Name of the Procedure:

Bronchoscopy, Rigid or Flexible, Including Fluoroscopic Guidance, When Performed; with Bronchial Thermoplasty, 2 or More Lobes

Summary

Bronchoscopy is a procedure where a doctor uses a special instrument called a bronchoscope to view the inside of the airways and lungs. The procedure can be performed using either a rigid or flexible bronchoscope. Bronchial thermoplasty is a treatment that uses heat to reduce muscle tissue in the airways to help improve breathing. Fluoroscopic guidance can be used for better visualization during the procedure.

Purpose

This procedure primarily addresses severe asthma that is not well-controlled by standard treatments. The goal is to improve breathing by reducing the airway smooth muscle, thereby decreasing the airways' ability to constrict and cause asthma symptoms.

Indications

• Severe asthma not controlled by regular medication.
• Frequent asthma attacks despite treatment.
• Persistent symptoms such as shortness of breath and wheezing.

Preparation

• Patients may be required to fast for several hours before the procedure.
• Certain medications might need to be paused or adjusted.
• Pre-procedure tests may include pulmonary function tests, chest X-rays, and detailed medical history assessments.

Procedure Description

1. The patient is typically sedated or given general anesthesia.
2. A bronchoscope, either rigid or flexible, is inserted through the mouth or nose and advanced into the airways.
3. Fluoroscopic guidance may be used to enhance visualization.
4. Bronchial thermoplasty involves delivering controlled heat to the airway walls, treating each applicable lobe.
5. The procedure focuses on 2 or more lobes of the lungs.

Duration

The bronchoscopy with bronchial thermoplasty typically takes between 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital setting, often in a specialized unit for bronchoscopy.

Personnel

• Pulmonologist or thoracic surgeon
• Anesthesiologist
• Nurses and respiratory therapists

Risks and Complications

• Common risks: coughing, wheezing, mild discomfort.
• Rare risks: infection, bleeding, airway injury, respiratory distress.
• Severe complications are rare and can be managed with appropriate medical care.

Benefits

• Reduction in asthma symptoms.
• Decrease in the number of asthma attacks.
• Improved quality of life with better breathing.
• Benefits can often be noticed within several weeks after the procedure.

Recovery

• Observation for a few hours post-procedure is typical.
• Patients might experience mild chest discomfort, cough, or shortness of breath temporarily.
• Specific post-procedure care instructions will be provided.
• Typical recovery time is a few days, with follow-up appointments for monitoring.

Alternatives

• Asthma management with medications (inhalers, pills).
• Lifestyle changes and avoidance of asthma triggers.
• Pros and cons: Bronchial thermoplasty could be more effective for severe cases, while medications are less invasive but may not control severe asthma symptoms.

Patient Experience

• During the procedure: Patients are generally sedated or under general anesthesia, so discomfort is minimized.
• After the procedure: Mild discomfort, temporary coughing, or breathing difficulty might be experienced. Pain management and comfort measures will be provided as needed.