Severe asthma · Interventional pulmonology · London
Bronchial thermoplasty, for severe asthma when biologics are not enough.
A three-session bronchoscopic treatment using the Alair radiofrequency system to reduce airway smooth-muscle mass. NICE IPG419. Done in a severe-asthma centre, after a proper MDT review, and only when it is genuinely the right next step.
Why patients choose us
- 01
A named interventional pulmonologist, in a severe-asthma centre
Not a general bronchoscopy list. A consultant with a bronchial thermoplasty case volume, working inside a formal severe-asthma multidisciplinary team.
- 02
MDT first, thermoplasty second
BT is only right after biologics have been tried, or ruled out for a good reason. We push for the MDT review before you commit to the three sessions.
- 03
Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private bronchial thermoplasty course costs in London.
Indicative ranges across our London partner centres. Send the severe-asthma summary and we quote firm figures across two or three options.
In short
A full three-session course in a London centre: £14,000 to £28,000, all inclusive, over nine weeks.
| Item | Indicative range | Duration | Turnaround |
|---|---|---|---|
| Severe-asthma MDT review (second opinion) | £450–£900 | 45 min | 48 hours |
| Bronchial thermoplasty - single session | £4,800–£9,500 | 60–90 min | Same day home |
| Full three-session course (all inclusive) | £14,000–£28,000 | 3 sessions | 9 weeks total |
| Peri-procedure OCS and pharmacy pack | Included | n/a | Dispensed on the day |
| 12-month follow-up with spirometry and ACQ | £350–£550 | 30 min | Same visit |
Prices vary by centre, by consultant, by whether GA or deep sedation is used, and by length of ward stay. NHS availability is limited to a small number of designated severe-asthma centres by specialist referral.
The journey
From referral to session three - what happens, in order.
One team from first message to twelve-month follow-up. Three sessions, three weeks apart, one lobe group at a time.
- 01
Before
You send us the severe-asthma summary
Recent clinic letters, spirometry, biologic history, exacerbation count and current ICS/LABA doses. A short confidential form.
- 02
Before
MDT-style review within a working day
A specialist reads the file. Is BT the right next step, or is a fourth biologic, tiotropium or macrolide the better call? An honest read, either way.
- 03
Before
Three sessions booked three weeks apart
One session per lobe group: right lower, left lower, then both upper lobes. Prednisolone 50 mg for three days before and two days after each.
- 04
On the day
Arrival, anaesthetic review, consent
A morning admission. Anaesthetist reviews airway, oxygen saturations and current inhaler use. General anaesthesia or deep sedation is your choice with the team.
- 05
On the day
The Alair catheter through a flexible bronchoscope
30 to 60 minutes of active treatment. The Alair catheter delivers controlled radiofrequency energy at 65 degrees Celsius to the airway walls, reducing smooth-muscle mass.
- 06
On the day
Recovery bay, then home the same day
A few hours of monitored recovery with a peak flow check. Most patients are discharged the same afternoon with written aftercare and a 24/7 contact number.
- 07
After
Two-week symptom window, then the next session
A transient flare of cough, wheeze or breathlessness for one to six weeks is normal. We call at 48 hours and again at two weeks before session two.
Session cadence: 3 weeks apart. Full course: 9 weeks. Symptom flare window: 1 to 6 weeks after each session.
When it helps
Who is bronchial thermoplasty actually for.
The severe-asthma phenotype where BT has the strongest evidence, plus the exclusions that mean it is not the right treatment today.
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Severe persistent asthma on GINA step 5
Uncontrolled despite high-dose ICS plus LABA and optimised inhaler technique, with an ACQ score consistently above 1.5.
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Biologics failed or contraindicated
Non-response to at least one appropriate biologic (omalizumab, mepolizumab, benralizumab, dupilumab, tezepelumab) or a documented contraindication.
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Frequent severe exacerbations
Two or more OCS-requiring exacerbations in the past year, or an unscheduled hospital admission for asthma in the past 12 months.
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FEV1 above 60 percent predicted
Pre-bronchodilator FEV1 greater than 60 percent predicted. Fixed severe obstruction below that threshold makes BT unsafe.
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Non-smoker or ex-smoker over one year
Current smokers and recent quitters are excluded. Ongoing smoking blunts response and increases procedural risk.
