Breathe Better – Managing Severe Asthma

Symptoms of asthma such as coughing, shortness of breath, wheezing and chest tightness are commonly caused by two major changes to the airways of the lungs.

1. The airways become swollen, which causes thick mucus to obstruct the airways.
2. The muscles around the airways constrict, causing them to narrow.

As a result of these changes, it becomes difficult for air to get past the narrowed airways and reach the lungs. The goal of asthma management, which is tackled in this article, is to gain control over this process.

How to prevent asthma attacks

Besides avoiding known triggers and actively monitoring symptoms, a combination of medications are also usually prescribed. Drugs to reduce inflammation and mucus can be taken daily to help prevent asthma attacks. Medication to help the airways relax can also be part of a daily routine, or they can be used for quick relief. It is important to understand the purpose of each medication – maintenance or rescue – and how to take them. This is typically explained in an asthma action plan, which is created specifically for you by your doctor. Your action plan will outline the methods for keeping symptoms under control and what to do if they suddenly worsen.

When routine treatment isn’t enough

According to Dr. Yaser Abu El Sameed, pulmonologist at Cleveland Clinic Abu Dhabi, traditional therapies work for the majority of patients, but about 10% of asthma patients have persistent symptoms. Fortunately, there is a procedure called bronchial thermoplasty which can help these severe cases.

“Asthma causes the airways to narrow over time due to chronic inflammation” says Dr. Abu El Sameed. “Bronchial thermoplasty can help patients with severe asthma. The procedure decreases the airway’s ability to constrict and therefore improves asthma control.”

A thin, flexible tube with a small camera at the tip is inserted through the nose or mouth into the airway using a bronchoscope. A small catheter is able to deliver short pulses of energy (heat) to muscles within the airway walls to reduce the thickened muscle tissue. The procedure takes about an hour and patients usually go home the same day. It’s performed over three sessions, at three week intervals, to allow full treatment of the airway.

Bronchial thermoplasty is suited only for severe asthma cases, and does not work well for smokers or those with emphysema. For those who are eligible, the intervention often offers long term improvements.