Interventional Bronchoscopic Therapies for Chronic Obstructive Pulmonary Disease

Key points

Bronchoscopic approaches to lung volume reduction

There has been intense recent investigation into less invasive bronchoscopic procedures for lung volume reduction in patient with severely hyperinflated emphysematous. This interest has resulted in US Food and Drug Administration approval of 2 different types of EBVs. Other bronchoscopic techniques currently under investigation include endobronchial placement of self-activation coils, targeted destruction and remodeling of emphysematous tissue, and airway bypass stenting.

Targeted lung denervation

Cholinergic sympathetic nerves provide innervation to both small and large airways providing the dominant innervation to human lung. Activation of parasympathetic nerves in airways lead to bronchoconstriction and mucus production.²⁴ Pharmacologic manipulation of the parasympathetic nervous system in the lung is a mainstay of COPD therapy. Tiotropium, a long-acting muscarinic antagonist, has been shown to significantly improve lung function, decrease static and dynamic hyperinflation, improve

Summary

Patients with advanced COPD who have disabling symptoms or poor quality of life despite maximal medical therapy have surgical and other interventional options that can dramatically improve lung function, dyspnea, and quality of life in carefully selected patients. For patients with severe emphysema, most experts suggest evaluation for bronchoscopic lung volume reduction with EBVs if they qualify. Lung volume reduction surgery can be reserved for those not eligible for EBVs owing to the presence

Disclosure

Dr. Marchetti reports personal fees from Astrazeneca, personal fees from Realta Life Sciences, grants from Blade Therapeutics, grants from NIH, outside the submitted work.

Dr. Duffy has nothing to disclose.

Dr. Criner reports grants and personal fees from Galaxo Smith Kline, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Chiesi, grants and personal fees from Mereo, personal fees from Verona, grants and personal fees from Astra Zeneca, grants and personal fees