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Severe asthma sufferers get new treatment

A revolutionary new treatment is halving hospitalisation rates for severe asthma sufferers.

Last updated: 26 Jul 2014 08:58
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London, UK - "I was just sitting talking to my husband, laughing and the next thing, I could feel my chest getting tighter and tighter. I felt like I was suffocating … I ended up in intensive care and woke up five days later. That's when I was like: 'This is serious. I could die from this.'"

Amanda Daubney, a mother of two living in Surrey, suffers from severe asthma. It's not the type of asthma that can be controlled with a couple of puffs of a regular inhaler. She suffers from a major asthma attack every other day and is hospitalised every other month. However, a revolutionary procedure called bronchial thermoplasty, now being introduced across Europe, the Middle East, and Asia, is dramatically changing the lives of severe asthma sufferers for the better.

At the end of the day, I'd swim through mud if it meant you were going to get a little better.

- Amanda Daubney, a mother of two who suffers from severe asthma

Asthma is a chronic condition which affects 235 million people worldwide. Although urbanisation has been linked to asthma, the WHO states that this relationship remains unclear and asthma occurs in all countries regardless of development. The causes of asthma are still not completely understood and while it can be controlled with medication, it remains incurable.

Daubney suffered her first asthma attack as a teenager in Australia and the condition steadily worsened, leading to her retirement on medical grounds at the age of 45.

"I've had to give up work because of my asthma, we've moved further out of London because of my asthma. I can't plan things like holidays or even meeting up with friends because today I'm fine but tomorrow I could be different… Everything revolves around my asthma. It's always there."

During an asthma attack, the lining of the air passages of the lungs swell, causing the airways to narrow, making it hard to breathe. For Daubney, this inflammation of the bronchial tubes can be triggered by a range of environmental allergens such as pollen, dust and pet dander. Currently, Daubney's treatment consists of 50ml of steroids and around 40 tablets.

"Shake me and I rattle," Daubney jokes. Her steroid dependency, however, has come with devastating consequences - depression, pain, as well as significant weight gain for which she's had a gastric band fitted. "There have been times when I've thought my family's lives would be better without me because I'm such a burden to them. They say I'm not but that's not how I felt … but I guess that was the depression through the steroids."

Bronchial thermoplasty

Despite the side effects of steroids, for many severe asthma sufferers it's their only option. A new treatment called bronchial thermoplasty, however, is changing that. Performed in three stages, the procedure consists of inserting a special catheter into the airways of the lungs and applying heat at 65C to destroy the smooth muscle in the airway wall. The smooth muscle in the airways of asthma sufferers is usually thicker and so when it contracts, it significantly restricts the airway. This procedure destroys this excess muscle and so helps people's airways stay open during an asthma attack.

Al Jazeera joined Daubney the day before her procedure at London's Royal Brompton Hospital and although she was visibly nervous, she was determined to have the procedure.

Amanda Daubney went through revolutionary asthma treatment [The Cure/Al Jazeera]

"At the end of the day, I'd swim through mud if it meant you were going to get a little better," she said. "I don't want this to be my life … going to hospital, going home recovering and coming back to hospital. I want to be able to go back to swimming - to be reliable enough to take care of my grandson every once in a while."

According to the latest clinical data collected over the past five years, this new procedure can almost halve the number of severe asthma attacks and cut the average number of emergency hospitalisations in treated patients by over 80 percent. Globally, there are now more than 350 centres offering the procedure - mostly in North America - with over 25 centres based in Europe. Since 2010, when the technology first became commercially available, 2,500 patients worldwide have undergone bronchial thermoplasty to deal with their asthma.

"Anything we can do to reduce the steroids is important," said Dr Pallav Shah, a consultant physician in respiratory medicine at Royal Brompton Hospital who will perform the procedure. Shah hopes the bronchial thermoplasty will allow Daubney to cut her steroid use by half. As Daubney already takes a high dose of steroids, it's difficult for her to control an asthma attack at home by upping her steroids. So if the procedure helps cut her steroids, she could better control her asthma and avoid unscheduled hospital visits.

In total, the procedure takes around 45 minutes and consists of 104 applications of energy to help destroy the airway smooth muscle. As Daubney was only sedated during the treatment, it was extremely unpleasant and uncomfortable and her airways would need time to heal before she will see any results.

Major asthma attacks reduced

Al Jazeera caught up with Daubney four months after the procedure, and she was happy to report that things are looking up. She's managed to cut steroids from 50mg down to just 15mg - the lowest it's been in years. And from an asthma attack every other day, she's only experienced two minor attacks since the procedure. She does wheeze a little more but she said that it's just her body adjusting and she's happy that it's nothing to worry about.

One unwelcome outcome of reducing her steroids that still hasn't been resolved is pain in her legs and hips. Initial assessments suggested it may be a side effect of long-term steroid use that she has only begun to feel now that her dose has been lowered - however nothing has been confirmed.

While bronchial thermoplasty doesn't replace steroids and is not a neat solution for all, it can be life-changing for people with severe asthma. For Daubney, the new found ability to plan and commit to outings and spend time with her grandson is liberating.

"Unfortunately I haven't been swimming yet but that is not asthma-related and I just need to get myself organised to do it," she said. "I have, however, taken my grandson for a couple of swimming lessons which we both love."

Follow Arwa Aburawa on Twitter: @arwa_journalist

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Al Jazeera
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