Your doctor has suggested you have a procedure called bronchial thermoplasty* as part of your treatment at National Jewish Health. Bronchial thermoplasty is a procedure that may be recommended for adults with severe, persistent asthma that is not well controlled on inhaled steroids combined with a long-acting bronchodilator medicine. If you think this applies to you, talk with your doctor.
Image courtesy of Boston Scientific
A bronchoscope is a small tube that allows the doctor to look inside the airways in the lungs. The Alair® bronchial thermoplasty system can be placed thru the bronchoscope. The Alair System then delivers controlled thermal energy (heat) to the airway wall in the lung. This controlled thermal energy helps to reduce excess airways smooth muscle. There is often excess smooth muscle in the airways with severe persistent asthma. When the excess airway smooth muscle is reduced, the airways are less likely to constrict. This may reduce the frequency of asthma attacks. Bronchial thermoplasty is a procedure that is done in three visits; each visit is two to three weeks apart.
Learn more about how BT works, side effects and who is a good candidate for the BT procedure.
- You will be scheduled to see the pulmonary doctor who performs the bronchial thermoplasty before the procedure. The doctor will give you instructions for preparation and review risks involved with the procedure. Please ask questions if you don’t understand.
- Talk with the doctor about all the medicines you are taking, including herbal supplements. Tell the doctor if you have any allergies, especially to anesthesia. Tell the doctor if you have a pacemaker, internal defibrillator or other implanted devices.
- You will also be called on the telephone by a health care provider before the procedure.
- There may be certain medicines which you will need to stop taking. The nurse and/or your doctor will tell you about these. Your doctor may advise you to stop taking aspirin or a blood thinner before your procedure.
- You will take a medication called prednisone for a total of about five days before and after the procedure. The doctor and nurse will review this with you.
- The medication you receive during the bronchial thermoplasty makes you sleepy. Ask a companion (family member or friend) to pick you up after your procedure and stay with you during the night. You will not be able to drive or take a taxi home after the test.
- If you wear oxygen at home, please bring a portable oxygen unit with you. This includes oxygen use when you sleep and/or are active. You may need oxygen for awhile after the procedure.
The Day of the Procedure:
- Remember to have someone drive you home when you are done.
- Remember to bring portable oxygen if you use it at home.
- Do not eat food or drink liquids for at least eight hours before the procedure.
- If you are diabetic, please bring your blood glucose monitor and medicine, including insulin.
- Arrive 1 ½ hours before the bronchial thermoplasty is scheduled.
- Inform your doctor about recent illnesses and other medical conditions.
- The medication you receive during the bronchial thermoplasty makes you sleepy, so plan to have someone drive you home when you are done.
- Do take your inhaled medicines as you normally do.
- Take your oral medicines with a small sip of water.
- Please check in when you arrive at National Jewish Health. A nurse from MIDC (Minimally Invasive Diagnostic Center) will come and get you.
What is done during the bronchial thermoplasty?
When you arrive, the nurse will explain what will be done before, during and after the bronchial thermoplasty. If you have any questions, please ask. Before the procedure you will need to remove all clothing and jewelry from the waist up. You will be given a hospital gown to wear. The nurse will start an IV. The IV will be used to give medicine to make you sleepy. Right before the procedure, medicine will be squirted in your nose and throat. This medicine makes the nose and throat numb.
You will be monitored closely during the procedure. An EKG will monitor your heart rate. A blood pressure cuff will be placed on your arm to monitor your blood pressure. A pulse oximeter will be placed on your finger to monitor the oxygen level in your blood. You will be given oxygen during and after the bronchial thermoplasty to make sure your body is getting enough oxygen.
During the bronchial thermoplasty, the bronchoscope will be placed through the nose into the lungs. The Alair System will be placed through the bronchoscope to a specific section of the lungs to be treated. Once the Alair System is near the end of an airway, controlled thermal energy is applied along the airway. This is repeated with all the airways in the section of the lungs to be treated.
Once the bronchial thermoplasty is done you will rest. You will be sleepy in the beginning and your throat may still feel numb. You will be on oxygen in the beginning. When your throat isn’t numb you can have something to eat and drink. This often takes at least 1 hour. Your doctor will determine when you are able to go home. It is usually two hours after the procedure ends.
The bronchial thermoplasty will be done during three visits. A different section of the lungs will be treated during each of the three visits. After the third procedure, all the lung sections will have been treated except the right middle portion, which is not supposed to be treated.
How long will the procedure take?
Plan on being at National Jewish Health for at least four to six hours, although sometimes people stay longer. The preparation for the bronchial thermoplasty will take about one hour. The bronchial thermoplasty will take from 45 minutes to 60 minutes. The recovery may take from two to four hours. Sometimes, an overnight stay is required.
What should you do after the procedure?
- You will be monitored by a nurse for two to four hours after the procedure.
- A companion (family member or friend) will need to pick you up after the procedure. You will not be able to drive or take a taxi home after the test. Avoid driving on the day after the test also.
- You will be called on the telephone by the nurse 24 hours, 48 hours and 7 days after the procedure to see how you are doing.
- You will have a clinic visit in 2 to 3 weeks to see how you are doing and schedule the next bronchial thermoplasty.
How do you get to your procedure?
On the day of your scheduled procedure, check in at the front desk. A nurse from MIDC will come get you. If you have questions, please call 303.398.1355. Also, if you need to cancel the appointment, please call.
*Bronchial thermoplasty is an elective procedure that may not be covered by your insurance plan. Please check with your insurance provider to verify coverage.
This information has been approved by Ali Musani, MD, FACP, FCCP (April 2011).