Development of a Bronchial Thermoplasty Program at the VA Boston Healthcare System

SESSION TITLE: Procedures 1 - EMN/BT/Rigid/Cryo SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Bronchial thermoplasty (BT) is a treatment for severe persistent asthma which uses bronchoscopically delivered radiofrequency energy to induce smooth muscle atrophy thereby decreasing bronchoconstriction. The Pulmonary and Allergy Section of the VA Boston Healthcare System was the first Department of Veterans Affairs Medical Center to implement bronchial thermoplasty for our veteran population. METHODS: The VA Boston serves as a regional referral center for both Pulmonary and Allergy patients with a catchment area encompassing the northern New England region. The Asthma clinic also delivers care via a network of community-based outpatient clinics throughout Massachusetts, Rhode Island, New Hampshire and Maine. Via this network, referring providers were educated about the principles behind BT and its benefits in the treatment of patients with uncontrolled severe persistent asthma despite maximal medical therapy. Pulmonologists at nearby VA Medical Centers were also individually contacted to aprise them of the availability of BT. Patients screened for bronchial thermoplasty were evaluated for immunotherapy and omalizumab. All were on maximal medical therapy and had continued asthma flares. Outreach to providers supporting the procedure included presentations on the principles of BT, its relationship to conventional diagnostic bronchoscopy as well as expectations for level of anesthesia and duration of the procedure. All treatments were performed under moderate to deep sedation with anesthesiology support. Patients were pre-treated with prednisone as per the AIR2 trial and received an anti-sialagogue as well as a cough suppressant on the day of the procedure. Pre- and post-procedure spirometry were obtained to verify that patient's were near their baseline lung function and that they were safe for discharge subsequent to the procedure. RESULTS: In the first year, five patients with severe persistent asthma completed treatment. Referrals were drawn from within the Medical Center as well as from other regional centers. All had severe persistent asthma symptoms with elevated Astma Control Test scores as well as significant bronchodilator reversibility on spirometry. Patients had undergone allergy testing as well as immunotherapy or treatment with anti-IgE therapy where appropriate. Patients underwent the recommended three procedures at one month intervals under moderate sedation. ACT scores improved following treatment reflecting improved asthma control with decreased prednisone requirements, daily symptoms and exacerbations. CONCLUSIONS: Successful implementation of a bronchial thermoplasty program requires education of referring and participating providers as well as close coordination between multiple departments within the medical center on the day of the procedure. Close follow-up and outreach to patients ensures that the multiple procedures required are successfully completed. CLINICAL IMPLICATIONS: Development of regional bronchial thermoplasty centers in the VA network will help to serve the needs of our veterans with severe persistent asthma who have failed conventional medications and immunotherapy. DISCLOSURE: The following authors have nothing to disclose: Ting-hsu Chen, Claire Murphy, Ronald Goldstein No Product/Research Disclosure Information