Novel Bronchoscopic Interventions Appear Promising for Patients with COPD

Bowser AD. Chest Physician, November 3, 2022. Available at: https://www.mdedge.com/chestphysician/article/248210/copd/novel-bronchoscopic-interventions-appear-promising-patients-copd?channel=39313

Dr. Christian Ghattas reported on several emerging bronchoscopic treatments for patients with chronic obstructive pulmonary disease at the annual meeting of the American College of Chest Physicians (1).

Targeted Lung Denervation

Targeted lung denervation is one promising novel therapeutic option that is safe and may improve clinical outcomes. The targeted lung denervation system under study (dNerva®, Nuvaira Inc.) which involves the use of a radiofrequency catheter to ablate the peribronchial branches of the vagus nerve. The goal of disrupting pulmonary nerve input is to achieve sustained bronchodilation and reduce mucous secretion, thereby simulating the effect of anticholinergic drugs. AIRFLOW-1 demonstrated the safety and procedural success of bronchoscopic lung denervation (2). In AIRFLOW-2, a randomized, sham-controlled trial enrolling patients with symptomatic COPD targeted lung denervation plus optimal drug treatment led to fewer respiratory adverse events of interest, including hospitalizations for COPD exacerbation(3). Respiratory adverse events occurred in 32% of treated patients versus 71% of sham-treated patients in a predefined 3- to 6.5-month postprocedure window. Currently underway is AIRFLOW-3, a randomized study of targeted lung denervation versus sham procedure in patients with COPD. The study has a primary outcome measure of moderate or severe COPD exacerbations over 12 months and is slated to enroll 480 patients.

Metered Cryospray

One novel intervention with the potential to benefit patients with chronic bronchitis is metered cryospray (RejuvenAir), which works by delivering liquid nitrogen to the tracheobronchial airways. This targeted delivery ablates abnormal epithelium, facilitating the regeneration of healthy mucosa. In the study, 34 of 35 participants received three treatments 4-6 weeks apart. Investigators reported that at 3 months there were significant reductions in the COPD Assessment Test that were durable to 6 months, and changes in the St. George's Respiratory Questionnaire and the Leicester Cough Questionnaire that were durable to 9 months (4).

An ongoing randomized study called SPRAY-CB is comparing metered cryospray to sham procedure in an anticipated 210 patients with COPD with chronic bronchitis.

Bronchial Rheoplasty

Bronchial rheoplasty (RheOx, Gala Therapeutics), is another promising intervention under investigation for the treatment of chronic bronchitis.

This system delivers nonthermal pulsed electrical energy with the intention of ablating goblet cells in the airways. In 12-month results of multicenter clinical trial, bronchial rheoplasty was technically feasible and safe, with reductions in goblet cell hyperplasia and changes in patient-reported quality of life seen following the procedure (5).

A larger randomized, double-blind prospective trial with a sham control arm is underway and will include 270 patients.

References

1. Novel bronchoscopic interventions appear promising for patients with COPD Bowser AD. Chest Physician, November 3, 2022. Available at: https://www.mdedge.com/chestphysician/article/248210/copd/novel-bronchoscopic-interventions-appear-promising-patients-copd?channel=39313
2. Pison C, Shah PL, Slebos DJ, et al. Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes. Respir Res. 2021 Feb 19;22(1):62. [CrossRef] [PubMed]
3. Slebos DJ, Shah PL, Herth FJF, et al. Safety and Adverse Events after Targeted Lung Denervation for Symptomatic Moderate to Severe Chronic Obstructive Pulmonary Disease (AIRFLOW). A Multicenter Randomized Controlled Clinical Trial. Am J Respir Crit Care Med. 2019 Dec 15;200(12):1477-1486. [CrossRef] [PubMed]
4. Garner JL, Shaipanich T, Hartman JE, et al. A prospective safety and feasibility study of metered cryospray for patients with chronic bronchitis in COPD. Eur Respir J. 2020 Dec 17;56(6):2000556. [CrossRef] [PubMed]
5. Valipour A, Fernandez-Bussy S, Ing AJ, et al. Bronchial Rheoplasty for Treatment of Chronic Bronchitis. Twelve-Month Results from a Multicenter Clinical Trial. Am J Respir Crit Care Med. 2020 Sep 1;202(5):681-689. [CrossRef] [PubMed]