In 2010, more patients were discharged from Jamaica Hospital Medical Center after being admitted for asthma-related issues than from any other hospital in Queens.
Why the high number of asthma-related problems at Jamaica is up for debate, and many of the cases treated are minor and can be controlled with drugs, but for a small number of patients, the problem is extreme and life-threatening and now Jamaica Hospital is offering a new treatment for those patients.
Dr. Craig Thurm, director of pulmonary medicine at Jamaica Hospital, said about five to ten percent of patients with asthma have symptoms that are very severe and not well controlled by medication.
“First, you do evaluations of patients,” Thurm explained. “But then, sometimes you’re stuck with some asthma patients who are good patients but still have problems.”
For those patients there is another option, an injection of a drug called XOLAIR, which lowers immunoglobulin E, a natural substance in the body that is often blamed for exacerbating asthmatic issues when high levels of it are present.
But even then, some patients don’t respond and the drug is often expensive. Thurm said the patients who can’t afford or don’t respond well to that medication are the most at risk. Four thousand people die each year due to asthma and the costs for hospitalization and treatment are significant.
“Bad asthma patients are often hospitalized, and are disproportionately upping costs for treatment,” Thurm said.
That led him to bring a new kind of asthma treatment to the hospital — bronchial thermoplasty.
The procedure is minimally invasive, usually outpatient, and is only for those with severe asthma that hasn’t been improved by other available treatments. The Food and Drug Administration only recently approved bronchial thermoplasty and Jamaica Hospital is the only location in Queens offering it.
Patients can undergo complete anesthesia for the procedure or it can be done under mild sedation. Dr. Thurm, who is the only doctor who performs the procedure, places a periscope into the airways three different times in three different parts of the lungs in three procedures done every few weeks. A special catheter with prongs in the scope that is connected to a box is put into middle size airways of the lungs. Thurm then presses a pedal on the box sending thermal energy to the airway to decrease the smooth muscle that often constricts during asthma attacks. The procedure is not uncommon and is done already for other pulmonary issues, Thurm said.
Patients are pretreated with drugs such as Prednisone, which alleviates inflammation.
Thurm, who has done the procedure on six patients so far, said the FDA approved the treatment after conducting it on 280 patients. He notes there are side effects and initially, symptoms will remain and could get worse.
“Hopefully a month or so after the procedure, you should see the benefits,” he said, noting that only one of his six patients had to be hospitalized after the procedure and only for one night. He said many of those who took part in the trial before FDA officially approved the treatment saw reduced severity of asthma attacks and fewer visits to the emergency room.
Of the other five patients that he’s conducted the treatment on, one was able to come off oral mediation, another saw dramatic improvement, a third saw some early improvement, a fourth saw no improvement at all and the fifth is still undergoing the treatment. The FDA is working on a five-year time frame to analyze data to see what improvements occur.
The treatment is only approved for adults and only as a last resort after all other treatment has failed. Some insurance companies do cover the procedure.