Doctors at Bryan Medical Center are the first in Nebraska to perform an innovative new procedure for severe asthma patients called bronchial thermoplasty (BT). It is an outpatient procedure for adults whose asthma is not controlled with medications.
In this segment, Dr. John Trapp, pulmonologist with Nebraska Pulmonary Specialties and Dr. Vinay Mehta, allergist-immunologist with Allergy, Asthma and Immunology Associates, discuss how Bryan Medical Center offers innovative severe asthma treatment with proven results that include fewer visits to the ED and fewer asthma attacks so that you can start enjoying life.
Selected Podcast
How to Manage Your Severe Asthma
Featured Speaker:
Learn more about Vinay Mehta, MD
John Trapp, MD is a pulmonologist with Nebraska Pulmonary Specialties.
Learn more about John Trapp, MD
Vinay Mehta, MD & John Trapp, MD
Vinay Mehta, MD is an allergist-immunologist with Allergy, Asthma & Immunology Associates.Learn more about Vinay Mehta, MD
John Trapp, MD is a pulmonologist with Nebraska Pulmonary Specialties.
Learn more about John Trapp, MD
Transcription:
How to Manage Your Severe Asthma
Melanie Cole (Host): According to the CDC, approximately 25 million people are living with asthma and the numbers are increasing every year. Doctors at Bryan Medical Center are the first in Nebraska to perform an innovative new procedure for severe asthma patients called bronchial thermoplasty. My guests today are Dr. John Trapp. He is a pulmonologist with Nebraska Pulmonary Specialties and Dr. Vinay Mehta. He is an allergist, immunologist with Allergy, Asthma and Immunology Associates. Welcome to the show gentlemen. So, Dr. Trapp, I will start with you. What is asthma and how prevalent is it?
Dr. John Trapp, MD (Guest): Well, thank you Melanie. You know asthma is a very common condition that as you have mentioned, effects a large number of people. It is primarily an inflammatory disorder of the airway that results in symptoms such as shortness of breath, chest tightness, wheezing, cough and exacerbations. Asthma can range anywhere from very mild symptomatology from exercise related to daily symptoms and we are really focused now on trying to achieve better control of those patients with very severe asthma.
Melanie: Dr. Mehta, how is asthma diagnosed?
Vinay Mehta, MD (Guest): Well, to properly diagnose asthma, you need to have symptoms consistent with asthma and you also need to demonstrate reversible airflow obstruction on breathing tests called spirometry. Getting a spirometry is especially important because there are many mimickers of asthma such as chronic obstructive pulmonary disease, vocal cord dysfunction, acid reflux, and heart problems. Also, as an allergist, I like to skin test my patients to determine if they have allergies since asthma can often be allergy driven and therefore treating one’s allergies; can actually improve one’s asthma control.
Melanie: So, Dr. Mehta, I am sticking with you for a minute. Why is asthma difficult to control for some people?
Dr. Mehta: Well maintaining good asthma control can be challenging for those with severe asthma; which is roughly about 10% of all asthmatics. Most of them suffer from a type of asthma called eosinophilic asthma. These patients have a large number of eosinophils present in their blood and in lung tissue. Many of them also have chronic sinusitis which further contributes to the inflammation in the lungs and in such cases; inhaled corticosteroids alone are simply not enough to completely get rid of the inflammation. Now, poor asthma control not only adversely affects the person’s quality of life; it also increases the risk of a severe asthma attack. In fact, each year, poorly controlled asthma is directly responsible for approximately 10.6 million office visits, about 1.8 emergency room visits, 440,000 hospitalizations and 3600 deaths. So, clearly, we in the medical community, need to do better.
Melanie: Wow. And so, Dr. Trapp, what are some of the challenges that you face in treating patients with severe asthma?
Dr. Trapp: Well, in a lot of patients, it is recognizing these patients because frequently they don’t have access to health resources or they may end up in the emergency room and not get the care they need. A lot of physicians have been taught that inhaled corticosteroids are one of the only therapies for asthma and recently, we have had additional therapeutic options for patients who have more persistent symptoms. So, really, it is about making the right diagnosis, excluding other diagnoses that may mimic asthma and then getting them the right treatment which may require a comprehensive approach.
Melanie: Dr. Mehta, tell us more about Bryan Health’s Severe Asthma Clinic?
