Asthma treatment deemed too expensive

For most asthmatics avoiding allergens and using inhaled medications are enough to keep asthma under control. But for the minority with severe, persistent asthma, medication and lifestyle changes are not enough. Frequent hospital trips are almost inevitable and powerful steroids like prednisone, which can cause thinning bones, cataracts, depression and other debilitating side effects become a necessity.

Tim Elder who lives in America had to give up recreational basketball and resort to using a golf cart rather than walking the green because of his worsening asthma condition. The 56-year old also found his physical stamina at work challenged lifting heavy boxes multiple times a day was no longer possible.

“It certainly was a concern that if I didn’t find some way to change the situation, it would get worse over time and really impact the quality of my life,” said Mr Elder, who suffers from a severe form of adult onset asthma.

The promise of change came with a new procedure called bronchial thermoplasty, which works by delivering thermal energy to the airway wall, to reduce airway smooth muscle that typically is enlarged in asthma patients.

During the procedure, a doctor guides a bronchoscope into a patient’s airways. There it heats the lungs to 149 degrees Fahrenheit, cooler than a cup of coffee, but warm enough to shrink the smooth muscle in the airways, which swells during an asthma attack and restricts breathing. After the procedure the airways no longer are so prone to constricting, studies show. Asthma patients suffer fewer attacks and need fewer hospital visits.

In America, for the approximately 15 percent of asthma sufferers for whom the condition is severe, those who find themselves routinely missing work or school and in the emergency room more than once a year, inhalers and allergy medicines often are not enough to control symptoms and prevent flares.
“These are people whose lives are just miserable because they don’t know when the next flare will come or when the next time that they won’t be able to breathe will be,” said Dr. Robert Kruklitis, chief of pulmonary medicine at the Lehigh Valley Health Network in Allentown. He continued, “This gives people much more control over their life. They still take their asthma medications, but now they have asthma that is controlled.”

In America, asthma treatment costs exceed $10 billion a year and over half of that is spent on severe asthmatics, who make up only 10 percent of the asthma population. Doctors say, “Bronchial thermoplasty has given them a new weapon in the battle against severe asthma, and many patients call it life changing. But the procedure is expensive, costing around $20,000, and insurers have been reluctant to cover it. As a result, many people who need it are forced to go without it.”

“For those of us in the field who work with severe asthmatics and see how limited they are, it’s frustrating because we have this new therapy, we’ve seen it work, and the data says it works,” said Dr. Roy St. John, a pulmonary disease specialist at Columbus Pulmonary and Critical Care in Ohio. “But the big insurers have all denied it.”

At the advice of his allergy doctor, Mr Elder mentioned at the outset, recently enrolled in a study of bronchial thermoplasty being offered at Hershey Medical Center. The Medical Center, which is conducting the trial with funding from the maker of the device, is actively recruiting patients with moderate to severe asthma.

Mr Elder said, “It was absolutely painless and I was back to work the next day. I could tell a difference right away I feel like my lung capacity is improved and I can lift more. It’s too early to say that a big weight has been lifted from my shoulders for good, but the signs are positive so far.”

Excitement is somewhat tempered, however, because insurance companies are balking at having to pay for the procedure, which can cost $7,000 to $12,000, depending on the type of anesthesia used. Some patients have to pay significant portions of the cost themselves, which means not everyone who could benefit from it is able to afford it.

But three five year studies have already been completed. Many asthma specialists believe that insurers are taking a shortsighted approach. The one-time cost of $20,000, they say, is dwarfed by the tens of thousands of dollars in hospital bills and medication costs that a severe asthmatic can easily accumulate in a single year.

Dr Feller Kopman said, “Studies are under way to see if bronchial thermoplasty can replace medications in the future. People who breathe well all the time don’t appreciate what this means, I borrow a line from the American Lung Association all the time, when you can’t breathe, nothing else matters.”