"For two decades Patricia DiGiusto struggled with severe asthma httpshealth.nytimes.comhealthguidesdiseaseasthmaoverview.htmlinlinenytclassifier. Powerful medications and frequent use of her inhaler could not prevent repeated trips to the emergency room. On one particularly bad night Ms. DiGiusto watched from her hospital bed as doctors and nurses prepared to insert plastic tubing down her windpipe to help her breathe. Gasping for air she was certain she would not survive. Ill never forget that feeling said Ms. DiGiusto  a speech pathologist in Braintree Mass. The feeling that Im never going to see my kids or husband again and that asthma is finally going to get me. Two years ago Ms. DiGiustos doctor told her about a new procedure called bronchial thermoplasty the first nondrug therapy approved by the Food and Drug Administration for patients with severe asthma. During the procedure a doctor guides a bronchoscope into a patients airways. There it heats the lungs to  degrees Fahrenheit  cooler than a cup of coffee but warm enough to shrink the smooth muscle in the airways which swells during an asthma attack and restricts breathing. After the procedure the airways no longer are so prone to constricting studies show. Asthma patients suffer fewer attacks and need fewer hospital visits. Ms. DiGiusto had the procedure in March . Since then she has ended most of her medications and has not had a single asthma attack. Im a language therapist she said but I cant even think of the word to describe how much better this has made my life. Across the country about  million people suffer from asthma. Every year about  die because of it. Avoiding allergens and using inhaled medications are enough to keep asthma under control in most patients. But for the minority with severe persistent asthma medication and lifestyle changes are not enough. Frequent hospital trips are almost inevitable and powerful steroids httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicssteroidsindex.htmlinlinenytclassifier like prednisone  which can cause thinning bones cataracts httpshealth.nytimes.comhealthguidesdiseasecataractoverview.htmlinlinenytclassifier depression and other debilitating side effects  become a necessity. Nationwide asthma treatment costs exceed  billion a year and over half of that is spent on severe asthmatics who make up only  percent of the asthma population. Doctors say bronchial thermoplasty has given them a new weapon in the battle against severe asthma and many patients call it lifechanging. But the procedure is expensive costing around  and insurers have been reluctant to cover it. As a result many people who need it doctors say are forced to go without it. For those of us in the field who work with severe asthmatics and see how limited they are its frustrating because we have this new therapy weve seen it work and the data says it works said Dr. Roy St. John a pulmonary disease specialist at Columbus Pulmonary and Critical Care in Ohio. But the big insurers have all denied it. Although bronchial thermoplasty was approved by the F.D.A. only two years ago clinical studies on it began in . Since then about  patients across the country have had the procedure. It takes place in three steps each separated by about three weeks. Each time a different section of the lungs is treated. Some patients report temporary coughing mucus and other respiratory symptoms brought on by irritation of airways. But several fiveyear studies showed no longterm safety issues. And researchers at Washington University School of Medicine found that compared with a control group https bronchial thermoplasty patients saw their asthma attacks drop by a third their emergency room visits fall by  percent and the number of days they lost from work and school drop by  percent. This isnt a cure but it is definitely a breakthrough said Dr. Pratik S. Patel director of Interventional Pulmonary Medicine at Newark Beth Israel Medical Center in New Jersey. Its not going to get rid of asthma but it is going to reduce symptoms and hospitalizations and make patients more functional in their daily life. For now the procedure is only for severe asthmatics who  unlike a vast majority of asthma patients  cannot keep flareups at bay with standard medications said Dr. Kyle Hogarth an assistant professor of medicine at the University of Chicago who was involved in clinical studies of the treatment. There are millions and millions of asthmatics he said. There will not be millions of thermoplasty patients. Still even patients with severe asthma often are denied insurance coverage for the procedure. Susan Pisano a spokeswoman for Americas Health Insurance Plans the industry trade group said insurers are awaiting the results of an additional fiveyear clinical trial required by the F.D.A. when it approved bronchial thermoplasty. That trial will not be completed until at least . Until then Ms. Pisano said many insurers are denying coverage on the grounds the procedure is experimental. The issue here for health plans is the longterm safety and efficacy have yet to be established she said. But three fiveyear studies have already been completed. Many asthma specialists believe that insurers are taking a shortsighted approach. The onetime cost of  they say is dwarfed by the tens of thousands of dollars in hospital bills and medication costs that a severe asthmatic can easily accumulate in a single year. One such patient Alberto Gaulion  a retired importer in Miami estimated that for much of the last decade his insurer Blue Cross Blue Shield spent about  a year on his medical care. Every two or three weeks I had to go to the hospital he said and I was taking everything that was on the market. I was on a cocktail of drugs. Blue Cross would not cover the procedure for him so Mr. Gaulion paid out of pocket when he had it in . Since then he has had no hospital visits and no asthma attacks and takes only one medication instead of five. Now I can breathe he said and Im saving my insurance company a fortune. Dr. Charlene McEvoy a director of an asthma center run by Health Partners the largest health plan in Minnesota believed in thermoplasty enough to push the insurer to start covering it. Dr. McEvoy argued that it made economic sense and earlier this year Health Partners agreed. When plans look at the cost savings I think theyre going to cover it said Dr. McEvoy an assistant professor of medicine at the University of Minnesota. You have to show that theres a return on investment."