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Age 18 to 65, stable comorbidities
Licensed age range. Uncontrolled cardiac disease, active infection, pacemakers or defibrillators need specialist review before booking.
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No bronchiectasis, no active infection
Significant bronchiectasis, active respiratory infection or an exacerbation in the past two weeks postpones the procedure.
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Red flag: acute severe asthma today
Rising reliever use, night waking, or a peak flow below 60 percent of personal best needs urgent asthma review, not a BT booking.
How the course is delivered
Three sessions, one lobe group at a time.
The Alair protocol splits the treatment into three sessions three weeks apart. This is not a research option - it is how BT has been delivered since the AIR2 trial and the NICE IPG419 guidance.
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Alair system by Boston Scientific
The only radiofrequency system licensed for BT. A single-use catheter delivers a controlled 10-second pulse at 65 degrees Celsius to airway walls 3 to 10 mm in diameter.
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Session 1 - right lower lobe
The first session treats the right lower lobe airways. Around 40 to 70 activations, mapped systematically from distal to proximal.
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Session 2 - left lower lobe
Three weeks later, the same approach on the left. Splitting the lower lobes over two sessions reduces the risk of a bilateral post-procedure flare.
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Session 3 - both upper lobes
Six weeks after the first session, both upper lobes are treated together. The right middle lobe is deliberately not treated - a safety design of the trial protocol.
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Deep sedation vs general anaesthesia
Some centres use anaesthetist-delivered propofol and a laryngeal mask; others prefer full GA. Choice depends on airway, comorbidities and centre preference.
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Peri-procedure prednisolone
Prednisolone 50 mg daily for three days before and two days after each session, per the AIR2 protocol - reduces post-procedure airway oedema and symptom flare.
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Biologic bridge, not replacement
For most patients, biologics are continued through the BT course. BT is added to, not substituted for, existing severe-asthma therapy.
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Second-opinion MDT review
A specialist review of your clinic letters, spirometry and biologic history - sometimes the answer is a different biologic or macrolide, not thermoplasty.
London centres
Where bronchial thermoplasty is done privately in London.
A short list of London centres offering BT with the interventional pulmonology, severe-asthma MDT and post-procedure monitoring the protocol requires.
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Royal Brompton Private Care
The historic UK reference centre for severe asthma, with a full biologics service alongside BT.
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HCA Wellington Hospital Chest Clinic
A high-volume private chest service in St John’s Wood with anaesthetist-led sedation and ward stay if needed.
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Guy’s and St Thomas’ Private Chest Clinic
BT in a large university-hospital environment with a formal severe-asthma MDT and biologics pathway.
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Chelsea and Westminster Private Care
A West London option with respiratory and anaesthesia teams experienced in bronchoscopic interventions.
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Imperial Private Healthcare, Charing Cross
BT delivered inside an academic respiratory service, with research and long-term follow-up available.
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NHS severe-asthma centres
Bronchial thermoplasty is available on the NHS by specialist referral in a small number of designated severe-asthma units.
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Interventional pulmonologists with bronchial thermoplasty case volume, not general bronchoscopy lists
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Formal severe-asthma multidisciplinary team review before every booking
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Access to the full biologics ladder in the same service, so BT is a considered next step
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Anaesthetist-delivered sedation or GA with post-procedure high-dependency observation available
Safety, evidence and recovery
What the AIR2 and BT10 evidence actually says.
The AIR2 randomised trial reported a 32 percent reduction in severe exacerbations. The BT10 long-term follow-up showed that benefit sustained out to ten years, with no signal of late harm. The peri-procedure symptom flare is the trade-off worth planning for.
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General anaesthesia or deep sedation
BT is done under GA or anaesthetist-delivered deep sedation via a flexible bronchoscope. Airway control and continuous saturation monitoring are standard.
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Transient worsening for one to six weeks
Cough, wheeze, chest tightness and a rise in reliever use are common for one to six weeks after each session. This is expected, and settles.
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Hospitalisation risk during the treatment period
Roughly 8 percent of patients need at least one respiratory admission during the treatment period, most within a week of a session.
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Respiratory tract infection
Lower respiratory tract infection can complicate the post-procedure window. Report new fever, purulent sputum or a step-up in reliever use to the team.
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Prednisolone 50 mg, 3 days before, 2 after
The AIR2 peri-procedure steroid protocol is not optional. It reduces post-procedure inflammation and the risk of a severe symptom flare.
