UAMC Offering New Procedure to Treat Severe Asthma

The Alair® Bronchial Thermoplasty System, approved by the FDA in 2010, uses radio-frequency waves to treat patients at The University of Arizona Medical Center-University Campus.
May 7, 2012
Dr. James Knepler
Dr. James Knepler
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It had been years since Laura Bradley of Tucson had taken a deep breath. A lifelong asthma sufferer, the 42-year-old had tried everything to manage her breathing difficulties – controlled inhalers, rescue inhalers, oral medications – but nothing seemed to work.

In January, a severe asthma attack sent her to the emergency room and she spent two and a half days in the hospital. It was then she decided she needed to try something different. Bradley made an appointment with Dr. James Knepler at The University of Arizona Medical Center-University Campus.

Knepler, an associate professor of medicine and associate division chief of pulmonary and critical care at the UA, recently became the first physician in Arizona to offer a cutting-edge procedure, known as bronchial thermoplasty, for patients with severe asthma.

Knepler says that while everyone has a layer of smooth muscle in their airways to allow them to contract, that muscle layer is thicker than normal in some asthma sufferers, so when it constricts down, the airway becomes very narrow, making breathing difficult.

The Alair® Bronchial Thermoplasty System, approved by the FDA in 2010, uses radio-frequency waves to reduce that thick layer of muscle.

During the procedure, a bronchoscope is inserted down the patient's throat and into the airways to deliver thermal energy to the smooth muscle layer. The heat shrinks the muscle to a more normal size, preventing the airways from restricting as much during an asthma attack.

It was worth a try for Bradley, whose worsening asthma had dramatically changed her life in the past five to 10 years.

"My quality of life had gotten to where I couldn't do anything," she says. "My husband and I are very active. We like to go camping and hiking and I couldn't do that anymore. I'm 42 and I felt like I was 80 years old."

The severity of Bradley's case, and her lack of success with other treatment methods, made her a good candidate for the procedure, Knepler says.

"We see a lot of difficult asthmatics who have had frequent hospitalizations and they really do not have any kind of normal life," he says. "To be able to offer them something like this, hopefully we can get their asthma is under better control."

The outpatient procedure is done in three separate treatments, targeting three different areas of the lungs. Each treatment takes about an hour and they are usually scheduled about three weeks apart to allow for healing between treatments, Knepler says.

Bronchial thermoplasty is not a cure for asthma, which afflicts more than 20 million Americans and has no known cure, Knepler says. However, the procedure can be extremely helpful in controlling severe asthma in patients who have not seen results, or who have experienced adverse side effects, from common asthma treatments, such as inhaled and oral steroids.

"The thought behind this is that it should help improve their asthma symptoms and hopefully improve their quality of life and reduce visits to the ER," says Knepler, who also holds an appointment in the Arizona Respiratory Center, a center of excellence within the UA College of Medicine.

Bradley says she began to notice a change just a few weeks after her final treatment.

"I'm now able to, for the first time in years, actually take a deep breath," she says.

Although she still uses an inhaler twice a day, Bradley says she now finally feels like her asthma is manageable, which is especially important to her as a new grandmother to a baby boy.

"I want to be around for my grandkids and be able to actually do things with them," she said. "If anyone has been through what I've been through, I'd definitely recommend this procedure. I know for a fact I made the right decision."