New Asthma Treatment for Severe Asthma

The National Institute for Health and Care Excellence (NICE), are consulting again on the safety and efficacy of a new asthma treatment. The new treatment, bronchial thermoplasty, is likely to be offered to adults with severe asthma. The procedure involves applying thermal energy (heat) to the inside walls of the airways.

New asthma treatment

Bronchial thermoplasty will take place under sedation or general anaesthetic. Short pulses of radiofrequency energy are applied to the airway wall. Following that, patients will need to attend an additional two sessions, with 3-week intervals, to complete the procedure.

The aim of this new treatment is to reduce the smooth muscle mass lining the airways, decreasing their ability to constrict. Hopes are that by having this procedure, the severity and frequency of severe asthma attacks may decrease. NICE is currently in the process of considering the evidence for this treatment. Additionally, it’s listening to the views of specialist advisers with knowledge of the procedure.

Furthermore, to ensure safety, NICE is recommending that only a multidisciplinary team treat patients. In addition, they recommend that only specialist centres with on-site access to intensive care should carry out the procedure. Finally, they are proposing that only clinicians with experience of bronchial thermoplasty and managing severe asthma should perform the procedure.

As it stands, NICE believe there is adequate evidence to support the use of this new asthma treatment.

Severe asthma

In their consultation document, NICE say that in severe asthma, the lining of the airways becomes inflamed and narrow. Furthermore, this narrows the airways, making it harder for air to pass through. This makes it harder to breathe. And it is this that bronchial thermoplasty aims to tackle.

Complementary treatment for asthma

Research shows there to be an alternative, complimentary asthma treatment for opening up the airways and assist in easier breathing. This treatment is Inspiratory Muscle Training (IMT). Simply put, it is breathing muscle training, such as with the POWERbreathe IMT device. It too is clinically proven. Furthermore, it is drug-free.

The research reaches the conclusion that six-months of specific inspiratory muscle training improves inspiratory muscle strength and endurance. It also results in improvement in asthma symptoms, hospitalisations for asthma, visits to the emergency department, absence from school or work, and medication consumption in patients with asthma.

Alternative treatment for asthma – IMT

Inspiratory Muscle Training, such as with POWERbreathe IMT, is easy to use, straight out of the box. Because it is drug-free, there are only minimal precautions and contraindications that the Healthcare Professional needs to be aware of before prescribing IMT.

POWERbreathe IMT is an evidence-based, non-invasive asthma treatment. In fact, it is the amount of medical research behind the rigorous assessment that led to the POWERbreathe Medic being made available for prescription on the NHS. It offers people with asthma a clinically-proven method of reducing symptoms and putting them in control of their asthma.

Research shows that after only 3-weeks of IMT, asthma symptoms improve by up to 75%. Furthermore, patients with asthma experience improvement of symptoms, quality of life and a reduction in the consumption of medication of up to 79%.

In fact, three separate studies show an average 51% reduction in β2-agonist consumption (from 3.9 to 1.6 puffs per day) after IMT. One study also shows a decrease in corticosteroid use ~80%.

Finally, longer observations show that 6-months of IMT reduces absence from school/work (by ~95%) and use of healthcare resources (by ~75%).

POWERbreathe IMT is Beneficial for Patients with Asthma

POWERbreathe Inspiratory Muscle Training is clinically proven to be beneficial for patients with asthma.

POWERbreathe Medic IMT available for prescription in the UK

After 20 months of rigorous assessment, the POWERbreathe Medic IMT device was made available in the UK for prescription in the National Health Service (NHS) Drug Tariff: PIP 232-1040. It found that the POWERbreathe Medic offers people with asthma a drug-free and clinically-proven method to reduce symptoms and put them in control of their asthma.

POWERbreathe Medic IMT rigorously assessed

Although the role of IMT in the management of asthma has been less widely studied than in COPD, data exists from five randomised controlled trials that are unanimously supportive of IMT in the management of asthma.

Asthma patients benefit from POWERbreathe Medic IMT

After as little as 3 weeks’ POWERbreathe training, patients experience a reduction in dyspnoea, the medical term for breathlessness or shortness of breath, as well as improvements in quality of life. Most striking however are the observations that longer-term IMT (6 months) reduces absence from school/work (by ~95%), use of healthcare resources (by ~75%), and the consumption of medication (by ~79%).

The five randomised controlled clinical trials in support of POWERbreathe IMT

  1. Inspiratory muscle training improves lung function and reduces exertional dyspnoea in mild/moderate asthmatics – McConnell, A. K., M. P. Caine, et al. (1998). Clinical Science 95(2): 4P.
  2. Inspiratory muscle training in patients with bronchial asthma 
  3. Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled beta(2)-agonists
  4. The relationship among inspiratory muscle strength, the perception of dyspnea and inhaled beta2-agonist use in patients with asthma
  5. Influence of gender and inspiratory muscle training on the perception of dyspnea in patients with asthma

POWERbreathe Medic helps patients with breathing problems AND saves NHS money and resources

Health bosses announced back in October 2014 that the NHS in England needed extra money and an overhaul to services in order for patient care not to suffer.

