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Over 20 million Americans live with asthma, a common yet incurable lung disease. The burden to the patient and the health care system is heavy, with frequent days missed from work or school, emergency department visits, and costly hospitalizations. Conventional guideline-directed therapy suggests stepwise increase in inhaler regimen culminating in oral corticosteroids or immune-modulating medications. Severe asthma is often refractory to this therapy. Bronchial thermoplasty offers a novel asthma therapy applying thermal ablation to the mucosa layer to reduce the hypertrophied bronchial smooth muscle mass of the asthmatic airways. We present and review the data supporting bronchial thermoplasty—from early feasibility studies to 5-year follow-up trials. In addition, complications, safety, and cost effectiveness are discussed.