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Increase monitoring for severe asthma treatment, says NICE
London, UK (January 24, 2012) – Doctors who are considering offering a treatment for severe asthma, which involves heating the tissue of the lung airways, should take special care when deciding who to offer the procedure to and ensure that patients are fully informed about what is involved. This is because the National Institute for Health and Clinical Excellence (NICE) has said that further research is still needed to show that the procedure is safe and clinically effective in the long term.
The procedure, called "bronchial thermoplasty", is the first non-drug treatment for severe asthma. It could help some people manage their asthma better by potentially reducing the need to use as many medicines and inhalers, and reducing hospital admissions.
During the procedure, a special catheter is inserted through the patient’s nose or mouth and passed into the tubes which carry air to the lungs (called bronchi). The catheter then delivers radiofrequency heat which destroys part of the muscle lining of the airways; this is the muscle that would contract and narrow the airways during asthma attacks, making breathing difficult.
The latest evidence and expert opinion report that bronchial thermoplasty can lead to fewer asthma attacks and people having to take fewer medications or days off work due to illness. However, some people who have had the procedure can also experience worsened symptoms in the short term. Also, evidence is not yet available to indicate whether the procedure reduces the severity and frequency of asthma attacks in the long term or whether it might cause any long term damage to the lungs.
For these reasons, today (25 January) NICE has published final guidance for the NHS, which advises experienced respiratory teams considering the procedure for people with severe asthma to:
take special care to explain the uncertainties and risks to their patients before obtaining their consent,
inform their clinical governance leads (usually the hospital’s medical director), and
audit the clinical outcomes so that more can be learnt about it in the longer term
Professor Bruce Campbell, Chair of the independent committee that develops NICE’s Interventional Procedures guidance said: "The evidence suggests that bronchial thermoplasty can offer significant improvements in quality of life by making breathing easier and reducing the need for medicines and inhalers. However, more evidence is needed about its benefits in the long term. Thermoplasty may cause symptoms to worsen to start with, which can be serious for people with severe asthma.
"Our guidance highlights the need for experienced respiratory teams to take care in selecting those patients with severe asthma who are most likely to benefit from the procedure and to inform them fully about what is involved."
NICE’s guidance outlines what NHS healthcare professionals should do if they wish to consider bronchial thermoplasty as a treatment option, based on its safety and efficacy only. Cost is not considered in this type of guidance – decisions on whether to offer the procedure are still made locally by NHS bodies.
About the draft guidance
1. The interventional procedures guidance on Bronchial thermoplasty for severe asthma will be available from Wednesday 25 January 2012 at: www.nice.or.g.uk/IPG419
2. Bronchial thermoplasty is usually performed with the patient under moderate sedation or light anaesthesia. A specially designed catheter is passed through a bronchoscope and introduced into the bronchial tree through either the nose or mouth. An electrode array at the tip of the catheter is expanded to contact the airway wall circumferentially. Short activations of radiofrequency energy are applied to adjacent portions of the wall, moving from distal to proximal. All airways larger than 3mm in diameter are usually treated in three sessions, each one at least three weeks apart. After the first treatment session, previously treated airways are evaluated by bronchoscopy before proceeding with further treatment.
3. NICE’s Interventional Procedures guidance applies to NHS healthcare settings in England, Northern Ireland, Scotland and Wales. The guidance makes recommendations on the safety of a procedure and how well it works.
4. Interventional Procedures guidance does not cover whether or not the NHS should fund a procedure. Decisions about funding are taken by local NHS bodies after considering how well the procedure works and whether it represents value for money for the NHS. For further information, please read the factsheet.
5. Asthma is a chronic disorder of the airways, characterised by increased responsiveness to various allergic stimuli and airflow obstruction. Symptoms include episodes of wheezing, breathlessness, chest tightness and coughing.
1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health
2. NICE produces guidance in three areas of health:
public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies – guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
3. NICE produces standards for patient care:
quality standards – these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
Quality and Outcomes Framework – NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
National Institute for Health and Clinical Excellence (NICE), 24.01.2012 (tB).