Jennifer Teresa-Kim lives in a beautiful one-story house at the top of a gentle hill in the town of Nuevo, southeast of Riverside. Getting there is a little tricky. A sharp left turn off a two-lane blacktop is required, followed by a little jaunt up a slithery dirt road.
Ambulance drivers know it well.
Jennifer Teresa-Kim, who underwent a new surgical technique for her severe asthma condition last December, sits in the hills near her home in Nuevo.
STEVEN GEORGES, FOR THE REGISTER
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Teresa-Kim figures she has been whisked away under flashing lights to the hospital eight times in the past five years because of an asthma attack that gripped her chest at some unpredictable hour of the day or night. The last time, the worst time, came in June 2012, about 8 p.m. Thankfully, her daughter was sleeping, so she didn't have to see what this one did to her mom.
"It kind of broke me ? I guess that was it," Teresa-Kim said. "That's all I could take. I was like, I can't do this anymore. I'm done."
She learned about a new treatment called bronchial thermoplasty. The airways inside the lungs are heated with a catheter, reducing the smooth muscle tissue inside the airways that often tightens during an asthma attack. The FDA approved the device in April 2010, making it the first nondrug treatment for asthma on the market. Since undergoing the three-step process between October and December, Teresa-Kim can take deep breaths for the first time in years.
"It's totally changed my life, even my outlook on life," she said. "It gave me hope. I do have a future. Because for a while I was thinking, 'I ain't gonna make it to 40. I ain't gonna make it out of this year. This thing's gonna kill me.'"
Grim statistics
Asthma affects 18.9 million American adults (about 8 percent of the population) and 7.1 million children (9.5 percent), according to data collected by the Centers for Disease Control and Prevention in 2011. About 3,400 people die from it each year, and it's a huge drain on the health-care system: The CDC estimates asthma costs about $20.7 billion every year in hospitalizations, regular doctor visits, medications and lost work hours.
About 10 percent of asthma patients have the most severe form of the disease, but this group accounts for more than half of asthma-related costs. Difficulty breathing is a part of everyday life, and the symptoms can be worsened by air pollution and seasonal allergies.
Teresa-Kim, 38, believes she's had asthma since she was 2. It has hindered her life for as long as she can remember. She didn't play sports, and she struggled to explain to others what her condition was.
"I felt embarrassed, because they'd be like, 'What's wrong with you? Just ch-chk and you're fine,'" she said, mimicking the spritz of an inhaler filled with a steroid or some other drug. "But it's not like that for me. I don't just ch-chk. I'm not better. I could do that all day and I'm not better. So I got to the point where I didn't want to talk about it and didn't want to tell anybody."
Her illness forced her to take time off from work as a school nurse, and she couldn't take part in the activities of her active daughter Katelynn, 11.
"I was a sideline mom," she said. "I could only play for a second, then I'd have to sit down."
She estimates she was on as many as 18 medications, including methotrexate, a drug used in cancer treatment; and Xolair, an asthma medication that costs $30,000 to $40,000 a year; and Prozac, to treat the depression that arrived as her condition persisted throughout the years. The steroids made her put on weight, and nothing seemed to help anyway.
"A lot of asthmatics are so desperate for something, and their doctors say, 'Well, I have nothing else to offer you,'" said Dr. Robert Goldberg, a pulmonologist at Mission Internal Medical Group in Mission Viejo who is the first physician in Orange County to perform the outpatient treatment.
How it works
As it happened, Teresa-Kim was losing all hope at the time when bronchial thermoplasty was becoming widely known in the United States. The device used in the procedure, called the Alair, was developed by a Silicon Valley company called Asthmatx, which was then acquired by Boston Scientific.
Goldberg was among the first wave of doctors to receive training on the device after its approval. So far, he has treated four patients, including Teresa-Kim. The treatment is for those 18 and older, and it's only for patients with the most severe form of asthma, when other treatments have failed.
Once a patient has met the criteria, it's a remarkably simple process: The patient goes in three times, three weeks apart, and usually doesn't have to stay the night at the hospital. Before her final treatment in December, Teresa-Kim looked nervous in her bed at Mission Hospital before she was wheeled in for a 45-minute session.
The gadget has a heating coil on the end that pops out of a bronchoscope, a tube that is inserted into the mouth or nose and snaked down into the lungs. The right lower lobe, with all its branches, is done first; then the left lower lobe the next session; and finally both upper lobes.
Metal prongs come out of the scope, like aluminum branches of an umbrella unfolding. The wires are heated through radio frequency energy to 149 degrees Fahrenheit, just cooler than a fresh cup of coffee. The scope is inserted as far as the doctors can see, into each bronchial tube. On the monitor, it looks like a sci-fi movie, with an astronaut peering into dark tunnels lined with mucus.
The wires touch the walls of the tube at four points, heating them up for 10 seconds. The scope is then withdrawn a half-centimeter at a time, and the heating begins again.
The largest clinical trial of the Alair system, which was published in 2010 and played a big role in the FDA's approval, showed that patients who underwent bronchial thermoplasty showed immediate and long-lasting improvement in their symptoms.
Among the 558 patients ? treated at 30 centers in six countries ? there was an 84 percent reduction in ER visits and a 73 percent reduction in hospitalizations over the course of a year, compared with the control group.
But it's not a cure for asthma, and patients likely will need to continue medication, though some have reduced the dosage.
Boston Scientific also acknowledges that about 3.4 percent of patients have an asthma attack afterward that's severe enough to require hospitalization. During the 2010 trial, 8.4 percent of bronchial thermoplasty patients had to be admitted during the treatment phase, compared with 2.4 percent who received a "sham" treatment.
This is partly why some insurers won't pay for the treatment, which costs around $20,000.
Proponents of the treatment, including groups representing respiratory doctors, say the one-time costs of the treatment are far lower than continued ER trips and expensive drugs. Gold-berg has spent much of his time fighting for prospective patients to get approval from their insurers, and he notes that some plans already are covering it.
Teresa-Kim is with Kaiser, which paid for it. As of Jan. 1, Medicare pays for it without prior approval.
"I think that's a testament to their understanding that this is a viable procedure that makes a large difference in people's lives," Goldberg said.
Teresa-Kim didn't expect much from the new treatment, since everything else had failed. But it has opened up new possibilities for life with her husband and daughter.
"I'm a shallow breather," she said. "I never could take a deep breath. And I saw Dr. Goldberg a couple weeks ago. He was like, 'Let me listen.' He said, 'Take a deep breath.' And I was like, 'Whhhh.' He said, 'Oh, my God! You can take a deep breath!'"
Contact the writer: 714-796-2221 or lhall@ocregister.com
Source: http://www.ocregister.com/articles/treatment-497631-asthma-teresa.html
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