Dr. Andy

Reflections on medicine and biology among other things

Wednesday, May 24, 2006

Bronchial thermoplasty

Which articles do and don't get extensive media coverage has always been a bit of a mystery to me, but never more so than this one. Everyone from my sister to my secretary have e-mailed me about this.

I think it is mostly hype. So far, the results of 16 patients treated with bronchial thermoplasty (BT) have been published. That trail had no control group and showed modest improvements in their asthma: days without symptoms increased from about 1/2 to 3/4 of days. The peak flow (how fast patients could blog air out) also improved somewhat. But without a control group we can't know how untreated patients would have done. In addition, the patients in this study had relatively mild asthma.

I might considering this at least a promising avenue of investigation if the intervention was innocuous, but it isn't. The procedure involves putting a flexible tube down into the airway and burning the tissue to reduce the amount of muscle. And once isn't enough; patients get multiple bronchs so that enough muscle can be burned.
Most patients had side effects such as cough or wheeze. In addition follow up was only 2 years, so long term negative effects of the procedure may not yet be evident.

I don't know about you but I'd rather just take my Flovent or Advair twice a day.

In fairness, the article also mentions data from a larger controlled study was presented at the ATS (American Thoracic Society) meeting this week in San Diego, and they are recruiting for an even bigger study.

I'm very skeptical this will be useful. I suspect side effects will be intolerable in the really severe asthmatics who need the treatment most. For milder asthmatics, we already have safe, effective therapies available

27 Comments:

At 7:18 PM, Blogger Flea said...

Why go cheap and dirty when you can go expensive and flashy?

best,

Flea

 
At 8:42 AM, Anonymous Jaime Borbon said...

Doctor,

With all due respect, you must not be asthmatic. Asthma is like living with a bear. He's a burden everywhere you go, he's hard to hide, and you never know when he's just going to sit on your chest.

Current asthma medication is nothing but trail and error. It took me years to find an asthma medication that worked. Then it became ineffective and I had to begin the search again. If this surgery may provide a certain relief or cure, it should be researched and supported.

The facts are that this surgery has been tested in Canada and in Europe successfully and is currently being tested in the US, as per US regulations. All persons who have had this surgery have reported marked and sometimes drastic improvement in their symptoms. While it's not a cure, it is better than anything we have now.

As for your comment about not considering it because it is not innocuous, then consider this. Most major surgeries performed today are invasive, life threatening and have considerably lengthy side effects. Would you rule out heart surgery because it is too invasive? What about liposuction, a totally cosmetic and temporary surgery that is life threatening and has long lasting side effects.

As for those side effects, I would be willing to hack and cough my head off for a week, to be rid of or reduce my symptoms permanently and certainly.

I have been following the story on this surgery for years now. ASTHMATX is the company that is pioneering this in the US. When it is approved in the US, I plan on signing myself and my son for it to better our lives in a real and measurable way. Inhalers have obviously not been an answer. This may just be.

V/R

Jaime Borbon

jaborbon@gmail.com

 
At 10:02 PM, Anonymous Joe Bonnell said...

I'd have to agree with Jaime on this. I'm currently on _6_ different meds to try to control my asthma. The good news is I'm down from 5-7 hits a day on the albuteral, to 1 every other day. But I'm still nowhere close to seeing real marked improvement- after many months of these 6 meds, I've improved breathing by roughly 20%, but considering I was roughly 33% of normal, that's not nearly enough.

If you'd like to get an idea of what asthma really feels like, have a sumo wrestler sit on your chest and try to have a normal conversation...not fun.

Regards

 
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At 11:22 AM, Anonymous Gerhard said...

I'm with the other guys on this one. My asthma is barely controlled with flovent and lots of Ventolin. To make it more fun the flovent can be, as I found out the hard way last week, knocked out by certain anti inflamatitories. At least with a procedure like this I wouldn't have to worry so much about drug reactons almost killing me.

 
At 10:43 PM, Blogger Karin said...

I am currently taking 5 medications for my asthma and it is not under control. This June, I will be particpating in the latest study from ASTHMATX and I can't wait. I am hoping that I will not be the one in three that is a control so that I will begin feeling better soon. If you have severe asthma you should consider this study, it's given me hope just knowing I might feel better in a year.

 
At 11:56 PM, Blogger Jan said...

For those of you that cant understand why someone with asthma would consider this treatment "ponder" the following senerio.

On your next visit to Starbucks, pickup one of those red plastic straw like coffee sticks. Clamp a wooden clothes pin over the end of you nose and place the stiring stick between your lips. Now, breathe through this for the next 6 hours. At the end of tbis 'clinical' test period write me a report on why you wouldnt opt for this new clinical procedure...

 
At 4:15 AM, Anonymous Liz the wheezy said...

Plus the fact that Advair, which is the best drug for many of us, is being threatened by the FDA and may be pulled from the market within the next couple of years. Not to mention it includes low doses of steroids... and their nasty side-effects. Advair keeps me from turning blue, but at what cost?

Sign me up. Seriously.

 
At 8:49 AM, Anonymous Anonymous said...

As a patient with multiple drug reactions and allergies, I cannot tolerate alot of the asthma meds.And Jaime is right about the fact that they are effective for a while and then they stop working.

Among my Dr.'s concerns about the thermoplasty is that the long term effects are not known; they may include cancerous changes in the cells of the lungs, similar to Barret's esophagus in GERD. Still, as other choices for treatment are limited and steroids are not a good long term alternative, we are considering the thermoplasty. I, too, would give almost anything to have a semi-normal life.

 
At 10:36 AM, Anonymous Bob Davies said...

