. However still, there is about five percent of the adults suffering from asthma who have difficulties to treat this form of asthma. This made the patients as well as the clinicians to be frustrated as far as the treatment of this disease was concerned.
In most cases, the patients used to need a three to four period of treatment which involved the longterm use of corticosteroids for unblocking and clearing the airways. This led to the need for the development of more potent and advantageous methods which offers an alternative for steroid methods of asthma treatment (Castro, p.120). Moreover, most of the mortality and morbidity was caused by the difficult to treat asthma. More threatening symptoms and exacerbations are also experienced by these patients which have negative effects on the society like missing work or lack of attending schools. As a result of this, the bronchial thermoplasty method of asthma treatment was approved by the food and drug administration in the year 2010 following the promising results which were obtained from the previous clinical trials. The rule of the thumb as stated by this agency is that the patients should be above eighteen years of age and their asthma should be described as being uncontrollable by use of corticosteroids for inhaling as well as beta agonists.
The bronchial thermoplasty, therefore, was developed in the United States of America in an effort to prevent the negative consequences that were being observed by the asthma patients caused by too much narrowing of the airways. The development of this technology was also driven by the fact that most patients would recover from asthma after using the usual corticosteroids, while a few others succumbed to this disease. Moreover, the patients who had a poorly controlled disease were observed to spend much of the resources allocated to health care. Then a series of trials were carried out to determine the efficacy of the bronchial thermal last. The first trial was carried out on dogs whereby heat was best delivered to the bronchus at a temperature of 75 ºC. when these dogs were observed for a period of three years, it was found that airway smooth muscle reduced significantly and was finally eliminated.
Later on, a set of nine human subjects were treated with bronchial thermalplasty which required lobe resecting with effects similar to those in dogs. Then another set of sixteen patients were subjected to the same treatment with promising results like lowered bronchial hyperactivity. Later on, the Research in Severe Asthma clinical trials were carried out. This trial was aimed at determining the efficacy of the bronchial thermoplasty especially in patients who were at that time using high doses of inhaling corticosteroids (Doeing, p. 216). These patients were monitored whereby some adverse effects such as coughing were observed but resolved within a short time. The patients were finally shown to have a clinical improvement in the asthma symptoms. After several other trials, the bronchial thermoplasty method was finally approved by the Food and Drug Agency for commercial use.

Cost of bronchial thermoplasty in the United States
The Americans spend about 18 billion US dollars on the treatment of asthma although a greater proportion of this amount is normally used to treat this disease via medications and hospital visits. Though considered to be an effective method, bronchial thermoplasty is also very expensive costing about fifteen thousand to twenty thousand US dollars, which depends on the method being used for this treatment. In most cases, even the insurance companies have been found to refuse to cater for this form of medication for their clients. This method requires the use of three catheters which each costs about one thousand to two thousand five hundred US dollars.
Cost-effectiveness of bronchial thermoplasty
Although bronchial thermalplasty has been in use, its cost effectiveness is not clearly understood. In most instances, the cost effectiveness of bronchial thermoplasty depends on a likelihood of development of exacerbations resulting from asthma especially in the normal group of care as well as the cost of the overall procedure. For this method of asthma treatment to be effective in terms of cost, it needs to be used only in the patients who have exacerbations of asthma (Pavord, p.1890).
With increased background of mortality resulting from asthma, the cost effectiveness of bronchial thermoplasty lowers as the age of the patient’s increases. It is therefore recommended for this method of cancer treatment to be used in the young asthma patients who meet the criteria set up by the food and Drug administration of the United States. This is because such patients could be at risk of developing exacerbations and thus making the procedure to be more cost effective.

In a study to determine the cost-effectiveness of bronchial thermoplasty as compare to the other methods of treatment for a period of ten years, a Markov decision analytical model was used. The population studied was a cohort of about forty-one years old whereby the cost was in dollars per additional quality-adjusted life year in 2013 (Zein, p. 197). The study found out that the use of bronchial thermoplasty resulted in 6.40 QALYs and $7512 in cost for those who used bronchial thermoplasty as compared to 6.21 QALYs and $2054 for the patients who used the usual care method. This suggests that the increase in the cost effectiveness of this method in a period of ten years was about $29 821/QALY. This means that as long as the patients with poorly controlled asthma are willing to pay about $50 000 per QALY, then the bronchial thermoplasty remains to be a cost effective method in America not unless this cost goes above $10 384 to cover for all the three bronchoscopic procedures that are required to carry out thermoplasty (Neumann, p.797).
Conclusion
So far, bronchial thermoplasty is the method of choice for treatment of patients who are at a risk of developing exacerbations. However, these patients treated using bronchial thermoplasty need to be followed up for a period of five years so as to get the knowledge about the cost-effectiveness of this method.

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Works Cited
Castro, Mario, et al. “Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial.” American journal of respiratory and critical care medicine 181.2 (2010): 116-124.
Cox, Gerard, et al. “Bronchial thermoplasty for asthma.” American journal of respiratory and critical care medicine 173.9 (2006): 965-969.
Doeing, Diana C., et al. “Safety and feasibility of bronchial thermoplasty in asthma patients with very severe fixed airflow obstruction: a case series.” Journal of Asthma 50.2 (2013): 215-218.
Neumann, Peter J., Joshua T. Cohen, and Milton C. Weinstein. “Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold.” New England Journal of Medicine 371.9 (2014): 796-797.
Pavord, Ian D., et al. “Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma.” American journal of respiratory and critical care medicine 176.12 (2007): 1185-1191.
Zein, Joe G., et al. “Cost effectiveness of bronchial thermoplasty in patients with severe uncontrolled asthma.” Journal of Asthma 53.2 (2016): 194-200.