Competence in bronchial thermoplasty

Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a device called Alair (TM) Catheter (Boston Scientific, Natick, MA, USA). The Alair (TM) system is the first device that works by delivering radiofrequency or thermal energy to selectively reduce the amount of airway smooth muscle (ASM) in bronchi. Literature showed significant improvement in clinical outcomes such as symptom control, severe exacerbation rate, hospitalization, quality of life, and number of working or school days lost for asthma. Besides smooth muscle effects changes in inflammatory pattern after BT have been documented. Bronchial thermoplasty requires an experienced physician who had a proficiency training in bronchoscopy and had rigor, dexterity and a thorough knowledge of the airway anatomy. Furthermore, right selection of severe asthma patient is crucial in order to have best response after BT. This article reviews BT device description and how to perform the procedure. Criteria for right selection and management of patient before and after BT will be discussed.