May 27, 2018
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Thermplasty helps ease a lifetime of illness

By By Judith Meyer, The Sun Journal

LEWISTON, Maine — Anne Marie Mahar — who is living with severe, persistent asthma — next month is scheduled to undergo bronchial thermoplasty, an innovative new outpatient procedure to heat her airways, improving air flow and preventing bronchial spasms.

She will be the second patient in Maine to undergo this specialized treatment.

Mahar anticipates the procedure will increase her ability to breathe, reduce her prescription drug costs and — she hopes — eliminate future asthma attacks.

“It’s a gift,” she said, to believe that she can be free of frightening bronchial spasms.

As a child living in Canada, Mahar remembers struggling with allergies. She would wake up wheezing and couldn’t exercise like other children.

“As my breathing worsened,” she remembers, “it would hold me back.”

Now an adult working as a quality and infection control specialist at Rumford Hospital, Mahar was diagnosed with asthma when she was 21 years old and couldn’t recover from a cold.

“It was rough,” she remembers, until doctors diagnosed the asthma and worked for months to craft a prescription drug combination to ease her breathing.

Shortly after that, Mahar became a registered nurse and started work in the emergency department at a Toronto hospital. There, she watched a male patient die from an asthma attack.

His dying distress has stayed with her as an adult, and she thought about that man years later as she lay near death herself, hooked to a respirator in the ICU at Rumford.

It was the only time, Mahar said, when she really thought asthma would kill her.

There were times when Mahar couldn’t climb a flight of stairs. Her breathing was so taxed she couldn’t work full time and sought treatment in the emergency room as many as nine times a year. And during two pregnancies she struggled for every breath, was forced to sleep sitting upright in a chair and suffered regular acid reflux.

“For me,” Mahar said, “pregnancy was not a state of well-being. It was a state of ill health.”

She estimates that she’s been hospitalized dozens of times, as often as four times a year, when her asthma was out of control. The hospitalizations happened most often in spring and fall, when Mahar’s allergies are most affected, and she eventually moved from her home in Andover to Rumford where she could be closer to the hospital in case of emergency.

In that new house, Mahar made sure the heating system was forced hot air, she had the carpets removed and became a self-described “germaphobe” to protect herself from allergens and dust.

About five years ago, Mahar — now 53 — started taking injections of Xolair, a prescription to treat moderate and severe asthma caused by allergens in the air.

“It felt like a miracle to me,” she said. “I know it’s medicine, but that’s what I feel.”

She was able to walk the distance across the parking lot from her car to her office without wheezing, and had fewer asthma crises.

That was also the last time she was hospitalized.

Mahar now walks 2 miles a day to maintain lung health, regularly checks her respiration strength with a peak flow meter and takes Allegra, Singulair, Advair and several inhaler and nasal medications every day to control her symptoms.

She’s conscious that the years of prednisone and inhaled steroid use has diminished her bone density, and is treated for osteoporosis.

Her asthma is severe, but she works hard to take care of herself, she said, which makes her a prime candidate for the bronchial thermoplasty procedure, which will be done in three stages on an outpatient basis at Central Maine Medical Center.

The procedure was approved by the Federal Drug Administration for use in the United States last year and is widely used to treat asthmatics in Europe and Canada, but is not covered by some U.S. insurance companies that consider the treatment experimental.

Mahar’s pulmonologist, Dr. Neil Duval, managing physician at Central Maine Pulmonary and Sleep Medicine in Lewiston, explained that the thermoplasty procedure heats the inside of a patient’s airways, damaging smooth soft tissue and preventing further bronchial spasms by decreasing the airways’ ability to constrict.

Patients are medicated but conscious during the bronchoscopic procedure.

Dr. Stephen Gorman of Chest Medicine Associates in Portland performed the first bronchial thermoplasty in Maine last February.

That patient, he said, was treated at Maine Medical Center and “has definitely experienced improvement in terms of the short-term.”

Gorman is specially trained to perform thermoplasty, and said research data “shows some improvement over the course of time, in particular for severe asthma in reducing asthma flairs, improving quality of life and reducing the amount of (emergency) inhaler therapy.”

The procedure is used only on severe asthmatics who must meet fairly specific treatment criteria, Gorman said, including being a nonsmoker and having a certain level of lung function. Patients still need to continue taking controller prescription drugs post-treatment, but life-threatening asthma attacks are greatly reduced or eliminated.

Duval said that he hopes, in time, the procedure can be used to treat people with moderate asthma to ease bronchospasms.

Dr. Charles Irvin, director of the Vermont Lung Center at the University of Vermont, a research center associated with the American Lung Association, is not convinced of thermoplasty’s promise.

On behalf of the American Thoracic Society, Irvin penned a recent New England Journal of Medicine editorial cautious of the procedure, and said that although thermoplasty may improve symptoms, it doesn’t improve asthma. He worries about the long-term effects of the procedure and said the clinical evidence is not strong enough to convince physicians at Fletcher Allen in Burlington to do this work.

In May, Boston Scientific Corp. announced results of the third in a series of Research in Severe Asthma trials that demonstrated stable lung function in thermoplasty patients over a five-year period, lending scientific confidence to the procedure.

A number of other studies, including an Asthma Intervention Research trial demonstrating the safety of thermoplasty, have been published in recent years. The results of the most recent and supportive AIR trial appears in the April issue of Annals of Allergy Asthma & Immunology.

Mahar has faith in her physician and is convinced the procedure is right for her, and she’s eager for the treatment. She said she’ll be able to stop taking Xolair once the procedure is done, saving the $1,000 monthly cost of that injection.

“I feel like I was born at the right time,” Mahar said, to have had access to Xolair and now having access to thermoplasty. “The right medicines are here now to help me,” she said.

“When I was a kid, no one knew why” she couldn’t breathe like everyone else, Mahar said, but she hopes that improved education and treatments developed during her lifetime will help others who are struggling to breathe.

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