Dr. Mehta: Yeah, so this is a severe asthma clinic. It is a multidisciplinary clinic designed to help evaluate and manage patients whose asthma is poorly controlled. The team consists of myself an allergist, Dr. John Trapp a pulmonologist and Dr. Chris Cederberg an ENT specialist. We also have a nurse navigator Mary Kunambi. And so, patients with severe asthma, as I mentioned, often have underlying conditions such as allergies, sinus problems, acid reflux, sleep apnea, some even have a condition called aspirin sensitivity and so having a multidisciplinary team of specialists to address each of these conditions is extremely valuable and also cost effective. So, our first goal is really, is to confirm the diagnosis of asthma, make sure that this is truly asthma. Second, identifying and manage asthma triggers. Third optimize asthma medications. Fourth teach and optimize asthma self-management skills and fifth provide access to specialized therapies when conventional asthma medications alone are not enough. And in addition, our nurse navigator, will help keep track of patients whose asthma is poorly controlled. She will do this by telephone and really inform us whenever there is a problem. We want to do our absolute best to improve people’s quality of life and keep them out of urgent care, keep them out of the emergency room.
Melanie: So, Dr. Mehta, what are some of those specialized asthma therapies you just mentioned that the Severe Asthma Clinic can offer?
Dr. Mehta: Sure, well there are currently three injectable drugs on the market specifically designed for treating severe eosinophilic asthma. Xolair, Nucala and Cinqair. These medications greatly reduce the eosinophilic airway inflammation which in turn helps improve both asthma symptoms and lung function. They are also very effective in reducing the risk of an asthma attack which will often enable patients to reduce their need for steroid medications. I personally know of many patients who have experienced a night and day improvement in their quality of life since starting these therapies. Now, in addition, for patients with aspirin sensitive asthma; we can offer aspirin desensitization. We start out by giving them a very low dose of aspirin then gradually increase the dose until they can tolerate dose up to 650 mg. It turns out taking a high dose of aspirin on a daily basis for certain patients, can actually improve asthma control as well as help prevent nasal polyps and then finally, there is a relatively new procedure called bronchial thermoplasty that targets excessive airway smooth muscle and for that, I want to turn it over to Dr. Trapp to discuss this further.
Dr. Trapp: So, yeah so bronchial thermoplasty is a procedure that we have been doing in Lincoln, Nebraska for a number of years and offering this to our more severe asthmatic patients. It is really a technique where we use a bronchoscope and we go through the airways using sedation, and we apply a thermal energy using a specialized probe to those distal airways that have smooth muscle. Now the role of smooth muscle in asthma is that this is the area of the lung where the smooth muscle contracts and typically causes those symptoms of chest tightness and shortness of breath and wheezing and by using thermal energy; we can reduce the size and the strength of those muscles so that patients have reduced symptoms. This had had a major impact on those patients that have already undergone this procedure. It can reduce hospitalizations; emergency room visits as well as improve quality of life. Now what is important to stress, is that bronchial thermoplasty alone does not manage all asthma patients; but it is really an ancillary tool that we can use to help improve asthma management in addition to anti-inflammatory therapy for asthma.
Melanie: Dr. Mehta, who would be an appropriate patient for the Severe Asthma Clinic?
Dr. Mehta: So, any adult aged 18 years and older, diagnosed with asthma, whose symptoms are not well-controlled would be a good candidate. So, this includes anyone who experiences daily asthma symptoms in spite of taking asthma medications, anyone who has experienced two more asthma attacks requiring steroids in the preceding year, or anyone who has had an asthma related emergency room visit or hospitalization. So, any of these patients are certainly welcome to be evaluated at the Severe Asthma Clinic.
Melanie: So. Dr. Mehta, I’d like to start with you as a summary to wrap up. What would you like to tell the listeners about asthma and the Severe Asthma Clinic at Bryan Health?
Dr. Mehta: Yes, so, again, this is a resource that we are offering our community where patients will have the opportunity to see a multidisciplinary team consisting of an allergist, a pulmonologist, ENT specialist and a nurse navigator to really comprehensively and holistically evaluate, number one to confirm if they have asthma and secondly to evaluate some of the triggers of their asthma, identify what type of asthma they have and then select appropriate therapies. Again, this is a tool that we have, that we are offering and it is open to adults 18 and older whose asthma is poorly controlled.
Melanie: And Dr. Trapp, last word to you. Best advice for those suffering from asthma, you are a pulmonologist; what do you tell people every day about living with and managing their asthma?
Dr. Trapp: Well, asthma is a very common disorder and we have really good therapy for asthma. People oftentimes underestimate the severity of their asthma or they just simply live with daily symptoms of asthma and that may limit their lifestyle, their exercise tolerance and their overall wellbeing. They need to recognize that those symptoms can be managed more effectively and the hope is that through a clinic like this, that is comprehensive and multidisciplinary in approach; we can really review their asthma management and make recommendations that can improve their quality of life and potentially save their life.
