How is radiofrequency energy delivered in bronchial thermoplasty (BT)?

Updated: Mar 30, 2021
  • Author: Said A Chaaban, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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BT (see the video below) can be performed via either a nasal or an oral approach; the nasal approach is rpeferred because patients tend to have less gagging and fewer secretions. Most BT procedures are performed with conscious sedation. The procedure is generally well tolerated, provided that patients are given periprocedural corticosteroids and bronchodilators and receive appropriate sedation.

Bronchial thermoplasty, delivered by the Alair™ Bronchial Thermoplasty System. Courtesy of Boston Scientific.

After the airway has been examined bronchoscopically, the Alair catheter is introduced under direct visualization through the bronchoscope working channel. The single-use catheter of the Alair system fits through a 2-mm working channel of a standard 5-mm fiberoptic bronchoscope. This catheter has an expandable four-electrode basket at its distal tip that has heating and temperature-sensing elements for feedback control.

Bronchial thermoplasty catheter in airway. Bronchial thermoplasty catheter in airway.

Once the catheter is in the site to be treated, the four-electrode array is expanded until the four wires are in firm contact with the airway wall circumferentially. The bronchoscopist initiates the delivery of energy through a footswitch, and the controller delivers energy automatically using an active feedback to maintain the desired treatment temperature of 65°C for 10 seconds.

The left lower lobe and the right lower lobe are treated in separate procedures, and both upper lobes are treated during a third procedure. Each procedure usually requires 50-75 activations of the device to cover the targeted airways, as determined during treatment planning. The sites are treated meticulously and are recorded on a bronchial airway map to ensure that treatment sites are not skipped or overlapped.

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