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Temperature-controlled Laminar Airflow (TLA)

L.A.S.E.R. stands for ‘Laminar Airflow in Severe asthma for Exacerbation Reduction.’

Temperature-controlled Laminar Airflow (TLA) is an evidence-based, non-pharmaceutical treatment for atopic asthma. The treatment is non-invasive and has an excellent safety record. TLA treatment works by stopping body convection and creating an area of essentially allergen free air in the patient’s breathing zone overnight. TLA treatment drastically reduces the level of allergens inhaled during night-time sleep and gives the asthmatic patient’s hyperactive immune system long and regular periods of essential recovery. TLA treatment is delivered by a device called an Airsonett® device.

To request additional information about the LASER trial or TLA please contact us.

Patient Information Contact LASER Team

The Significance of Allergen Exposure and Environmental Interventions

In the case of atopic asthma, the immune system’s abnormal reaction to inhaled allergens is an important contributory factor in both acute and chronic asthma symptoms. Minimising inhaled allergens such as those from house dust mites, cats and dogs is an important step towards improving the control of perennial atopic asthma.

More than 70% of severe asthmatic patients are sensitised to common aeroallergens and/or moulds, and the level of allergen exposure determines symptoms; those exposed to high allergen levels are at increased risk of asthma exacerbations and hospital admissions.

Domestic exposure to allergens is also known to act synergistically with viruses in sensitised patients to increase the risk and severity of exacerbations. Allergen avoidance has been widely recognised as a logical way of treating these patients. In controlled conditions, long-term allergen avoidance in sensitised asthmatics reduces airway inflammation with consequent symptomatic improvement, further supported by high-altitude, clean-air studies.

Unfortunately, effective methods of allergen reduction have proved elusive with current measures unable to reduce allergen load sufficiently to yield a consistent clinical improvement, thus leaving a significant gap in the potential strategies for reducing asthma severity through allergen reduction.


Temperature Controlled Laminar Airflow (TLA) Therapy

Temperature-controlled Laminar Airflow (TLA) is an evidence-based, non-pharmaceutical treatment for atopic asthma. The treatment is non-invasive and has an excellent safety record.

TLA technology works by stopping body convection and creating an area of essentially allergen free air in the patient’s breathing zone.
TLA treatment drastically reduces the level of allergens inhaled during night-time sleep and gives the asthmatic patient’s hyperactive immune system long and regular periods of essential recovery.

The body heat of a person lying in bed creates an upward air flow known as body convection. The blanket acts as a “chimney” that constantly directs this stream of warm air into the breathing zone.

In a normal bedroom, bedclothes are a significant allergen reservoir. When a person moves in bed, the allergens are released from the reservoirs in the bed-clothes and follow the body convection to the breathing zone where the allergens are inhaled.

Proof-of-concept studies have shown that TLA treatment reduces the total number of airborne particles >0.5μm in the breathing zone by 3000-fold (p<0.001), cat allergen exposure by 7-fold (p=0.043) and significantly reduces the increase in particles generated when turning in bed for all particle sizes. When compared to a best in class traditional air cleaner TLA is able to reduce exposure to potential allergens by a further 99%. We postulate that this highly significant reduction in nocturnal exposure, targeted to the breathing zone, explains why TLA may succeed in an area where so many other measures, including air filters, have failed.


How the TLA device works

Ambient air is sucked into the TLA device and passes through a filter which stops allergens and other particles. By supplying a flow of filtered air which is slightly cooler than the ambient temperature in the room TLA can exploit the forces of gravity to control the speed of the descending air. The TLA device can fine tune the speed of the descending air in such a way as to achieve a balance in which the person’s body convection is broken and, at the same time, draughts and dehydration are avoided.


Evidence of Benefit with TLA Therapy

The TLA device when compared to a placebo device, has proven efficacy on asthma-related quality of life and bronchial inflammation (measured by exhaled nitric oxide) in a pan European multicentre Phase III study, (n=282, age range 7-70 years). The greatest benefit was seen in the more severe asthma patients requiring higher intensity treatment at GINA Steps 4-5 (inhaled corticosteroid dose ≥1000μg/day beclomethasone (BDP) equivalent plus an additional controller medication such as a long acting ß2-agonist, leukotriene receptor antagonist or a sustained release theophylline), and in patients with poorly-controlled asthma (Asthma Control Test <19). This definition of severe asthma is also consistent with ATS/ERS Guidance 2013 and BTS/SIGN Guideline treatment Steps 4-5. Whilst not powered to ascertain an effect on exacerbations, a post-hoc analysis showed a decreased exacerbation rate in more severe patients treated with TLA when compared with placebo with a trend towards significance (mean 0.23 TLA; 0.57 placebo p=0.07). The LASER trial aims to investigate this further with frequency of exacerbations as the primary outcome measure.

The LASER Trial - A breath of fresh air in Asthma!

The LASER Trial is funded by the National Institute for Health Research Health Technology Assessment Programme
(Project number 12/33/28)

Healthcare Professionals March 15, 2015

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The LASER trial team
Dept. of Respiratory Medicine
Level C, Queen Alexandra Hospital
Southwick Hill Road
Cosham
Portsmouth, PO6 3LY
Website: http://lasertrial.co.uk
Email: info@lasertrial.co.uk

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