Melanie: Thank you gentlemen, so much for being with us today. For further questions or to schedule an evaluation at the Severe Asthma Clinic; please call 402-481-8901. That’s 402-481-8901. For additional information on the Severe Asthma Clinic at Bryan Medical Center; you can visit www.bryanhealth.org . That’s www.bryanhealth.org . This is Bryan Health Radio. I’m Melanie Cole. Thanks so much for listening.
How to Manage Your Severe Asthma
Melanie Cole (Host): According to the CDC, approximately 25 million people are living with asthma and the numbers are increasing every year. Doctors at Bryan Medical Center are the first in Nebraska to perform an innovative new procedure for severe asthma patients called bronchial thermoplasty. My guests today are Dr. John Trapp. He is a pulmonologist with Nebraska Pulmonary Specialties and Dr. Vinay Mehta. He is an allergist, immunologist with Allergy, Asthma and Immunology Associates. Welcome to the show gentlemen. So, Dr. Trapp, I will start with you. What is asthma and how prevalent is it?
Dr. John Trapp, MD (Guest): Well, thank you Melanie. You know asthma is a very common condition that as you have mentioned, effects a large number of people. It is primarily an inflammatory disorder of the airway that results in symptoms such as shortness of breath, chest tightness, wheezing, cough and exacerbations. Asthma can range anywhere from very mild symptomatology from exercise related to daily symptoms and we are really focused now on trying to achieve better control of those patients with very severe asthma.
Melanie: Dr. Mehta, how is asthma diagnosed?
Vinay Mehta, MD (Guest): Well, to properly diagnose asthma, you need to have symptoms consistent with asthma and you also need to demonstrate reversible airflow obstruction on breathing tests called spirometry. Getting a spirometry is especially important because there are many mimickers of asthma such as chronic obstructive pulmonary disease, vocal cord dysfunction, acid reflux, and heart problems. Also, as an allergist, I like to skin test my patients to determine if they have allergies since asthma can often be allergy driven and therefore treating one’s allergies; can actually improve one’s asthma control.
Melanie: So, Dr. Mehta, I am sticking with you for a minute. Why is asthma difficult to control for some people?
Dr. Mehta: Well maintaining good asthma control can be challenging for those with severe asthma; which is roughly about 10% of all asthmatics. Most of them suffer from a type of asthma called eosinophilic asthma. These patients have a large number of eosinophils present in their blood and in lung tissue. Many of them also have chronic sinusitis which further contributes to the inflammation in the lungs and in such cases; inhaled corticosteroids alone are simply not enough to completely get rid of the inflammation. Now, poor asthma control not only adversely affects the person’s quality of life; it also increases the risk of a severe asthma attack. In fact, each year, poorly controlled asthma is directly responsible for approximately 10.6 million office visits, about 1.8 emergency room visits, 440,000 hospitalizations and 3600 deaths. So, clearly, we in the medical community, need to do better.
Melanie: Wow. And so, Dr. Trapp, what are some of the challenges that you face in treating patients with severe asthma?
Dr. Trapp: Well, in a lot of patients, it is recognizing these patients because frequently they don’t have access to health resources or they may end up in the emergency room and not get the care they need. A lot of physicians have been taught that inhaled corticosteroids are one of the only therapies for asthma and recently, we have had additional therapeutic options for patients who have more persistent symptoms. So, really, it is about making the right diagnosis, excluding other diagnoses that may mimic asthma and then getting them the right treatment which may require a comprehensive approach.
Melanie: Dr. Mehta, tell us more about Bryan Health’s Severe Asthma Clinic?
Dr. Mehta: Yeah, so this is a severe asthma clinic. It is a multidisciplinary clinic designed to help evaluate and manage patients whose asthma is poorly controlled. The team consists of myself an allergist, Dr. John Trapp a pulmonologist and Dr. Chris Cederberg an ENT specialist. We also have a nurse navigator Mary Kunambi. And so, patients with severe asthma, as I mentioned, often have underlying conditions such as allergies, sinus problems, acid reflux, sleep apnea, some even have a condition called aspirin sensitivity and so having a multidisciplinary team of specialists to address each of these conditions is extremely valuable and also cost effective. So, our first goal is really, is to confirm the diagnosis of asthma, make sure that this is truly asthma. Second, identifying and manage asthma triggers. Third optimize asthma medications. Fourth teach and optimize asthma self-management skills and fifth provide access to specialized therapies when conventional asthma medications alone are not enough. And in addition, our nurse navigator, will help keep track of patients whose asthma is poorly controlled. She will do this by telephone and really inform us whenever there is a problem. We want to do our absolute best to improve people’s quality of life and keep them out of urgent care, keep them out of the emergency room.
