Imagine a map of the inside of your lungs similar to a map of Wise County’s network of roads – from major highways down to state highways, farm roads, two-lane county roads and finally, narrow driveways.
Pulmonologist Dr. Syed Rizvi wants to widen those roads – to improve not traffic, but airflow.
Dr. Rizvi, who came to Wise Regional in May 2011, has a new tool in his toolbox to help asthma victims. He is in the midst of performing the first bronchial thermoplasty (BT) at Wise Regional Health System in Decatur.
BT was designed as a non-drug method to treat severe, persistent asthma. Working through a bronchoscope – a thin, tube-like instrument inserted into the patient’s lungs via the mouth – the physician uses a catheter armed with an electrode to deliver radio frequency energy to the airway wall in a precisely controlled manner.
The purpose is to reduce the mass of the muscles that constrict breathing during an asthma attack.
Last Friday morning, in about 30 minutes, he did the second of three procedures needed to complete a full treatment on the patient, Michael McCoy.
McCoy has suffered from asthma since birth, controlling it with medication and doing his best to “not let it get in my way.” The 66-year-old Rhome resident retired from GTE after 30 years and then worked 15 years in loan processing for mortgage bankers.
He was in the Decatur hospital for some routine lab work a few months ago when he saw a poster about the BT treatment.
“I came home and looked it up on the Internet, and knew immediately that it was something I wanted to pursue,” McCoy said Tuesday.
McCoy had the first of three outpatient procedures done Oct. 18, targeting the airways in the lower lobe of his right lung. Friday’s procedure was in the lower left lobe, and on Dec. 6 the final session will target airways in the upper lobes of both lungs.
Recovery time from the first procedure was minimal.
“I can’t say that I’ve felt any further improvement,” he said Tuesday. “I felt real good within a few days of that first one, and I feel real good now. I certainly haven’t backed up at all.”
He said he probably won’t get the full benefit of the procedures until six months after the last one.
“I’m cautiously optimistic,” he said. “I don’t perceive this to be any kind of a cure, but I’m hoping it will improve the quality of life for a few extra years.”
WATCHING ON THE BIG SCREEN
McCoy was wheeled into surgery Friday morning about 10 minutes before the outpatient procedure began. There’s no incision, but everyone was gowned and masked.
When Dr. Rizvi came in, he consulted with nurse Carleen Fessenden, R.N., who spent most of her time plotting the procedure on a map of the lungs. With the lights down and everyone watching live, high-definition video from inside McCoy’s lungs on the OR’s big-screen television, she captured still photos at numerous intervals.
Dr. Rizvi spent a half-hour positioning the instrument, then quietly saying, “Open…” to the technician operating it, then “Close…” when the impulse had been delivered.
“Open” means the technician presses a button and the electrode array – which looks like a tiny cage – is expanded to touch all the walls of the airway. The physician then activates it with a foot pedal, and the 10-second countdown begins, punctuated by beeps at two-second intervals and a longer tone when it’s done.
The radio frequency energy that is delivered is about 148 degrees – there is no burning or smoke, just “thermal energy.” The procedure leaves a faint striping on the airway walls – but it also leaves them somewhat permanently expanded.
The catheter is then collapsed and pulled back to treat another segment of the airway. Dr. Rizvi said he likes to go into the smallest area he can still see, then pull back and treat on his way out.
Friday’s procedure consisted of about 50 of those 10-second thermal deliveries.
“People who have asthma, when they are exposed to any kind of allergen or other respiratory factor, the muscle contracts and makes the breathing tube narrow,” Dr. Rizvi said after the procedure was over. “That makes breathing more difficult. By treating the muscle, you are preventing the constriction of the bronchial tube.”
BT has shown the ability to reduce the size of that muscle, helping reduce the frequency and severity of asthma attacks.
A PROBLEM THAT’S WORSE HERE
More than 24 million Americans suffer from asthma – and 10 percent of those are diagnosed with severe persistent asthma, which cannot be fully controlled even with the use of inhalers and other medications.
With the asthma comes coughing, wheezing and shortness of breath along with chest tightness. These patients’ quality of life is severely affected by their asthma – and with all the pollen and the severe swings in the weather in this part of Texas, Dr. Rizvi said he sees a lot of asthma sufferers here.
“When people are exposed to any kind of precipitant – cold weather, smoke particles, perfume or any common allergens in the environment like pollen, dust or grass – it produces a chemical reaction which causes the bronchial walls to constrict,” he said.
Asthma accounts for 13.9 million unscheduled doctors’ office visits, 1.8 million emergency room visits and half-a-million hospitalizations every year. In the U.S., there are approximately 3,400 asthma-related deaths every year – nine every day.
Dr. Rizvi believes BT can reduce those numbers and improve the quality of life for asthma sufferers.
“It’s a very safe procedure,” he said. “We have almost five years, and there has been no significant complication like a lung collapse, puncture of the bronchial tube or bleeding. It’s a very clean and safe procedure.”
He noted that McCoy had to go through a rigorous screening process to make sure he was a good candidate for the procedure.
“It’s not for everybody,” he said. “There are certain criteria. We have to make sure we are doing it on the right patient.”
Still, he believes there are many more people in this area who are candidates for BT.
“We are looking forward to treating more and more patients who have severe asthma,” Dr. Rizvi said.