NICE consults on first non-drug asthma treatment
A new treatment that heats the airways in the lungs could help reduce the symptoms of severe asthma, if further research supports its long term safety and efficacy, says draft guidance from the National Institute for Health and Care Excellence (NICE).
The procedure, called “bronchial thermoplasty”, could reduce the need for people who have severe asthma to depend on large numbers of medicines and inhalers. It involves inserting a special catheter through their nose or mouth, into the tubes which carry air to the lungs (called bronchi). The catheter delivers radiofrequency heat which destroys part of the muscle lining of the airways; this is the muscle that would contract to cause attacks of asthma and make breathing difficult.
The latest evidence and expert opinion indicate that bronchial thermoplasty can lead to fewer asthma attacks and people having to take fewer medications or days off work due to illness. However people can also experience worsened symptoms in the short term and the evidence is not yet available to indicate whether the procedure improves lung function beyond the trial period or whether there are long term health concerns associated with it.
The draft guidance from NICE has been published today (22 July) for a public consultation. It provisionally advises respiratory doctors considering the procedure to explain the uncertainties and risks to their patients before obtaining their consent, to inform their clinical governance leads (usually the hospital's medical director), and to audit the clinical outcomes so that more can be learnt about it in the longer term.
Professor Bruce Campbell, Chair of the independent committee that develops NICE's Interventional Procedures guidance 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“Our draft guidance highlights the need for experienced respiratory teams to take care in selecting those patients with severe asthma who are most likely benefit from the procedure and to inform them fully about what is involved.
“We welcome comments from patients and their families, from specialists and from any other interested people during this consultation, so that our final guidance can be of the greatest use to patients who have severe asthma and the respiratory teams involved in decisions about their treatment.”
The consultation period will end on Thursday 19 August. NICE then hopes to publish its final guidance in November. The final guidance will outline what NHS healthcare professionals should do if they wish to consider bronchial thermoplasty as a treatment option, based on its safety and efficacy only. Cost is not considered in this type of NICE guidance - NHS bodies decide locally whether it should be funded.
Notes to Editors
About the draft guidance
1. The draft guidance on “Bronchial thermoplasty for severe asthma” is available here.
2. Bronchial thermoplasty is usually performed with the patient under moderate sedation or light anaesthesia. A specially designed catheter is passed through a bronchoscope and introduced into the bronchial tree through either the nose or mouth. An electrode array at the tip of the catheter is expanded to contact the airway wall circumferentially. Short activations of radiofrequency energy are applied to adjacent portions of the wall, moving from distal to proximal. All airways larger than 3mm in diameter are usually treated in three sessions, each one at least three weeks apart. After the first treatment session, previously treated airways are evaluated by bronchoscopy before proceeding with further treatment.
3. NICE's Interventional Procedures guidance applies to NHS healthcare settings in England, Northern Ireland, Scotland and Wales. The guidance makes recommendations on the safety of a procedure and how well it works.
4. Interventional Procedures guidance does not cover whether or not the NHS should fund a procedure. Decisions about funding are taken by local NHS bodies after considering how well the procedure works and whether it represents value for money for the NHS. For further information, read the factsheet.
5. Asthma is a chronic disorder of the airways, characterised by increased responsiveness to various allergic stimuli and airflow obstruction. Symptoms include episodes of wheezing, breathlessness, chest tightness and coughing.
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
3. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.
4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 21 July 2011