Melanie: So, Dr. Mehta, what are some of those specialized asthma therapies you just mentioned that the Severe Asthma Clinic can offer?
Dr. Mehta: Sure, well there are currently three injectable drugs on the market specifically designed for treating severe eosinophilic asthma. Xolair, Nucala and Cinqair. These medications greatly reduce the eosinophilic airway inflammation which in turn helps improve both asthma symptoms and lung function. They are also very effective in reducing the risk of an asthma attack which will often enable patients to reduce their need for steroid medications. I personally know of many patients who have experienced a night and day improvement in their quality of life since starting these therapies. Now, in addition, for patients with aspirin sensitive asthma; we can offer aspirin desensitization. We start out by giving them a very low dose of aspirin then gradually increase the dose until they can tolerate dose up to 650 mg. It turns out taking a high dose of aspirin on a daily basis for certain patients, can actually improve asthma control as well as help prevent nasal polyps and then finally, there is a relatively new procedure called bronchial thermoplasty that targets excessive airway smooth muscle and for that, I want to turn it over to Dr. Trapp to discuss this further.
Dr. Trapp: So, yeah so bronchial thermoplasty is a procedure that we have been doing in Lincoln, Nebraska for a number of years and offering this to our more severe asthmatic patients. It is really a technique where we use a bronchoscope and we go through the airways using sedation, and we apply a thermal energy using a specialized probe to those distal airways that have smooth muscle. Now the role of smooth muscle in asthma is that this is the area of the lung where the smooth muscle contracts and typically causes those symptoms of chest tightness and shortness of breath and wheezing and by using thermal energy; we can reduce the size and the strength of those muscles so that patients have reduced symptoms. This had had a major impact on those patients that have already undergone this procedure. It can reduce hospitalizations; emergency room visits as well as improve quality of life. Now what is important to stress, is that bronchial thermoplasty alone does not manage all asthma patients; but it is really an ancillary tool that we can use to help improve asthma management in addition to anti-inflammatory therapy for asthma.
Melanie: Dr. Mehta, who would be an appropriate patient for the Severe Asthma Clinic?
Dr. Mehta: So, any adult aged 18 years and older, diagnosed with asthma, whose symptoms are not well-controlled would be a good candidate. So, this includes anyone who experiences daily asthma symptoms in spite of taking asthma medications, anyone who has experienced two more asthma attacks requiring steroids in the preceding year, or anyone who has had an asthma related emergency room visit or hospitalization. So, any of these patients are certainly welcome to be evaluated at the Severe Asthma Clinic.
Melanie: So. Dr. Mehta, I’d like to start with you as a summary to wrap up. What would you like to tell the listeners about asthma and the Severe Asthma Clinic at Bryan Health?
Dr. Mehta: Yes, so, again, this is a resource that we are offering our community where patients will have the opportunity to see a multidisciplinary team consisting of an allergist, a pulmonologist, ENT specialist and a nurse navigator to really comprehensively and holistically evaluate, number one to confirm if they have asthma and secondly to evaluate some of the triggers of their asthma, identify what type of asthma they have and then select appropriate therapies. Again, this is a tool that we have, that we are offering and it is open to adults 18 and older whose asthma is poorly controlled.
Melanie: And Dr. Trapp, last word to you. Best advice for those suffering from asthma, you are a pulmonologist; what do you tell people every day about living with and managing their asthma?
Dr. Trapp: Well, asthma is a very common disorder and we have really good therapy for asthma. People oftentimes underestimate the severity of their asthma or they just simply live with daily symptoms of asthma and that may limit their lifestyle, their exercise tolerance and their overall wellbeing. They need to recognize that those symptoms can be managed more effectively and the hope is that through a clinic like this, that is comprehensive and multidisciplinary in approach; we can really review their asthma management and make recommendations that can improve their quality of life and potentially save their life.
Melanie: Thank you gentlemen, so much for being with us today. For further questions or to schedule an evaluation at the Severe Asthma Clinic; please call 402-481-8901. That’s 402-481-8901. For additional information on the Severe Asthma Clinic at Bryan Medical Center; you can visit www.bryanhealth.org . That’s www.bryanhealth.org . This is Bryan Health Radio. I’m Melanie Cole. Thanks so much for listening.