When it comes to respiratory care the NHS could save both money and resources if they prescribed POWERbreathe Medic Respiratory Muscle Training (RMT) for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease.

In a 2005 study of the benefits of a 12-month programme of POWERbreathe RMT, researchers observed significant reductions in the use of healthcare resources.1

POWERbreathe RMT for COPD

Accordingly to Professor Peter Calverley (Lung Report III. British Lung Foundation), in the average PCT serving 250,000 people, there would be 14,200 GP consultations per year for chronic obstructive pulmonary disease (COPD), and 9,600 inpatient bed days. Reducing length of hospital stay is an NHS productivity indicator.

POWERbreathe reduced hospital bed days by 29% and GP consultations by 23% compared with placebo (see table above).

POWERbreathe RMT for Asthma

In another study, Weiner et al2 observed an 86% reduction in hospitalisations/emergency room visits following respiratory muscle training in moderate/severe asthmatics (from 1.4 to 0.2 per 3 months per patient).

And in three separate studies, Weiner et al. observed an average 51% reduction in β2-agonist consumption (from 3.9 to 1.6 puffs per day)2,3,4 after respiratory muscle training, and in one study3, corticosteroid use decreased ~80%.

How POWERbreathe Medic could save NHS money & resources

In 2005 when this study was conducted, the total potential annual savings derived from POWERbreathe Medic prescription per average PCT due to reduced hospital bed days and medication consumption (not including savings due to reduction in GP consultations) were substantial.

The POWERbreathe Medic offers an evidence-based, drug-free treatment for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease. It is the only Inspiratory Muscle Training device for RMT available for prescription that has been used in research into the benefits of IMT for a variety of medical conditions and prescribed by medical professionals as either a standalone intervention or as part of a rehabilitation programme.

For respiratory care professionals there is a POWERbreathe Medic Try-Before-You-Prescribe demonstration kit; an educational tool designed to help healthcare professionals and patients understand and experience the effect POWERbreathe Medic has on the respiratory muscles.

Since the approval of the POWERbreathe Medic for prescription in 2006, POWERbreathe has introduced the revolutionary, electronic POWERbreathe KH1, intended for use by healthcare professionals for respiratory muscle training and assessment in patients with dyspnoea, including patients with asthma, COPD, bronchitis, cystic fibrosis, emphysema, heart disease, neuromuscular disease, Parkinson’s disease and spinal injury.

The POWERbreathe KH1 is also suitable for use with disposable TrySafe filters and can be used bedside, on the ward, as part of a pulmonary program, or for single patient use at home under medical supervision.

Launched after the POWERbreathe Medic, following the latest technological advances in research and design, is the next generation POWERbreathe Medic: the POWERbreathe Medic Plus for patients to use at home, straight out of the box, with improved airflow dynamics and a more comfortable user experience. And for healthcare professionals (and their patients), is the new POWERbreathe KH2 with Breathe-Link Medic Live Feedback Software.

References:

  1. Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest. 2005 Nov;128(5):3177-82.
  2. Weiner P, Azgad Y, Ganam R, Weiner M. Inspiratory muscle training in patients with bronchial asthma. Chest. 1992;102(5):1357-61.
  3. Weiner P, Berar-Yanay N, Davidovich A, Magadle R, Weiner M. Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled beta(2)-agonists. Chest. 2000;117(3):722-7.
  4. Weiner P, Magadle R, Massarwa F, Beckerman M, Berar-Yanay N. Influence of gender and inspiratory muscle training on the perception of dyspnea in patients with asthma. Chest. 2002;122(1):197-201.

Inspiratory Muscle Training And Respiratory Exercises In Children With Asthma

“The aim of the present study was to evaluate the effects that inspiratory muscle training (IMT) and respiratory exercises have on muscle strength, peak expiratory flow (PEF) and severity variables in children with asthma.”

Conclusion:

“Programs involving IMT and respiratory exercises can increase mechanical efficiency of the respiratory muscles, as well as improving PEF and severity variables.”

Read Inspiratory muscle training and respiratory exercises in children with asthma >

Influence of Gender and Inspiratory Muscle Training on the Perception of Dyspnea in Patients With Asthma

“Men and women respond differently to asthma. Maximal inspiratory mouth pressure (PImax), ?2-agonist consumption, and perception of dyspnea (POD) were measured in 22 women and 22 men with mild persistent-to- moderate asthma. Next, the women were randomized into two groups: those who received inspiratory muscle training and those who received sham training. The training ended when the PImax of the training group was equal to that of the male subjects. POD was then measured once again.”

