Bronchial Thermoplasty
DESCRIPTION
Bronchial thermoplasty is a new asthma therapy that involves the controlled delivery of radiofrequency energy to heat tissues in the distal airways. Bronchial thermoplasty is based on the premise that individuals with asthma have a proliferation of smooth muscle in the airway and that spasmodic contraction of this smooth muscle is a major cause of airway constriction. The thermal energy delivered via bronchial thermoplasty aims to reduce the amount of smooth muscle and thereby decrease muscle mediated bronchoconstriction with the ultimate goal of reducing asthma-related morbidity. Bronchial thermoplasty is intended as a supplemental treatment for patients with severe persistent asthma.
Bronchial thermoplasty procedures are preformed on an outpatient basis and last approximately one hour each. During the procedure, a standard flexible bronchoscope is placed through the patient’s mouth or nose into the most distally targeted airway and a catheter is inserted into the working channel of the bronchoscope. Controlled thermal energy is delivered through the catheter to heat airway muscle tissue. The positioning of the catheter and application of thermal energy is repeated several times in contiguous areas along the accessible length of the airway. At the end of the treatment session, the catheter and bronchoscope are removed. A course of treatment consists of multiple (usually 3) separate procedures in different regions of the lung scheduled about 3 weeks apart.
POLICY
Bronchial thermoplasty for the treatment of asthma is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Published scientific evidence in peer-reviewed journals regarding the utilization of bronchial thermoplasty for the treatment of asthma is scant. There is insufficient evidence to permit conclusions regarding the use of bronchial thermoplasty and its’ effects on health outcomes. Bronchial Thermoplasty is associated with short term increases in asthma-related morbidity. Long term safety and efficacy studies are currently ongoing.
SOURCES
Australian Government, Department of Health. Australia and New Zealand Horizon Scanning Network. (August 2007). Bronchial thermoplasty for asthma. Retrieved August 22, 2010 from http://www.health.gov.au/internet/horizon/publishing.nsf/Content/EB9D6E423A452B99CA2575AD0080F352/$File/PS%20-%20Bronchial%20Thermoplasty.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2010) Bronchial thermoplasty (7.01.127). Retrieved August 19, 2010 from BlueWeb. (8 articles and/or guidelines reviewed)
Cox, G., Miller, J., McWilliams, A., FitzGerald, J., & Lam, S. (2006). Bronchial thermoplasty for asthma. American Journal of Respiratory and Critical Care Medicine, 173 (9), 965-969. (Level 4 Evidence – Industry sponsored)
National Institute for Health and Clinical Excellence. (2007). Bronchial thermoplasty for asthma (Alair catheter). Retrieved July 29, 2010 from http://guidance.nice.org.uk/IP/675.
Pavord, I., Cox, G., Thomson, N., Rubin, A., Corris, P., Niven, R., et al. (2007). Safety and efficacy oh bronchial thermoplasty in symptomatic, severe asthma. American Journal of Respiratory and Critical Care Medicine, 176 (12), 1185-1191. (Level 2 Evidence – Industry sponsored)
U. S. Food and Drug Administration. (2010 April). Center for Devices and Radiological Health. Pre market approval decisions for April 2010. Retrieved July 30, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf8/P080032c.pdf.
ORIGINAL EFFECTIVE DATE: 2/13/2011
MOST RECENT REVIEW DATE: 2/13/2011
ID_BA
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