National Institute for Health and Clinical Excellence (NICE)
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Draft guidance launched on new surgical treatment for severe asthma

A treatment for severe asthma that applies heat to the walls of the airway could reduce symptoms and improve quality of life, says draft guidance from NICE.

Asthma is a common condition which causes the airways to become narrower. Symptoms include wheezing, breathlessness, chest tightness and coughing. These symptoms get worse when a person has an asthma attack, which can be triggered by several factors including infection, allergy, smoke or exercise.

Current treatments range from taking inhaled therapies to using oral corticosteroids (tablets used to reduce inflammation in the whole body).

NICE publishes draft guidance on bronchial thermoplasty today. This procedure aims to remove some of the smooth muscle in the airway, consequently decreasing the ability of the airways to constrict, and lowering the severity of asthma symptoms and the amount of medication requirements.

The procedure involves placing a special catheter into the bronchi (the tubes which carry air into the lungs) via the patient's nose or mouth. The catheter then delivers radiofrequency heat to destroy part of the muscle lining in the airways, limiting its ability to contract and narrow.

NICE examined latest evidence and expert opinion in order to produce the draft guidance. The evidence suggests that bronchial thermoplasty can lead to fewer asthma attacks in people, and improve their quality of life.

However, the evidence also shows that some people experienced worse short-term symptoms. And there is not yet enough evidence to show whether the procedure improves lung function beyond the trial periods investigated, or whether it has any long-term health concerns associated with it.

The draft guidance on bronchial thermoplasty provisionally advises respiratory doctors considering the procedure to explain its uncertainties and risks to their patients before obtaining their consent.

It also urges doctors to inform their clinical governance leads (usually the hospital's medical director). And it is additionally recommended that doctors should audit clinical outcomes so that more can be learnt about this procedure in the longer term.

Professor Bruce Campbell, Chair of the independent committee that develops interventional procedures guidance for NICE, said: “The evidence suggests that bronchial thermoplasty can offer significant improvements in quality of life by making breathing easier and reducing the need for medicines and inhalers.

“However, more evidence is needed about its benefits in the long term. Thermoplasty may cause symptoms to worsen to start with, which can be very serious for people with severe asthma.

“Our draft guidance highlights the need for experienced respiratory teams to take care in selecting those patients with severe asthma who are most likely to benefit from the procedure and to inform them fully about what is involved.”

The consultation period for this treatment ends on Thursday 19 August, with final guidance expected to be published in November. This will outline what NHS healthcare professionals should do if they are considering bronchial thermoplasty as a treatment option.

NICE will additionally be publishing information for patients and carers, which is written with patient consent in mind. This provides a summary of the guidance published together with a patient-friendly précis of what the procedure involves and the safety and efficacy evidence that NICE looked at.

NICE's interventional procedures programme recently published its 400th piece of guidance. You can access this and information on other procedures from our website.

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