Non-drug Therapy Considered Breakthrough for Asthma Patients

For 25 years, pulmonologist Rodney Benjamin, M.D., has treated Esperanza Graveran’s severe asthma with the best drug therapy available. During the last year, that included an oral dose of prednisone, a type of steroid that reduces inflammation but also carries the risk of serious side effects.

More recently, Dr. Benjamin performed a new treatment on Ms. Graveran at South Miami Hospital.

Bronchial thermoplasty is the first non-drug therapy approved by the Food and Drug Administration for adults whose asthma can’t be controlled with medication.

(Pictured: Esperanza Graveran takes fewer drugs following her bronchial thermoplasty.)

“It isn’t a cure, but it’s a breakthrough,” Dr. Benjamin said. “This new treatment has been shown to improve patients’ quality of life, reduce their number of doctor and emergency room visits and lost days of work or school.”

The new treatment, for people 18 and older, reduces the smooth muscle in the airways, which decreases the airways’ ability to constrict. That, in turn, lessens the frequency and severity of asthma attacks.

“It’s minimally invasive and doesn’t involve any form of incision so there’s no risk of bleeding, and the safety of the procedure has been well-documented,” said lung specialist Raul Valor, M.D., chief of pulmonary medicine at Baptist Hospital.

About 25 million Americans have asthma, and for about 10 percent, including Ms. Graveran, it is both persistent and severe. “She was practically dying from asthma when I first met her 25 years ago,” Dr. Benjamin said.

Over the years, “I have taken everything on the market,” said Ms. Graveran, 53, a business analyst who
lives in Coconut Grove. “Sometimes I’d get a little better but then I’d get really bad. An asthma attack is scary. You always feel like you’re going to die.”

Prednisone has kept her out of the hospital but is detrimental to another of her medical problems,  osteoporosis.

In addition, prednisone can lead to other debilitating side effects, including cataracts, high blood sugar and mood swings.

Always in search of new, less toxic alternatives, Ms. Graveran followed the medical trials for bronchial thermoplasty.

When Dr. Benjamin suggested it, she was ready. “I trust him completely,” she said. “He has a human touch that is hard to find in the world we live in.”

The outpatient procedure involves three one-hour treatments, each scheduled three weeks apart and targeting a different area of the lungs.

The patient is moderately sedated before the doctor guides a specially equipped catheter, or tube, into the airways through a bronchoscope that is inserted through either the patient’s nose or mouth. Then the catheter delivers precisely controlled radiofrequency energy to the airway wall for a few seconds, destroying targeted tissue with heat. Each activation covers about 5 millimeters, less than a quarter of an inch, and is repeated until all the accessible airways are treated.

Even after the first procedure, Ms. Graveran started feeling better. “I knew it would work, but I wasn’t expecting any change right away,” she said.

After two treatments, “I was even able to work outside on my yard, which I haven’t been able to do in a long time. I was cutting bushes and I felt fine.”

After her final treatment in late December, “I continued to breathe better,” Ms. Graveran said. “I’m not wheezing now.”

She said the treatments weren’t painful and required no downtime.

After each, Ms. Graveran returned to work the next day.

Bronchial thermoplasty will not replace all medications for asthma patients. “It’s a complementary
therapy,’’ Dr. Valor said. “You still need medication to control inflammation.”

Before the procedures, Ms. Graveran typically took 20 milligrams of prednisone daily. By the end of the treatment, she was at 5 milligrams daily and decreasing, “hopefully to nothing,” Dr. Benjamin said. “This was an especially dramatic response. Not only is she weaning off prednisone, she is experiencing no asthma, which is a sea change for her.”

Ms. Graveran agreed. “I wish they’d discovered this treatment years ago,” she said. “I feel better than ever.”