Although the mortality rate of asthma is lower than COPD, roughly 180,000 deaths per year worldwide, the prevalence is higher and the financial burden of health care is lifelong. Asthma affects approximately 300 million people worldwide.  In North America, 7% to 10% of the population has asthma. The cost to the US economy for managing the care of its 20-30 million asthma patients is estimated at $18.3 billion, including $10.1 billion in direct costs and $8.2 billion in indirect costs. Expenditures for medication make up 40% of the direct costs, or $4 billion.

Newly approved bronchial thermoplasty applies radiofrequency heating to airway smooth muscle, reducing its thickness and hyper-reactivity. This novel minimally invasive intervention is applied to all airways 3mm and larger over the course of three procedures. We hypothesize that hyperpolarized xenon (HXe) MRI could identify the subset of dysfunctional airways that dominate the patient’s symptoms. An image-guided single-session procedure could thereby avoid treating consistently patent airways while potentially yielding an essentially equivalent benefit, eliminate any additional risk and lost productivity associated with treating those airways, reduce costs of managing this patient group, and convince more payers to reimburse.