New bronchoscopic treatment modalities for patients with chronic bronchitis

Abstract

Chronic bronchitis is a chronic, progressive disease that is difficult to treat. Despite much effort, patients remain highly symptomatic. Currently, a number of innovative bronchoscopic treatments for this disease are under investigation. Liquid nitrogen metered cryospray, bronchial rheoplasty and balloon desobstruction all aim to destroy the hyperplastic goblet cells and excess submucous glands using different strategies. These therapies are in an early phase of clinical research and larger randomised controlled trials are needed to confirm the pilot data available and to evaluate the treatment durability. The fourth technique, targeted lung denervation (TLD), aims to decrease the release of acetylcholine, which regulates smooth muscle tone and mucus production by ablating the parasympathetic nerves running alongside the main bronchi. Evaluation of this treatment is at a more advanced stage and promising effects on exacerbation frequency have been shown. However, confirmation of the benefit in improvement in chronic bronchitis symptoms is still needed.

Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission

“…Novel treatments under investigation include bronchoscopic delivery of liquid nitrogen to destroy and denude the epithelial layer (including hyperplastic goblet cells). 237 The epithelium regenerates rapidly after the procedure and matures into a more normal epithelium within 3 or 4 weeks. An alternative approach is rheoplasty, in which non-thermal pulsed electrical fields are used to ablate the epithelium, which again regenerates as normal epithelium.…”

Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema

“…There is continued need for improvement and new developments in this field, especially for other COPD phenotypes. Some promising interventional bronchoscopic procedures are currently under development for COPD patients who mainly experience productive cough and/or exacerbations, as reviewed in this journal before [ 136 ]. As recently stated in a Lancet Commission on the elimination of COPD [ 137 ], we should look beyond smoking-induced COPD and take other causes and contributing factors into account.…”

Mucus Hypersecretion in Chronic Obstructive Pulmonary Disease and Its Treatment

“…Novel Therapy. A more significant idea of this therapy evaluation has revealed encouraging results on the frequency of exacerbation [115,116]. Some of the bronchoscopy therapies are noted in Table 3.…”