Miriam Rivera spent a large portion of her life in doctors’ offices and hospitals and a lot of insurance money managing her severe asthma, until a new procedure changed her life in just a matter of weeks.
The procedure is called bronchial thermoplasty.
“I would go to the hospital almost once a month and stay there for two weeks,” said the Miami Gardens resident.
Rivera, 65, has suffered from severe asthma since she was 32 and has been on a long list of medications, including a high dose of cortisone daily.
Asthmatics have trouble breathing for two reasons: their breathing pipes have smaller diameters due to extra muscle tissue and their breathing pipes are also prone to inflammation, which causes them to further constrict, restricting the air from passing through, said Dr. Eduardo Oliveira, medical director of interventional pulmonology at the Cleveland Clinic Florida.
About 25 million Americans have asthma. And while asthma tends to be associated with children, there is a growing concern about asthma in seniors. A University of Cincinnati study recently published in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), revealed that the death rate among the 65-and-over set is 14 times higher than in asthma patients 18 to 35 years old.
Bronchial thermoplasty is a three-part, minimally invasive treatment that is usually done on an outpatient basis, unless — like in Rivera’s case — the patient needs to stay overnight due to other complications such as diabetes.
Rivera felt immense improvement even after the first procedure.
“After the first portion of the treatment I was able to go to Orlando and visit my mother who was in her 90s and dying,” she said. “I was able to breathe well enough to make the trip.”
Dr. Rodney Benjamin, a pulmonologist at South Miami Hospital, explained that the treatment is reserved for “refractory asthma.”
“These are the folks that have been treated [with medication] and still aren’t well,” he said.
For the procedure, the patient is administered general anesthesia and the doctor inserts a scope into the lungs. “Once in the lungs, we insert this little catheter that opens up like an umbrella,” Oliveira said. “We deliver thermal energy to the breathing pipes and this doesn’t destroy them, but it causes a little bit of damage on the muscles that line the pipes,” he said, therefore creating a larger diameter for the air to pass through.
There are thousands of breathing pipes, Oliveira said, so he described the procedure as a tedious process, even though each of the three sessions only takes about an hour.
Rivera was Oliveira’s first bronchial thermoplasty patient, even though he had been trained to perform the procedure for about a year and a half. There’s a simple reason behind the delay: Her insurance now pays for it. Oliveira is now treating his second patient, who is paying out of pocket for the treatment. Oliveira said it costs between $21,000 and $30,000.
Insurance companies resisted paying for the treatment because of its novelty, doctors say.
“Once it becomes the standard of care and a more common thing, it’s easier to get the insurance companies to approve it,” said Dr. Raul Valor, chief of pulmonary subsection at Baptist Hospital of Miami.
Both doctors have patients in the pipeline, but they are trying to get insurance approval.
Valor predicts that when insurance companies start doing the math, they will see that paying for the treatment would be in their best interest as well.
“This treatment is suggested for severe asthma, and those patients spend well beyond $30,000 a year on medical treatment, so it would make sense for those patients to get this treatment,” Valor said.
The treatment is also considered permanent.
“My life has changed about 90 percent: I can walk, I can go to the stores ... it had been years since I could go to the stores because I couldn’t walk between the aisles of clothing.”