Breathing Easy at Last, Dayton Woman Keeps Asthma in Check

A smiling Lisa Levan is walking and not wheezing.

The 48-year-old Dayton mom is enjoying her daughter's high school band performances even during chilly days. These are activities Levan couldn't consider just a year ago, but they are now becoming a way of life thanks to a procedure known as bronchial thermoplasty performed at University of Cincinnati Medical Center.

Bronchial thermoplasty was approved by the U.S. Food and Drug Administration in 2010 to help patients with severe asthma. While under monitored anesthesia, a bronchoscope is inserted through the mouth into the lungs. A catheter then delivers mild heat to the smooth muscle of the airways in the lungs, reducing the amount of excessive smooth muscle, explains Sadia Benzaquen, MD, an interventional pulmonologist at UC Medical Center.

"It has 100 percent improved my life so far," says Levan. "I can enjoy going to the pool, store and walking short distances which are things I didn't get to do before without having a breathing episode. I had taken a steroid every day for 12 years before the procedure. Now, I haven't since July. The staff at UC Medical Center have treated me so well and I have been blessed beyond measure with this treatment. Everyone I have worked with has been nothing but helpful."

Levan says despite the procedure's benefits her journey to claim its rewards has been an arduous one dating back to 2003. Her use of steroids created brittle bones and later led two broken shoulders and a broken leg which has left her with permanent damage. A bone scan revealed she needed an alternative to the injections. Steroid use also led to weight problems; Levan was over 300 pounds during the time of her steroid injections.

"I had to carry my nebulizer to work all the time," says Levan, a former travel agent.  "I had to have it there as a precaution. I was miserable actually.  I didn't enjoy myself.  When I was out I was always worried about what was going to happen. As soon as I would start having asthma attacks, I would go to the hospital.  Fall and summer were really bad, especially with the humidity in the summer time and I would always have asthma exacerbation episodes."

In October 2013, Levan was referred to Benzaquen, who did a series of test to make sure that Levan's asthma diagnosis was correct. Benzaquen, also an assistant professor in the UC College of Medicine, says at least 20 percent of the patients who are referred to him have something other than asthma causing their breathing difficulties.

His tests look at pulmonary function and then rule out other ailments such as vocal card dysfunction, allergic bronchopulmonary aspergillosis, or excessive dynamic airway collapse—all which can mimic asthma. Once the tests showed Levan was a good candidate for bronchial thermoplasty, another hurdle remained.

"The main limitation we have is the fact insurance companies still consider this experimental," says Benzaquen. "This is not experimental. There is enough data in the medical literature showing that in patients carefully chosen patients, bronchial thermoplasty works."

Benzaquen's staff muddled through an assortment of paper work with insurance to gain approval for the procedure. Unfortunately, the process took a year-and-a-half before Levan could have the procedures.

Between January and April 2015, Levan underwent three separate thermoplasty procedures.

"First we treat the right lower lobe, then three weeks later we treat the left lower lobe, and finally three after we treat both upper lobes" says Benzaquen.

Benzaquen has performed the outpatient procedures on more than two dozen patients at UC Medical Center and says the trio of procedures is only approved for once in a patient's lifetime.

"The fact that this can be done once in a patient's life you want to make sure that whoever is performing the procedures has a process for ruling out other causes and is an experienced interventional pulmonologist," he explains. "I tell patients the fact you get thermoplasty doesn't mean your asthma is cured, but hopefully you feel better and experience an improved quality of life. Our main objective is to improve these patients' quality of life."

In the days immediately following each thermoplasty procedure, patients usually experience a worsening of asthma-related symptoms. That, however, is only temporary, says Benzaquen.

"I had a little tightness and some wheezing and I was like 'I don't know about this.' But after three days it went away and I felt better," says Levan, who completed all three phases of the bronchial thermoplasty procedure. "Every time I see somebody struggling with asthma, I go, 'You have got to call Dr. Benzaquen. It's given me a better quality of life. I can do more stuff."