Conclusion:

“Our study shows that the inspiratory muscles in women could be trained within 20 weeks to reach the same strength as in their male counterparts. This increase in inspiratory muscle strength completely concealed the gender differences in POD and ?2 -agonist consumption, suggesting that the gender differential in maximal inspiratory muscle strength is responsible for the fact that women are more symptomatic than men. However, other possibilities for the gender differences could not be negated in our study, and further investigations are needed to completely clarify the issue.”

Read Influence of Gender and Inspiratory Muscle Training on the Perception of Dyspnea in Patients With Asthma >

The Relationship Among Inspiratory Muscle Strength, The Perception Of Dyspnea And Inhaled Beta2-Agonist Use In Patients With Asthma

“It is well documented that the perception of dyspnea (POD), subjectively reported by patients, is related to the activity and strength of the inspiratory muscles, and influences the use of ‘as needed’ beta2-agonists. This study investigated the relationship among the increase in inspiratory muscle strength after specific inspiratory muscle training, beta2-agonist consumption and the POD in patients with persistent, mild to moderate asthma.”

Conclusion:

“In patients with mild to moderate, persistent asthma, there is a correlation between the POD and the mean daily beta2-agonist consumption. When the inspiratory muscles are strengthened, there is a significant decrease in the POD and in beta2-agonist consumption.”

Read The relationship among inspiratory muscle strength, the perception of dyspnea and inhaled beta2-agonist use in patients with asthma >

Specific IMT In Patients With Mild Asthma With High Consumption Of Inhaled Beta2-Agonists

“It has been known for many years that there are variations between asthmatic patients in terms of their perception of breathlessness during airway obstruction. This study investigated the relationship between 2-agonist consumption and the score of perception of dyspnea, in mild asthmatics, and the relationship between the effect of specific inspiratory muscle training (SIMT) on the score of perception of dyspnea and ?2-agonist consumption in ‘high perceivers’.”

Conclusion:

“Patients with mild asthma, who have a high ?2-agonist consumption, have a higher perception of dyspnea than those with normal consumption. In addition, specific inspiratory muscle training was associated with a decrease in perception of dyspnea and a decrease in ?2-agonist consumption.”

Read Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled beta(2)-agonists >

Inspiratory Muscle Training In Patients With Bronchial Asthma

“In patients with asthma, the respiratory muscles have to overcome the increased resistance while they become progressively disadvantaged by hyperinflation. We hypothesized that increasing respiratory muscle strength and endurance with specific inspiratory muscle training (SIMT) would result in improvement in asthma symptoms in (p<O.O5), and the number of hospital (p<O.05) and sick patients with asthma.”

Conclusion:

“We conclude that SIMT, for six months, improves the inspiratory muscle strength and endurance, and results in improvement in asthma symptoms, hospitalizations for asthma, emergency department contact, absence from school or work, and medication consumption in patients with asthma.”

Read Inspiratory muscle training in patients with bronchial asthma >

IMT Improves Lung Function And Reduces Exertional Dyspnoea In Mild/Moderate Asthmatics

“Weiner et al. (1992) have reported improvements in lung function, asthma symptoms and reductions in usage of medication following six months of pressure threshold inspiratory muscle training (IMT). Where interventions require compliance with a programme of training, it is important that patients perceive benefits rapidly if compliance is to be maintained. This study examined the changes induced by 3 weeks of IMT in mild/moderate asthmatics.”

Conclusion:

“Data are consistent with those of Weiner et al. (1992) and confirm their hypothesis that improvements in MIP and lung function translate into a reduction in exertional dyspnoea. In addition, the data suggest that where appropriate training regimens are used, these changes are observed within 3 weeks of commencement of IMT and lead to an increase in patients’ motivation to take exercise.”

Read Inspiratory muscle training improves lung function and reduces exertional dyspnoea in mild/moderate asthmatics >

Effect of Inspiratory Muscle Training on Exercise Tolerance in Asthmatic Individuals

“The aim of this study was to determine the effects of inspiratory muscle training (IMT) on exercise tolerance, inspiratory muscle fatigue, and the perception of dyspnea in asthmatic individuals.”

Conclusion:

“This study has shown that 6 wk of IMT in individuals with mild to moderate asthma significantly increased inspiratory muscle strength, reduced inspiratory muscle fatigue, improved exercise tolerance, and reduced the perception of dyspnea during cycling exercise at È70% V ̇O2max to the limit of tolerance. These data suggest that IMT may be a helpful adjunct to asthma management and has the potential to improve participation and adherence to exercise training in this group. However, it should also be noted that the perception of breathlessness is also an important signal of bronchoconstriction, and thus, caution should be exercised if this symptom is abnormally low.”

Read Effect of Inspiratory Muscle Training on Exercise Tolerance in Asthmatic Individuals >