Bronchial Thermoplasty proving safe & effective for severe asthma patients in Assam

Dr Viswesvaran Balasubramanian

Consultant Interventional Pulmonology& Critical Care, Yashoda Hospitals, Hyderabad

Assam recorded significant increase in the number of cases and fatalities due to Acute Respiratory Infections (ARI), attributed to increasing levels of particulate matter (PM) 2.5 and PM 10 by air pollution experts. According to the National Health Profile, 2018, released by the Central Bureau of Health Intelligence (CBHI), Assam reported 20,667 ARI cases and 200 deaths in 2016 due to ARI. The state reported 22,834 ARI cases with 225 deaths in 2017. According to the report, Assam accounted for the highest deaths among the northeastern states, attributable to ARI in 2017. Increasing level of pollution, mostly in winter and post-monsoon seasons, industrial & construction activities in and around Guwahati are an addition to the increasing particle levels. Moreover, pollen from local vegetation may also be a cause for the increase in asthma cases.

A case in point, Guwahati based 40-year-old Gautom Bohra (name changed) has been juggling between a hospital's emergency room, office and use of inhalers to deal with his bouts of asthma attack before he heard about Bronchial Thermoplasty. Over the last 10 years, the severity of his illness has increased as he struggles to climb stairs gasping for his breath. Battling a lone fight for breathing is extremely tough for Gautom. It gets severe in the city where he constantly has to deal with increasing pollution due to factors like vehicular emissions &particulate matter, sedentary lifestyle and thousands smoking in and around the city. Visiting an emergency room for life may not be a good idea for patients like him with severe asthma whose symptoms are not being controlled by available medications and inhalers.

According to the National Database of Indian Medical Journals, 3% of the population was reported to be suffering from asthma. What's striking is that in Assam prevalence of asthma (3278/100000) is higher than the level reported for India as a whole (2468/100000), being more prominent among males than in females.

Asthma, a long term chronic disease, is characterized by airway inflammation, which results in difficulty while breathing. Though hereditary, it is more common to turn into a severe one largely due to ignorance, seasonal variations leading to cough & cold, incomplete treatment at initial stage, moreover, modern lifestyle habits including smoking. Asthma symptoms can be triggered by several factors including environmental triggers (dust, pollen), air pollution, respiratory infections, climate changes, severe physical or emotional stress and hormonal changes.

Asthma symptoms, often characterized by shortness of breath, wheezing, cough with expectorant and disturbed sleep can be prevented from getting serious if addressed in time. Medications include rescue inhalers as well as controllers used with medicine and inhaled deep into the airways, helping relaxing the tightened muscles in the lungs. However, people continue to suffer from severe asthma with symptoms of chest pain and breathlessness.

To improve quality of life of patients with severe asthma which includes about 5% of asthmatic patients, an advanced solution and a life changing technology to all the above problems is 'Bronchial Thermoplasty' (BT). It is a technological innovation developed for asthma patients above 18 years of age. Having performed highest number of successful Bronchial Thermoplasty in India at Yashoda Hospital, this technique not only reduces emergency hospital visits of patients, but also improves their quality of life by reducing recurrent asthma attacks, increasing their participation in social activities, which generally asthma patients refrain to do in fear of asthma attacks.

Asthma patients have narrower airways because of increase in the muscle mass and mucus production, which makes it difficult to breathe. It also triggers coughing and wheezing. As the airways continue to become narrower, the chance of severe asthma attacks are increased. Bronchial Thermoplasty is one such technology being used in Yashoda Hospital to reduce this muscle mass, under which controlled heat energy is applied to patient's airways with the help of bronchoscope. The heat energy reduces the smooth muscle around the airways and help in broadening the airways. The therapy includes three sessions in three weekly intervals for a patient.

While modern technologies in healthcare can always provide world class treatment, using some preventive measures is always recommended. Do not have any misconception about asthma that exercise is prohibited. Gentle warm ups and slow exercising are always recommended to asthma patients. A short acting medicine can be taken before exercise to prevent attacks.

Having plenty of water and a balanced diet rich in Vitamin D, Vitamin A, beta carotene, magnesium can improve one's overall health as well as asthma. An asthma patient should have ample of fresh fruits and green leafy vegetables, and say no to food loaded with artificial ingredients, added colour, high salt, refined and tempting packaged food over the shelves.

With a healthy lifestyle, routine checkups, proper medications, and positive attitude towards treatment, one can always win the breathing battle against asthma.