Bronchial Thermoplasty Periprocedural Care

Updated: Dec 15, 2015
  • Author: Said A Chaaban, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
  • Print
Periprocedural Care

Pre-Procedure Planning

Patients selected for bronchial thermoplasty (BT) should be monitored by a medical team (pulmonologist, an experienced bronchoscopist) to ensure that the patient has undergone a detailed medical evaluation. It is imperative to adhere to the recommendations based on previous studies in order to ensure an ideal outcome. [27]

The success of the procedure depends on a number of variables, including a patient profile similar to that studied in previous clinical trials, [27] the technique of the bronchoscopist, and adequate patient management at the time of the procedure.

Next:

Equipment

The thermal energy used in bronchial thermoplasty is delivered via the Alair System (Boston Scientific, Natick, MA).

Alair System, Asthmatx Inc., Boston Scientific Cor Alair System, Asthmatx Inc., Boston Scientific Corporation

This system consists of the Alair radiofrequency controller and the single-use catheter with an expandable 4-electrode basket at one end and a deployment handle on the other.

The Alair thermoplasty system is used in conjunction with a flexible bronchoscope with a 2-mm minimum working channel to allow the deployment of the Alair catheter and a 4.9- to 5.2-mm outer diameter that allows access of smaller airways.

This catheter is deployed under direct visualization through the working channel. The array of electrodes at the distal tip of the catheter is expanded to contact the airway wall circumferentially, and the source energy is then activated. The electrical energy delivered is converted into heat when it meets tissue resistance. Continuous feedback to the energy generator ensures a close regulation of the degree and time of tissue heating to the desired prespecified temperature of 65°C. [9]

All accessories need to be connected for the controller to deliver energy. If the array of electrodes is not in contact with the airway wall, the front panel notifies the bronchoscopist to reposition the electrode array.

Previous
Next:

Patient Preparation

Patients are given 50 mg of prednisone 3 days before the procedure, on the day of the procedure, and after the procedure to minimize postprocedural inflammation of the airways. Nebulized albuterol (2.5-5 mg) is given before the patient undergoes screening spirometry to assess FEV1 and again before the procedure.

The patient should have had nothing by mouth after midnight the day before bronchoscopy to reduce the risk of pulmonary aspiration.

Anesthesia

Topical anesthesia with 5 mL of 1% lidocaine jelly is applied to the nostril being used for bronchoscopy; 2-mL aliquots of 1% lidocaine are then applied at the level of the vocal cords until the patient is comfortable with minimal cough. Additional 2-mL aliquots of lidocaine can be applied to the tracheobronchial tree. It is recommended to use a 1% concentration of lidocaine to limit the risk of lidocaine toxicity.

Positioning

The patient is placed in the supine position, and the bronchoscopist positions himself/herself at the head of the table.

Previous
Next:

Monitoring & Follow-up

After each procedure, the patient should be observed for 3-4 hours before discharge. Immediate postprocedure follow-up includes assessment of gag reflex, vital signs, and FEV1. All patients should receive a follow-up appointment shortly after the procedure, as respiratory-related symptoms are expected to worsen before resolving with standard medical care within an average of one week.

Previous