I am currently taking 4 meds for asthma. I have had two surgeries to remove sinus polyps. I accumulate mucous that I have to cough out about every 3 hours.

I believe that Bronchial Thermoplasty could help me immensely by opening up the airways.

Is there a projection as to when this procedure will get approval?

Coughing in Charlotte

 
At 11:59 PM, Anonymous Martin D said...

As I sit here reading this I am amazed...actually no I am not...most doctors love to push drugs and would rather do so than fix a problem. I cannot fathom anyone who does not have asthma understanding how we suffer...most people around me have little to no understanding what so ever. Obviously a method which may reduce dependence on drugs is not favorable to doctors or the phamacology industry. But it would be excellent for us asthma sufferers...don't knock it and suggest Advair whcih has terrible side effects and is the ONLY effective drug (right now) at it's highest dose for me. The lower doses do not work...I'm on the lowest now as my doctor is trying to ween me from Advair..and yes I'm wheezing and have used my Albuterol a short time ago.

 
At 10:45 AM, Anonymous Anonymous said...

I am considered a mild asthmatic: through various trial and error methods over years I have reduced medication from steroids and flovent to using Primatene as needed (less in Winter, much more in allergy season). Asthma is a true misery, even for a mild case.
I personally think the drugs we use make us more dependent, our lungs more sensitive to changes in environment and stress. ANYTHING that can lessen the asthma reaction should be considered a godsend--Sign me up as soon as its available--even if I have to go outside the US, as getting something approved that takes $$ away from big pharma will be fought tooth and nail.

 
At 11:10 AM, Anonymous Anonymous said...

i have had asthma for all my life i am 16, and its really difficlt to breath even whilst typing this, i think that this new cure or treatment should be supported im with everyone else on this. its such a good idea, baring in mind i live in the UK. i couldn't care if i have to go to the US to get this treatment.

steven connor

 
At 4:41 AM, Anonymous Anonymous said...

Does anyone know if it works for COPD (Chronic Obstructive Pulmonary Disease)?

We've just had an article published in the UK in The Times newspaper on bronchial thermoplasty and its effect on asthma.

 
At 8:32 PM, Anonymous Anonymous said...

I am married to an asthmatic and for 12 of the last 16 years with him I've watched him suffer tremendously. He is so bad that at the age of 23 he was awarded Social Security Disablitly on the first try. Steriods have blown him up, weight wise, not to mention the other horrific side effects of depression, arthristis, swollen legs and feet and aching all over. At one time he was on 32 different meds to help his breathing and conteract the side effects from the steriods. The breathing through the stir stick has been describe to me by him. I hate watching him suffer. I hate leaving him at home to go to church, go to family gatherings, go to the movies, go to the kids games, or even to see the fireworks. I do this to keep life "normal" for the kids. All the time looking at other happy couples wondering if they know how lucky they are to be spending that time together. People take their health for granted. If this procedure can help him have a half way "normal"life and help him not miss out on so much of the "little" things than sign us up! I hate waiting around to see if/when an asthma attack is going to take him away from us forever. Where do we sign up for this?

 
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At 11:29 PM, Anonymous Anonymous said...

At the age of sixteen, I have had asthma for about fifteen years now. I have been determined since I was about ten to make it in college sports. You would never know what it is like to have your asthma medication be changed every year, and have various consequences. The thought of this procedure made my heart leap. Imagine running with the varsity team as a freshman, being so proud of your accomplishments, just to feel your chest beginning to tighten and no air entering your lungs. I don't know what really happened next, but my teammate grabbed my and held me up against the fence and my eyes were rolling into my head. I have heard various accounts, some say I sounded like a bird, but I personally thought of a dying squirrel with a very high pitched squeak, with every ounce of me trying to get that air in. I take ten medications, one being asthmanex and three others being inhalers I use three times daily. I could not use my fast acting inhaler for I had used it an hour before in sprints. So, when you begin to see black and you panic because you cannot breathe, you let me know about your new research.

 
At 1:39 PM, Anonymous Anonymous said...

I feel for you folks. I am an osteopathic physician who actually incorporates our form of manual medicine (OMT) into my practice on every single patient. In a nutshell, it helps to remove musculoskeletal/fascial asymmetry and restrictions that impair normal fluid/nerve flow and organ function. It is not chiropractic, as most people would assume. Look into it as an option to further meds and procedures, as it is a great way to improve head/neck/respiratory functioning so your body requires less (or no) medications. Find someone who uses it on 60% of their patients or more for the best efficacy and preferably understands fascial strain. Best of luck.

 
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At 2:21 PM, Blogger Darren said...

Nice post about Bronchial thermoplasty, in these days bronchial asthma is more common and people have to try to be careful with their health for example I spend much money in buying generic viagra only because I need it.

 
At 9:17 AM, Anonymous buy cialis said...

I've been reading a lot of articles about and the Asthma treatment technology may have taken a huge leap forward with the development of bronchial thermoplasty. The treatment involves applying radio-frequency energy directly to the lungs.

 
At 9:46 PM, Anonymous How To Get Rid Of Bad Breath said...

i just hope that the technology will benefit many people

 
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At 8:37 PM, Blogger tabitha willbanks said...

I have been suffering from asthma since I was four years old and I am now 29. In the past two years my asthma has taken a turn for the worst. I have been hospitalized 6 times, been on prednisone straight on top of my other maintence medications. I am having terrible side effects from all of the steroids... My doctor just talked to me about this procedure today and I am all for it. I can't take Advair because I have bad reactions to it. If this will help me get some stability back for my health, I say sign me up!

 
At 9:39 PM, Anonymous Anonymous said...

My husband is getting this done he has been thru two out of the three surgerys and has already has made a huge difference!

 

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