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Bronchial thermoplasty is an advanced medical procedure used to treat adults living with severe asthma, recurring respiratory infections, and coughing up blood. These conditions can continue to disrupt daily life despite consistent use of medication and inhalers. Unlike standard treatments that mainly manage inflammation on the surface, bronchial thermoplasty delivers controlled thermal energy directly into the airways. The procedure targets and removes excess smooth muscle tissue that can cause dangerous airway constriction.
Treatment is performed in three outpatient sessions, spaced three weeks apart. Most patients can return home on the same day as the procedure.
For eligible patients, bronchial thermoplasty may provide:
1. Fewer severe asthma attacks
2. Reduced dependence on high-dose steroids
3. Fewer hospitalizations
4. Improved overall quality of life
These benefits have been reported to last for up to five years.
For many people, asthma can be controlled with medication. However, some patients have a more severe type of asthma that remains difficult to manage and can seriously affect daily life.
People with severe refractory asthma often experience:
1. Asthma symptoms that do not improve despite strong medication
2. Even with high-dose inhalers, bronchodilators, oral steroids, and biologic treatments, they may still have shortness of breath and difficulty breathing.
3. Frequent hospital or emergency visits
4. Many patients continue to need urgent medical care, emergency room visits, or unexpected doctor appointments even when they carefully follow their treatment plan.
5. Ongoing breathing problems and side effects from treatment
6. Severe asthma can cause reduced lung function, constant fatigue from breathing difficulties, and side effects from long-term steroid use.
These are signs of Refractory Severe Asthma, meaning the condition no longer responds well to standard medications. In many cases, the airways have become physically thicker and narrower over time, making it harder for medicine alone to work.
Bronchial Thermoplasty is an FDA-approved outpatient procedure for adults with severe asthma that remains uncontrolled despite maximum medical treatment.
Unlike inhalers or oral steroids that temporarily relax the airways, Bronchial Thermoplasty works by changing the structure of the airway itself. During the procedure, an interventional pulmonologist uses a specialized catheter to deliver carefully controlled heat to the airway walls. This reduces excess smooth muscle tissue inside the lungs, helping prevent the airways from tightening or going into spasm.
“Bronchial thermoplasty is not for every asthma patient, but for those who qualify, it can change the course of the disease. The key is proper evaluation to ensure the right patient receives the right treatment.”
— Asst. Prof. Thitiwat Sriprasart, Director of Interventional Pulmonology, Vejthani International Hospital.
In severe asthma, long-term inflammation can permanently change the airways. This process is called airway remodeling.
1.Healthy Airways vs. Severe Asthma Airways: Healthy airways contain a thin layer of smooth muscle that helps control breathing. In severe asthma, this muscle becomes thicker and more sensitive over time. Medications can temporarily relax muscles, but they cannot remove excess muscle tissue.
2.Severe Attack: When exposed to triggers, the thickened airway muscles tighten strongly, narrowing the airways and making breathing difficult. In severe cases, inhalers may not fully relieve the blockage.
Bronchial Thermoplasty uses controlled therapeutic heat to safely reduce the amount of excess muscle in the airway walls. With less muscle tissue, the airways are less likely to tighten severely, allowing air to flow more freely.
To ensure safety, Bronchial Thermoplasty is performed in three separate outpatient sessions, each about three weeks apart.
| Session | Timing | Target Area |
| Session 1 | Baseline | Right Lower Lobe |
| Session 2 | 3 Weeks Later | Left Lower Lobe |
| Session 3 | 6 Weeks Later (from start) | Both Upper Lobes |
Note: The right middle lobe is not treated to reduce the risk of complications.
Patients usually take oral steroids for a short period beginning three days before the procedure, continuing on the treatment day, and for two days afterward. This helps reduce airway inflammation.
The procedure is usually done without an overnight hospital stay, although some patients may stay one night for observation.
Under sedation or general anesthesia, the doctor inserts a flexible bronchoscope through the mouth or nose and delivers controlled heat to the airway walls using a specialized catheter.
Patients are monitored for several hours before going home.
Temporary symptoms such as coughing, wheezing, or chest tightness are common and usually improve within a few days.
Patients should contact their doctor or go to the emergency department immediately if they experience:
1. Chest tightness that does not improve with rescue medication
2. Severe or worsening breathing difficulties
3. Rapid worsening of asthma symptoms
4. Persistent fever or chills
For suitable patients, Bronchial Thermoplasty can provide long-term improvement.
1. Fewer and Less Severe Asthma Attacks: Reducing excess airway muscle lowers the chance of severe airway tightening.
2. Reduced Dependence on Medication: Many patients can reduce the amount of long-term medications, including oral steroids, helping minimize side effects.
3. Fewer Emergency Visits and Hospitalizations: Studies show that BT can reduce emergency room visits, hospital admissions, and missed workdays.
4. Long-Term Results: The international BT10+ study showed that the benefits of Bronchial Thermoplasty can last for 10 years or longer.
Note: Results may vary between patients, and ongoing asthma medication may still be needed as part of long-term management.
Bronchial Thermoplasty may be suitable for patients who meet the following conditions:
1. Adults aged 18 years or older
2. Severe asthma that remains poorly controlled despite high-dose inhalers and oral medications
3. Frequent severe asthma attacks requiring emergency treatment or repeated steroid use
4. Non-smokers for at least one year
A detailed evaluation by a pulmonologist is necessary to determine eligibility.
Adults aged 18 and older with severe asthma that remains uncontrolled despite maximum medical treatment may be candidates. A specialist evaluation is required.
The treatment consists of three outpatient sessions scheduled about three weeks apart to allow healing between procedures.
No. Patients are under sedation or anesthesia during the procedure. Mild coughing, wheezing, or chest tightness afterward is common but usually temporary.
Yes. Bronchial Thermoplasty is designed to support existing asthma treatment, not replace it completely. Many patients can reduce medication doses over time, but daily controller medication often remains important.
Research has shown that the benefits of BT, including fewer severe asthma attacks and emergency visits, can last for at least 10 years.
The Internal Medicine Center at Vejthani International Hospital provides advanced care for complex respiratory diseases.
1. Experienced Multidisciplinary Team: More than 30 medical sub-specialists work together to provide comprehensive care for severe asthma patients.
2. Advanced Interventional Pulmonology Expertise: Led by specialists such as Asst. Prof. Thitiwat Sriprasart, the team uses advanced bronchoscopic imaging and catheter technology.
3. International Patient Support: The hospital offers dedicated coordinators, multilingual translation services, and assistance with international insurance pre-authorization.
Severe uncontrolled asthma is a serious condition that can cause permanent lung damage if left untreated. Early specialist evaluation can help patients receive an accurate diagnosis and a personalized treatment plan.
Bronchial Thermoplasty is not an emergency rescue treatment and does not replace rescue inhalers. Please consult a qualified pulmonologist at Vejthani Hospital to determine whether this treatment is suitable for your condition.
Internal Medicine
Pulmonary Medicine and Pulmonary Critical Care
