Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe

Summary

Bronchoscopy is a medical procedure where a doctor inserts a thin tube (bronchoscope) into the lungs to view the airways. It can be done using a rigid or flexible bronchoscope, often with X-ray guidance (fluoroscopy). This version includes bronchial thermoplasty, a treatment that applies controlled heat to treat asthma in one lobe of the lung.

Purpose

This procedure primarily addresses severe asthma that isn't well-controlled with medication. The expected outcome is a reduction in asthma symptoms and fewer asthma attacks by reducing the amount of smooth muscle in the airways, thus minimizing airway constriction.

Indications

• Severe, persistent asthma not controlled by medication
• Frequent asthma attacks
• Poor quality of life due to asthma symptoms

Preparation

• Fasting: No food or drink for at least 6 hours before the procedure.
• Medications: Adjust intake as instructed by your doctor, especially asthma and blood-thinning medications.
• Pre-procedure tests: These might include lung function tests, blood tests, and a chest X-ray.

Procedure Description

1. Anesthesia: Administered general anesthesia or sedation.
2. Insertion: A bronchoscope is inserted through the mouth or nose.
3. Guidance: Fluoroscopy may be used to help visualize the airways.
4. Bronchial Thermoplasty: A catheter delivers controlled thermal energy to the airway walls of one lobe to reduce smooth muscle mass.
5. Completion: The bronchoscope and other equipment are removed.

Duration

The procedure typically takes about 1-2 hours.

Setting

Performed in a hospital or outpatient surgical center.

Personnel

The procedure involves a pulmonologist (lung specialist), anesthesiologist, nurses, and potentially radiology technicians.

Risks and Complications

Common risks:

• Sore throat
• Coughing
• Mild bleeding

Rare complications:

• Infection
• Pneumothorax (collapsed lung)
• Severe bleeding
• Adverse reactions to anesthesia

Benefits

• Reduction in asthma symptoms
• Fewer asthma attacks
• Improved quality of life Benefits may be noticed within weeks to months after the procedure.

Recovery

• Observation period post-procedure for a few hours.
• Rest and avoid strenuous activities for a couple of days.
• Follow-up appointments to monitor lung function and recovery.

Alternatives

• Continued medical management (inhalers, oral medications)
• Subcutaneous or intravenous biologic therapies
• Lifestyle modifications and environmental control Each alternative varies in effectiveness and potential side effects compared to bronchial thermoplasty.

Patient Experience

During the procedure, the patient is typically under sedation or general anesthesia, so they should not feel any pain. Post-procedure, they may experience temporary sore throat, coughing, and mild chest discomfort, which can be managed with over-the-counter pain relievers and rest.