An innovative non-drug therapy developed for asthmatics

Asthma sufferers can now breathe easier as two Canadian doctors have developed the first non-drug therapy for the chronic respiratory disease that would reduce their dependence on drugs to control their asthma.

A potential breakthrough therapy for asthmatics, called bronchial thermoplasty or specially-heated air fed into the lungs, in a clinical trial showed an overall improvement in asthma control.

The innovative technique uses a flexible scope inserted through the nose or mouth into the lungs to apply radio waves and heat to the tissue in the narrow bronchioles, the smallest airways, to destroy the smooth muscle.

The study published in Wednesday's online issue of the New England Journal of Medicine (NEJM) was authored by Co-Principal Investigators, Dr. Gerard Cox, a respirologist at St. Joseph’s Healthcare Hamilton’s Firestone Institute for Respiratory Health, and Professor at McMaster University, and Dr. John Miller, Division Head of Thoracic Surgery at St. Joseph’s Healthcare Hamilton and McMaster University.

In their year-long global trial, titled Asthma Intervention Research (AIR) Trial, Drs. Cox and Miller included 112 patients between the ages of 18-65 at 11 centers in four countries, and followed these patients for one year after treatment.

The randomized controlled trial was intended to examine the effectiveness and safety of bronchial thermoplasty as a treatment for patients with moderate or severe asthma.

After observing the study subjects for a year, the researchers found that patients treated with bronchial thermoplasty, compared to controlled group of 112 patients who did not receive the procedure, showed significant positive changes.

One year after bronchial thermoplasty, 56 sufferers involved in the study showed tremendous improvement such as decreases in asthma attacks, increases in days with no asthma symptoms, improvement in asthma-related quality of life, reduction in using medication, and an improvement in asthma control.

"These findings are very encouraging and are consistent with earlier trial results on bronchial thermoplasty," explains Dr. Cox. "These results make us hopeful that bronchial thermoplasty may be a new option for asthma patients who have asthma symptoms despite use of current drug therapies."

Patients treated with the novel therapy experienced around 10 fewer asthma attacks per year, as well as were free of their asthma symptoms with an average of 86 additional days per year and required significantly less rescue medication, researchers said.

The novel procedure is not yet widely available, with only a few Canadian centres using it in clinical trials. Bronchial thermoplasty therapy is completed in three treatment sessions, each lasting less than one hour, and done at three-week intervals.

Just like many other flexible endoscopy procedures, this non-drug therapy is also done under light anesthesia, and the patient returns home the same day. The study authors said the procedure is easy to do, and they hope after some refinements, the therapy will be approved for wider use by the end of 2008.

Asthma is an allergic inflammatory disease of the airways, in which the airways in the lung become inflamed, excess airway mucus is produced, and airways narrow when muscles within the airway walls contract, producing wheezing and breathlessness sometimes to the point where the patient gasps for air.

Asthma currently affects more than 2 million people in Canada, and nearly 12 million people in America, while more than five million patients in Britain suffer from asthma and around 70,000 are admitted to hospital each year with life-threatening attacks. Around 5000 people in US die of asthma each year.

In South Asia, Indians are most at risk for developing asthma. About 15-20 million Indians suffer from it and one in every 10 children in the country is asthmatic.