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No treatment of the right middle lobe
The right middle lobe is not treated by design - a safety feature of the trial protocol that has carried through into routine practice.
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Sustained benefit at ten years - BT10
The BT10 long-term study showed a 32 percent reduction in severe exacerbations from AIR2 sustained out to 10 years, with stable FEV1 and no signal of late harm.
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Not reversible
Airway smooth-muscle reduction is a structural change. That is the mechanism of benefit, but it also means BT cannot be undone if you change your mind.
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Red flags after discharge
Severe breathlessness not settling with reliever, chest pain, fever above 38 degrees, or haemoptysis needs the unit contact number the same day, or A&E.
Reading your procedure note
Your BT note in four parts. Read the last one first.
Whichever centre performed the session, the note the interventional pulmonologist sends you keeps to the same shape.
- 01 Header
Lobe treated, activations, energy delivered
Which lobe group was treated, how many activations were delivered, and any airways that were technically not reachable.
- 02 Technique
Anaesthesia, bronchoscope, catheter
GA versus deep sedation, size of the flexible bronchoscope, and the Alair catheter serial number for medical-device traceability.
- 03 Findings
Airway appearance and immediate complications
Baseline airway appearance, any mucus plugging, and whether there was intra-procedure bleeding, desaturation or bronchospasm.
- 04 Impression
Next session date and OCS plan
Read this first: the date of the next session, the prednisolone schedule and the 24/7 contact number for the two-week symptom window.
Ready to talk about BT?
Send us the severe-asthma summary. We come back within one working day.
A specialist reads your clinic letters, spirometry and biologic history, and tells you whether bronchial thermoplasty is the right next step, or whether a different biologic, macrolide or trial referral is a better fit. Impartial, and free to you.
Recognised by major UK insurers
Cover for bronchial thermoplasty varies by insurer and by prior treatment history. We confirm cover in writing before booking.
Frequently asked
Everything we get asked about bronchial thermoplasty.
Quick answers on eligibility, cost, London centres and what recovery actually looks like.
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What is bronchial thermoplasty and how does it work?
Bronchial thermoplasty is a bronchoscopic treatment for severe asthma. The Alair catheter, made by Boston Scientific, delivers controlled radiofrequency energy at 65 degrees Celsius to the walls of medium-sized airways, reducing the mass of airway smooth muscle. Less smooth muscle means less bronchoconstriction, fewer severe exacerbations, and better asthma control.
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Who is bronchial thermoplasty for?
BT is for adults with severe persistent asthma that stays uncontrolled on high-dose inhaled corticosteroids plus a long-acting beta-agonist, where biologics have been tried and failed or are contraindicated. You need to be a non-smoker or an ex-smoker of at least one year, with a pre-bronchodilator FEV1 above 60 percent predicted, and free of active respiratory infection. Selection sits inside a severe-asthma MDT.
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Is it approved by NICE?
Yes. NICE published interventional procedures guidance IPG419 covering bronchial thermoplasty. The evidence base is anchored by the AIR2 randomised trial, which showed a 32 percent reduction in severe exacerbations, and by the BT10 long-term follow-up demonstrating sustained benefit and safety out to ten years.
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How much does bronchial thermoplasty cost privately in London?
A full three-session course in a London private centre is typically £14,000 to £28,000 all-inclusive of anaesthesia, catheter, ward stay and follow-up. A single session runs £4,800 to £9,500, and a severe-asthma MDT second opinion is £450 to £900. We confirm firm figures within one working day.
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Where can I have bronchial thermoplasty in London?
London centres offering BT privately include the Royal Brompton Private Care, HCA Wellington Hospital Chest Clinic, Guy’s and St Thomas’ Private Chest Clinic, Chelsea and Westminster Private Care, and Imperial Private Healthcare at Charing Cross. On the NHS, BT is available in a small number of designated severe-asthma centres by specialist referral only.
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What is recovery like and what are the risks?
Expect a transient worsening of asthma symptoms, including cough, wheeze and increased reliever use, for one to six weeks after each session. Roughly 8 percent of patients need a short respiratory admission during the treatment period, most within a week of a session. Peri-procedure prednisolone 50 mg for three days before and two days after each session reduces this flare. Longer term, benefit is sustained without a signal of late harm.
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